Fundamenta N.Presentation By Mr. Rebira.pptx

Significance

1. ASSESSMENT OF GENETOURINARY SYSSTEM GENITAL AND URINARY SYSTEMS

2. OUTLINES Anatomy & physiology overview of gus Subjective data /History taking Objective data /Physical Examination DIAGNOSTIC STUDIES OF THE US Cystoscopy Radiologic Examination Reference

3. ANATOMY & PHYSIOLOGY OVER VIEW Anatomy of the kidney & Urinary System Include:- Kidneys Ureters Bladder & Urethra Urine is formed in the kidney and flows through other structures to be eliminated from the body.

4. Kidneys Are pairs of bean- shaped Brownish red- structure Located retroperitoneally-behind & outside the peritoneal cavity Vertically found b/n T12- L3 in the adult. Average weight- 113 to 170g Length- 10 to 12cm long 6cm wide & 2.5 cm thick

5. Kidneys… The right kidney is slightly lower than the left due to the location of the liver. Kidneys are supported by two major layers of tissues . A) Externally:- Renal fascia, perirenal fat capsule and renal capsule B) Internally:- Renal cortex, medulla and renal pelvis.

6. Nephrons Are functional and structural units of the kidney. Each kidney is made up of about 1 million nephrons Each nephron has two major components A glomerulus Renal tubule Two types Cortical nephrons Makes up 80% -85% of total number. Located in the outermost part of the cortex Blood supply from peritubular capillaries

7. 2) Juxtamedullary Nephrons Make up 15% to 20%. Located deeper in the cortex. Vasa recta This nephron:- Maintains osmolality Filters blood & Maintains acid-base balance

8. BLOOD SUPPLY TO THE KIDNEY Renal arteries which are the direct branches of abdominal aorta supply the kidney. Afferent arteriole Brings blood into the glomerular capillary. Efferent arteriole Takes blood from the glomerulus to peritubular capillary & vasa recta. Then to the renal veins, ends in inferior vena cava. Large blood flow goes to the kidneys Ap. ¼ th (1200 ml ) of blood flows from the heart to the kidneys each minute. That is, approximately 20-25% of the total CO.

9. Accessory Excretory structures 1) URETERS The ureters are urine-bearing tubes that exit the kidney and empty into the urinary bladder. 2) BLADDER Smooth, collapsible, muscular sac that temporarily stores urine. Accumulates 300 to 400 ml but as high as 1.5 L of urine. As urine accumulates, the bladder expands without significant rise in internal pressure.

10. 3) Urethra Muscular tube that drains urine from the bladder and moves it out of the body. Propels semen (in males) It is 4 cm in female and 12 cm in males. The urethra has two syphincters Internal sphincter – involuntary urethral sphincter External sphincter – voluntary urethral sphincter Levator ani muscle – voluntary urethral sphincter NB The genito-urinary system also includes M & F genitalia

11. Renal Physiology 1) Regulation of: Electrolyte balance Acid-base balance Blood pressure 2.) Excretion of Metabolic products Foreign substances (drugs and other chemicals) Excess substances (water)

12. Renal Physiology… 3) Secretion of Erythropoeitin 1,25-dihydroxy vitamin D3 (vitamin D activation) Renin Prostaglandin 4) Involved in gluconeogenesis

13. 1) ASSESSMENT SUBJECTIVE DATA Include:- Demographic data Characterization of symptoms History of present illness Past medical and surgical history & Lifestyle factors

14. Sub... Signs and symptoms involving the urinary tract may be due to disorders of The kidneys Ureters, or Bladder Surrounding structures, or Disorders of other body systems

15. Past Health History Obtaining urologic health history requires excellent communication skills. B/c many pts are uncomfortable talking about genitourinary symptoms. Use language the pt can understand Avoid jargon Review risk factors ( high risk pts).

16. … Ask consciously about the presence or history of diseases that are related to renal or other urologic problems. Some of these diseases are Hypertension Diabetes mellitus Metabolic problems

17. … Tuberculosis Viral hepatitis Congenital disorders, neurologic conditions (e.g. stroke, back injury ) or Trauma

18. … Specific urinary problems such as: Cancer Infections Benign prostatic hyperplasia & Calculi should be noted

19. Medications current and past use of medications Over-the-counter drugs Prescribed medications Herbs. Drugs affect the urinary tract in several ways. Many drugs are known to be nephrotoxic . Certain drugs may alter the quantity and character of urine output (e.g. diuretics ).

20. Example 1.Phenazopyridine (Pyridium )-analgesics Dark orange color or dark red color of urine. 2.Nitrofurantoin ( Macrodantin)-antibiotic for UTI Change the color of urine. 3. Anticoagulants -may cause hematuria ( heparin & warfarin ) . Many antidepressants

21. … C alcium channel blockers Nifedipine- edema of the ankle Antihistamines & D rugs used for neurologic & M usculoskeletal disorders affect the ability of the bladder or sphincter to contract or relax normally

22. Surgery or Other Treatments Ask previous hospitalizations related to: Renal or urologic diseases Past surgeries ( particularly pelvic surgeries ) Urinary tract instrumentation – ascending infection. Any radiation or chemotherapy treatment for cancer

23. … All urinary problems during past pregnancies Duration Severity Its treatment & Patient's perception of any problem

24. Functional Health Patterns Health Perception–Health mgt Pattern. Ask general health- particularily w/n d/se affecting kidney is suspected. Feeling tired all of the time Changes in weight or Appetite Excess thirst Fluid retention

25. Complaints of : Headache, P ruritus, or Blurred vision may be r/t abnormal kidney function. The elderly patient may report Malaise and Non-localized abdominal discomfort as the only symptoms of UTI

26. History of Occupation Exposure to chemicals can affect the kidneys and UTS Phenol and ethylene glycol are nephrotoxic chemicals. Aromatic amines and certain organic chemicals may increase the risk of bladder cancers . Textile workers, painters, hairdressers, and industrial workers have a high incidence of bladder tumors .

27. History of Smoking Cigarette smoking is a major risk for bladder cancer. Tumors occur 4 times more frequently in cigarette smokers than in non smokers .

28. Family History The presence of certain renal or urologic problem is r/t genetic in origin-familial . Ask family members if they may have the ff d/ ses in he past time Polycystic renal disease& Congenital urinary tract abnormalities congenital nephritis

29. Nutritional-Metabolic Pattern Q uantity and types of fluid taken is important information related to UTD . Dehydration ( Metabolic alkalosis ) may contribute to: U rinary infections C alculi formation & R enal failure Large intake dairy product foods or foods high in proteins may also lead to calculi formation.

30. Nutrition… Caffeine A lcohol C arbonated beverages or S picy foods often aggravate urinary inflammatory diseases. Many herbal teas also cause diuresis ( excess urine). An unexplained weight gain may be the result of fluid retention secondary to a renal problem.

31. … Anorexia Nausea & Vomiting can dramatically affect fluid status Require careful assessment & fluid replacement.

32. ELIMINATION Asking about urine elimination patterns are the cornerstone of the health history in the patient with a LUT disorder. The majority eliminate urine by spontaneous voiding Asked about daytime ( diurnal ) voiding frequency –Under normal condition 6-8 times a day. The frequency of night time ( nocturia )

33. … Pelvic organ prolapse Particularly advanced anterior vaginal prolapse May cause suprapubic pressure Frequency Urgency & Incontinence secondary to urinary retention. Ask the patients about some other lower urinary tract symptoms Urgency Incontinence ( Inability to control urine) Urinary retention

34. … Change in color If normal -clear, pale to deep yellow Appearance of urine Blood in urine Bowel function Problems with fecal incontinence may signal neurologic causes for bladder problems Because of shared nerve pathways .

35. Constipation and Fecal I mpaction O bstruct the urethra causing Inadequate bladder emptying Overflow incontinence & Infection

36. Activity Assess pt’s activity A sedentary lifestyle causes stasis (loss of tone ) of urine Predispose to infection & Calculi Demineralization (loss of minerals) of bones in a person with limited physical activity can cause increased urine calcium precipitation.

37. Increasing activity May aggravate the urinary problem. Pt with prostate surgery (weakened pelvic floor muscles ) may leak urine when running. C hronic inflammatory prostatitis or epididymitis after heavy lifting or long-distance driving.

38. Sleep &Rest Nocturia Is a common Is lower urinary tract symptom that often leads to Sleep deprivation Daytime sleepiness & Fatigue.

39. … Occurs in multiple disorders affecting the lower urinary tract Urinary incontinence Urinary retention & Interstitial cystitis

40. … Up to one episode of nocturia is considered normal in younger adults Up to two episodes are acceptable among adults age 65 years or older. Sleep problems associated with a urinary disorder should be documented.

41. Cognitive Types Dysuria Groin pain Ccostovertebral pain-B/n 12 th rib & spine Suprapubic pain

42. Self-Perception , Self-Concept Problems r/t urinary system may lead to anemia Result in loss of self-esteem and a negative body image . Ask systematically to elicit cues to problems Role-Relationship Pattern U/P can affect many aspects of a person's life Including the ability to work and relationships with others.

43. Sexuality-Reproductive Pattern Ask the pt about the effect of renal or urologic problem on her or his sexual patterns and satisfaction . Problems related to personal hygiene and fatigue can seriously affect a sexual relationship . Urinary incontinence is not directly associated with sexual dysfunction It has a devastating effect on self-esteem, social and intimate relationships.

44. Symptoms R/t Irritation of the LUT Dysuria pain or difficult urination. Frequency voiding occurs more commonly than usual Increasing frequency can result from a variety of conditions such as Infection & UTD Metabolic disease Hypertension Medications (diuretics)

45. Urgency Strong desire to urinate that is difficult to postpone. Causes Inflammatory conditions of the bladder , prostate, or urethra Acute or chronic bacterial infections Neurogenic voiding dysfunctions Chronic prostatitis or bladder outlet obstruction in men Urogenital atrophy in postmenopausal women.

46. Strangury Slow and painful urination Only small amounts of urine voided Blood staining may be noted. Seen in severe cystitis and interstitial cystitis It is also called as bladder pain syndrome

47. … Is a chronic health issue of bladder Feeling of pain and pressure in the bladder area. Pain along with the lower urinary tract symptoms May last up to 6wk s without having an infection

48. Nocturia Excessive urination at night which interrupts sleep. Urologic conditions Poor bladder emptying Bladder outlet obstruction Overactive bladder Metabolic causes Decreased renal concentrating ability Diabetes mellitus Increased urine production at rest that occurs with aging.

49. Symptoms R/t Obstruction of LUT Weak Stream Decreased force of stream when compared to usual stream of urine when voiding Hesitancy- Pause Undue delay and difficulty in initiating voiding. May indicate :- Compression of urethra, Outlet obstruction, Neurogenic bladder (dysfunction of bladder by neurologic damage).

50. Terminal dribbling-To cut off little by little Urine from the meatus after urination is complete. May be caused by bladder outlet obstruction . Incomplete emptying Feeling that the bladder is still full even after urination. Indicates either urinary retention or a condition that prevents the bladder from emptying well Leads to infection .

51. Involuntary Voiding Incontinence I nvoluntary loss of urine May be pathologic, anatomical, physiological factors Enuresis Involuntary voiding during sleep May be physiologic during early childhood

52. Urinary Tract Pain GU Pain Is not always present in renal disease, but is generally seen in the more acute conditions of US . Kidney pain Felt as a dull ache in CVA Or may be sharp & colicky pain felt in the flank area Radiates to the groin or testicle Due to distension of the renal capsule

53. Ureteral pain Pain felt in the back Radiates to the groin or scrotum - upper ureter is the source, Radiates to the suprapubic area, penis, and urethra-lower ureter is the source. Bladder pain –LAP-Suprapubic Pain May be due to bladder infection or over distension

54. Urethral pain Irritation of bladder neck Foreign body in canal Urethritis Pain increases when voiding Pain in Scrotal Area B/c of inflammatory swelling of epididymis or testicle, or torsion of the testicle.

55. Testicular Pain Due to injury, orchitis( Painful) , torsion of spermatic cord Perineal or rectal discomfort Due to acute prostatitis, prostatic abscess. Back and leg pain Due to cancer of prostate with metastases to bone. Pain in glans penis U sually from prostatitis Penile shaft pain is from urethral problems

56. Related Symptoms GI symptoms related to urologic conditions include:- Nausea Vomiting Diarrhea Abdominal discomfort Paralytic ileus and GI hemorrhage with uremia

57. … These two systems have common autonomic & sensory innervations & Because of renointestinal reflexes Fever and chills may also occur with infectious processes

58. 2) Physical Examination Techniques of Physical Examination Inspection Palpation Percussion Auscultation

59. i) INSPECTION Assess for changes in the following: Skin Pallor , yellow , excoriations, changes in turgor, bruises, texture (e.g .rough, dry skin ). Mouth Stomatitis , ammonia breath odor Face and extremities Generalized edema, peripheral edema, bladder distention, masses, enlarged kidneys

60. Abdomen Striae Any surgical incision Contour for midline mass in LA -indicates urinary retention Unilateral mass-indicates large tumor or polycystic kidney

61. Weight Weight gain secondary to edema Weight loss & muscle wasting - renal failure General state of health Fatigue Lethargy & Diminished alertness

62. ii) Palpation A landmark useful in locating the kidneys is the costo -vertebral angle ( CVA ) Formed by the 12 th rib & the vertebral column . The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally the lower pole of the right kidney is palpable.

63. A landmark to Locate Kidney -CVA A landmark useful in locating the kidneys is the costo -vertebral angle ( CVA ) Formed by the 12 th rib & the vertebral column . The normal-sized left kidney is rarely palpable because the spleen lies directly on top of it. Occasionally the lower pole of the right kidney is palpable. CVA-B/n 12 th rib & spine.

64. … To palpate the right kidney , the examiner's left hand is placed behind and Supports the patient's right side between the rib cage and the iliac crest . The right flank is elevated with the left hand, and the right hand is used to palpate deeply for the right kidney .

65. … The lower pole of the right kidney may be felt as a smooth, rounded mass that descends on inspiration. If kidney is palpable, its size, contour, and tenderness should be noted. Enlarged kidney -suggests of neoplasm or other pathologic conditions .

66. … Urinary bladder is normally not palpable unless - distended with urine. Full bladder - felt as a smooth, round, firm and sensible to palpation .

67. PALPATING BOTH KIDNEYS B/n the rib cage & iliac crest Palpating Rt kidney Palpating Lt kidney

68. iii) Percussion Tenderness may be detected in the flank area . Performed by striking the fist of one hand against the dorsal surface of the other hand Which is placed flat along the posterior CVA margin . Normally a firm blow in the flank area should’t elicit pain.

69. … If CVA tenderness and pain are present-indicate a kidney infection or polycystic kidney disease . Bladder is not percussible until it contains 150 ml of urine. Full bladder -dullness is heard above the symphysis pubis. A distended bladder may be percussed as high as the umbilicus. Percussion of CVA

70. IV) Auscultation Use the bell of stethoscope to auscultate over both CVA s and in the UAQ. With this technique, the abdominal aorta and renal arteries are auscultated for a bruit ( murmu r) Which indicates impaired blood flow to the kidneys.

71. 3) DIAGNOSTIC STUDIES OF THE URINARY SYSTEM I. Urine Studies Urinalysis U/A is a general examination of urine Establish baseline information Provide data to establish a tentative diagnosis Determine whether further studies are to be ordered

72. U/A… Try to obtain first urinated morning specimen. Ensure that specimen is examined within 1 hr of urination Wash perineal area if soiled with menses or fecal material.

73. Creatinine Clearance Creatinine Waste product of protein breakdown- muscle mass The first-line test in the diagnosis of renal failure. Approximates GFR. Collect 24-hr urine specimen ( full 24hrs period). Normal finding: 85-135 ml/min

74. Composite Urine Collection The purpose is to examine or measure specific components such as Electrolytes Glucose Protein Creatinine & Minerals Composite urine specimens are collected over a period that may range from 2-24 hr.

75. … Discard this first urine specimen. Ask the patient to urinate and add the urine to the container. Reminding the patient to save all urine during the study period is critical. Specimens may be refrigerated , or preservatives may be added to the container used for collecting urine .

76. Urine culture Done to confirm suspected urinary tract infection identify causative organisms Use sterile container for collection of urine. Touch only outside of container.

77. … For women , separate labia with one hand & Clean meatus with other hand, using at least three sponges in a front-to-back motion . For men , retract foreskin (if present) and cleanse glans with at least three cleansing sponges.

78. … After cleaning, instruct the patient to void in sterile container. The initial voided urine flushes out most contaminants in the urethra and perineal area. Catheterization - If unable to cooperate with the procedure. Normally , bladder is sterile , but urethra contains bacteria and a few WBCs .

79. If properly collected, stored, and handled <10,000 organisms/ml usually indicates no infection 10,000-100,000 /ml is usually not diagnostic , and test may have to be repeated >100,000/ml indicates infection.

80. Concentration Test Study evaluates renal concentration ability. Concentration is measured by specific gravity readings. Instruct patient to fast after given time in evening (in usual procedure). Collect three urine specimens at hourly intervals in morning. Normal finding : 1.020-1.035

81. Residual Urine Study determines amount of urine left in bladder after urination. Finding may be abnormal with bladder innervation , sphincter impairment, BPH, or urethral strictures If residual urine test is ordered, catheterize patient immediately after urinating or use bladder ultrasound equipment. If a large amount of residual urine is obtained, health care provider may want catheter left in bladder. Normal finding : 50 ml urine (increases with age)

82. Protein Determination Dipstick ( Albustix, Combistix ) Dipstick test detects protein ( primarily albumin ) in urine. Dip end of stick in urine and read result by comparison with color chart on label as directed. Grading is from 0 to 4. Interpret with caution. A positive result may not indicate significant proteinuria some medications may give false-positive readings. Normal finding: 0-trace

83. Quantitative Test for Protein A 12- or 24-hr collection gives a more accurate indication of the amount of protein in urine. Persistent proteinuria usually indicates glomerular renal disease . Perform 12- or 24- hr urine collection. Normal finding: <150 mg/24 hr (<0.15 g/24 hr) Consisting mainly of albumin

84. Urine cytology-Study of Cells Is the standard non invasive method for diagnosis in detection of bladder carcinoma. Cytology is used to assess morphologic changes in intact cells The test may also detect cancers of the kidney , ureters, prostate & urethra. Urine can be analyzed to identify abnormal cellular structures with bladder cancer and follow the progress of bladder cancer.

85. … Specimens may be obtained by voiding or catheterization The first morning's voided specimen should not be used Because epithelial cells may change in appearance in urine held in the bladder overnight. As with urinalysis , the specimen should be fresh or brought to the lab within a hour . An alcohol based fixative is then added to preserve the cellular structure.

86. II. Blood Chemistries BUN( Blood Urea Nitrogen) Urea concentration of blood is often expressed in terms- BUN BUN is most commonly used to identify presence of renal problems. Concentration of urea in blood is regulated by rate at which kidney excretes urea Sample : serum , plasma and urine When interpreting BUN, non renal factors may cause .ed.

87. … e.g. Rapid cell destruction from infections Fever GI bleeding Trauma, Athletic activity - excessive muscle breakdown Corticosteroid therapy Normal finding: 10-30 mg/dl (1.8-7.1 mmol/L)

88. Creatinine Is a substance derived from creatine & creatine phosphate. Is a product of protein metabolism Not significantly reabsorbed or secreted by tubules Creatinine is more reliable than BUN Good test for GFR As it is determinant of renal function

89. … Creatinine is end product of muscle and protein metabolism Is liberated at a constant rate. Sample - serum, plasma, urine Normal finding: 0.5-1.5 mg/dl ( 44-133 μmol/L ).

90. Uric acid This test measures uric acid levels in blood or urine Uric acid urine test is used to dx the cause of recurrent kidney stone & Gout for stone formation Uric acid blood test ordered when a high uric level is suspected. Is made during the normal break down of cells & in the digestion of certain food. Uric acid study is used as a screening test primarily for disorders of purine metabolism But can indicate kidney disease as well

91. … If increased in blood gout, kidney stone, bone, joint & tissue damage Values depend on renal function rate of purine metabolism and dietary intake of food rich in purine Sample : Serum, plasma urine Not a good test for GFR Normal finding : Women-- 2.5-5.5 mg/dl (149-327 mol/L) Men --4.5-6.5 mg/dl (268-387 mol/L)

92. Sodium (Na + ) Na + is main extracellular electrolyte determining blood volume. Usually, values stay within normal range until late stages of renal failure. Normal finding : 135-145 mEq /L (135-145 mmol /L)

93. Potassium (K + ) Kidneys are responsible for excreting majority of body's K + In renal disease, K + determinations are critical Because K + is one of the first electrolytes to become abnormal. Elevated K + levels of >6 mEq /L can lead to muscle weakness and cardiac dysrhythmias. Normal finding : 3.5-5.0 mEq /L (3.5-5.0 mmol/L )

94. Calcium (Ca 2+ ) Ca 2+ is main mineral in bone Aids in muscle contraction, neurotransmission , and clotting. In renal disease, decreased reabsorption of Ca 2+ leads to renal osteodystrophy Bone d/s that occurs when kidney fails to maintain proper calcium level Normal finding: 9-11 mg/dl Or 4.5-5.5 mEq /L, 2.25-2.74 mmol/L

95. Phosphorus In renal disease, phosphorus levels are elevated Because the kidney is the primary excretory organ. Normal finding : 2.8-4.5 mg/dl (0.95-1.45 mmol/L) Bicarbonate (HCO 3 − ) Most patients in renal failure have metabolic acidosis - low serum HCO 3 − levels. Normal finding: 22-26 mEq /L (22-26 mmol/L)

96. RFT ( Renal Function Test ) Is a profile of biochemistry blood tests that are useful to assess renal function . Is used to evaluate the severity of kidney disease & To follow the patient's clinical progress . This test also give information concerning the kidneys effectiveness in caring out their execratory function S erum creatinine (NR:0.5 - 1.5 mg/dl)

97. 4) Cystoscopy Cystoscopey is the endoscopy of the urinary bladder via the urethra. Is carried out with a cystoscope which has lenses like telescope or microscope. Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses an endoscope especially designed for examination of the bladder, lower urinary tract, and prostate gland .

98. … The cystoscope is inserted through the urethra into the bladder Which has a self-contained optical lens system that provides a magnified, illuminated view of the bladder. The cystoscope allows complete visualization of the urethra , bladder , ureteral orifices and prostatic urethra . It can also be used to collect urine samples, perform biopsies , and remove small stones . A cystoscopy typically lasts from 10 to 40 minutes .

99. Main purpose of cystoscopy To inspect the interior of the bladder with a tubular lighted scope (cystoscope). Used to insert ureteral catheters, remove calculi, obtain biopsy specimens of bladder lesions, and treat bleeding lesions. Lithotomy position is used. Local or general anesthesia my be used depending on needs and condition of patient.

100. Complications Urinary retention Urinary tract hemorrhage Bladder infection Perforation of the bladder

101. Professional Responsibilities Before: g ive IV fluids if general anesthesia is to be used. Ensure consent form is signed. Explain procedure to patient. Give preoperative medication. After: Explain that burning on urination, pink-tinged urine, and urinary frequency are expected effects. Observe for bright red bleeding , which is not normal. Do not let patient walk alone immediately after procedure because orthostatic hypotension may occur. Offer warm sitz baths, heat, and mild analgesics to relieve discomfort.

102. Visualizing the urinary system .

103. 5) Radiologic Studies Of GUS a) X-Ray An x-ray study of the abdomen or kidneys , ureters and bladder may be performed to delinature The size, Shape, & Position of the kidneys & To reveal urinary system abnormalities

104. b) General Ultrasonography I s a non- invasive procedure that uses sound waves passed into the body through a transducer to detect abnormalities of internal tissues & organs. Can identify abnormalities such as fluid accumulation, masses, congenital malformation, changes in organ size & obstruction. Requires a full bladder , therefore fluid intake is encouraged before the procedure.

105. c) Bladder Ultrasonography Is a non invasive method of measuring urine volume in the bladder. Indication Urine frequency Inability to void after removal of catheter To measure post voiding residual urine volume Inability to void postoperatively Portable, battery operated devices are available for bed side use. The scan head is placed on the pt’s abdomen& directed toward the bladder The device automatically calculates & display urine volume.

106. d) CT & MRI Computed tomography ( CT) & magnetic resonance imaging ( MRI) are non invasive techniques That provide excellent cross- sectional views of the anatomy of the kidneys and urinary tract. Used to evaluate genitourinary masses, nephrolithiasis, chronic renal infection, renal or urinary tract trauma , metastatic disease, and soft tissue abnormalities. Occasionally, an oral or IV radiopaque contrast agent is used in CT scanning to enhance visualization.

107. E) Biopsy Renal & Urethral Brush Biopsy Bush biopsy techniques provide specific information when abnormal x-ray findings of the ureters or renal pelvis raise questions about whether a defect is a tumor , stone, blood clot, or artifact. 1 st Cystoscopic examination is conducted Then, ureteral catheter is introduced followed by a biopsy brush that is passed through the catheter. The suspected lesion is brushed back & forth to obtain cells & surface tissue fragments for histological analysis.

108. f) Kidney Biopsy Used to help diagnose & evaluate the extent of kidney disease. Indication of kidney biopsy include: Unexplained acute renal failure Persistent proteinuria or hematuria Transplant rejection Glomerulopathies-

109. Contraindication of Kidney Biopsy Bleeding Uncontrolled HTN A solitary kidney-single Morbid obesity Before the biopsy is carried out, coagulation studies are conducted to identify any risk of postbiopsy bleeding .

110. … Fasting 6 to 8hrs before the test IV line is established Urine specimen is obtained Saved to compare with the postbiopsy specimen If needle-pt breaths in & hold that breath. Is to prevent kidney from moving while the needle is inserted Place sedated pt in prone position with a sand bag under the abdomen

111. … Local anesthesia is used to infiltrate the skin The biopsy needle is introduced inside the renal capsule of the kidney. The location is confirmed with fluoroscopy or ultrasound- special probe is used. With open biopsy-Small incision is made over the kidney, allowing direct visualization Preparation for an open biopsy is similar to that for major abdominal surgery.

112. Nursing Responsibilities Administer IV fluid Monitor vital sign Monitor input output Follow signs of infection -Fever -Bleeding urine may contain blood ( 24-48 hrs) from oozing at the site.

113. Reference 1, Medical- surgical Nursing vol 1, 13 th edition 2, Medical- surgical Nursing vol 2, 13 th edition 3, Medical- surgical Nursing 10 th edition 4, Google

114. THANKS!