I Clicker Digestive System review Difficult Digestion: Deglutition Dysphasia Aphagia Polyphagia Dyspepsia E. – Dyspepsia Dys – bad/difficult Pepsia - digestion

-rrhagia -rrhapy -ectasis -stasis I Clicker Suture: B – rrhapy (wrappy)

I Clicker Hyperemesis Hematemesis Hemorrhage Hemoptysis Hemolysis Spitting up blood from the respiratory tract and lungs: Hyperemesis Hematemesis Hemorrhage Hemoptysis Hemolysis D. Hemoptysis – hem op tuh sis – ptysis – spitting – heme – blood Rrhage – bursting forth (of blood)

Palatoplasty: I Clicker Over growth of the gum tissue Surgical repair of the tongue Cleft Palate Surgical repair of the roof of the mouth Prolapse of the Palate palat/o = palate plasty = surgical repair D. Surgical repair of the roof of the mouth

Laparoscopy Colonoscopy Liver scan Coloectomy Enterorrhaphy I Clicker Visual examination of the abdomen: Laparoscopy Colonoscopy Liver scan Coloectomy Enterorrhaphy Laparoscopy - Visual examination of the abdomen Colonoscopy – visual examination of the colon Liver Scan – not a visual exam Coloectomy – removal of the colon Enterorrhaphy – suture of the small intesting

Chapter 7: Urinary System Talking a little bit about digestion and absorption as it pertains to the Urinary System – specifically talking about the kidneys and other major organs, such as the ureter, urethra and urinary bladder. To begin, in order for your body to digest protein, to be used by cells in the body – Proteins contain an element called Nitrogen (which is not present in the C, H and O of CHO and Lipids). So, it is the uninary system that filter these nitrogenous waste products, such as urea, creatinine and uric acid from the blood (so they do not accumulate and become harmful to the body). -

Figure 11-1 Urinary system.

Kidney Ureter Triangular region where the ureters enter and urethra exits bladder Urinary bladder So, as blood passes through the kidneys, the kidneys filter that nitrogenous waste (urea, creatinine and uric acid) to form urine (comprised also of water, salts, and acids). The urine leaves the body through the ureters, urinary bladder and the urethra. Besides filtering blood of the nitrogenous wastes, the kidney has other important functions such as maintaining proper balance of water, electrolytes (Na+ and K+) and acids. They also secrete substances such as renin (raises blood pressure) and erythropoietin (stimulates RBC production in the bone marrow). They also secrete an active form of Vit. D, degrade and eliminate hormones, such as insulin and parathyroid from the bloodstream. This diagram are the organs of the urinary system in the male: 1) Kidneys – pair of them - Sitting on top of the kidneys – Adrenal Glands. Also, you will see the medulla, renal vein, renal artery and the hilum (Hi lum) 2) Ureter – attached to the kidney’s – the kidney’s do all the filtering and make urine – then it moves down the ureter towards the 3) Urinary Bladder – collecting tank for all the urine – or temporary reservoir for urine. Trigone- three or triangular at the base of the bladder areas where the ureter’s empty into the bladder and the bladder empties the urine into the urethra - Prostate gland – sitting at the bladder neck - Moving into the urethra and the urinary meatus (me/at/tus) Urethra – have less of a chance of bladder infections due to the length of the urethra – we will look at the females anatomy we will see a shorter urethra, which is easier for the bacteria to flow up into the bladder causing a bladder infection. Urethra

Female urinary system – as mentioned earlier you can see how short that urethra is – there is the same set-up with the kidneys (pair of them) the adrenal glands, arteries and veins, ureter, But it goes down and it goes behind the uterus – the bladder sits right on top of the uterus. Which is why with pregnancy women, they are always heading to the bathroom, as the uterus expands with the baby, the urinary bladder gets scrunched and smaller. The vagina sits behind the urinary bladder as noted in the diagram, then the urethra and the urinary me/at/tus (meatus) which is smaller in comparison to it’s male counterpart.

WHAT ARE THE TERMS FOR “VOIDING”? URINATION MICTURITION Here are the terms for voiding Urination Mic/trition – don’t see very often – but you will see those in your test – so should know both of these terms.

Afferent = towards Efferent = away from Discuss the renal arteries – the kidney depends on high blood flow and adequate blood pressure to help the kidneys function properly… Right and left renal artery that comes into the right and left kidney – passes through the renal pelvis and then breaks down into arterioles in the cortex of the kidney – as shown here in A This is where the glomeruli are, but as you can see there is blood flow coming into the kidney. Now if the blood flow to the kidneys diminish, then the kidneys secrete renin and it discharges into the blood, which promotes the formation of a substance that stimulates the contraction of arterioles. This increases blood pressure and restores blood flow to the kidneys to normal. If you don’t have adequate blood pressure, it is not able to push the substances, such as nitrogenous wastes, sugar, water through the glomeruli and form urine – It is not able to clean or filter the blood it there is not adequate blood pressure and blood supply. That is how the kidney’s produce urine is by filtration and in B – see how it works out.. Notice – Afferent renal arterial and an efferent renal arterial – what occurs is- as the blood stream from the renal artery enters the glomerulus and the bowman capsule, Afferent arterioles means towards glomerulus – Efferent arterioles carry away from it – know these… As Afferent goes in (glomerulus), the sugar, water, salts and urea/wastes), get filtered out of that blood and the efferent system takes the blood away from the kidney Afferent = towards Efferent = away from

I clicker A. sugar, water, salts B. urea, wastes, water, protein Urine (prior to tubular reabsorption) contains: A. sugar, water, salts B. urea, wastes, water, protein C. sugar, water, salts, and acids This slide is up for discussion – because there is sugar, water, salts and acids in the urine prior to tubular reabsorption. However, once it pass through the tubular reabsorption, most of the water, all of the sugar, some salts (such as sodium( return to the blood stream through tiny capillaries surrounding each tubule. This active process of reabsorption ensures that the body retains essential substances such as sugar (glucose), water and salts. The final process in the formation of urine is secretion of some substances from the blood stream into the renal tubule. At the end, Urine contains 95% water, 5% wastes, (urea, creatinine), salts, acids and drugs (see page 221).

TERMS TO KNOW!!!! pyel/o = renal pelvis cystalgia = cyst (bladder) algia (pain) cystitis = ???? cystorrhagia = ????? enuresis = bedwetting/involuntary urination nephrolithiasis = ?????? Cystitis – inflammation of Cystorrhagia- hemorrhage from Enuresis Nephrolithiasis – Lith – stone Nephro – Kidney Condition of Renal calculi

WHAT IS THE DIFFERENCE BETWEEN… nephr/o and pyel/o nephr/o = kidney pyel/o = renal pelvis The renal pelvis is the area at the center of the kidney. Urine collects here and is funneled into the ureter. Both terms related to kidney… Pyel/o (pie/lo)– not only does it mean kidney – but it means the renal pelvis of the kidney

Three steps in the formation of urine when looking at diagram A Glomerular filtration of water, sugar, waste, creatinine and salts – Afferent blood supply coming in through that glomerulus through that arterial -where formation of urine and glomerular filtration begins and the process – As moves down and comes out of that arteriole – in the efferent portion of that blood flow – hit the area designated as #2 2) Tubular Reabsorption – some water, sugars and salts are reabsorbed from that area, move down the renal tubula, we hit the capillaries at that point, there is the exchanges going on with 3) Tubular secretion –of acids, potassium and drugs are picked up and pushed back into the renal tubular – once that occurs – that collects in the urine and passes through the body B gives you an idea or breakdown what looks it like in the gomerular tubular / reabsorption area –this all takes place in a small area - give an idea of how urine and wastes are pulled out of the blood stream.

The unit of filtration in the kidney is the: I clicker The unit of filtration in the kidney is the: A. nephron B. glomerulus C. Bowman’s capsule D. Renal tubes B. glomerulus

Ureter is the tube leading from each kidney to the urinary bladder cup-like collecting region of the renal pelvis Section of the kidney showing the renal pelvis, the calyces and the ureter Calyces (kal cies) are the kinda like collecting regions of the renal pelvis Renal pelvis is the central collecting region of the kidney – as we discussed as everything goes through that area Ureter is the tube leading from each kidney to the urinary bladder Central collecting region of the kidney tube leading from each kidney to the urinary bladder

Diagram – need a good-working knowledge of this, then you’ll have a good idea of the urinary system Bloodstream

Urinary System: The nephron http://www.youtube.com/watch?v=hiNEShg6JTI

Diseases Kidneys and Ureters Hydronephrosis Nephrolithiasis nephr/o- = kidney; nephron lith/o- = stone -iasis = state of; process of

Due to a blockage caused by a stone Hydro/nephrosis – stone that is proximal to the kidney – causing the kidney to retain fluid and swell, painful and very difficult and hard on the kidneys B – Hydroureter – stone is distal to the kidney – more proximal to the bladder – the ureter is swollen, taking on the fluid and being blocked so the ureter is dilated rather than the kidney; however, if you have hydroureter for a long enough time, you’ll have a good bout of hydro nephrosis The only thing to do for these patients is to drain that urine before it causes any more damage The stone has to be removed either by lithotripsy (shock waves crush the urinary tract stone) – or cystoscopy where the stone is moved

Figure 11-9 Kidney stone.

Figure 11-10 Nephrolithiasis.

Diseases Kidneys and Ureters Nephropathy Nephroptosis 11-3 Diseases Kidneys and Ureters Nephropathy Nephroptosis Nephro:kidney -ptosis: drooping Polycystic kidney disease Hereditary disease that causes cysts in the kidney.

Polycystic kidney – dysfunctional, not necessarily painful – but taking up more than the allotted space. This a hereditary condition remaining asymptomatic until adult life. Leads to nephromegaly, hematuria, UTI hypertension and uremia. (222)

Diseases Bladder Bladder cancer Cystitis Cystocele Overactive bladder 11-3 Diseases Bladder Bladder cancer Cystitis Acute inflammation of the bladder Cystocele Cyst/o: bladder -cele: hernia Overactive bladder Urinary urgency and frequency Urinary retention Inability to empty bladder

Diseases Urine and Urination Glycosuria- sugar in urine 11-3 Diseases Urine and Urination Glycosuria- sugar in urine Hematuria- blood in urine Hypokalemia: low blood potassium Ketonuria- ketones in the urine Nocturia- urination at night Oliguria- scanty urine Polyuria- many urine Pyuria- pus in the urine Urinary tract infection (UTI)- AKA bladder infection

A. nephrosclerosis B. nephroptosis C. nephropathy D. nephrostomy I Clicker A term meaning drooping of the kidney: A. nephrosclerosis B. nephroptosis C. nephropathy D. nephrostomy B. nephroptosis

Laboratory and Diagnostic Procedures 11-3 Laboratory and Diagnostic Procedures Urine Tests Urinalysis (UA) Color―Normal urine is light yellow to amber in color, depending on its concentration. Odor―Urine has a faint odor due to the waste products in it. pH―A test of how acidic or alkaline the urine is. Protein Not normally found in the urine; its presence indicates damage to the glomerulus. Glucose Not normally found in the urine; presence indicates uncontrolled diabetes mellitus.

Laboratory and Diagnostic Procedures 11-3 Laboratory and Diagnostic Procedures Radiology and Nuclear Medicine Procedures Intravenous pyelography (IVP) Kidneys, ureters, bladder (KUB) x-ray

Figure 11-18 Intravenous pyelogram. 11-3

Medical and Surgical Procedures 11-3 Medical and Surgical Procedures Medical Procedures Catheterization Dialysis Intake and output (I&O)

Figure 11-20 Foley catheter. 11-3

Foley catheter placed in the urinary bladder to drain urine if the patient is having issues with voiding or due to surgery – the three-way catheter being placed in the bladder has three separate lumens – for drainage of urine, for inflation of balloons in the bladder and for introduction of irrigating solutions into the bladder (helps keep the clots washed out of the bladder). These are typically used for proste/tec/tomy or removal of the prostate

Figure 11-21 Hemodialysis. 11-3

Arteriovenus fistula – created so they can do hemodyalsis on the patient. The radial artery and vein are an/ass/to/mossed together so that it shoves the arterio blood to the vein so that blood supply goes out to the dialysis machine or dialysizer and then is returned to the patient. If you meet or know anyone who has one of these shunts – ask if you can place your fingers on top of it and feel the pressure it creates on the forearm

Figure 11-22 Urine output. 11-3

Medical and Surgical Procedures 11-3 Medical and Surgical Procedures Surgical Procedures Cystectomy Cystoscopy Kidney transplantation Lithotripsy lith/o- = stone -tripsy = process of crushing

Kidney or renal transplant – On the left is the donor – who’s left kidney is removed and brought over to the recipient. As you can see the artery and vein is cut as well as the ureter on the donor to be brought over to the recipient. The donor, on the other hand can live with one kidney – it enlarges (hypertohpies) to take over almost full function for the donor. For the recipient – you see the the new kidney is cradles in the iliac fossa and the artery and veins and ureter are connected respectively on the recipient.

Cystoscope looks like – light cord is attached – shine light into the bladder to see where we are going - also a water cord is attached to large bags of sterile water – down the scope into the bladder, not only to inflate the bladder, hydro inflate the bladder to see what we are looking at – but also wash out the bladder as looking – this is a male patient, the scope goes up through the urethra past the prostate gland into the bladder. This is how to remove the prostate gland.

Figure 11-25 Lithotripsy. 11-3

-rrhagia Blood bursting forth Review Suffixes -rrhaphy Suture -rrhea Flow -rrhagia Blood bursting forth

-Ectasis Widening or dilation Opposites: Malacia Softening Sclerosis Hardening -Stenosis Narrowing -Ectasis Widening or dilation Ex tay/sha – ectasis – widening or dilation (dill-a-tation)