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Lower GU Dysfunction
GU Dysfunction By Lucy
| Question | Answer |
|---|---|
| Bladder Infection | Can be caused by obstruction, impaired by changes in structure, and can be impaired by other diseases. |
| Obstructive Uropathy | Interference of urine flow, stasis and accumulation, infection or damage, and causes can be tumors, calculi, trauma, and edema. |
| Complications of Obstruction | Increase hydrostatic pressure-the urine has no where else to go so it goes back into the ureters, renal pelvis, calculi, and then the glomular area. |
| Dilation of Structures | Hydroureter and hydronephrosis |
| Hematuria | Blood in the urine. |
| Infection | Bacteria builds up in the kidneys because of the urine being stagnant. |
| Kidney failure | Renal mass is decreased, renal function is reduced. |
| Narrowing of the urethra | Can be caused due to catheritization. Men have more problems because there urethra is longer than womens. |
| Fibrosis or Inflammation | Can be caused by STDs-urithritis, Trauma, Urologic procedures, childbirth, and congenital. |
| Most common symptoms- Obstruction of Urine flow | Diminished or split urinary stream, straining with urinating, dribbling, hx of trauma, urethritis, UTI, and difficulty with catheterization. |
| Best chance of longterm cure | Surgical treatment by urethroplasty. |
| A temporary measure | Dilation of the urethra. |
| Stents | A mesh stent that opens the lumen and is only temporary. The stents are not comfortable. |
| Most common site of Urothelial Cancer | A Cancer that occurs in the lining of the bladder. 73% are transitional cell carcinoma of the bladder. |
| Papillary Tumors | On the surface of the bladder wall or within the bladder. When it is in the bladder it can spread more easily and is the most aggressive kind. |
| Pathophysiology of Bladder Cancer | Malignant tumors of the urothelium lining, origin is multifocal and recurrent, once it spreads it is highly invasive and metastiatic, site of metastasis, 80% of bladder cancers are non-invasive. |
| Risk Factors of Bladder Cancer | Cigarette smoking, toxins, long-term use of drugs-Phenacetin, Cytoxan (chemo drug that can cause bladder cancer), radiation, chronic, recurrent kidney calculi, and chronic lower UTIs. |
| Clinical Manifestations of Bladder Cancer | Hematuria-gross painless bleeding, Bladder irritability- frequency, urgency, dysuria, nocturia, dribbling, and bone pain-if it cancer starts to spread. |
| Diagnostic Studies for Bladder Cancer | UA and Cytology-look for neoplastic cells, IV pyelography-determine the bleeding, Ultrasound-shows the masses but not stagable, CT or MRI-how far the cancer has spread, Biopsy-to determine if it is cancer, and Cystoscopy. |
| Management of Bladder Cancer | Diagnosis and staging of disease, nonsurgical-radiation and chemotherapy, Intravesical therapy-putting chemo within the bladder itself, and surgery. |
| Radiation Therapy | Used with cystectomy, conjunction with chemotherapy are used together for in-operable cancer. |
| Chemotherapy | Systemic treatment and treat metastasis |
| Intravesical Therapy | Direct instillation of chemo or immune-stimulating agents into bladder. Thiotepa-reduces WBC if it enters the blood system, Valnubicin, BCG (Bacille Calmette Guerin)-for tissue cancers, and Alpha interferon. Weekly for 6-12 weeks. |
| Surgical Treatment for Cancer | Transurethral resection of bladder tummor (TURBT)-Endoscopic, Cystectomy, laser photocoagulation, and open loop resection. |
| Postoperative care | Fluid intake, avoid alcohol, blood tinged urine, analgesics (fall risk), stool softners, sitz bath 2-3X/day, Cystoscopy Q3 to 6 months for 3 yrs-to make sure the cancer does not come back, and bright red color in the urine means blood and is not good. |
| Diversions of the Urine | To find other ways to divert the urine. |
| Conduit | A pouch from the small bowel (ileum) and then they have a stoma where the urine can be removed. These are called incontinence pouch. |
| Ureterostomy | The ureters are connected to one and is diverted to the outside. |
| Ureter Diversion | They can divert the ureters to the large colon and they are more susceptible to diarrhea. |
| Nephrostomy | The ureters are pulled out and are in the back area you are by passing the GU this is temporary or permanent, but are susceptible to infection. |
| Continent pouch | They make a pouch from the intestine and has the stoma on the outside, but there is a spincter to keep the urine inside. The patients have to self-cath themselves and to irrigate ever so often. |
| Neobladder | Create another bladder from small intestine make the bladder and connected to the bladder neck of urethra. The bladder neck has to be viable to have the internal spincter. It allows for normal voiding. Self-cath twice a day to get remaining urine out. |
| Post abdominal surgical care | Turn, cough, deep breathe, early ambulation, monitor patency of tubes, monitor I&O, change dressing, and output should be at least 30 mL per hour. |
| Post-operative Care | Prevent injury to stoma, increase fluid intake, assess patency of tubes, catheterization, irrigation, education (stoma care, appliance care, and neobladder catheterization), and psychosocial support. |
| Complications | Atelectasis, bleeding, thrombophlebitis, small bowel obstruction, paralytic ileus, and UTI. |
| Urolithiasis | Is a stone that is formed outside of the kidney. |
| Predisposing factors of Urolithiasis | Metabolic defects- hyperparathyroidis-Ca+, Gout-increase uric acid levels, hypercalciuria- excessive Vit. D or ca+, obstruction-urinary stasis, retention. |
| 3 Precipitation Factors of Urolithiasis | urine pH-when you have high alkaline in your urine your calcium and phosphates are not able to absorb, high solute concentration, and reduction of inhibitors. |
| Pathophysiology of Urolithiasis | Crystal evolves, trapped in urinary tract, attracts more crystals, urinary stasis, infection, and invected stones trapped in collecting system of the kidneys. |
| Types of renal stones | Calcium oxalate or phosphate-most common, struvite-this one takes a microorganism most common in women than men, staghorn stones-because it looks like it has horns, uric acid, and cystine (less common). |
| Signs and Symptoms of Urolithiasis | Sudden sharp cramping, abdominal or flank pain, renal colic, hautonomic system is hematuria, autonomic system is stimulated, nausea, vomiting, oliguria or anuria. |
| Diagnostic Assessment of Urolithiasis | Pain, UA, PH of urine, BUN, serum creatine, IVP, US, CT/MRI, Hx of gout, X-ray-KUB, and 24 hr urine. |
| Pain management of Urolithiasis | Drug therapy (opiods-morphine, NSAIDS-Toradol, spasmolytic drugs (ditropan), control level, repositioning, relaxation techniques. |
| Lithotripsy | Sound, laser,or dry shock wave energy- to pulverize the stone and can be eliminated through the bladder and urinate. |
| Edoscopic Procedures | Remove the stones directly if the patient cannot pass it themselves. |
| Lithotomy | Incision, a stone cannot be removed any other ways and you are concerned abut damage to the kidneys. |
| Drug therapy to prevent obstruction depends on what is forming the stone | Calcium-diuretic, Oxalate- allopurinol, Vit. B6, Uric acid- K+ or SN+, Cystine-Captopril. |
Created by:
tiniekittie12
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