1. Urology & Nephrology

2. Sections  Anatomy and Physiology  General Mechanisms of Nontraumatic Tissue Problems  General Pathophysiology, Assessment, and Management  Renal and Urologic Emergencies  Anatomy and Physiology  General Mechanisms of Nontraumatic Tissue Problems  General Pathophysiology, Assessment, and Management  Renal and Urologic Emergencies

3. Anatomy & Physiology  The Urinary System  Female  Male  Urology & Nephrology  The Kidneys  The Urinary System  Female  Male  Urology & Nephrology  The Kidneys

4. Anatomy & Physiology  The Kidneys  Hilum  Medulla  Pyramids  Papilla  Renal Pelvis  The Kidneys  Hilum  Medulla  Pyramids  Papilla  Renal Pelvis

5. Anatomy & Physiology  Nephrons  Glomerulus  Bowman’s capsule  Proximal Tubule  Loop of Henle  Distal Tubule  Collecting Duct  Nephrons  Glomerulus  Bowman’s capsule  Proximal Tubule  Loop of Henle  Distal Tubule  Collecting Duct

6. 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  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

7. Anatomy & Physiology  Formation of Urine  Glomerular Filtration  GFR  Reabsorption & Secretion  Simple diffusion and osmosis  Facilitated diffusion Active transport  Formation of Urine  Glomerular Filtration  GFR  Reabsorption & Secretion  Simple diffusion and osmosis  Facilitated diffusion Active transport

8. 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  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

9. Anatomy & Physiology  Ureters  Urinary Bladder  Urethra  Testes  Epididymus and Vas Deferens  Prostate Gland  Penis  Ureters  Urinary Bladder  Urethra  Testes  Epididymus and Vas Deferens  Prostate Gland  Penis

10.  Inflammatory or Immune-Mediated Disease  Infectious Disease  Physical Obstruction  Hemorrhage  Inflammatory or Immune-Mediated Disease  Infectious Disease  Physical Obstruction  Hemorrhage General Mechanisms of Nontraumatic Tissue Problems

11.  Differentiating GI and Urologic Complaints  Pathophysiologic Basis of Pain  Causes of Pain  Types of Pain  Visceral pain  Referred pain  Differentiating GI and Urologic Complaints  Pathophysiologic Basis of Pain  Causes of Pain  Types of Pain  Visceral pain  Referred pain General Pathophysiology, Assessment and Management

12.  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  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 Assessment and Management

13.  Physical Exam  Appearance  Uncomfortable appearance.  Posture  Lying with knees drawn up.  Relief with walking.  Level of Consciousness  Determine if changes are acute or chronic.  Physical Exam  Appearance  Uncomfortable appearance.  Posture  Lying with knees drawn up.  Relief with walking.  Level of Consciousness  Determine if changes are acute or chronic. Assessment and Management

14.  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  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 Assessment and Management

15.  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  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 Assessment and Management

16.  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  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 Renal and Urologic Emergencies

17. 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  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

18. Acute Renal Failure

19.  Assessment  Focused History  Change in urine output  Swelling in face, hands, feet, or torso  Presence of heart palpitations or irregularity  Changes in mental function  Assessment  Focused History  Change in urine output  Swelling in face, hands, feet, or torso  Presence of heart palpitations or irregularity  Changes in mental function

20. Acute Renal Failure  Physical Assessment  Altered mental status  Hypertension  Tachycardia  ECG indicative of hyperkalemia  Pale, cool, moist skin  Physical Assessment  Altered mental status  Hypertension  Tachycardia  ECG indicative of hyperkalemia  Pale, cool, moist skin

21. Acute Renal Failure  Physical Assessment  Edema of face, hands, or feet  Abdominal findings dependent on the cause of ARF  Physical Assessment  Edema of face, hands, or feet  Abdominal findings dependent on the cause of ARF

22. Acute Renal Failure  Management  Airway, Breathing, Circulation  IV Access  Protect fluid volume.  Positioning and Transport  Management  Airway, Breathing, Circulation  IV Access  Protect fluid volume.  Positioning and Transport

23. 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  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

24. Chronic Renal Failure

25.  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  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

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

27. Chronic Renal Failure

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

29. Chronic Renal Failure  Long-Term Management  Renal Dialysis  Hemodialysis  Common complications  Long-Term Management  Renal Dialysis  Hemodialysis  Common complications

30. Chronic Renal Failure  Long-Term Management  Renal Dialysis  Peritoneal dialysis  Common complications  Long-Term Management  Renal Dialysis  Peritoneal dialysis  Common complications

31. Renal Calculi  Pathophysiology  Results when “too much insoluble stuff” accumulates in the kidneys.  Stone types  Calcium salts  Struvite stones  Uric acid  Cystine  Pathophysiology  Results when “too much insoluble stuff” accumulates in the kidneys.  Stone types  Calcium salts  Struvite stones  Uric acid  Cystine

32. 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  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

33. 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.  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.

34. 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  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

35. 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  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

36. 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.  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.

37. Urology and Nephrology  Anatomy and Physiology  General Mechanisms of Nontraumatic Tissue Problems  General Pathophysiology, Assessment, and Management  Renal and Urologic Emergencies  Anatomy and Physiology  General Mechanisms of Nontraumatic Tissue Problems  General Pathophysiology, Assessment, and Management  Renal and Urologic Emergencies