Urology & Nephrology

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Urology Nephrology
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Sections

• Anatomy and Physiology
• General Mechanisms of Nontraumatic Tissue
  Problems
• General Pathophysiology, Assessment, and
  Management
• Renal and Urologic Emergencies

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Anatomy Physiology

• The Urinary System
• Female
• Male
• Urology Nephrology
• The Kidneys

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Anatomy Physiology

• The Kidneys
• Hilum
• Medulla
• Pyramids
• Papilla
• Renal Pelvis

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Anatomy Physiology

• Nephrons
• Glomerulus
• Bowmans capsule
• Proximal Tubule
• Loop of Henle
• Distal Tubule
• Collecting Duct

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Anatomy Physiology

• Functions of the Kidneys
• Forming and Eliminating Urine
• Maintaining blood volume with proper balance of
  water, electrolytes, and pH.
• Retaining key compounds such as glucose, while
  excreting wastes such as urea.
• Controlling Arterial Blood Pressure
• Regulating Erythrocyte Development

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Anatomy Physiology

• Formation of Urine
• Glomerular Filtration
• GFR
• Reabsorption Secretion
• Simple diffusion and osmosis
• Facilitated diffusion
• Active transport

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Anatomy Physiology

• Tubular Handling of Water and Electrolytes
• Diuresis and Antidiuresis
• Tubular Handling of Glucose and Urea
• BUN and Creatinine
• Control of Arterial Blood Pressure
• The Renin-Angiotensin System
• Control of Erythrocyte Production
• Erythropoietin

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Anatomy Physiology

• Ureters
• Urinary Bladder
• Urethra
• Testes
• Epididymus and Vas Deferens
• Prostate Gland
• Penis

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General Mechanisms of Nontraumatic Tissue Problems

• Inflammatory or Immune-Mediated Disease
• Infectious Disease
• Physical Obstruction
• Hemorrhage

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General Pathophysiology, Assessment and Management

• Differentiating GI and Urologic Complaints
• Pathophysiologic Basis of Pain
• Causes of Pain
• Types of Pain
• Visceral pain
• Referred pain

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Assessment and Management

• Scene Size-up
• Initial Assessment
• Focused History
• OPQRST History
• Prior History of Similar Event
• History of Nausea, Vomiting, and Weight Loss
• Change in Bowel Habits and Stool
• Last Oral Intake
• Presence of Chest Pain

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Assessment and Management

• Physical Exam
• Appearance
• Uncomfortable appearance.
• Posture
• Lying with knees drawn up.
• Relief with walking.
• Level of Consciousness
• Determine if changes are acute or chronic.

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Assessment and Management

• Apparent State of Health
• Skin Color
• Examination of the Abdomen
• Inspection for distention, ecchymosis, or
  scarring
• Pain associated with percussion of abdomen
• Palpation
• Normal or ectopic pregnancy
• Masses
• Assessment Tools
• Vital Signs

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Assessment and Management

• Management
• Airway, Breathing Circulation
• Pharmacologic Interventions
• IV access and analgesics.
• Nonpharmacological Interventions
• Nothing by mouth (NPO).
• Maintain position of comfort.
• Reassess mental status and vital signs
  frequently.
• Transport Considerations

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Renal and Urologic Emergencies

• Risk Factors
• Older Patients
• History of Diabetes
• History of Hypertension
• Multiple Risk Factors
• Renal and Urologic Emergencies
• Acute Renal Failure
• Chronic Renal Failure
• Renal Calculi
• Urinary Tract Infection

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Acute Renal Failure

• Pathophysiology
• Prerenal Acute Renal Failure
• Dysfunction before the level of kidneys
• Most common and most easily reversible
• Renal Acute Renal Failure
• Dysfunction within the kidneys themselves
• Postrenal Acute Renal Failure
• Dysfunction distal to the kidneys

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Acute Renal Failure
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Acute Renal Failure

• Assessment
• Focused History
• Change in urine output
• Swelling in face, hands, feet, or torso
• Presence of heart palpitations or irregularity
• Changes in mental function

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Acute Renal Failure

• Physical Assessment
• Altered mental status
• Hypertension
• Tachycardia
• ECG indicative of hyperkalemia
• Pale, cool, moist skin

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Acute Renal Failure

• Physical Assessment
• Edema of face, hands, or feet
• Abdominal findings dependent on the cause of ARF

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Acute Renal Failure

• Management
• Airway, Breathing, Circulation
• IV Access
• Protect fluid volume.
• Positioning and Transport

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Chronic Renal Failure

• Chronic Renal Failure
• Permanent Loss of Nephrons
• End-Stage Renal Failure (ESRF)
• Pathophysiology
• Similar to Renal ARF
• Microangiopathy, glomerular injury
• Tubular cell injury
• Insterstitial injury

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Chronic Renal Failure
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Chronic Renal Failure

• Impairment of Kidney Functions
• Maintenance of blood volume with proper balance
  of water, electrolytes, and pH
• Increased sodium, water, and potassium retention
• Retention of key compounds such as glucose with
  excretion of wastes such as urea
• Loss of glucose and buildup of urea within the
  blood
• Control of arterial blood pressure
• Disruption of the renin-angiotensin loop
  resulting in HTN
• Regulation of erythrocyte development
• Development of chronic anemia

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Chronic Renal Failure

• Assessment
• Differentiate chronic and acute problems.
• Focused history and physical exam.
• Gastrointestinal complaints
• Changes in mental status
• Marked abnormalities during physical exam
• Uremic frost

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Chronic Renal Failure
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Chronic Renal Failure

• Immediate Management
• Monitor and support ABCs.
• Establish IV access.
• Regulate fluid volume.
• Monitor vital signs and cardiac rhythm.
• Expedite transport to an appropriate facility.

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Chronic Renal Failure

• Long-Term Management
• Renal Dialysis
• Hemodialysis
• Common complications

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Chronic Renal Failure

• Long-Term Management
• Renal Dialysis
• Peritoneal dialysis
• Common complications

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Renal Calculi

• Pathophysiology
• Results when too much insoluble stuff
  accumulates in the kidneys.
• Stone types
• Calcium salts
• Struvite stones
• Uric acid
• Cystine

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Renal Calculi

• Assessment
• Focused History
• Severe pain in one flank that increases in
  intensity and migrates from the flank to the
  groin
• Painful, frequent urination with visible
  hematuria
• Prior history of calculi
• Physical Exam
• Difficult due to patient discomfort
• Tachycardia with pale, cool, and moist skin

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Renal Calculi

• Management
• Maintain ABCs.
• Maintain position of comfort.
• Establish IV access.
• Fluid bolus may promote stone movement and urine
  formation.
• Consider medication administration.
• Parenteral narcotic analgesics may be indicated.

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Urinary Tract Infection

• Pathophysiology
• Risk Factors
• Increased risk in female or catheterized patients
• Sexual activity
• Lower and Upper UTIs
• Urethritis
• Cystitis
• Prostatitis
• Pyelonephritis
• Community-acquired vs. nosocomial infections

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Urinary Tract Infection

• Assessment
• Focused History
• Abdominal pain
• Frequent, painful urination
• A burning sensation associated with urination
• Difficulty beginning and continuing to void
• Strong or foul-smelling urine
• Similar past episodes

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Urinary Tract Infection

• Physical Exam
• Restless, uncomfortable appearance.
• Presence of a fever.
• Vital signs vary with degree of pain.
• Management
• Maintain ABCs.
• Establish IV access.
• Consider analgesics.
• Transport to appropriate facility.

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Urology and Nephrology

• Anatomy and Physiology
• General Mechanisms of Nontraumatic Tissue
  Problems
• General Pathophysiology, Assessment, and
  Management
• Renal and Urologic Emergencies