urinarysystem泌尿系統(tǒng)全英文ppt課件

1、 Urinary System ContentnComposition nAnatomy nPhysiology nCommon diseasenExamination 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 lea

2、ve the 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

3、 About 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 Urine formation proceeds through 3 major processes in the kidney:Glomerular filtration-by the glomeruli.2. Tubular re

4、absorption and secretion in the renal tubules.3. Tubular secretionnephronrenal corpusclerenal tubuleglomerular capsule(Bowmans capsule)glomerulusafferentarterioleefferentarteriole腎單位腎單位腎小體腎小體腎小球腎小球Urine formation proceeds through 3 major processes in the kidney:1. Glomerular filtration-by the glomer

5、uli.2. Tubular 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 t

6、he circulation through the renal vein.New words about kidneyGeneral EnglishRootEg.kidneyRen/oRenographySuprarenalLienorenalNephr/oNephritisHydronephrosisRenal pelvisPyel/oPyelographyPyelonephritisPelvi/opelvilithotomy pelvioplastyGlomerularGlomerul/oGlomerulonephritisPart 2 Ureters Two muscular tube

7、s which convey the urine from the renal pelvis to the urinary bladder.Each measures 20-30cm in length, 0.5-0.7cm in diameter.According to the course, each ureter can be divided into 3 parts: Abdominal part Pelvic part Intramural partThree constrictions:1st: at pelviureteric junction2nd : where urete

8、r crosses the pelvic inlet and iliac vessels3rd : at intramural partNew words about uretersGeneral General EnglishEnglishRootRootEg.Eg.UretersUreter/oUreteroceleUreterographyUreterostenosisUreterorrhaphyPart 3 Urinary bladder The urinary bladder is a hollow muscular organ situated in the pelvic cavi

9、ty posterior to the pubic symphysis. In the floor of the urinary bladder is a small, smooth triangular area, the trigone. The ureters enter 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 u

10、rinary bladderGeneral EnglishGeneral EnglishRootRootEg.Eg.Urinary bladderVesic/oIntravesicalvesicoureteralCyst/oCystitisCystographyCystoptosiscystostomy Part 4 Urethra Female urethra isrelatively shorter(about 3-5cm long),wider and straighter.Internal orifice of urethra External orifice of urethra：(

11、opens into vaginal vestibule)New words about urethra and urineGeneral EnglishGeneral EnglishRootRootEg.Eg.UrethraUrethr/oUrethritisUrethrograpyMeat/oMeatorrhaphyMeatotomyUrineUrin/oUrinogenitialUrinationUr/oHematuriaUrobilin PolyuriaAnuriaTHE URINARY SYSTEMIncluding the kidneys, ureters, urethra and

12、 urinary bladder.The kidneys are the primary excretory in 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 includ

13、e:1. Filtering waste products of metabolism from the blood 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：Produci

14、ng the enzyme Renin which regulates blood pressure and proper kidney functioning；Producing the hormone Erythropoietin （EPOwhich regulates and stimulates erythrocytes production;Metabolizing vitamin D to its active form. Mechanism Urinary Systemfilter and remove waste products from the bloodproductio

15、n and excretion of urinemain functionresult in Urinary system diseases The most common disease list Acute renal failure (ARF) Chronic renal failure (CRF) Urinary tract infection Urinary calculus Primary glomerular disease Acute glomerulonephritis (AGN) Chronic glomerulonephritis(CGN) Nephrotic syndr

16、ome(NS) A kidney infection Acute pyelonephritis Chronic pyelonephritis Cystitis Perinephric abscess Renal damage in metabolic disease Diabetic nephropathy Hyperuricemia nephrosis auxiliary examinationHow to use the auxiliaryexamination(輔助檢查) in diagnosisof urinary system diseases ?nIconographynUrina

17、lysisnRenal biopsynKidney function test IconographynX-ray examination：n （1Plain abdominal radiograph n （radio- 放射，放射，-graph 描繪、記錄，描繪、記錄， radiograph X光照片光照片 ）n （2Urography：n Excretory urography n Retrograde urography （retro- 向后、倒退，向后、倒退， Retrograde 逆行性）逆行性）n Selective renal arteriography nCT detectio

18、nn Plain scan CTn Enhanced CT nMagnetic Resonance Imaging nUltrasonography n （ultrasono- 超聲）超聲）Comparation and Preference 1. Urography examination use for hydronephrosis , ureterectasis and congenital anomaly detection and diagnosis, as well as preoperative assessment of the value of the contralater

19、al 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 for further diagnosis and differential diagnosis. Urinalysis1.A urinalysis (

20、UA) , is an array of tests performed on urine, and one of the most common methods of medical diagnosis.2.The target parameters that can be measured or quantified in urinalysis include many substances and cells, as well as other properties, such as specific gravity.3.It is the main basis for diagnosi

21、s of kidney injury. 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 urine known as hematuriaspecif

22、ic gravity比重比重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 infectionsEosinophiluria asso

23、ciated 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 pyelonephritis(Heme) granular c

24、asts associated with acute tubular necrosisCrystalluria associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN)Calcium oxalatin associated with ethylene glycol2.Microscopic examination3.Other methods of urinalysisUrine culture a microbiological culture of urine samples, detect

25、ing bacteriuria, is indicated when a urinary tract infection is suspected.Ictotest this test is used to detect the destruction of old red blood cells in the urine.Hemoglobin test this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urina

26、ry system, which cause hemoglobin to appear in the urine. Renal biopsy Renal biopsy , often used in the diagnosis of kidney 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 thera

27、peutic effect. Sometimes we need to repeat it. kidney function testClearance rate: Glomerular filtration rate GFR Endogenous creatinine clearance rate ，Ccr Renal blood flow RBFConcentration-dilution test濃縮稀釋濃縮稀釋試驗(yàn)）試驗(yàn)）（ARF） Difinition Classification Pathogenesis Diagnosis Differential Treatment Progn

28、osisDefinitionDefinitionnAcute renal failure （ARFis a syndrome characterized by a relatively rapid decline in renal function that leads to the accumulation of water , crystalloid solutes , and nitrogenous metabolites in the body. Classification Prerenal Acute Renal Failure Postrenal Acute Renal Fail

29、ure Intrarenal Acute Renal Failure EtiologyDiabetic nephropathy Hypertensive nephrosclerosis Primary or secondary glomerulonephritis Tubulointerstitial disease （tubulo- 管， tubulointerstitial 小管間質(zhì)性 ） Renal vascular diseasevas- 血管、輸精管）Hereditary kidney diseases Main Mechanismn renal hemodynamic change

30、s n renal ischemian （reperfusion cell damage) n acute tubular damagePathogenesisPathogenesisDecreased Renal blood flowRenal ischemiaIschemia-reperfusion injury GFRAcute renal tubular damageHypovolemiaThe resistance of afferent arteriole increasedRenal poisoningARFPathology of acute renal failurenIn

31、general： nephromegaly , kidney is pale, Renal cortex is pale and Renal medulla is dark red.n（-megaly 異常擴(kuò)大，異常擴(kuò)大，eg. Splenomegaly cardiomegaly）nMicroscope: renal tubular epithelial cells are degenerative, necrotic and deciduous .nToxicant cause: Pathological changes is uniform in the proximal tubule,

32、glomerular basement membrane(GBM) is relatively complete.nIschemia cause: Pathological changes is not uniform in medullary thick ascending limb and distal convoluted tubule, glomerular basement membrane(GBM) is fractured.The epithelial cells of renal proximal convoluted tubule are hydropiceg：The mos

33、t striking change in the tubules is hydropic degeneration of the epithelium. Manifestations of acute renal failurenOliguric acute renal failure n oliguric stagen diuretic stagen recovery stagenNonoliguric acute renal failure Manifestations of Oliguric acute renal failure 1.The initial phase The prim

34、ary disease performance: Hypotension，Manifestations caused by bleeding 、infection、poison and so on.(1) General symptoms of each systemThe digestive system dyspnea，thoracalgia The respiratory system hypertension，myocardiosis The circulatory system nausea，vomiting The nervous system hemorrhage，anemia

35、The blood system uremic encephalopathy coma2.Maintenance phase (oliguric stage)(2) Water, electrolyte and acid-base balance disordersMetabolic acidosis：weak 、cephalalgia、coma 、arrhythmiahyperpotassaemia(K+5.5mmol/L )： early stage ：no characteristic manifestations. later stage ：weak、tendon reflex dis

36、appearing、drowsiness、arrhythmia. Hyperpotassaemia is one of the most common causes of death！ hyponatremia hapntrem (Na+135mmol/L) hypochloraemia hapkl:ri:mj (Cl-95mmol/L) hypocalcemia hapklsi:m (Ca2+1.61mmol/L)(2) Water, electrolyte and acid-base balance disorders3. recovery phase (diuretic stage) H

37、ydrouria :more than 3000ml-5000ml /d.Early stage: the markely elevated Creatinine (Cr) and blood urine nitrogen(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

38、 acute renal failuren Characteristics:nunobvious oligurianlow specific gravity of urinenlow urinary sodium levels nazotemianmost 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 bl

39、ood creatinine values increased from 25% to 100%.Differential diagnosis1. Firstly, we should exclude the ARF based on 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 prere

40、nal and postrenal causes.3. After the determination of renal ARF, there should be differentiated whether it is causaed by glomerular, renal vascular or tubulointerstitial lesions.(1)ATN vs. Pre-renal oligurianFluid infusion test n Prior to the onset ,there are medical history such as capacity lack a

41、nd body fluid loss etc.If the physical examination found skin and mucous membranes dry,and hypotension, we should consider 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 re

42、turned to normal and urine volume increased after the supplement of blood volume , it supports the diagnosis of prerenal 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 t

43、hat prerenal azotemia have transformed into ATN. (2)ATN vs. urinary tract obstruction Post-renal obstruction of the urinary tract:1.Cause：stone/tumor /prostatauxe2.Symptom：anuria or intermittent anuresis suddenly; Renal colic, rib abdomen or abdominal pain; Renal percussive pain ;3.Auxiliary examina

44、tion： Ultrasonography and X-ray examination can help diagnosisTreatment and prognosis of acute renal failureThe principle of treatmentnTreatment of primary disease nTreatment based on symptomsn 1. Strictly control the liquid intaken 2. Treatment of hyperkalemia 高鉀血癥 n 3. Correction of metabolic acid

45、osis 代謝性酸中毒n 4. Therapy of azotemia 氮質(zhì)血癥 n 5. Dialysis therapy 透析療法 Treatment Correct the reversible etiology, prevent additional damage:Active treatment of the primary disease, eliminate the factors that lead to or exacerbate(加重加重) ARF ； Quickly and accurately supplement the blood volume, maintain

46、effective circulating blood volume enough； Prevent and correct low perfusion, avoid the use of nephrotoxic drugs。Treatment Maintain 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內(nèi)生水量 Estimating: the liquid feeding

47、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 reducing 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 abnormalit