Urinary System泌尿系統(tǒng)全英文課件

1、 Urinary System ContentComposition Anatomy Physiology Common diseaseExamination CompositionKidney Ureter Urinary bladderUrethra Part 1 kidneyBean-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 th

2、e 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. NephronsThe functional unit of the kidney Responsible for the actual purification and filtration of the blood Abou

3、t 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 近端小管遠(yuǎn)端小管Urine formation proceeds through 3 major processes in the kidney:Glomerular filtration-by the glomeruli.2. Tubular

4、 reabsorption and secretion in the renal tubules.3. Tubular secretionWorking 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

5、 through the renal vein.New words about kidneyGeneral EnglishRootEg.kidneyRen/oRenographySuprarenalLienorenalNephr/oNephritisHydronephrosisRenal pelvisPyel/oPyelographyPyelonephritisPelvi/opelvilithotomy pelvioplastyGlomerularGlomerul/oGlomerulonephritisNew words about uretersGeneral EnglishRootEg.U

6、retersUreter/oUreteroceleUreterographyUreterostenosisUreterorrhaphyPart 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 en

7、ter 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 bladderGeneral EnglishRootEg.Urinary bladderVesic/oIntravesicalvesicoureteralCyst/oCystitisCystographyCystoptosiscystostomyNew wo

8、rds about urethra and urineGeneral EnglishRootEg.UrethraUrethr/oUrethritisUrethrograpyMeat/oMeatorrhaphyMeatotomyUrineUrin/oUrinogenitialUrinationUr/oHematuriaUrobilin PolyuriaAnuriaTHE URINARY SYSTEMIncluding the kidneys, ureters, urethra and urinary bladder.The kidneys are the primary excretory in

9、 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 bloo

10、d and removing the wastes from the body via the urine；2. Responsible for homeostasis:Regulate the level of electrolytes such as sodium, potassium, chloride, bicarbonate.Maintain the correct pH range within the body3. Endocrine function：Producing the enzyme Renin which regulates blood pressure and pr

11、oper kidney functioning；Producing the hormone Erythropoietin （EPO）which regulates and stimulates erythrocytes production;Metabolizing vitamin D to its active form. Urinary system diseases The most common disease list Acute renal failure (ARF) Chronic renal failure (CRF) Urinary tract infection Urina

12、ry 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 auxi

13、liary examinationHow to use the auxiliaryexamination(輔助檢查) in diagnosisof urinary system diseases ?IconographyUrinalysisRenal biopsyKidney function test IconographyX-ray examination： （1）Plain abdominal radiograph （radio- 放射，-graph 描繪、記錄， radiograph X光照片 ） （2）Urography： Excretory urography Retrograde

14、 urography （retro- 向后、倒退， Retrograde 逆行性） Selective renal arteriography CT detection Plain scan CT Enhanced CT Magnetic Resonance Imaging Ultrasonography （ultrasono- 超聲）Comparation and Preference 1. Urography examination use for hydronephrosis , ureterectasis and congenital anomaly detection and dia

15、gnosis, 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 fo

16、r further diagnosis and differential diagnosis. Urinalysis Methods1.Urine test strip Leukocytes with presence in urine known as leukocyturiaNitrite with presence in urine known as nitrituriaProtein with presence in urine known as proteinuria, albuminuria, or microalbuminuriaBlood with presence in ur

17、ine known as hematuriaspecific 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 conditionsPyuria associated with urinary inf

18、ectionsEosinophiluria associated with allergic interstitial nephritis, atheroembolic diseaseRed blood cell casts associated with glomerulonephritis, vasculitis, or malignant hypertensionWhite blood cell casts associated with acute interstitial nephritis, exudative glomerulonephritis, or severe pyelo

19、nephritis(Heme) granular casts associated with acute tubular necrosisCrystalluria associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN)Calcium oxalatin associated with ethylene glycol2.Microscopic examination Renal biopsy Renal biopsy , often used in the diagnosis of kidney

20、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 testClearance rate: Glomerular filtration rate GFR Endogenous

21、 creatinine clearance rate ，Ccr Renal blood flow RBFConcentration-dilution test（濃縮稀釋試驗(yàn)）Acute Renal Failure （ARF）DifinitionClassificationPathogenesisDiagnosisDifferential TreatmentPrognosisDefinitionAcute renal failure （ARF）is a syndrome characterized by a relatively rapid decline in renal function t

22、hat leads to the accumulation of water , crystalloid solutes , and nitrogenous metabolites in the body. Classification Prerenal Acute Renal Failure Postrenal Acute Renal Failure Intrarenal Acute Renal Failure ARFEtiologyDiabetic nephropathy Hypertensive nephrosclerosis Primary or secondary glomerulo

23、nephritis Tubulointerstitial disease （tubulo- 管， tubulointerstitial 小管間質(zhì)性 ） Renal vascular disease（vas- 血管、輸精管）Hereditary kidney diseases Main Mechanism renal hemodynamic changes renal ischemia （reperfusion cell damage) acute tubular damagePathogenesisDecreased Renal blood flowRenal ischemiaIschemia

24、-reperfusion injury GFRAcute renal tubular damageHypovolemiaThe resistance of afferent arteriole increasedRenal poisoningARFPathology of acute renal failureIn general： nephromegaly , kidney is pale, Renal cortex is pale and Renal medulla is dark red.（-megaly 異常擴(kuò)大，eg. Splenomegaly cardiomegaly）Micros

25、cope: renal tubular epithelial cells are degenerative, necrotic and deciduous .Toxicant cause: Pathological changes is uniform in the proximal tubule, glomerular basement membrane(GBM) is relatively complete.Ischemia cause: Pathological changes is not uniform in medullary thick ascending limb and di

26、stal convoluted tubule, glomerular basement membrane(GBM) is fractured.Nephromegaly normal kidneyThe epithelial cells of renal proximal convoluted tubule are hydropic（eg：The most striking change in the tubules is hydropic degeneration of the epithelium. Pathological sectionsManifestations of acute r

27、enal failureOliguric acute renal failure oliguric stage diuretic stage recovery stageNonoliguric acute renal failure Manifestations of Oliguric acute renal failure 1.The initial phase The primary disease performance: Hypotension，Manifestations caused bybleeding 、infection、poison and so on.(1) Genera

28、l symptoms of each systemThe digestive system dyspnea，thoracalgia The respiratory system hypertension，myocardiosis The circulatory system nausea，vomiting The nervous system hemorrhage，anemia The blood system uremic encephalopathy coma2.Maintenance phase (oliguric stage)(2) Water, electrolyte and aci

29、d-base balance disordersMetabolic acidosis：weak 、cephalalgia、coma 、arrhythmiahyperpotassaemia(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！ hyponatremiahapn

30、trem (Na+135mmol/L) hypochloraemiahapkl:ri:mj (Cl-95mmol/L) hypocalcemia hapklsi:m (Ca2+1.61mmol/L)(2) Water, electrolyte and acid-base balance disorders3. recovery phase (diuretic stage) Hydrouria :more than 3000ml-5000ml /d.Early stage: the markely elevated Creatinine (Cr) and blood urine nitrogen

31、(BUN) levelsLater stage : hyponatremia , dehydration All kinds of complications can still exist A few patients have severe and permanent renal function damages.Manifestations of Nonoliguric acute renal failure Characteristics:unobvious oligurialow specific gravity of urinelow urinary sodium levels a

32、zotemiamost patient have not hyperpotassaemiaDiagnostic criteriaThe 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 diagnosis1. Firstly, we should exclude the ARF based on

33、 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 causae

34、d by glomerular, renal vascular or tubulointerstitial lesions.(1)ATN vs. Pre-renal oliguriaFluid 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 consid

35、er 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

36、 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 urin

37、ary tract:1.Cause：stone/tumor /prostatauxe2.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 diagnosisTreatment and prognosis of acute renal failureThe principl

38、e of treatmentTreatment of primary disease Treatment based on symptoms 1. Strictly control the liquid intake 2. Treatment of hyperkalemia 高鉀血癥 3. Correction of metabolic acidosis 代謝性酸中毒 4. Therapy of azotemia 氮質(zhì)血癥 5. Dialysis therapy 透析療法 Treatment Correct the reversible etiology, prevent additional

39、 damage:Active treatment of the primary disease, eliminate the factors that lead to or exacerbate(加重) ARF ； Quickly and accurately supplement the blood volume, maintain effective circulating blood volume enough； Prevent and correct low perfusion, avoid the use of nephrotoxic drugs。Treatment Maintain

40、 fluid balance Fluid volume is equal to dominant fluid loss add non dominant fluid loss subtract the endogenous content補(bǔ)液量顯性失液量非顯性失液量?jī)?nèi)生水量 Estimating: the liquid feeding amount is equal to amount of urine add 500ml 估算：進(jìn)液量尿量ml Treatment Diet and nutritionWe should provide sufficient heat, thereby redu

41、cing to break tein. carbohydrate and fat Protein restriction is 0.8g / (kg d) As much as possible to reduce the intake of sodium(鈉) , potassium(鉀) and chloride(氯).Treatment Hyperkalemia （Hyperkalemia 6.5mmol / L, ECG abnormality） l0% calcium gluconate 10 20ml after dilution (IV 5 minutes) 5% sodium bicarbonate 100ml iv drop 50% glucose 50ml add 10U insulin iv drop slowly Oral: ion exchange resin交換樹(shù)脂 Dialysis Trea