Anatomy and physiology of gento-urinary system
The main parts of the urinary system are as follow.
1. Two Kidneys-These organs extract waste from the blood and
balance body fluid, these are also the organs of excretion that form
urine.
2. Two ureters-These tubes conduct urine from the kidneys to the
urinary bladder.
3. A single urinary bladder-this reservoir receive and stores the urine
brought to it by the two ureters.
4. A single urethra - This tube conducts urine from the bladder to the
out side of the body for elimination.
The kidneys
LOCATION OF THE KIDNEYS
The kidneys are a pair of brownish-red structures located
retroperitoneally (behind and outside the peritoneal cavity) on the
posterior wall of the abdomen from the 11th (Left) and12th (Right)
thoracic vertebra to the 3rd lumbar vertebra in the adult.
The two kidneys lie against the muscle of the back in the upper abdomen.
Each kidney is enclosed in a membranous capsule that is made of fibrous
connective tissue.
Blood supply to the kidneys
Kidney get blood supply from renal artery and it takes 20-25% of the
total CO.
After entering the kidney the renal artery sub divided in to smaller and
smaller branches, which eventually make contact with the functional unit
of the kidney called nephron.
Blood leaves the kidney by vessel that finally merges to from the renal
vein. The renal vein carries blood into the inferior vena-cave for return to
the heart.
Function of the kidneys
1. Regulation of:
body fluid osmolarity and volume
electrolyte balance
acid-base balance
blood pressure
2. Excretion of;
metabolic products
foreign substances (pesticides, chemicals etc.)
excess substance (water, etc)
3. Secretion of;
erythropoitin
1,25-dihydroxy vitamin D3 (vitamin D activation)
renin
prostaglandin
4. Urine formation.
5. Renal clearance.
THE URETERS
The two ureters are long slander muscular tube that originate at the lower
portion of the renal pelvis and terminate in the trigone of the bladder wall.
Their length naturally varies with the size of the individual (approximately
from 25 cm - 33 cm long).
The left ureter is slightly shorter than the right. (why?)
Function:-Transmit urine from renal pelvis in to the bladder.
The urinary bladder
The urinary bladder is a muscular, hollow sac located just behind the
pubic bone.
Adult bladder capacity is about 300 to 600 ml of urine.
In infancy, the bladder is found within the abdomen.
Characteristic of the bladder
When it is empty, the urinary bladder is located below the partial
peritoneum and behind the pubic joint.
When it is filled it pushes the peritoneum up ward and may extend well
in to the abdominal cavity.
The urinary bladder is a temporary reservoir for urine.
The urethra
At a neck of the bladder that the urethra leave, there is bundles of
involuntary smooth muscle that form a portion of the urethral sphincter
known as the internal sphincter control by autonomic nervous system
(involuntary control).
The portion of the sphincteric mechanism that is under voluntary control
is the external urinary sphincter at the anterior urethra, the segment most
distal from the bladder.
The length of urethra varies with sex;
Female urethra-7.5 cm (3 inches).
Male urethra-15 to 25 cm (6 to 10 inches).
Assessment of urinary system
Subjective data (The History)
This section discusses the data related to assessment of urinary system that
a nurse should elicit from a client to obtains a health history
1. Chief Compliant
Pain;
§Usually flank/loin region-obstruction, infection.
§dull persistent-tumor.
§Pain radiate to the iliac fossa, the testicle or the labia- ureteric stone
obstruction.
§Suprapubic region and perineum-cystitis or urethritis.
N.B. Glomerulonephritis is usually painless.
Hematuria;
can be;
üContinuous
üPainless parenchymal renal disease
ümicroscopic e.g. glomerulonephritis
(occasionally macroscopic).
intermittent
painful renal tumours
macroscopic.
Oliguria/anuria;
Oliguria:-passage of <500mL urine per day.
Prerenal oliguria: decrease in renal blood
Renal oliguria: intrinsic renal disease
Postrenal oliguria: renal obostruction
§Anuria:-complete absence of urine flow.
Polyuria;
psychogenic polydipsia
beer drinking
diabetes mellitus
chronic renal failure
diuretic use
nephrogenic diabetes insipidus
Frequency;
oexcessive fluid intake
oreduced functional bladder capacity (prostatic hypertrophy and
bladder outlet obstruction).
oCystitis
omultiple sclerosis (neurologic disease)
Nocturia;
§Implies the need to empty the bladder during the hours of sleep.
§Often associated with:
üreduction of functional bladder capacity
üDiuretics use
Dysuria;
pain immediately before, during or after micturition.
Urgency;
is the loss of the normal ability to postpone micturition beyond the
time when the desire to pass urine is initially perceived.
Incontinence;
is the involuntary passage of urine.
Enuresis;
is usually used to describe noctural enuresis, or bed-wetting.
Slow stream, hesitancy and terminal dribbling;
triad of symptoms is most frequently seen in elderly men with
prostatic hypertrophy (BPH).
Urethral discharge;
urethritis
sexually transmitted infection
Edema;
facial ( periorbital ), ankle, ascites, anasarca, etc.
Other constitutional symptom
üfatigue,
üheadache,
üblurred vision,
üincreased B/P,
ülack of appetite,
ünausea,
üitching,
üthirsts,
üchills etc...
2. History of Present Illness
üFull elaboration of all presenting sign and symptoms in terms of;
üDuration
üLocation
üQuality
üQuantity
üAggravating factors
üRelieving factors
üAssociated manifestation
N.B.
üwhen reviewing a health history, it is important to be sure that the
patient understand the question being asked.
üIn discussing problem involving the genitalia, the pt may deny
symptoms b/c of anxiety. There fore, encourage the client to talk
about it.
2. Past medical history
The client should be questioned about the existence or history of the
following disease which have known to be related to renal problem;
hypertension,
diabetes mellitus,
gout,
connective tissue disease,
cystitis,
kidney infection,
renal calculi,
infections disease etc....
The client should also be questioned about any hospitalization related
to the above disease.
The client should questioned if he/she has ever been catheterized or
has had diagnostic study involving instrumentation of the urinary
tract.
An assessment of the client’s current and past use of medications is
very important.
3. Family history
The presence of certain renal or urological problems in a family history
accessed the likelihood of similar problems occurring in a family member.
The specific disease related to renal problems to ask the client is about
congenital urinary tract abnormalities, polycystic kidney disease,
urinary tract infection, urinary calculi, hypertension, gout, connective
tissue disorder, etc…