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Module 7: Urinary System

Introduction

In this module, you will learn medical terminology associated with the
urinary system. When you complete this module, you should be familiar
with terms that describe the anatomy and physiology of the urinary
system (in particular, the kidney's process in producing urine), disorders
of the urinary system, and tests and procedures used to diagnose and
treat urinary system conditions.

Exercises in all modules may require you to use word parts either
introduced in earlier modules or provided only in your text, so have your
text available for ready reference as you work through the exercises in
this module. Remember that this integrated learning program is intended
as a supplement to your text—not as a substitute.

Each section ends with a quiz that covers the objectives of that section.
The quizzes will be scored and will be used to help measure what you've
learned in that section.

NOTE: Not all terms presented in your text will appear in this module. At
the same time, some additional terms may have been added to the
module to further apply what you've learned in your text.
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Module Objectives

<obfig01>

NEW ART Source: # 12901903 from Photos.com
http://images.photos.com/thm/thm17/STXP/20090306/PRJ/6/60/601/129
01903.thm.jpg?3505754__40437106



       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




In this module, you will learn to:

         Name essential organs and describe their locations and functions.
         Identify common pathologic conditions.
         Recognize how urinalysis is used and interpreted as a diagnostic
          test.
         Define combining forms, prefixes, and suffixes.
         List and explain clinical procedures, laboratory tests, and
          abbreviations.
         Understand medical terms in their proper contexts, such as medical
          reports and records.
Screen 1 of 1

Section I: Anatomy and Physiology

Section I Objectives

In this section, you should strive to recognize and use terms related to
urinary anatomy and physiology. In particular, you should be able to:

      Define anatomy and physiology terms for the urinary system.
      Label urinary anatomy.
      Describe the sequences of filtration and reabsorption.
Screen 1 of 10

Lesson 1: Kidney Structures

1.1 Threaded Case Studies: Vicky James and Owen Seagraves

Fig. 7-1

NEW ART Source: Photos.com #3659147



       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




DEVELOPER: Please crop existing photo of Owen Seagraves
(below), replacing him with black male above. Thanks.




To help us understand how the urinary system functions, let's meet two
patients: Vicky James and Owen Seagraves. They are each visiting their
general practitioner, Dr. Pandit, to express some concerns about
symptoms that seem, in one sense, intriguingly similar, yet in other ways
seem to indicate different disorders altogether.

Vicky is a third-grade teacher and an avid hiker. Owen is an athletic
director at a small college. The two patients have never met, though in
the small tourist town in which they both live, they happen to share the
same doctor—Dr. Pandit.
Screen 2 of 10

Lesson 1: Kidney Structures

1.2 Threaded Case Study: Vicky James

Fig. 7-2




Dr. Pandit's nurse calls Vicky into an exam room first. Vicky says she
hasn't been feeling well lately. She complains primarily of blood in the
urine but is also concerned about swollen ankles and back pain. The nurse
takes her blood pressure and asks Vicky for a urine sample.
Screen 3 of 10

Lesson 1: Kidney Structures

1.3 Threaded Case Study: Owen Seagraves

Fig. 7-3


 NEW ART Source: Photos.com #3659147



       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




Unlike Vicky, Owen says at first that he has "no urinary symptoms" that
he can identify, but that, instead, he's been having what he refers to as
"gas pains that are getting worse and worse—I mean, excruciating." He
says that these pains also give him nausea. In addition, he has the same
leg swelling Vicky reports but also complains of a rash.

Only when asked about elimination does Owen think to mention a "slight
decrease" in urine output but an increase in the number of times he has
to get up in the middle of the night.
Screen 4 of 10

Lesson 1: Kidney Structures

1.4 Threaded Case Studies: Vicky James and Owen Seagraves

Fig. 7-4




The similarity of some of Vicky and Owen's symptoms intrigues the nurse
who takes their histories. After the remainder of her intake interview with
her patients, the nurse muses that they both have flank pain and leg
swelling and both mention they're exhausted. But one has weight loss and
blood in the urine, while the other has less urine overall.

During preexamination interviews, the nurse also discovered that Vicky
isn't the only one with high blood pressure today. Owen's blood pressure
is high as well.

The nurse also records that Vicky has a fever. She is curious to see how
the doctor will approach each patient's symptoms.
Screen 5 of 10

Lesson 1: Kidney Structures

1.5 Urine Production (Animation)

Fig. 7-5




To understand disorders of the urinary system, we need to have a look at
the system. The main components of the urinary system are the kidney,
ureter, urinary bladder, and urethra. These components work together
in filtration—a process for removing from the blood substances such as
urea, potassium, uric acid, creatinine (a nitrogenous waste), and
other wastes or excess ions. Eventually, these wastes, toxins, excess ions,
and drugs are removed from the body as urine.

Urea is a nitrogenous waste formed in the liver and carried in the
bloodstream to the kidneys. There, the urea passes out of the
bloodstream as the kidneys produce urine (ur/o, urin/o), composed
also of water, salts, and acids. The urine then travels down the ureters
(ureter/o) into the bladder (cyst/o) and out of the body through the
urethra (urethr/o). This process of urination is also called voiding.

Urine Production


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07s01l0305/07s01l0305p1.htm
Screen 6 of 10

Lesson 1: Kidney Structures

1.6 <Activity icon>Activity: Animation Review: Urine Production

   Objective: Name essential organs and describe their locations and
   functions.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0101p1.htm
Screen 7 of 10

Lesson 1: Kidney Structures

1.7 Components of the Urinary System (Fast Fact)

Fig. 7-6




In addition to filtering the blood and eliminating these waste materials,
the urinary system also contributes to the body's homeostasis by
maintaining a good balance of essentials, such as water, salts, and acids,
in the body fluids. These essentials also include electrolytes, such as
sodium (nat/o) (Na+) and potassium (kal/o) (K+); these electrolytes
are chemical elements that, when dissolved in water, transmit electrical
charges needed for proper muscle and nerve functioning.

The kidney (ren/o) also secretes substances such as renin (an
enzymatic hormone important in the control of blood pressure) and
erythropoietin, a hormone that stimulates the production of red
(erythr/o) blood cells in the bone marrow (-poietin = substance that
forms).




Your kidney is about the size of your fist, weighing between 4 and 6
ounces in the average-sized adult. Make a fist now to get an idea of the
size of your own kidney. Compare fists of two different-sized people in
your class to get an idea of the variations in size.
Screen 8 of 10

Lesson 1: Kidney Structures

1.8 Kidney Structures (Animation)

Fig. 7-7




The kidney is divided into two regions. The cortex (cortic/o), or outer
region, cradles around 1 million nephrons (nephr/o). These nephrons
are considered the parenchyma, or distinctive and essential part, of the
kidney because this is where urine is actually formed. The medulla, or
inner region, holds most of the collecting tubules. Waste products enter
the kidney from the bloodstream through the renal artery, which enters
the kidney through an outer concave, hollow notch called the hilum.
Blood vessels and nerves enter and leave the kidney through this hilum.




Kidney Structures



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Lesson 1: Kidney Structures

1.9 <Catch That icon>Activity: Catch That?



Did you catch that? The functional part of the kidney—the part that
does the work of forming the urine—is actually found in the outer region
of the kidney, that is, the ________.

Type your answer in the text box below, then click Submit to check your
answer.



cortex



We are used to thinking of the functional part of an organism as being
protected by layers of other tissues. Not so with the kidney. The
nephrons, which produce urine, lay in the outer cortex of the kidney. This
is because the inner region of the kidney holds the collecting tubules.

Want a quick review to reinforce this rather unusual little discovery? Click
on the following link to review Screen 1.8. Or if you prefer, you can come
back to it later.

Click here to proceed.
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Lesson 1: Kidney Structures

1.10 <Activity icon>Activity: Identification: Kidney Structures

Let’s review structures covered in this lesson.

   Objective: Name essential organs and describe their locations and
   functions.




Engine Type     Identification
Screen          <<Drag each label to its appropriate lead line.>>
Appearance




Engine         Identification Flash Engine
Specifications     Use engine master: pictureit.swf
                   Engine Size: 580 x 350 pixels
                   Image required
                   Labels
                        o Learner drags number of answer choice to field
                        o Automatic randomizing
                        o Maximum # = 12
                        o Maximum # of characters = 17
                        o No distracters
                   Feedback
                        o None at the present time
                   Displays inline, framed
Image file     Screen 1.8 above
location
Questions
            Label Choices   Correct Positions
                            (Paste or reference an image)
            Ureter
            Medulla
            Cortex
            Renal artery
            Renal vein
            Hilum
Screen 1 of 6

Lesson 2: Filtration and Absorption: The Role of the Nephron

2.1 Renal Artery, Arterioles, and the Role of Renin

Fig. 7-8

DEVELOPER:

1. Please label the “Renal artery” (large red blood vessel to the
left of this illustration).

2. Please label the “Glomerulus” (round, egg-cup shaped ball
connected to and just right of and above the Renal Artery).




You may recall earlier that we talked about the urinary system's role in
the important process of filtration. Now we will see just how that happens.
When blood flows into the kidney through the renal artery, it passes
through smaller and smaller arteries in the cortex of the kidney. These
smallest arteries, called arterioles, are so small that, not surprisingly,
blood flow through them slows. If this slowed rate of flow drops low
enough, the kidneys secrete the hormone renin into the blood to
stimulate contraction of the arterioles so that blood pressure is increased
and the flow in the kidneys becomes normal again.
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Lesson 2: Filtration and Absorption: The Role of the Nephron

2.2 Filtration (Animation)

Fig. 7-9

NEW ART Source: Chabner textbook, 9e, Figure 7-3B LD, titled
“Glomerulus and Glomerular Capsule”.

DEVELOPER: On importing this line drawing, please use 9e labels
as opposed to original labels (i.e., change “Bowman capsule” to
“Glomerular capsule”.

Finally, please add one more label: “Distal tubule”—which is the
twisting tube leading into the Collecting Tubule (which is labelled
already). Thanks.



From the renal artery and the arterioles, the blood enters the microscopic
nephrons. The nephron (nephr/o) is the functional part of the kidney,
doing the bulk of its work, processing blood plasma and urine formation.
For practical functional purposes, the nephron can be said to consist of
the glomerulus and renal tubule. Let’s have a closer look at those.

The blood enters each nephron through a ball of even tinier blood vessels
called capillaries. This small ball is called a glomerulus (glomerul/o).
Blood pressure forces materials through hundreds of thousands of these
glomeruli, which open into the functional nephrons.

Once these substances enter the glomerulus and its glomerular capsule, it
is then filtered through the renal tubules (which include the proximal
and distal tubules and the loop of Henle). The distal tubules of several
nephrons then connect to form a common collecting duct.




Filtration



Click Next for an animation review activity.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07/assets/
07s01l0310/07s01l0310p1.htm
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Lesson 2: Filtration and Absorption: The Role of the Nephron

2.3 <Activity icon>Activity: Animation Review: Filtration

   Objective: Name essential organs and describe their locations and
   functions.



Engine Type       Sequencing
Screen            <<Arrange these structures encountered along the route of
Appearance        blood filtration by dragging them to fields in the right order or
                  sequence. Rearrange as necessary.>>




                  (under development)

Engine            Sequencing Flash Engine
Specifications       Use engine master: sequencing.swf
                     Engine Size: 580 x 350 pixels
                     Question sequencing sets
                         o Optional randomizing
                         o Maximum # = 10
                     Labels per question sequence set
                         o Optional randomizing
                         o Maximum # = 14
                         o Maximum # characters = unlimited
                         o Maximum # distracters = 6
                         o Will accommodate multimedia and hyperlinks
                         o Learner drags answer choices to fields; may
                            rearrange choices before clicking Submit
                         o Optional randomizing
                         o Will accommodate multimedia and hyperlinks
                     Target fields
                         o Optional numbering, lettering, none
                    Number of attempts:
                        o 2 to unlimited
                    Feedback
                        o Three levels: one correct, two incorrect
                        o Maximum # characters = unlimited
                    Scoring optional
                    Displays inline, framed
Question Set
                        Correct Sequence                    Media Link

               Renal artery
               Arterioles
               Glomeruli
               Renal tubules
               Loop of Henle
               Distal renal tubule
               Collecting duct
Screen 4 of 6

Lesson 2: Filtration and Absorption: The Role of the Nephron

2.4 Glomerular Capsule, Glomerulus

Fig. 7-10




Let's take a closer look at these structures of filtration.

Because the walls of each glomerulus are so thin, water, salts, sugar,
urea, and other wastes can pass through, leaving the bloodstream
altogether. They collect in a small cup at the mouth of a nephron, called
a glomerular (or Bowman's) capsule, which is wrapped around the
glomerulus to catch them. These two together, the glomerulus and its
capsule, comprise the renal corpuscle, the beginning of the nephron
unit. Larger substances like proteins and blood cells cannot filter through
the walls of the glomerulus and thus remain in the bloodstream to be
used.
Screen 5 of 6

Lesson 2: Filtration and Absorption: The Role of the Nephron

2.5 Reabsorption (Animation)

Fig. 7-11




Being trapped in the glomerular capsule isn't the last chance for these
materials, however. Some useful substances like water, salt, and sugar
have one more chance to be returned to the bloodstream, and that
happens right now. As these wastes exit the glomerular capsule by a
proximal renal tubule, most of the water, all of the sugar, and some
salts are returned to the bloodstream through tiny capillaries around each
tubule. The other wastes remain in the proximal tubule where they are
carried through the loop of Henle. The loop of Henle reabsorbs salts from
this tubule fluid before the fluid moves through the distal convoluted
tubule where water and salts are reabsorbed. The fluid is then carried out
of the nephron via the collecting tubule.


Reabsorption



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07s01l0313/07s01l0313p1.htm
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Lesson 2: Filtration and Absorption: The Role of the Nephron

2.6 <Activity icon>Activity: Write It, Find It: Filtration and
Absorption

Let's review material covered in this lesson.

   Objective: Name essential organs and describe their locations and
   functions.




Engine Type     Write It, Find It (text version)
Screen          <<Type in the correct answers.>>
Appearance




Engine         Write It, Find It Flash Engine
Specifications    Use engine master: writeit1.swf
                  Engine Size: 580 x 350 pixels
                  Questions
                        o No randomizing
                        o Maximum # = 10
                        o Maximum # characters per question = 200
                  Answer Choices
                        o Learner types answer in field
                        o No randomizing
                        o Maximum # correct = 10
                        o Maximum # characters = 17
                        o No distracters
                  Feedback
                        o Rationale of 200 maximum characters per question
                  Displays inline, framed
             Bold the correct answer(s) in each question
Question 1   When the blood flows into the kidney through the renal artery, it
             passes through smaller and smaller arteries, called arterioles.
Rationale:   This is how filtration works: a liquid (in this case, blood) passes
             through smaller and fine screens (in this case, from arteries to
             arterioles).
Question 2   If passage through increasingly smaller arteries slows blood flow
             enough, the kidneys secrete the hormone renin.
Rationale:   This particular hormone is easier to remember if you keep in mind
             that its root is ren, which means kidney. Renin stimulates
             contraction of the arterioles so that blood pressure is increased and
             the flow in the kidneys becomes normal again.
Question 3   The nephron is the functional part of the kidney.
Rationale:   Nephrons make up the bulk of the kidney and do the bulk of its
             work, processing blood plasma and urine formation.
Question 4   From the arterioles, the blood enters each nephron through a ball
             of even tinier blood vessels; this ball is the glomerulus.
Rationale:   It can be tempting to type ―capillaries‖—after all, that’s what this
             ball consists of. However, because we’re talking about the ball of
             capillaries itself, the answer is glomerulus.
Question 5   Once these substances enter the tiny ball of capillaries, it is then
             filtered through the renal tubules, which consist of the proximal
             and distal tubules and the loop of Henle.
Rationale:   The proximal tubules are so named because they are closest to the
             ball of capillaries (the glomerulus).
Question 6   Finally, the distal tubules of several nephrons connect to form a
             common collecting duct.
Rationale:   Here, the directional terms from earlier modules help: the distal
             tubules are those farthest away from the glomerulus, so naturally
             they are the ones most likely to connect to form a collecting duct
             for carrying urine away from the kidney.
Question 7   The glomerulus and its capsule together comprise the renal
             corpuscle.
Rationale:   The glomerulus and glomerular capsule together form the
             beginning, or mouth, of the entire nephron unit.
Question 8   In addition to elimination—that is, transporting wastes through the
             nephron—the renal tubules and loop of Henle are engaged in the
             process of reabsorption.
Rationale:   The proximal tubule returns most of the water, all of the sugar, and
             some salts to the bloodstream for use in the body. The loop of
             Henle reabsorbs salts, and the distal tubule absorbs water and
             salts.
Screen 1 of 6

Lesson 3: Urine Flow and Related Structures

3.1 Urine Flow: Renal Pelvis

Fig. 7-12




From the nephron units, the urine flows into the larger collecting tubules
in the renal pelvis (pyel/o), which is the central collecting region in the
kidney. This small basin in the central part of the kidney is made up of
more cup-shaped regions called calices, or calyces. Each calix (cali/o,
calic/o), or calyx, helps collect the urine and aids its passage through
the renal pelvis, which narrows into the ureter.
Screen 2 of 6

Lesson 3: Urine Flow and Related Structures

3.2 Urine Flow: Ureter, Bladder, Urethra (Animation)

Fig. 7-13




The ureter (ureter/o, vesic/o) is the urine's route out of the kidney and
down to the urinary bladder (cyst/o). Both ureters enter through a
triangular area in the bladder called the trigone (trigon/o), where the
urine is then transferred into the urethra (urethr/o) to exit the body.

Here is how this process works: The bladder itself is a collapsible, flexible
bag in which urine accumulates until it begins to expand the bladder and
put pressure on the base of the urethra, creating the desire to urinate.
The response to this urge is the release of urine from the bladder into the
urethra by a series of small muscles shaped like rings. These sphincters
control urine flow.




The Bladder



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07s01l0402/07s01l0402p1.htm
Screen 3 of 6

Lesson 3: Urine Flow and Related Structures

3.3 <Activity icon>Activity: Identification: Urinary Structures

   Objective: Name essential organs and describe their locations and
   functions.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0101p4.htm
Screen 4 of 6

Lesson 3: Urine Flow and Related Structures

3.4 Threaded Case Study: Owen Seagraves

Fig. 7-14

NEW ART Source: Photos.com #3659200




        Quic kT ime™ and a
          dec om pres sor
are needed to see this pict ure.




Remember Owen? He is having minimal difficulties with urination, but he
does have troublesome side pains. Dr. Pandit suspects—among other
things—that there could be a blockage in Owen's urinary system, perhaps
a stone. In fact, evidence of a stone in the ureters does often begin as
side pain. This pain later shifts to the lower back.
Screen 5 of 6

Lesson 3: Urine Flow and Related Structures

3.5 Male vs. Female Urethral Structures, Function

Fig. 7-15




Notice the difference in urethral structure between the male and female
systems. In the female (Fig. A), the urethra is approximately 1.5 inches
long, with a small meatus (meat/o), that is, the opening to the outside
of the body, between the clitoris and the opening of the vagina. The male
urethra (Fig. B) is approximately 8 inches long, with the meatus at the
tip of the penis. Notice that part of the urethra is embedded in the
prostate gland. The significant differences between these two don't lie
merely in physical structure. Perhaps the biggest functional difference is
the fact that, in the female, the urethra carries only urine out of the body,
but in the male, the urethra serves as an exit for both urine and semen.
Expelling the urine from the urethra is called voiding, or urination.
Screen 6 of 6

Lesson 3: Urine Flow and Related Structures

3.6 <Activity icon>Activity: Sequencing: Urine Flow

Let’s review concepts covered in this lesson.

   Objective: Name essential organs and describe their locations and
   functions.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0101p6.htm
Screen 1 of 1

Section I Quiz

You have completed Section I: Anatomy and Physiology.

If you feel comfortable with all the information, you may return to the
module folder and begin the Section I Quiz. If you pass this quiz, you will
have fulfilled the objectives of this section.

Click Next to begin Section II: Urinalysis and Pathologic Conditions.
Screen 1 of 1

Section II: Urinalysis and Pathologic Conditions

Section II Objectives

In this section, you should strive to recognize and use terms related to
urinary pathology. In particular, you should be able to:

      Analyze, define, and build terms related to pathology.
      Describe how urinalysis is used and interpreted as a test for a
       number of these pathologies.
Screen 1 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.1 Urinalysis

Fig. 7-16




The urinary system is unique to other systems in the sense that a great
number of common disorders can be detected through the same simple
multipurpose test: the urinalysis (UA). For that reason, this test will be
discussed in conjunction with these disorders rather than in the
procedures section of this module.

One of the first and easiest aspects to check is the urine specimen's color.
Although normal urine ranges fairly widely in color, other substances can
also affect its hue.
Screen 2 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.2 Threaded Case Study: pH Test, Blood Protein, and Glycosuria

Fig. 7-17

NEW ART Source:
http://coursewareobjects.elsevier.com/objects/MMTO/mod06/i
mages/06s03l0203.jpg




           QuickTime™ an d a
              decompressor
     are need ed to see this p icture .




After color analysis, the next test Vicky's urine undergoes is a pH test,
used to determine to what degree the urine is acidic or alkaline (or
basic). The abbreviation pH actually stands for ―potential hydrogen‖.
Urine pH may become alkaline in a bladder infection because of the
bacterial breakdown of urea, releasing ammonia, which is very alkaline.

In addition, one of the earliest signs of renal involvement in diabetes
mellitus is the presence of an abnormal amount of albumin, a major
blood protein in urine, called albuminuria (albumin/o = albumin;
-uria = urine condition). A special, sensitive urinalysis test can aid in
detecting albumin. The presence of glucose (glyc/o), or sugar, in the
urine is called glycosuria and is an indication of diabetes mellitus.
Screen 3 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.3 Additional Urinalysis Results

Fig. 7-18




Other factors that a urinalysis can detect are the following:

      Ketonuria: elevated levels of ketone bodies (ket/o, keton/o),
       also known as acetones, which are breakdown products
      Ketoacidosis (or ketosis): excessive blood acidity due to
       dangerous levels of blood ketones
      Pyuria: the presence of pus (py/o) in the urine, which will usually
       appear turbid, or cloudy
      Phenylketonuria (PKU): elevated levels of phenylketones
      Hyperbilirubinemia: excess levels of hemoglobin pigment
       bilirubin (BILI), which leads to bilirubinuria [excess bilirubin
       (bilirubin/o) in the urine]
      Specific gravity (sp gr): comparison of density between the urine
       and water
Screen 4 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.4 <Activity icon>Activity: Matching: Disorders Exposed in
Urinalysis

   Objective: Recognize how urinalysis is used and interpreted as a
   diagnostic test.

   Objective: Identify common pathologic conditions.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
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Screen 5 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.5 Threaded Case Study: Urinary Tract Infections (UTIs)

Fig. 7-19




Urinary tract infections are generally classified as either upper UTIs or
lower UTIs, as we see in this diagram. In Owen's case, not only is there
presence of infection, but Dr. Pandit is beginning to suspect Owen's bigger
problem is acute renal failure—possibly caused by an obstruction.

Renal failure is just what its name indicates: The kidney fails to excrete
urine. This condition may be acute or chronic. The severity of renal
failure can vary. The final phase of the chronic version is end-stage
renal disease (ESRD) or chronic kidney disease (CKD), which can be
fatal if not treated. More on that later, but first, let's finish our discussion
of the types of infections the humble urinalysis can detect.
Screen 6 of 6

Lesson 1: Disorders Commonly Exposed in Urinalysis

1.6 <Activity icon>Activity: Word Shop: Disorders Commonly
Exposed in Urinalysis

   Objective: Define combining forms, prefixes, and suffixes.

   Objective: Identify common pathologic conditions.

Let’s review terms covered in this lesson.

Engine Type             Word Shop
Screen Appearance       <<Combine the specified number of word parts to build a
                        term to match each definition.>>




Engine Specifications   Word Shop Flash Engine
                           Use engine master: wordshop.swf
                           Engine Size: 580 x 350 pixels
                           Words
                               o Learner drags answer choice to field
                               o Optional randomizing
                               o Maximum # = 10
                               o Maximum parts per word = 4
                               o Maximum # distracters = 6
                           Feedback
                               o Word parts merged into correct word
                           Displays inline, framed
         Word Parts                Definition
Word 1   keton/o + -uria           Urine condition of elevated levels
         (ketonuria)               of ketone bodies (2)
Word 2   py/o + -uria (pyuria)     Presence of pus in the urine (2)
Word 3   albumin/o + -uria         Abnormal amount of a protein in
         (albuminuria)             urine (2)
Word 4   ket/o + -osis (ketosis)   Excessive blood acidity due to
                                   dangerous levels of blood ketones
                                   (2)
Word 5   hyper- + bilirubin/o +    Excess levels of hemoglobin
         -emia                     pigment (3)
         (hyperbilirubinemia)
Word 6   glycos/o + -uria          Abnormal presence of glucose in
         (glycosuria)              urine (2)
Screen 1 of 6

Lesson 2: More Inflammatory Disorders

2.1 Threaded Case Study: Interstitial Nephritis

Fig. 7-20




Owen's particular inflammation occurs in the connective tissue lying
between the renal tubules (the renal interstitium); this condition is called
interstitial nephritis. In Owen's case, this condition is a response to his
recent administration of a penicillin medication for tonsillitis. It can also
develop from the excessive use of aspirin and aspirin-type drugs. In
addition to poor renal function, there may be fever, skin rash, like the one
shown in the illustration, and eosinophils in the blood and urine.

Dr. Pandit takes his patient off the offending drug to clear up the
nephritis.
Screen 2 of 6

Lesson 2: More Inflammatory Disorders

2.2 Acute Pyelonephritis

Fig. 7-21




Other inflammations include interstitial cystitis (IC) (chronic bladder
wall inflammation) and pyelonephritis. Acute pyelonephritis is a bacterial
(bacteri/o + -al) inflammation of the lining of the renal pelvis (pyel/o)
and renal parenchyma (nephrons). These are invaded with numerous tiny
abscesses, which are collections of pus (py/o), or there may be
evidence of pyuria (pus in the urine). An abscess can also be revealed
on radiographic images like this CT scan (arrow points to an abscess).
Screen 3 of 6

Lesson 2: More Inflammatory Disorders

2.3 <Catch That icon>Activity: Catch That?



Did you catch that? Patient K has ________, which is pus in the urine,
and Patient V has ________, which is an inflamed renal pelvis and renal
parenchyma.

Type your answer in the text box below, then click Submit to check your
answer.



pyuria; pyelonephritis



Did you confuse the two word parts py/o and pyel/o while answering
this question? Acute pyelonephritis is a bacterial inflammation of the lining
of the renal pelvis (pyel/o) and the nephrons (nephr/o). You may recall
that ―parenchyma‖ refers to the main, functional tissue or part of an
organ—in this case, the nephrons. Thus inflammation of the renal pelvis
and parenchyma is pyelonephritis. When nephrons are invaded with
numerous tiny abscesses, which are collections of pus (py/o), there may
be evidence of pyuria (pus in the urine): py/o + -uria (urine condition) =
pyuria.

Want a quick review to reinforce this rather unusual little discovery? Click
on the following link to review Screen 2.2. Or if you prefer, you can come
back to it later.

Click here to proceed.
Screen 4 of 6

Lesson 2: More Inflammatory Disorders

2.4 Threaded Case Study: Owen Seagraves

Fig. 7-22




You may remember that Dr. Pandit suspects—among other possibilities—
that Owen may have a urinary blockage. This can be caused by long-term
medication use or long-term use of an indwelling urinary catheter, which
can produce scarring and thus cause a fibrotic narrowing of the urethra,
called urethral stricture. The patient experiences diminished force,
dysuria, urinary frequency, and hesitation.
Screen 5 of 6

Lesson 2: More Inflammatory Disorders

2.5 Nocturia, Anuria, Diuresis

Fig. 7-23

NEW ART Source: Photos.com #11688892

http://images.photos.com/thm/thm9/STXP/20080817/PRL/8/8
0/801/11688892.thl.jpg?18647041_95395108




       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




Is coffee or alcohol becoming increasingly important in your daily routine?
If so, you should know that diuresis—increased urine formation and
secretion—can be caused by caffeine or alcohol intake.

Other urinary dysfunctions can include nocturia (frequent, excessive
urination at night; noct/o = night; -uria = urine condition) and anuria,
diminished or absent (an-) urination usually caused by either renal
dysfunction or a urinary tract obstruction.

Owen, it turns out, does not have a urethral stricture. Still, Dr. Pandit is
pretty sure some sort of obstruction is causing Owen's pain. Dr. Pandit is
beginning to think he knows precisely what that obstruction is.
Screen 6 of 6

Lesson 2: More Inflammatory Disorders

2.6 <Activity icon>Activity: Crossword: Inflammatory Disorders

   Objective: Identify common pathologic conditions.

   Objective: Define combining forms, prefixes, and suffixes.

Let’s review terms covered in this lesson.

Engine Type     Crossword
Screen          <<Type each answer in the row or column corresponding to its
Appearance      clue.>>




Engine         Crossword Flash Engine
Specifications     Use engine master: [under development]
                   Engine Size:
                   Clues and Terms
                       o Learner types answer in blocks
                       o Optional randomizing
                       o Maximum # = 30
                       o Maximum # characters per clue = unlimited
                       o Maximum # characters per answer: 20
                       o
                   Feedback
                       o
                   Displays inline, framed
Questions
            Terms                Clues
            interstitial         Pertaining to connective tissue lying
                                 between structures
            nephritis            Kidney inflammation
            cystitis             Chronic bladder wall inflammation
            pyelonephritis       Inflammation of the lining of the renal pelvis
                                 and renal parenchyma
            renal pelvis         Pyel/o (2 words)
            bacterial            Pertaining to bacteria
            pyuria               Pus in urine
            abscess              A collection of pus
            urethral stricture   Fibrotic narrowing of the urethra (2 words)
            dysuria              Difficult urination
            diuresis             Increased urine formation and secretion
            night                Noct/o
            anuria               Diminished or absent urination
Screen 1 of 5

Lesson 3: Kidney Stones, Cysts, and Similar Disorders

3.1 Threaded Case Study: Owen Seagraves

Fig. 7-24

NEW ART: Photos.com #3666405


       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




http://images.photos.com/thw/thw9/PH/5344_2004120014/02
0425_1467_01/3666405.thw.jpg?020425_1467_0168_l__s


Owen's next test is scheduled, but before he can take it, the side pains he
has complained about not only return, they are even worse and are now
occurring in his back. They are severe now, making him double over,
pace, sweat profusely, and vomit. Dr. Pandit sends Owen straight to the
emergency room.

From these symptoms, Dr. Pandit moves quickly to confirm his earlier
suspicion and takes action. Owen indeed has nephrolithiasis—that is,
the condition (-iasis) of having kidney (nephr/o) stones (lith/o), or
renal calculi. This condition has caused his other symptoms, inducing
acute renal failure (ARF)—more on that condition later. Dr. Pandit's
first move is to take care of the underlying cause—those kidney stones!
Screen 2 of 5

Lesson 3: Kidney Stones, Cysts, and Similar Disorders

3.2 Kidney Stones

Fig. 7-25




Kidney stones themselves are not UTIs, of course. Kidney stones are
thought to be formed by high levels of calcium or uric acid in the blood.
These stones tend to block passageways in the ureter, the bladder, or
renal pelvis. Dr. Pandit will find out where the obstruction is occurring and
determine how best to remove it.
Screen 3 of 5

Lesson 3: Kidney Stones, Cysts, and Similar Disorders

3.3 Threaded Case Study: Vicky James

Fig. 7-26




Let's go back to our patient Vicky.

Blood in the urine, along with symptoms like the pain in her back, the
swelling, high blood pressure, and fatigue, all suggest some sort of
nephropathy, that is, a kidney disorder. Yet Vicky does not have a UTI,
nor does she show evidence of having a kidney stone.
Screen 4 of 5

Lesson 3: Kidney Stones, Cysts, and Similar Disorders

3.4 Polycystic Kidney Disease

Fig. 7-27




          QuickTime™ and a
            decompressor
    are neede d to see this picture.




Heredity can also play a part in kidney disease. One hereditary disorder,
called polycystic kidney disease (PKD), is a condition in which multiple,
fluid-filled sacs, or cysts, form both inside and outside the kidney. This
condition is progressive but usually asymptomatic (without symptoms)
until middle age, when the patient develops nephrolithiasis, hematuria
(blood in the urine), urinary tract infection, hypertension, and uremia
(a toxic state in which a large amount of nitrogenous wastes accumulate
in the blood). Similar to this is azotemia (azot/o = nitrogen).
Fortunately, Vicky does not exhibit uremia or azotemia; however, she has
manifested hematuria and hypertension.
Screen 5 of 5

Lesson 3: Kidney Stones, Cysts, and Similar Disorders

3.5 <”Take It In” icon>Activity: “Take It In”: Kidney Stones,
Cysts, and Similar Disorders

Fig. 7-29

Let’s review terms covered in this lesson.

   Objective: Understand medical terms in their proper contexts, such as
   medical reports and records.

   Objective: Identify common pathologic conditions.

NEW ART Source: Photos.com
#4861066

http://images.photos.com/thw/thw8/PH/cs5359_20051104c/cs5359_2005
1104c/4861066.thw.jpg?5359_051105_74296


Engine Type     “Take It In!” (multiple choice)
Screen
Appearance      Screen will show Patient Photo plus Scenario, plus
                question (for easy referral to Scenario while
                solving). Designer may exhibit either (1) all
                questions or (2) one question at a time (with ―Next‖
                arrow)—at Designer’s discretion.



Engine         Case Study Flash Engine
Specifications    Use engine master: casestudychoices.swf
                  Engine Size: 580 x 300 pixels
                  Scenario
                       o Will accommodate one image
                       o Maximum # characters = 350
                  Questions
                       o Optional randomizing
                       o Maximum # = 15
                       o Maximum # characters per question =
                          200
                  Answer Choices
                       o Learner clicks answer choice
                       o Optional randomizing
                       o May be numerical or alphabetical
                       o Maximum # per question = 6
                       o Maximum # characters = 80
                      Feedback
                        
                         o Specific or general
                         o Maximum # characters = 200
                    Displays inline, framed
Instructions    Click on the correct answer to each question.
Photo



                        Quic kT ime™ and a
                          dec om pres sor
                are needed to see this pict ure.




Scenario text   Scilla is an active mom with two preschoolers and a
                daughter in middle school who has a history of
                painful UTIs and one occurrence of ARF. She has a
                family history of nephrolithiasis on her father’s side
                of the family but has not had this herself. Today,
                however, she has come to the clinic complaining of
                dysuria and hematuria. She is tested for uremia,
                azotemia, and PKD.
Question 1   The abbreviation UTIs in Scilla’s medical report
             means:
Answer                          Answer Choices
Choices      (Bold the correct response)
            Urination ischemia
             Urolithiasis
             Urinary trigonitis
             Urinary tract infections


Question 2   The abbreviation ARF in Scilla’s medical report
             means:
Answer                           Answer Choices
Choices      (Bold the correct response)
            Arterial filtration
             Albumin rate of filtration
             Acute renal failure
             Anuria filtration


Question 3   The term or abbreviation in Scilla’s medical report
             that indicates a history of kidney stones is:
Answer                         Answer Choices
Choices      (Bold the correct response)
            Nephrolithiasis
             Dysuria
             Hematuria
             ARF


Question 4   The term or abbreviation in Scilla’s medical report
             that indicates painful or difficult urination is:
Answer                         Answer Choices
Choices      (Bold the correct response)
            UTI
             Dysuria
             Hematuria
             ARF


Question 5   The term or abbreviation in Scilla’s medical report
             that indicates blood in the urine is:
Answer                         Answer Choices
Choices      (Bold the correct response)
            Dysuria
             Hematuria
             UTI
             ARF
Question 6   The term or abbreviation in Scilla’s medical report
             that indicates multiple, fluid-filled sacs in the kidney
             is:
Answer                        Answer Choices
Choices      (Bold the correct response)
            PKD
             Hematuria
             ARF
             Nephrolithiasis


Question 7   Scilla shows signs of _________, a toxic state in
             which a large amount of nitrogenous wastes
             accumulate in the blood.
Answer                         Answer Choices
Choices      (Bold the correct response)
            polycystic kidney disease
             hematuria
             uremia
             dysuria


Question 8   Scilla’s medical report indicates she’s being tested
             for possible ________, or blood nitrogen.
Answer                          Answer Choices
Choices      (Bold the correct response)
            hematuria
             UTI
             nephrolithiasis
             azotemia
Screen 1 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.1 Threaded Case Study: Renal Cell Carcinoma

Fig. 7-28




At one point, Dr. Pandit thought that the pain and a feeling of a lump in
Vicky's side might have meant a nephroptosis—that is, a dropping or
displacing (-ptosis) of the kidney (nephr/o) because of weak support.
However, there was a bit more involvement than that.

Blood in the urine, pain, and/or a lump in the back (or side), along with
leg and ankle edema can all signal a number of disorders, of course, but
one of the more serious is renal cell carcinoma, or cancerous tumor of
the kidney (also called hypernephroma). In Vicky's case, it was the
ultrasound that revealed renal cell carcinoma.
Screen 2 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.2 Wilms Tumor

Fig. 7-29




When discussing malignant renal tumors, mention should be made of
Wilms tumor, the childhood version of cancer of the kidney.
Screen 3 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.3 Bladder Malignancy

Fig. 7-30




Although most disorders of the urinary system involve the kidney, the
bladder is actually a more common site of malignancy, particularly in
men, smokers, and individuals over the age of 50. Chemicals used by
some kinds of industrial workers can also contribute to risk. Early
symptoms usually include blood in the urine, increased urinary frequency,
and dysuria, which means a difficult or painful (dys-) urine condition
(-uria). Cancer will be discussed in more detail in its own module later in
this course.
Screen 4 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.4 Renal Hypertension and Diabetes

Fig. 7-31

NEW ART Source: Photos.com #3658741

http://images.photos.com/thw/thw9/PH/5344_2004120013/02
0509_1497_00/3658741.thw.jpg?020509_1497_0014_l__sw




        Quic kT ime™ and a
          dec om pres sor
are needed to see this pict ure.




Three disorders that are closely linked to the urinary system's functioning
are renal hypertension, diabetes insipidus (DI), and diabetes
mellitus (DM). In diabetes insipidus, antidiuretc hormone (ADH) is
either not secreted adequately or is resisted in the kidney. In diabetes
mellitus, insulin is either not secreted adequately or not used properly in
the body. Two common symptoms of diabetes are polyuria—excessive
(poly-) excretion of urine—and polydipsia, excessive thirst (dips/o).
Screen 5 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.5 <Activity icon>Activity: Word Shop: Tumors and Nephrotic
Syndrome

   Objective: Identify common pathologic conditions.

   Objective: Define combining forms, prefixes, and suffixes.

Engine Type             Word Shop
Screen Appearance       <<Combine the specified number of word parts to build a
                        term to match each definition.>>




Engine Specifications   Word Shop Flash Engine
                           Use engine master: wordshop.swf
                           Engine Size: 580 x 350 pixels
                           Words
                               o Learner drags answer choice to field
                               o Optional randomizing
                               o Maximum # = 10
                               o Maximum parts per word = 4
                               o Maximum # distracters = 6
                           Feedback
                               o Word parts merged into correct word
                           Displays inline, framed
         Word Parts               Definition
Word 1   nephr/o + -ptosis        A dropping or displacing of the
         (nephroptosis)           kidney because of weak support
                                  (2)
Word 2   hyper- + nephr/o + -     Another name for renal cell
         oma                      carcinoma (3)
         (hypernephroma)
Word 3   dys- + -uria (dysuria)   Difficult or painful urine condition
                                  (2)
Word 4   poly- + -uria            Excessive excretion of urine (2)
         (polyuria)
Word 5   poly- + dips/o + -ia     Excessive thirst (3)
         (polydipsia)
Screen 6 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.6 Nephrotic Syndrome

Fig. 7-32




When excessive amounts of protein are lost in the urine, usually because
of a leaky glomerulus, the patient may experience swelling and
susceptibility to infection, developing hypoalbuminemia. This condition,
known as nephrotic syndrome, is most frequently caused by
glomerulonephritis (Bright's disease, or inflammation of the kidney
glomerulus), exposure to toxins, or other conditions such as diabetes
mellitus or cancer. Generalized edema (swelling caused by fluid in the
tissue spaces) and rapid weight gain are features of this condition.
Screen 7 of 7

Lesson 4: Tumors and Nephrotic Syndrome

4.7 <Activity icon>Activity: Fill-In: Tumors and Nephrotic
Syndrome

Let’s review terms covered in this lesson.

   Objective: Identify common pathologic conditions.

Engine Type     Fill-In (drag and drop)
Screen          <<Drag each term to complete a sentence correctly.>>
Appearance




Engine         Fill-In Flash Engine
Specifications      Use engine master: fillin.swf
                    Engine Size: 580 x 300 pixels
                    Will accommodate an image
                    Questions
                         o Optional randomizing
                         o Maximum # = 10
                         o Maximum # characters per question = 200
                    Answer Choices
                         o Learner drags answer choice to field
                         o Optional randomizing
                         o Maximum # correct = 10
                         o Maximum # distracters = 6
                         o Maximum # characters = 17
                    Feedback
                         o None at the present time
                    Displays inline, framed
             Bold correct answer(s) in each question
Question 1   Wendy was assessed for Wilms tumor, the childhood version of
             cancer of the kidney.
Question 2   Vicky’s ultrasound revealed that she has renal cell carcinoma, or
             cancerous tumor of the kidney.
Question 3   Although most disorders of the urinary system involve the kidney,
             the bladder is actually a more common site of malignancy.
Question 4   Mr. Jackson’s symptoms include blood in the urine, increased
             urinary frequency, and dysuria, which means a difficult or painful
             urine condition.
Question 5   In diabetes insipidus, antidiuretc hormone (ADH) is either not
             secreted adequately or is resisted in the kidney.
Question 6   In diabetes mellitus, insulin is either not secreted adequately or
             not used properly in the body.
Question 7   Claude exhibits signs of Bright’s disease, an inflammation of the
             kidney glomerulus—also known as glomerulonephritis.
Question 8   Georgia experiences generalized edema, which is swelling caused
             by fluid in the tissue spaces.
Screen 1 of 1

Section II Quiz

You have completed Section II: Urinalysis and Pathologic
Conditions.

If you feel comfortable with all the information, you may return to the
module folder and begin the Section II Quiz. If you pass this quiz, you will
have fulfilled the objectives of this section.

Click Next to begin Section III: Diagnostic Procedures and Therapeutic
Interventions.
Screen 1 of 1

Section III: Diagnostic Procedures and Therapeutic Interventions

Section III Objectives

In this section, you should strive to recognize and use terms and
abbreviations related to the diagnostic procedures and therapeutic
interventions for the urinary system. In particular, you should be able to:

      Analyze, define, and build terms related to diagnostic procedures
       and therapeutic interventions.
      Recognize and define abbreviations used to describe diagnostic
       procedures and therapeutic interventions.
Screen 1 of 13

Lesson 1: Diagnostic Procedures

1.1 Threaded Case Study: CT Scan

Fig. 7-33




Several different imaging techniques can be used to visualize cysts and
polycystic kidneys. Let’s start with a more familiar method: the CT scan.

The CT scan (shown here) can present multiple transverse x-ray views
with or without the use of contrast material. This CT scan clearly identifies
multiple cysts in the kidney.
Screen 2 of 13

Lesson 1: Diagnostic Procedures

1.2 Retrograde Pyelogram and Radioisotope Scan

Fig. 7-34




The retrograde pyelogram (RP) (figure on left) involves the injection of
contrast medium through a catheter into the ureters from the bladder
before creating x-ray images of the renal pelvis and ureters. The
radioisotope scan (seen on the right) is kidney imaging enhanced by
injection of a radioactive substance into the bloodstream. Both procedures
can reveal the presence of a renal embolus, urinary stones, and other
obstructions.
Screen 3 of 13

Lesson 1: Diagnostic Procedures

1.3 Cystoscopy

Fig. 7-35




The most common diagnostic procedure is cystoscopy or cysto. This
procedure involves inserting a hollow metal tube into the urinary meatus
and urethra and into the bladder. Using light, lenses, and mirrors, the
cystoscope reveals the urethra and bladder mucosa, which can be
examined for tumors, calculi, or inflammation. A cystoscope can also be
used to draw urine samples or inject contrast materials.
Screen 4 of 13

Lesson 1: Diagnostic Procedures

1.4 Voiding Cystourethrogram (VCUG)

Fig. 7-36




            QuickTime™ and a
              decompressor
     are need ed to see this picture.




The voiding cystourethrogram (VCUG) can also reveal abnormalities of
the bladder. In this procedure, the bladder is filled with contrast material
and x-rays are taken of the bladder and urethra as the patient expels
urine.
Screen 5 of 13

Lesson 1: Diagnostic Procedures

1.5 <Catch That icon>Activity: Catch That?

Did you catch that? Jeffrey undergoes a procedure in which a hollow
tube is inserted into the urinary meatus and urethra, extending into the
bladder. His brother Mac says he had a different procedure just last
month, in which his bladder was filled with contrast material; then x-rays
were taken of his bladder and urethra as he expelled urine. Jeffrey’s
procedure is called _________. Mac’s was a voiding _________.

Type your answer in the text box below, then click Submit to check your
answer.




[Popup]

Correct answer: cystoscopy; cystourethrogram

Feedback: Knowing word parts will help you get both answers. Jeffrey’s
diagnostic procedure is cystoscopy, the use of a scope to visualize
(-scopy) the bladder (cyst/o). Mac’s VCUG was a record (-gram) taken of
his bladder (cyst/o) and urethra (urethr/o) while expelling urine (voiding).

Want a quick review to reinforce this fact? Click on the following link to
review Screens 1.3 and 1.4. Or if you prefer, you can come back to it
later.
Screen 6 of 13

Lesson 1: Diagnostic Procedures

1.6 Threaded Case Study: Ultrasound

Fig. 7-37




Polycystic kidney disease can also be diagnosed using
ultrasonography by recording high-frequency sound waves within the
organs and tissues, producing an ultrasound image called a sonogram.
Screen 7 of 13

Lesson 1: Diagnostic Procedures

1.7 Intravenous Pyelogram with Nephrotomography

Fig. 7-38




Other diagnostic studies to detect renal tumors include the one shown in
the illustration—IVP with nephrotomography. This imaging technique
detects renal tumors through the injection and distribution of contrast
material into the kidney. It can detect and evaluate most masses.
Screen 8 of 13

Lesson 1: Diagnostic Procedures

1.8 MRI Detection of Tumors

Fig. 7-39




Small renal tumors are now found earlier than ever because of the
increased use of the CT scan and MRI. In MRI (magnetic resonance
imaging), a cylinder-shaped machine produces an image using a
changing magnetic to capture the movement of protons within the body,
producing images of the kidney and surrounding structures in three planes
of the body.
Screen 9 of 13

Lesson 1: Diagnostic Procedures

1.9 <Activity icon>Activity: Word Shop: Diagnostic Procedures

   Objective: Define combining forms, prefixes, and suffixes.

   Objective: List and explain clinical procedures, laboratory tests, and
   abbreviations.


Engine Type             Word Shop
Screen Appearance       <<Combine the specified number of word parts to build a
                        term to match each definition.>>




Engine Specifications   Word Shop Flash Engine
                           Use engine master: wordshop.swf
                           Engine Size: 580 x 350 pixels
                           Words
                               o Learner drags answer choice to field
                               o Optional randomizing
                               o Maximum # = 10
                               o Maximum parts per word = 4
                               o Maximum # distracters = 6
                           Feedback
                               o Word parts merged into correct word
                           Displays inline, framed
         Word Parts            Definition
Word 1   pyel/o + -gram        X-ray image of the renal pelvis
         (pyelogram)           and ureters (2)
Word 2   cyst/o + -scope       Hollow instrument providing
         (cystoscope)          direct visualization of the urinary
                               bladder (2)
Word 3   cyst/o + urethr/o +   Radiographic image of the
         -gram                 bladder and urethra, often taken
         (cystourethrogram)    while urine is expelled (3)
Word 4   son/o + -gram         Image made by recording high-
         (sonogram)            frequency sound waves within the
                               organs and tissues (2)
Screen 10 of 13

Lesson 1: Diagnostic Procedures

1.10 BUN and Creatinine Clearance Test

Fig. 7-40




A test used to determine how much urea and nitrogen have accumulated
in the blood (uremia) to determine severity is the urea and blood urea
nitrogen (BUN) test.

Of particular interest is the fact that chronic kidney disease (the final
phase of chronic renal failure, or CRF) is now classified according to the
level of creatinine clearance. The creatinine clearance test (Ccr)
measures the rate at which creatinine concentration in a blood sample is
excreted in the urine over a 24-hour period. This is useful in assessing the
glomerular filtration rate (GFR) as well.
Screen 11 of 13

Lesson 1: Diagnostic Procedures

1.11 KUB Imaging Series, MRI

Fig. 7-41




                  QuickTime™ an d a
                     decompressor
            are need ed to see this p icture .




At the time of his hospitalization with kidney stones, Owen's BUN
increased suddenly, along with his serum potassium levels. His serum
creatinine increased by 2 mg/dL at his last visit, while his creatinine
clearance was decreased.

Dr. Pandit requested two imaging procedures to help confirm the
diagnosis of renal failure. Both the kidney, ureters, and bladder (KUB)
exam (Fig. A)—also called urography—and magnetic resonance
imaging, or MRI (Fig. B), can demonstrate the kidneys in relation to
other organs in the abdominopelvic region.

However, often kidney or abdominal ultrasound is the best test.
Screen 12 of 13

Lesson 1: Diagnostic Procedures

1.12 Renal Angiogram

Fig. 7-42




In the case of the hypertensive patient, a renal angiogram can highlight
renal vessels by introducing a contrast material into the bladder and
ureters through a cystoscope, after which x-rays are taken. Renal
angiography thus helps diagnosis areas of bleeding within the kidney, as
well as detecting renal artery stenosis associated with hypertension.
Screen 13 of 13

Lesson 1: Diagnostic Procedures

1.13 <Activity icon>Activity: Crossword: Abbreviations of
Diagnostic Procedures


   Objective: List and explain clinical procedures, laboratory tests, and
   abbreviations.

Let’s review terms covered in this lesson.

Engine Type    Crossword
Screen         <<Type each answer in the row or column corresponding to its
Appearance     clue.>>




Engine         Crossword Flash Engine
Specifications     Use engine master: [under development]
                   Engine Size:
                   Clues and Terms
                       o Learner types answer in blocks
                       o Optional randomizing
                       o Maximum # = 30
                       o Maximum # characters per clue = unlimited
                       o Maximum # characters per answer: 20
                       o
                   Feedback
                       o
                   Displays inline, framed
Questions
            Terms               Clues
            renal angiography   Procedure that highlights renal vessels by
                                introducing a contrast material into the
                                bladder and ureters through a cystoscope,
                                after which x-rays are taken (2 words)
            kidneys ureter      KUB (3 words)
            bladder
            urography           Another name for KUB
            magnetic            MRI = ______ ______ imaging
            resonance
            creatinine          Ccr (2 words)
            clearance
            glomerular          GFR = ______ ______ rate
            filtration
            blood urea          BUN (3 words)
            nitrogen
            pyelogram         X-ray image of the renal pelvis and ureters
            cystourethrogram  Radiographic image of the bladder and
                              urethra, often taken while urine is expelled
            sonogram          Image made by recording high-frequency
                              sound waves within the organs and tissues
            nephrotomography Imaging technique involving injection and
                              distribution of contrast material into the
                              kidney; called IVP with _________
            cysto             Abbreviation for cystoscopy procedure
            radioisotope scan Kidney imaging enhanced by injection of a
                              radioactive substance into the bloodstream (2
                              words)
            retrograde        RP; involves injection of contrast medium into
            pyelogram         the ureters from the bladder before creating
                              x-ray images of the renal pelvis and ureters
                              (2 words)
            computed          CT (2 words)
            tomography
Screen 1 of 10

Lesson 2: Therapeutic Interventions

2.1 Treatment of Pyelonephritis

Fig. 7-43




Pyelonephritis can be treated with antibiotics. If this condition becomes
chronic, renal tissue necrosis and scar formation can result.

Treatment for urethral stricture or narrowing is usually surgical
(urethroplasty) and may involve, most typically, urethral dilation or
urethrotomy.
Screen 2 of 10

Lesson 2: Therapeutic Interventions

2.2 Treatment of Kidney Stones

Fig. 7-44




Owen's tests pinpoint the location of the kidney stones, which are treated
by lithotripsy, the process of crushing (-tripsy) calculi or stones (lith/o)
so that they can pass from the body in urine. In extracorporeal shock
wave lithotripsy (ESWL), a shock wave is administered from outside
(extra-) the body (corpor/o) to crush the stones for easier, eventual
passage from the body through the urethra.

Unlike Owen, some patients will need surgery to remove the stone
through an incision in the kidney, called a nephrolithotomy (nephr/o =
kidney; lith/o = stone or calculus; -tomy = process of cutting into).
Removing the stone through an incision in the renal pelvis is a
pyelolithotomy (pyel/o = renal pelvis).
Screen 3 of 10

Lesson 2: Therapeutic Interventions

2.3 Threaded Case Study: Owen Seagraves

Fig. 7-45

NEW ART Source: Photos.com #3659147


       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




http://images.photos.com/thw/thw9/PH/5344_2004120013/02
0516_1514_00/3659147.thw.jpg?020516_1514_0012_l__s


Being physically fit helps Owen to make a quick recovery from the
lithotripsy procedure. But treatment is still far from over. Now that the
primary cause—nephrolithiasis—has been taken care of, Owen, "…happy
and stone free," can be treated for secondary acute renal failure, a
complication of his kidney stones. Treatment consists of the
administration of the hormone erythropoietin to stimulate the
production of red (erythr/o) blood cells (-poietin = substance that
forms).
Screen 4 of 10

Lesson 2: Therapeutic Interventions

2.4 <Activity icon>Activity: Word Shop: Therapeutic Interventions

   Objective: Define combining forms, prefixes, and suffixes.

   Objective: List and explain clinical procedures, laboratory tests, and
   abbreviations.

Engine Type             Word Shop
Screen Appearance       <<Combine the specified number of word parts to build a
                        term to match each definition.>>




Engine Specifications   Word Shop Flash Engine
                           Use engine master: wordshop.swf
                           Engine Size: 580 x 350 pixels
                           Words
                               o Learner drags answer choice to field
                               o Optional randomizing
                               o Maximum # = 10
                               o Maximum parts per word = 4
                               o Maximum # distracters = 6
                           Feedback
                               o Word parts merged into correct word
                           Displays inline, framed
         Word Parts               Definition
Word 1   urethr/o + -plasty       Surgical repair of the urethra (2)
         (urethroplasty)
Word 2   urethr/o + -tomy         Incision into the urethra to
         (urethrotomy)            relieve stricture (2)
Word 3   lith/o + -tripsy         Process of crushing calculi or
         (lithotripsy)            stones (2)
Word 4   extra- + corpor/o +      Pertaining to from outside the
         -eal (extracorporeal)    body (3)
Word 5   nephr/o + lith/o +       Surgery to remove a stone
         -tomy                    through an incision in the kidney
         (nephrolithotomy)        (3)
Word 6   pyel/o + lith/o +        Removing a stone through an
         -tomy (pyelolithotomy)   incision in the renal pelvis (3)
Word 7   erythr/o + -poietin      Hormone administered to
         (erythropoietin)         stimulate red blood cell
                                  production (2)
Screen 5 of 10

Lesson 2: Therapeutic Interventions

2.5 Threaded Case Study: Owen Seagraves

Fig. 7-46

NEW ART: Photos.com #3659200




        Quic kT ime™ and a
          dec om pres sor
are needed to see this pict ure.




http://images.photos.com/thw/thw9/PH/5344_2004120013/02
0516_1514_00/3659200.thw.jpg?020516_1514_0072_l__s


Now that his kidney stones have been treated, Owen’s treatment can
focus on preventing the buildup of toxins by restricting his fluid intake,
along with other dietary modifications. Owen is also given antibiotics and
diuretics. The next focus is on bringing a potentially dangerous
hyperkalemia (increased blood potassium) under control. To help in all
this management, Owen is given IV calcium, glucose/insulin, and oral
potassium exchange resin. Finally, his blood pressure is brought back
under control.

Soon Owen is back at work. Along with his regular exercise routine, he
watches his sodium intake and has regained all his former energy.
Screen 6 of 10

Lesson 2: Therapeutic Interventions

2.6 Hemodialysis, Peritoneal Dialysis (Animation)

Fig. 7-47




Owen has made an excellent recovery. His renal failure did not become
chronic or, worse, turn into end-stage renal disease. When this
happens, when the kidneys can no longer separate nitrogenous waste
materials from the bloodstream, dialysis can save a patient's life. There
are two methods of dialysis. Hemodialysis (HD) (Fig. A) is the use of an
artificial kidney machine.

The other method is peritoneal dialysis (PD) (Fig B), which involves the
introduction of a peritoneal catheter and a special solution into the
abdomen. The wastes pass into the fluid from the bloodstream and are
then drained from the body.


Hemodialysis




http://www.coursewareobjects.com/objects/chabner8e_v1/mod07/assets/
07s02l0606/07s02l0606p1.htm
Screen 7 of 10

Lesson 2: Therapeutic Interventions

2.7 CAPD, CCPD, cath, Cystotomy, Renal Transplant

Fig. 7-48

DEVELOPER: This is not new art. Figure is cropped from previous
screen’s image to break up long text screen.




The abbreviation CAPD stands for continuous ambulatory peritoneal
dialysis, and CCPD is continuous cycling PD (use of night apparatus
during sleep). Catherization during peritoneal dialysis should not be
confused with urinary catheterization (cath), which is used for short-
term urine drainage. A related procedure, cystostomy, is the creation of
an artificial opening (-stomy) into the bladder (cyst/o) for insertion of a
catheter.

Finally, renal failure patients can become candidates for renal transplant
(receiving a kidney from a donor), particularly in cases in which dialysis is
no longer effective.
Screen 8 of 10

Lesson 2: Therapeutic Interventions

2.8 Renal Angioplasty

Fig. 7-49




Sometimes in the course of renal angiography, arterial constriction may
be identified as a cause of alterations in renal blood flow. When this
occurs, blood flow to the kidney can be greatly improved by a procedure
called renal angioplasty. In this procedure, a balloon catheter is inserted
through an artery and into the narrowed artery in the kidney. Inflating the
balloon not only widens stenosis (narrowing of the artery), but it also
redistributes lipid deposits within the artery. This improves blood flow to
the kidney. Stents (metal tubes) can be inserted to keep the vessel open.
Screen 9 of 10

Lesson 2: Therapeutic Interventions

2.9 Threaded Case Studies: Vicky James and Owen Seagraves

Fig. 7-50

NEW ART Source: Photos.com #3659147



       Quic kTime™ and a
         decom pres sor
are needed to s ee this picture.




DEVELOPER: Please crop existing photo of Owen Seagraves
(below), replacing him with black male above. Thanks.




Six months later, life is looking much better for both Vicky and Owen.
Both appear to be in good health after potentially life-threatening
disorders. Vicky, of course, will continue to receive periodic blood tests to
check for kidney function at three- or four-month intervals for several
years. Chest x-rays, CT scans of the abdomen and chest, and other
imaging tests will help in monitoring for any recurrence of the cancer.

When they have both left Dr. Pandit's office (separately, of course!) after
follow-up visits, the nurse remarks, "Those two amaze me. Just think, not
so many decades ago, recovery would have been a lot more difficult for
both of them."

Dr. Pandit nods, "And maybe out of reach."
Screen 10 of 10

Lesson 2: Therapeutic Interventions

2.10 <Activity icon>Activity: Listen and Spell: Therapeutic
Interventions

   Objective: List and explain clinical procedures, laboratory tests, and
   abbreviations.

Let’s review terms covered in this lesson.

Engine Type        Listen and Spell
Screen             << Click the Play button to hear the word; pronounce the term
Appearance         and then type it in the space.
                   >>




Engine             Listen and Spell Flash Engine
Specifications         Use engine master: listenspell.swf
                       Engine Size: 580 x 350 pixels
                       Words
                            o Learner listens to pronunciation and types answer
                               in label field
                            o No randomizing
                            o Maximum # = 10
                            o Maximum # correct spellings per word = 3
                            o Need audio files of words to spell
                       Feedback
                            o None
                       Displays inline, framed
           Word              Audio File
Word   1   urethroplasty
Word   2   lithotripsy
Word   3   nephrolithotomy
Word   4   eruthropoietin
Word   5   urethrotomy
Word   6   hemodialysis
Word   7   cystostomy
Word   8   pyelolithotomy
Word   9   peritoneal
           dialysis
Word 10    angioplasty
Screen 1 of 1

Section III Quiz

You have completed Section III: Diagnostic Procedures and
Therapeutic Interventions.

If you feel comfortable with all the information, you may begin the Section
III Quiz. If you pass this quiz, you will have fulfilled the objectives for this
section.

Click Next to begin Section IV: Building Your Word Bank.
Screen 1 of 5


Section IV: Building Your Word Bank

If you've completed this chapter in your text, you're now ready for the
additional practice you'll receive with word parts in this module. For
definitions of all the word parts used in the following exercises, consult the
glossary and your text. To review construction of medical terms using
prefixes, combining forms, and suffixes, have your textbook handy.
Screen 2 of 5

Activity: Word Shop

      DEVELOPER: Please delete Question 3 (“perivesicular”).



      DEVELOPER: Please change the definition phrasing for
       Question 2 (“ureterogram”) from “Diagnostic imaging of…”
       to read “Diagnostic image of…” Thanks.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0103p2.htm
Screen 3 of 5

Activity: Part Puzzler


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0102p13.htm
Screen 4 of 5

Activity: Word Shop


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0102p4.htm
Screen 5 of 5

Activity: Word Shop


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0102p6.htm
Screen 1 of 4

Section V: Applications

Medical Report

Click on the Medical Report link to read the surgical report on Mr.
Seagraves. There are two sets of exercises for this activity. Be sure to
complete all pop-up questions within the Medical Report itself; then
answer the questions in the follow-up set on the next screen.

DEVELOPER: Questions to appear within each inter-Medical Report Question Pop-
Up follow below.



Medical Report
Red Brook Medical Building

SURGICAL REPORT
Owen Seagraves
January 11, 200X_

CHIEF COMPLAINT: This is a 54 y.o. male admitted to ER with worsening
side pains radiating to the back, profuse sweating, nausea, vomiting,
dysuria, polyuria, and hematuria.


<Q2 Pop-up>

<Q3 Pop-up>

<Q5 Pop-up>

PATIENT HISTORY: Anterior MI 1999, GERD 2000, chronic nephritis 2002,
pneumonia 2002, type 2 diabetes 2004.


<Q1 Pop-up>

LAB VALUES: CMP: Na 130 mEg/L, Potassium 5.5 mEg/L, BUN 30, Creat.
2 mg/dl, Creat Ratio 15; UA: 3+ blood, WBC: 7 cells/hpf, pH 8, sp gr
1.002; Creat CI 215.


<Q6 Pop-up>

RULE OUT: Urethral stricture, renal cell carcinoma.

DIAGNOSIS: Acute renal failure complicated by nephrolithiasis,
hyperkalemia, drug reaction exanthema.
<Q4 Pop-up>

<Q7 Pop-up>



TREATMENT: Initial PCN stopped, patient then treated with successful
lithotripsy. IV calcium, glucose/insulin, and oral potassium exchange resin
initiated immediately postsurgery.


<Q8 Pop-up>

POSTSURGICAL RECOMMENDATIONS: Restrict fluid intake during
recovery; Cipro 500 mg q 12 hr and HCTZ 25 mg/day, magnesium oxide
400 mg/day, oxalate-rich food restrictions recommended.
DEVELOPER: Content for pop-up questions follows here:

Engine Type   Write It, Find It (text version)
Screen        <<Type in the correct answers.>>
Appearance




Engine         Write It, Find It Flash Engine
Specifications    Use engine master: writeit1.swf
                  Engine Size: 580 x 350 pixels
                  Questions
                        o No randomizing
                        o Maximum # = 10
                        o Maximum # characters per question = 200
                  Answer Choices
                        o Learner types answer in field
                        o No randomizing
                        o Maximum # correct = 10
                        o Maximum # characters = 17
                        o No distracters
                  Feedback
                        o Rationale not to exceed 220 characters
                  Displays inline, framed

Question 1    Owen’s inflammation of the kidney is indicated by the term
              nephritis in this report.
Rationale:    This is the only term in the report that combines nephr/o (kidney)
              with the suffix -itis (inflammation), so nephritis is the only possible
              correct term.
Question 2    Owen’s pain on urination is described as dysuria.
Rationale:    Use word part knowledge to build this term: dys- = pain or
              difficulty;
              -uria = urine condition.
Question 3    This patient reports polyuria, or frequent urination.
Rationale:    Again, knowing your word parts make this easy: poly- = multiple
              or frequent or difficulty; -uria = urine condition.
Question 4    The physician is able to rule out a narrow urethra, known as (2
              words): urethral stricture.
Rationale:    The term stricture means narrowing; urethr/o = urethra, and -al
             means pertaining to. So urethral stricture is a narrowing of the
             urethra.
Question 5   The blood in this patient’s urine is called hematuria.
Rationale:   This term breaks down as follows: hemat/o = blood; -uria = urine
             condition. Thus blood in this patient’s urine is called hematuria.
Question 6   The abbreviation BUN in this report stands for blood urea
             nitrogen.
Rationale:   The BUN test is used to determine how much urea and nitrogen
             have accumulated in the blood (uremia).
Question 7   The condition of having kidney stones is called nephrolithiasis.
Rationale:   Analyzed and broken down into its parts, nephr/o = kidney; lith/o
             = stone; -iasis = abnormal condition. So the abnormal condition of
             having a kidney stone is called nephrolithiasis.
Question 8   A procedure for crushing Owen’s stones using shock waves is
             lithotripsy.
Rationale:   The suffix -tripsy means crushing; lith/o means stone. Lithotripsy,
             then, is a procedure for crushing stones.
Screen 2 of 4

Medical Report Follow-up: Part Puzzler


NOTE: Retain Tab 2 Activity (Part Puzzler activity) as a new screen
here. Thanks.

Page Info Referring URL:

http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0104p1-t1.htm
Screen 3 of 4

Case Study 1

Fig. 7-51




                       Ms. Asaad comes to the clinic near her home saying
that she thinks she may have blood in her urine because of its unusual
color. She reports periods of anuria followed by periods of pain with
urination and a "cloudy" appearance to her urine. She receives several
tests, including those that look for blood and bacteria in her urine. In a
second test, her urine is also analyzed for the presence of pus. Ms. Asaad
tests positive for UTI and is treated with an antibiotic.

On a return visit, Ms. Asaad complains of edema and rapid weight gain.
She is found to be losing excessive amounts of protein in her urine due to
a leaky glomerulus and is diagnosed with nephrotic syndrome caused by
glomerulonephritis.



There are two sets of exercises for this activity (see tabs numbered 1–2).
Be sure to complete all of the questions in each set. When you have
completed all of the questions under a tab, select the next tab.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0104p2-t1.htm
Screen 4 of 4

Case Study 2

Fig. 7-52




                    Sam, a 33-year-old male, reports trouble with a
recurrent urinary tract infection. A look at his history reveals that he has
had numerous UTIs over the last year, and now he also has hypertension
for the first time in his life. Six months ago, Sam had a cystoscopy that
revealed no apparent anomalies. Shortly after that, however, Sam was
found to have polyuria and polydipsia, and with subsequent testing, his
urine test results indicated albuminuria and glycosuria. Sam was
subsequently diagnosed with diabetes mellitus. Today, Sam receives a
BUN test and an IVP. After two examinations, he is diagnosed with
nephrotic syndrome caused by diabetic nephropathy.

There are two sets of exercises for this activity (see tabs numbered 1–2).
Be sure to complete all of the questions in each set. When you have
completed all of the questions under a tab, select the next tab.




http://www.coursewareobjects.com/objects/chabner8e_v1/mod07Activitie
s/07s01l0104p3-t1.htm
Screen 1 of 1

Learning Links

For additional information about diseases and treatment of the urinary
system, visit the following websites:



      JAMA Patient Page
      Diagnosis Health: On health, digestion/indigestion, other diseases,
       and diagnosis and treatment
      WebMD




http://jama.ama-assn.org/cgi/collection/patient_page


http://www.diagnosishealth.com/

http://www.webmd.com/

								
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