Pathophysiology Exam 3 Study Guide
Chapter 29 Alterations if Renal and Urinary Tract Function
1. Acute Kidney Injury (AKI) injury cause or Acute Renal Failure: is a sudden decline in kidney
function with a decrease in glomerular filtration and accumulation of nitrogenous waste
products in the blood as demonstrated by an elevation in plasma creatinine and blood urea
nitrogen (BUN) levels.
a. Results from extracellular volume depletion, decreased renal blood flow, or
toxic/inflammatory injury to kidney cells resulting in alterations in renal function that
may be minimal or severe.
b. Can be classified as prerenal (renal hypoperfusion), intrarenal (disorders involving
renal parenchymal or interstitial tissue), or postrenal (urinary tract obstructive
disorders)
2. Risk factor for Acute Pyelonephritis: is an infection of one or both upper urinary tracts (ureter,
renal pelvis, and interstitium). Most common underlying risk factor is urinary obstruction and
reflux of urine from the bladder (vesicoureteral reflux). One or both kidneys may be involved.
Most cases occur in women. Due to E. Coli, Proteus, or Pseudomonas. These microorganisms
also split urea into ammonia, making alkaline urine that increases the risk of stone formation.
The infection can be spread into the blood stream. The inflammatory process is usually focal
and irregular, primarily affecting the pelvis, calyces, and medulla. Acute pyelonephritis rarely
causes renal failure.
3. Location of pyelonephritis: one or both of the upper urinary tracts including the ureters, renal
pelvis and insterstitum.
4. Symptoms of bladder cancer: Gross painless hematuria is the archetypal clinical manifestation
of bladder cancer. Episodes of hematuria tend to recur, and they are often accompanied by
bothersome lower urinary tract symptoms including daytime voiding frequency, nocturia,
urgency, and urge urinary incontinence, particularly for carcinoma in situ. Flank pain may occur
if tumor growth obstructs one or both ureterovesical junctions.
5. Types of urinary incontinence:
a. Urge incontinence (most common): involuntary loss of urine associated with abrupt
and strong desire to void (urgency); often associated with involuntary contractions of
detrusor; when associated with neurologic disorder, this is called detrusor
hyperreflexia; when no neurologic disorder exists, this is called detrusor instability;
may be associated with decreased bladder wall compliance.
b. Stress incontinence (most common in women <60 yrs and men who had had prostate
surgery): involuntary loss of urine during coughing, sneezing, laughing, or physical
activity associated with increased abdominal pressure
c. Overflow incontinence: involuntary loss of urine with over distention of bladder;
associated with neurologic lesions below S1, polyneuropathies, and urethral
obstruction (ex: enlarged prostate).
, d. Mixed incontinence (most common in older women): combination of both stress and
urge incontinence.
e. Functional incontinence: involuntary loss of urine attributable to dementia or
immobility.
6. Renal calculi formation factors: renal calculi or urinary stones are masses of crystals, protein, or
other substances that are a common cause of urinary tract obstruction in adults. They can be
located in the kidneys, ureters, and urinary bladder. The risk of formation is influenced by age,
gender, race, geographic location, seasonal; factors, fluid intake, diet, and occupation. Stones
are made up of calcium (most common) oxalate or phosphate (70-80%), struvite (magnesium-
phosphate 15%), and uric acid (7%). Cystine stones are rare (<1%).
7. Compensation of kidney removal: kidney removal aka Nephrectomy. When a kidney is
removed, a person loses 50% of their nephrons and they are never regained. Typically, the
remaining kidney grows larger to compensate for the missing organ. “Growth” is understood to
signify the replication of cells to produce an overall larger organism. What occurs in the case of
significant nephron loss (eg. a radical nephrectomy or kidney removal) is a swelling of the
organ's individual cells, not an increase in their number.
8. Anemia and End-Stage Renal Disease:
a. End-Stage Renal Disease aka Chronic Kidney Disease: represents a progressive loss if
renal function. Plasma creatinine levels gradually become elevated as GFR declines;
sodium is lost in the urine; potassium is retained; metabolic acidosis develops; calcium
metabolism and phosphate metabolism are altered; and erythropoietin production is
diminished. All organ systems are affected by CKD.
b. Anemia: commonly occurs in people with CKD. It begins to develop in the early stages
when someone has 20-50% of normal kidney function. It tends to worsen as CKD
progresses. Most people who have total loss of kidney function, or kidney failure, have
anemia. This leads people to need hemodialysis or peritoneal dialysis.
i. Hemodialysis uses a machine to circulate a person’s blood through a filter
outside of the body.
ii. Peritoneal uses the lining of the abdomen to filter blood inside the body.
9. Renal function labs: BUN, Creatinine, GFR, along with urine analysis.
10. Bladder and Adrenal functions:
a. Bladder is a bag of smooth muscle fibers that forms the detrusor muscle and its
smooth lining of uroepithelium. While the bladder fills with urine, it distends and the
layers of uroepithelium slide past each other and become thinner. The uroepithelium
forms the interface between the urinary space and underlying vasculature and
connective, nervous, and muscle tissue. The uroepithelium maintains an important
barrier function to prevent movement of water and solutes between the urine and the
blood and communicates information about urine pressure and composition to
, surrounding nerve and muscle cells. The detrusor is the smooth muscle coat of the
bladder, and the trigone is a smooth muscle triangular area between the openings of
the 2 ureters and the urethra. The position of the bladder varies with age and gender.
The bladder has a profuse blood supply, accounting for the bleeding that regularly
occurs with trauma, surgery, or inflammation.
b. Adrenal: the adrenal glands, located at the top of each kidney, produce hormones that
help the body control blood sugar, burn protein and fat, react to stressors like a major
illness or injury, and regulate blood pressure. Two of the most important adrenal
hormones are cortisol and aldosterone.
11. UTI and bacteria association: Urinary Tract Infection is an inflammation if the urinary
epithelium usually caused by bacteria from gut flora. A UTI can occur anywhere along the
urinary tract including the urethra, prostate, bladder, ureter, or kidney. Most bacteria are
flushed out during micturition. Bacteria that can cause UTI are E. Coli (most common in women
due to proximity if anus and urethra), Staphylococcus saprophyticus (second most common).
Least common are Klebsiella, Proteus, Pseudomonas fungi, viruses, parasites, or tubercular
bacilli. Schistosomiasis is the most common cause of parasitic invasion of the urinary tract on a
global basis.
12. Acute Kidney Injury Labs: BUN, Creatinine, GFR, along with urine analysis.
Chapter 34 Alterations of Digestive Function
1. Liver functions: detoxified chemicals and metabolizes drugs. The liver secretes bile that ends
up back in the intestines, and makes proteins important for blood clotting and other functions.
Manufactures triglycerides, cholesterol, and glycogen synthesis.
2. Types of diarrhea: Diarrhea is an increase in the frequency of defecation and in the fluid
content and volume of feces. More than three stools per day are considered abnormal. The
three major mechanisms of diarrhea are osmotic, secretory, and motile:
a. Osmotic diarrhea. A non-absorbable substance in the intestine draws excess water into
the intestine and increases stool weight and volume, producing large-volume diarrhea.
Causes include lactase and pancreatic enzyme deficiency; excessive ingestion of
synthetic, non-absorbable sugars; full-strength tube-feeding formulas; or dumping
syndrome associated with gastric resection.
b. Secretory diarrhea. Excessive mucosal secretion of fluid and electrolytes produces
large-volume diarrhea. Infectious causes include viruses (e.g., rotavirus), bacterial
enterotoxins (Escherichia coli and Vibrio cholerae), or exotoxins from overgrowth
of Clostridium difficile following antibiotic therapy. Small-volume diarrhea is usually
caused by an inflammatory disorder of the intestine, such as ulcerative colitis or Crohn
disease, but also can result from fecal impaction.
c. Motility diarrhea. Food is not mixed properly, digestion and absorption are impaired,
and motility is increased. Causes include resection of the small intestine (short bowel
syndrome), surgical bypass of an area of the intestine or fistula formation between
loops of intestine, irritable bowel syndrome–diarrhea predominant, excessive motility
Chapter 29 Alterations if Renal and Urinary Tract Function
1. Acute Kidney Injury (AKI) injury cause or Acute Renal Failure: is a sudden decline in kidney
function with a decrease in glomerular filtration and accumulation of nitrogenous waste
products in the blood as demonstrated by an elevation in plasma creatinine and blood urea
nitrogen (BUN) levels.
a. Results from extracellular volume depletion, decreased renal blood flow, or
toxic/inflammatory injury to kidney cells resulting in alterations in renal function that
may be minimal or severe.
b. Can be classified as prerenal (renal hypoperfusion), intrarenal (disorders involving
renal parenchymal or interstitial tissue), or postrenal (urinary tract obstructive
disorders)
2. Risk factor for Acute Pyelonephritis: is an infection of one or both upper urinary tracts (ureter,
renal pelvis, and interstitium). Most common underlying risk factor is urinary obstruction and
reflux of urine from the bladder (vesicoureteral reflux). One or both kidneys may be involved.
Most cases occur in women. Due to E. Coli, Proteus, or Pseudomonas. These microorganisms
also split urea into ammonia, making alkaline urine that increases the risk of stone formation.
The infection can be spread into the blood stream. The inflammatory process is usually focal
and irregular, primarily affecting the pelvis, calyces, and medulla. Acute pyelonephritis rarely
causes renal failure.
3. Location of pyelonephritis: one or both of the upper urinary tracts including the ureters, renal
pelvis and insterstitum.
4. Symptoms of bladder cancer: Gross painless hematuria is the archetypal clinical manifestation
of bladder cancer. Episodes of hematuria tend to recur, and they are often accompanied by
bothersome lower urinary tract symptoms including daytime voiding frequency, nocturia,
urgency, and urge urinary incontinence, particularly for carcinoma in situ. Flank pain may occur
if tumor growth obstructs one or both ureterovesical junctions.
5. Types of urinary incontinence:
a. Urge incontinence (most common): involuntary loss of urine associated with abrupt
and strong desire to void (urgency); often associated with involuntary contractions of
detrusor; when associated with neurologic disorder, this is called detrusor
hyperreflexia; when no neurologic disorder exists, this is called detrusor instability;
may be associated with decreased bladder wall compliance.
b. Stress incontinence (most common in women <60 yrs and men who had had prostate
surgery): involuntary loss of urine during coughing, sneezing, laughing, or physical
activity associated with increased abdominal pressure
c. Overflow incontinence: involuntary loss of urine with over distention of bladder;
associated with neurologic lesions below S1, polyneuropathies, and urethral
obstruction (ex: enlarged prostate).
, d. Mixed incontinence (most common in older women): combination of both stress and
urge incontinence.
e. Functional incontinence: involuntary loss of urine attributable to dementia or
immobility.
6. Renal calculi formation factors: renal calculi or urinary stones are masses of crystals, protein, or
other substances that are a common cause of urinary tract obstruction in adults. They can be
located in the kidneys, ureters, and urinary bladder. The risk of formation is influenced by age,
gender, race, geographic location, seasonal; factors, fluid intake, diet, and occupation. Stones
are made up of calcium (most common) oxalate or phosphate (70-80%), struvite (magnesium-
phosphate 15%), and uric acid (7%). Cystine stones are rare (<1%).
7. Compensation of kidney removal: kidney removal aka Nephrectomy. When a kidney is
removed, a person loses 50% of their nephrons and they are never regained. Typically, the
remaining kidney grows larger to compensate for the missing organ. “Growth” is understood to
signify the replication of cells to produce an overall larger organism. What occurs in the case of
significant nephron loss (eg. a radical nephrectomy or kidney removal) is a swelling of the
organ's individual cells, not an increase in their number.
8. Anemia and End-Stage Renal Disease:
a. End-Stage Renal Disease aka Chronic Kidney Disease: represents a progressive loss if
renal function. Plasma creatinine levels gradually become elevated as GFR declines;
sodium is lost in the urine; potassium is retained; metabolic acidosis develops; calcium
metabolism and phosphate metabolism are altered; and erythropoietin production is
diminished. All organ systems are affected by CKD.
b. Anemia: commonly occurs in people with CKD. It begins to develop in the early stages
when someone has 20-50% of normal kidney function. It tends to worsen as CKD
progresses. Most people who have total loss of kidney function, or kidney failure, have
anemia. This leads people to need hemodialysis or peritoneal dialysis.
i. Hemodialysis uses a machine to circulate a person’s blood through a filter
outside of the body.
ii. Peritoneal uses the lining of the abdomen to filter blood inside the body.
9. Renal function labs: BUN, Creatinine, GFR, along with urine analysis.
10. Bladder and Adrenal functions:
a. Bladder is a bag of smooth muscle fibers that forms the detrusor muscle and its
smooth lining of uroepithelium. While the bladder fills with urine, it distends and the
layers of uroepithelium slide past each other and become thinner. The uroepithelium
forms the interface between the urinary space and underlying vasculature and
connective, nervous, and muscle tissue. The uroepithelium maintains an important
barrier function to prevent movement of water and solutes between the urine and the
blood and communicates information about urine pressure and composition to
, surrounding nerve and muscle cells. The detrusor is the smooth muscle coat of the
bladder, and the trigone is a smooth muscle triangular area between the openings of
the 2 ureters and the urethra. The position of the bladder varies with age and gender.
The bladder has a profuse blood supply, accounting for the bleeding that regularly
occurs with trauma, surgery, or inflammation.
b. Adrenal: the adrenal glands, located at the top of each kidney, produce hormones that
help the body control blood sugar, burn protein and fat, react to stressors like a major
illness or injury, and regulate blood pressure. Two of the most important adrenal
hormones are cortisol and aldosterone.
11. UTI and bacteria association: Urinary Tract Infection is an inflammation if the urinary
epithelium usually caused by bacteria from gut flora. A UTI can occur anywhere along the
urinary tract including the urethra, prostate, bladder, ureter, or kidney. Most bacteria are
flushed out during micturition. Bacteria that can cause UTI are E. Coli (most common in women
due to proximity if anus and urethra), Staphylococcus saprophyticus (second most common).
Least common are Klebsiella, Proteus, Pseudomonas fungi, viruses, parasites, or tubercular
bacilli. Schistosomiasis is the most common cause of parasitic invasion of the urinary tract on a
global basis.
12. Acute Kidney Injury Labs: BUN, Creatinine, GFR, along with urine analysis.
Chapter 34 Alterations of Digestive Function
1. Liver functions: detoxified chemicals and metabolizes drugs. The liver secretes bile that ends
up back in the intestines, and makes proteins important for blood clotting and other functions.
Manufactures triglycerides, cholesterol, and glycogen synthesis.
2. Types of diarrhea: Diarrhea is an increase in the frequency of defecation and in the fluid
content and volume of feces. More than three stools per day are considered abnormal. The
three major mechanisms of diarrhea are osmotic, secretory, and motile:
a. Osmotic diarrhea. A non-absorbable substance in the intestine draws excess water into
the intestine and increases stool weight and volume, producing large-volume diarrhea.
Causes include lactase and pancreatic enzyme deficiency; excessive ingestion of
synthetic, non-absorbable sugars; full-strength tube-feeding formulas; or dumping
syndrome associated with gastric resection.
b. Secretory diarrhea. Excessive mucosal secretion of fluid and electrolytes produces
large-volume diarrhea. Infectious causes include viruses (e.g., rotavirus), bacterial
enterotoxins (Escherichia coli and Vibrio cholerae), or exotoxins from overgrowth
of Clostridium difficile following antibiotic therapy. Small-volume diarrhea is usually
caused by an inflammatory disorder of the intestine, such as ulcerative colitis or Crohn
disease, but also can result from fecal impaction.
c. Motility diarrhea. Food is not mixed properly, digestion and absorption are impaired,
and motility is increased. Causes include resection of the small intestine (short bowel
syndrome), surgical bypass of an area of the intestine or fistula formation between
loops of intestine, irritable bowel syndrome–diarrhea predominant, excessive motility
