urinarysystem泌尿系统全英.ppt

Urinary System Content Composition Anatomy Physiology Common disease Examination Composition Kidney Ureter Urinary bladder Urethra Part 1 kidney Bean-shape: a concave area on the edge toward the centre called hilum, where renal artery enters the kidney and renal vein leaves it. The ureters also leave the kidneys at the hilum, leading to the bladder. The human kidneys represent about 0.5% of the total weight of the body, but receive 2025% of the total arterial blood pumped by the heart. Nephrons The functional unit of the kidney Responsible for the actual purification and filtration of the blood About one million nephrons are in the cortex of each kidney Consists of a renal corpuscle and a renal tubule The renal tubule consists of the convoluted tubule and the loop of Henle 近端小管近端小管 远端小管远端小管 Urine formation proceeds through 3 major processes in the kidney: 1. Glomerular filtration-by the glomeruli. 2. 2. Tubular reabsorption and secretion in the renal tubules. 3. Tubular secretion nephron renal corpuscle renal tubule glomerular capsule (Bowmans capsule) glomerulus afferent arteriole efferent arteriole 肾单位 肾小体 肾小球 Urine formation proceeds through 3 major processes in the kidney: 1. Glomerular filtration-by the glomeruli. 2. Tubular reabsorption and secretion in the renal tubules. 3. Tubular secretion Working mechanism of the kidneys: Blood is brought to the kidney via the renal artery. The kidneys filter the blood and then reabsorb useful materials such as glucose. After it has been purified the blood returns to the circulation through the renal vein. New words about kidney General EnglishRootEg. kidney Ren/o Renography Suprarenal Lienorenal Nephr/o Nephritis Hydronephrosis Renal pelvis Pyel/oPyelography Pyelonephritis Pelvi/o pelvilithotomy pelvioplasty GlomerularGlomerul/oGlomerulonephritis Part 2 Ureters Two muscular tubes which convey the urine from the renal pelvis to the urinary bladder. Each measures 20-30cm in length, 0.5-0.7cm in diameter. According to the course, each ureter can be divided into 3 parts: Abdominal part Pelvic part Intramural part Three constrictions: n1st: at pelviureteric junction n2nd : where ureter crosses the pelvic inlet and iliac vessels n3rd : at intramural part New words about ureters General English RootEg. UretersUreter/o Ureterocele Ureterography Ureterostenosis Ureterorrhaphy Part 3 Urinary bladder The urinary bladder is a hollow muscular organ situated in the pelvic cavity posterior to the pubic symphysis. In the floor of the urinary bladder is a small, smooth triangular area, the trigone. The ureters enter the urinary bladder near two posterior points in the triangle; the urethra drains the urinary bladder from the anterior point of the triangle. New words aboout urinary bladder General EnglishRootEg. Urinary bladder Vesic/oIntravesical vesicoureteral Cyst/o Cystitis Cystography Cystoptosis cystostomy Part 4 Urethra Female urethra is relatively shorter (about 3-5cm long), wider and straighter. nInternal orifice of urethra nExternal orifice of urethra：(opens into vaginal vestibule) New words about urethra and urine General EnglishRootEg. Urethra Urethr/oUrethritis Urethrograpy Meat/oMeatorrhaphy Meatotomy Urine Urin/oUrinogenitial Urination Ur/oHematuria Urobilin Polyuria Anuria THE URINARY SYSTEM Including the kidneys, ureters, urethra and urinary bladder. The kidneys are the primary excretory in the human body. They function by removing toxins from the body while returning necessary compounds back to the body.The kidneys filter approximately 200 liters of fluid from the body everyday. The Primary Functions of the Urinary System include: 1. Filtering waste products of metabolism from the blood and removing the wastes from the body via the urine； 2. Responsible for homeostasis: nRegulate the level of electrolytes such as sodium, potassium, chloride, bicarbonate. nMaintain the correct pH range within the body 3. Endocrine function： Producing the enzyme Renin which regulates blood pressure and proper kidney functioning； Producing the hormone Erythropoietin （EPO）which regulates and stimulates erythrocytes production; Metabolizing vitamin D to its active form. Mechanism Urinary System filter and remove waste products from the blood production and excretion of urine main function result in Urinary system diseases The most common disease list Acute renal failure (ARF) Chronic renal failure (CRF) Urinary tract infection Urinary calculus Primary glomerular disease Acute glomerulonephritis (AGN) Chronic glomerulonephritis(CGN) Nephrotic syndrome(NS) A kidney infection Acute pyelonephritis Chronic pyelonephritis Cystitis Perinephric abscess Renal damage in metabolic disease Diabetic nephropathy Hyperuricemia nephrosis auxiliary examination How to use the auxiliary examination(辅助检查) in diagnosis of urinary system diseases ? nIconography nUrinalysis nRenal biopsy nKidney function test Iconography nX-ray examination： （1）Plain abdominal radiograph （radio- 放射，-graph 描绘、记录， radiograph X光照片 ） （2）Urography： Excretory urography Retrograde urography （retro- 向后、倒退， Retrograde 逆行性 ） Selective renal arteriography nCT detection Plain scan CT Enhanced CT nMagnetic Resonance Imaging nUltrasonography （ultrasono- 超声） Comparation and Preference 1. Urography examination use for hydronephrosis , ureterectasis and congenital anomaly detection and diagnosis, as well as preoperative assessment of the value of the contralateral kidney function . 2.CT examination can be used in the founding of vast majority of tumors, stones, cysts and other diseases and congenital anomalies. 3. MRI is often used as secondary screening method of atypical lesions for further diagnosis and differential diagnosis. Urinalysis 1.A urinalysis (UA) , is an array of tests performed on urine, and one of the most common methods of medical diagnosis. 2.The target parameters that can be measured or quantified in urinalysis include many substances and cells, as well as other properties, such as specific gravity. 3.It is the main basis for diagnosis of kidney injury. Urinalysis Methods 1.Urine test strip nLeukocytes with presence in urine known as leukocyturia nNitrite with presence in urine known as nitrituria nProtein with presence in urine known as proteinuria, albuminuria, or microalbuminuria nBlood with presence in urine known as hematuria nspecific gravity比重 The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and may suggest a specific diagnosis. Hematuria associated with kidney stones, infections, tumors and other conditions Pyuria associated with urinary infections Eosinophiluria associated with allergic interstitial nephritis, atheroembolic disease Red blood cell casts associated with glomerulonephritis, vasculitis, or malignant hypertension White blood cell casts associated with acute interstitial nephritis, exudative glomerulonephritis, or severe pyelonephritis (Heme) granular casts associated with acute tubular necrosis Crystalluria associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN) Calcium oxalatin associated with ethylene glycol 2.Microscopic examination 3.Other methods of urinalysis nUrine culture a microbiological culture of urine samples, detecting bacteriuria, is indicated when a urinary tract infection is suspected. nIctotest this test is used to detect the destruction of old red blood cells in the urine. nHemoglobin test this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urinary system, which cause hemoglobin to appear in the urine. Renal biopsy Renal biopsy , often used in the diagnosis of kidney diseases, is regarded as the gold standard of the glomerular disease. It can not only guide our treatment options, but also timely reflect the prognosis and determine the therapeutic effect. Sometimes we need to repeat it. kidney function test Clearance rate: Glomerular filtration rate GFR Endogenous creatinine clearance rate ，Ccr Renal blood flow RBF Concentration-dilution test（浓缩稀释 试验） （ARF） Difinition Classification Pathogenesis Diagnosis Differential Treatment Prognosis Definition nAcute renal failure （ARF）is a syndrome characterized by a relatively rapid decline in renal function that leads to the accumulation of water , crystalloid solutes , and nitrogenous metabolites in the body. Classification n Prerenal Acute Renal Failure n Postrenal Acute Renal Failure n Intrarenal Acute Renal Failure Etiology Diabetic nephropathy Hypertensive nephrosclerosis Primary or secondary glomerulonephritis Tubulointerstitial disease （tubulo- 管， tubulointerstitial 小管间质性 ） Renal vascular disease（vas- 血管、输精管） Hereditary kidney diseases Main Mechanism n renal hemodynamic changes n renal ischemia （reperfusion cell damage) n acute tubular damage Pathogenesis Decreased Renal blood flow Renal ischemiaIschemia- reperfusion injury GFR Acute renal tubular damage Hypovolemia The resistance of afferent arteriole increased Renal poisoning ARF Pathology of acute renal failure nIn general： nephromegaly , kidney is pale, Renal cortex is pale and Renal medulla is dark red. n（-megaly 异常扩大，eg. Splenomegaly cardiomegaly） nMicroscope: renal tubular epithelial cells are degenerative, necrotic and deciduous . nToxicant cause: Pathological changes is uniform in the proximal tubule, glomerular basement membrane(GBM) is relatively complete. nIschemia cause: Pathological changes is not uniform in medullary thick ascending limb and distal convoluted tubule, glomerular basement membrane(GBM) is fractured. NephroNephromegaly normal kidneymegaly normal kidney The epithelial cells of renal proximal convoluted tubule are hydropic（eg：The most striking change in the tubules is hydropic degeneration of the epithelium. Pathological sectionsPathological sections Manifestations of acute renal failure nOliguric acute renal failure oliguric stage diuretic stage recovery stage nNonoliguric acute renal failure Manifestations of Oliguric acute renal failure 1.The initial phase The primary disease performance: Hypotension，Manifestations caused by bleeding 、infection、poison and so on. (1) General symptoms of each system The digestive system dyspnea，thoracalgia The respiratory system hypertension，myocardiosis The circulatory system nausea，vomiting The nervous system hemorrhage，anemia The blood system uremic encephalopathy coma 2.Maintenance phase (oliguric stage) (2) Water, electrolyte and acid- base balance disorders Metabolic acidosis：weak 、cephalalgia、coma 、 arrhythmia hyperpotassaemia(K+5.5mmol/L )： early stage ：no characteristic manifestations. later stage ：weak、tendon reflex disappearing、 drowsiness、arrhythmia. Hyperpotassaemia is one of the most common causes of death！ hyponatremia hapntrem (Na+1.61mmol/L) (2) Water, electrolyte and acid- base balance disorders 3. recovery phase (diuretic stage) Hydrouria :more than 3000ml-5000ml /d. nEarly stage: the markely elevated Creatinine (Cr) and blood urine nitrogen(BUN) levels nLater stage : hyponatremia , dehydration nAll kinds of complications can still exist nA few patients have severe and permanent renal function damages. Manifestations of Nonoliguric acute renal failure Characteristics: nunobvious oliguria nlow specific gravity of urine nlow urinary sodium levels nazotemia nmost patient have not hyperpotassaemia Diagnostic criteria The serum creatinine of absolute value of average daily increase of 44.2 mol/L, or 88.4 mol/L; or in the 24 72 hours blood creatinine values increased from 25% to 100%. Differential diagnosis 1. Firstly, we should exclude the ARF based on the CKD( chronic kindny diseases),which can be evidenced from the following signs:double kidney shrinks,anemia, uremia face and renal neuropathy . 2. Secondly we should exclude prerenal and postrenal causes. 3. After the determination of renal ARF, there should be differentiated whether it is causaed by glomerular, renal vascular or tubulointerstitial lesions. (1)ATN vs. Pre-renal oliguria nFluid infusion test Prior to the onset ,there are medical history such as capacity lack and body fluid loss etc.If the physical examination found skin and mucous membranes dry,and hypotension, we should consider firstly the prerenal oliguria.At this time you can try to infuse and inject loop diuretics for observing the load of circulatory system after infusion . If the blood pressure returned to normal and urine volume increased after the supplement of blood volume , it supports the diagnosis of prerenal oliguric. The hypotension lasts for at long time, especially for the elder with heart dysfunction and without increased urine output after fluid infusion ,it should be suspected that prerenal azotemia have transformed into ATN. (2)ATN vs. urinary tract obstruction Post-renal obstruction of the urinary tract: 1.Cause：stone/tumor /prostatauxe 2.Symptom：anuria or intermittent anuresis suddenly; Renal colic, rib abdomen or abdominal pain; Renal percussive pain ; 3.Auxiliary examination： Ultrasonography and X-ray examination can help diagnosis Treatment and prognosis of acute renal failure The principle of treatment nTreatment of primary disease nTreatment based on symptoms 1. Strictly control the liquid intake 2. Treatment of hyperkalemia 高钾血症 3. Correction of metabolic acidosis 代谢性酸中毒 4. Therapy of azotemia 氮质血症 5. Dialysis therapy 透析疗法 Treatment Correct the reversible etiology, prevent additional damage: nActive treatment of the primary disease, eliminate the factors that lead to or exacerbate(加重) ARF ； n Quickly and accurately supplement the blood volume, maintain effective circulating blood volume enough； n Prevent and correct low perfusion, avoid the use of nephrotoxic drugs。 Treatment Maintain fluid balance Fluid volume is equal to dominant fluid loss add non dominant fluid loss subtract the endogenous content 补液量显性失液量非显性失液量内生水量 Estimating: the liquid feeding amount is equal to amount of urine add 500ml 估算：进液量尿量ml Treatment Diet and nutrition We should provide sufficient heat, thereby reducing to break down. protein. n carbohydrate and fat n Protein restriction is 0.8g / (kg d) n As much as possible to reduce the intake of sodium(钠) , potassium(钾) and chloride(氯). Treatment Hyperkalemia （Hyperkalemia 6.5mmol / L, ECG abnormality） n l0% calcium g