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Medical Terminology for Health Care Professionals

Tenth Edition

Chapter 11

Urinary System

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Learning Objectives (1 of 2)

11.1 Name the organs of the urinary system.

11.2 Identify the primary functions of the organs of the urinary system.

11.3 Define urinalysis and explain its role as a diagnostic tool.

11.4 Identify normal and abnormal constituents of urine.

Learning Objectives (2 of 2)

11.5 Analyze, build, spell, and pronounce medical words.

11.6 Classify the drugs highlighted in this chapter.

11.7 Describe diagnostic and laboratory tests related to the urinary system.

11.8 Identify and define selected abbreviations and acronyms.

Anatomy and Physiology (1 of 2)

Urinary system: two kidneys, two ureters, one bladder, one urethra.

Also called the excretory, genitourinary (G U), or urogenital (U G) system.

Produces, stores, and eliminates urine.

Anatomy and Physiology (2 of 2)

Vital function of urinary system:

Extract certain wastes from bloodstream.

Convert these materials to urine.

Transport urine from kidneys via ureters to bladder.

Eliminate urine at appropriate intervals via urethra.

Figure 11.1 The urinary system: kidneys, ureters, bladder, and urethra.

The diagram of the urinary system reads as follows. • The kidneys sit at the back of the body, just under the ribs, on either side of the spine. • The adrenal glands sit on top of the kidneys. • The bladder sits in the bottom curve of the pelvis. • The ureter runs from the kidneys to the bladder. • The urethra runs from the bladder and allows elimination.

Table 11.1 Urinary System At-A-Glance

Organ/Structure	Primary Functions/Description
Kidneys	Produce urine, control body fluids, and help regulate the body
Ureters	Transport urine from the kidneys to the bladder
Urinary bladder	Serves as a reservoir for urine
Urethra	Passageway of urine to the outside of the body; in the male conveys both urine and semen

Figure 11.2 Position of the urinary organs.

The diagram of the urinary system reads as follows. • The adrenal glands sit on top of the kidneys at the T12 vertebra. • The kidneys sit under the adrenal gland. • The ureter runs from the kidneys to the bladder, past the L5 vertebra. • The bladder sits at the base of the pelvis. • The urethra runs out of the bladder.

Kidneys (1 of 7)

Purplish-brown, bean-shaped organs that lie against the dorsal body in a retroperitoneal position in the superior lumbar region, extending from the thoracic vertebra (T12) to the lumbar vertebra (L3).

Kidneys (2 of 7)

Kidney functions

Remove wastes and extra fluid from the body.

Remove acid produced by cells.

Maintain a healthy balance of water, salts, and minerals.

Filter and return fluid to the bloodstream.

Produce urine.

Make erythropoietin, renin, and angiotensin.

Convert vitamin D into its active form, calcitriol.

Kidneys (3 of 7)

External structure

Each kidney has a concave and convex border.

Center of concave border opens into a notch called the hilum.

Renal pelvis: Saclike collecting portion.

Figure 11.3 Kidney with an expanded view of a nephron.

The two part diagram of the kidney reads as follows. • The kidney is cut in half to reveal the inside. • Hilum of the kidney, the upper, rounded bit of the kidney. • Renal artery, enters the kidney through the renal pelvis. • Renal vein, enters the kidney through the renal pelvis. • Renal pelvis, the inner portion of the kidney, surrounded by chambers. • Ureter, runs out through the renal pelvis. • Pyramid in renal medulla, a chamber in the kidney that houses the nephron loops. • Renal cortex, the inner, meaty part of the kidney. • Renal capsule, the lining around the renal cortex. • Calyx, part of the renal pelvis that enters the chambers. A closeup of a nephron loop reads as follows. • Efferent arteriole, an arteriole in the area of the nephron loop. Waste leaves through it. • Afferent arteriole, an arteriole in the area of the nephron loop. Waste enters through it. • Glomerulus, a kidney-shaped part of the nephron loop. • Renal, proximal, tubule, a twisting tube above the nephron loop. • Renal, distal, tubule, a twisting tube above the nephron loop. • Nephron loop, a hook-like loop. • Collecting tube, the tube after the nephron loop.

Kidneys (4 of 7)

Internal structure

Cortex: the outer layer

Arteries, veins, convoluted tubules, glomerular capsules

Medulla: the inner portion

Renal pyramids, conelike masses with papillae projecting into calyces of pelvis

Kidneys (5 of 7)

Nephrons are the structural and functional units of the kidney.

Renal corpuscle

Consists of a glomerulus, a cluster of intertwining capillaries surrounded by the glomerular (Bowman) capsule.

Renal tubule

Extends from each glomerular capsule to a collecting tubule.

Consists of the proximal tubule, the nephron loop (loop of Henle), and a distal tubule.

Kidneys (6 of 7)

Nephron

Vital function to regulate, control, and remove waste products of metabolism from blood plasma.

Urea, uric acid, and creatinine.

Excess sodium chloride and potassium ions

Ketone bodies.

Plays a vital role in the maintenance of normal fluid balance in the body by regulating reabsorption of water and allowing selected electrolytes back into the blood.

Kidneys (7 of 7)

Nephron

Glomerular filtration filters excess fluid and waste products out of the blood into the urine-collecting tubules of the kidney.

The renal tubule helps remove excess acid from the blood.

Remaining fluid and wastes in the tubule become urine.

For Your Information (F Y I) 1

At 10 weeks’ gestation, urine forms and enters the bladder of the fetus.

At about the third month, the fetal kidneys begin to secrete urine. The amount increases gradually as the fetus matures.

The newborn's kidneys are immature and lack the ability to concentrate urine.

For Your Information (F Y I) 2

Glomerular filtration and reabsorption are relatively low until the child is 1 or 2 years of age.

Ureters

Each kidney has a ureter.

Narrow, muscular tubes that drain urine from kidneys to bladder.

Walls of ureters consist of three layers:

Inner coat of mucous membrane

Middle coat of smooth muscle

Outer coat of fibrous tissue

Urinary Bladder (1 of 2)

The muscular, membranous sac located in the anterior pelvic cavity that serves as a reservoir for urine

Consists of:

a lower portion, the neck, which is continuous with the urethra

an upper portion, the apex, which is connected with the umbilicus

Trigone: A small triangular area near the base of the bladder.

Urinary Bladder (2 of 2)

The wall of the bladder consists of four layers:

An inner layer of epithelium

A muscular coat of smooth muscle

An outer layer of longitudinal muscle (detrusor urinae)

A fibrous layer

Urethra (1 of 3)

A musculomembranous tube extending from the bladder to the outside of the body.

The external urinary opening is the urinary meatus.

Urethra (2 of 3)

Male urethra

Approximately 20 cm long

Conveys both urine and semen

Divided into three sections:

Prostatic

Membranous

Penile

Urethra (3 of 3)

Female urethra

Approximately 4 cm long

Urinary meatus is situated between clitoris and opening of vagina

Conveys urine out of body

Figure 11.6A Urinary tract anatomy showing the urethra in the male.

The diagram of the male and female urinary tract reads as follows. Part A. Sagittal section through male pelvis • Ureter, runs from the pelvis into the bladder. It passes in front of the rectum. • Pubic symphysis, the area just in front of the bladder. It ends in the center of the bladder. • Urinary bladder, a balloon-shaped organ at the base of the pelvis. • Prostatic urethra, the tube leading from the bladder. • Pelvic diaphragm, sits behind the membranous urethra. • Membranous urethra, part of the urethra below the prostatic urethra. • Spongy urethra, the end of the urethra going into the penis. • External urethral orifice, the opening at the end of the penis.

Figure 11.6B Urinary tract anatomy showing the urethra in the female.

The diagram of the male and female urinary tract reads as follows. Part B. Sagittal section through female pelvis • Ureter, runs from the pelvis into the bladder. It passes in front of the rectum. • Bladder, a balloon-shaped organ that sits below the uterus and in front of the rectum. Pubic symphysis, the area just in front of the bladder. It ends in the center of the bladder. • Urinary bladder, a balloon-shaped organ at the base of the pelvis. • Pelvic diaphragm, sits behind the urethra. • Urethra, the tube leading to the external urethral orifice. • External urethral orifice, the opening that allows urination. It sits in front of the vagina.

For Your Information (F Y I) 3

Urinary tract infections (U T I s) are common in children.

Microorganisms Escherichia coli, Klebsiella, and Proteus cause most U T I s seen in children.

The signs and symptoms of a U T I vary depending on the age of the child.

For Your Information (F Y I) 4

Infants can experience:

Fever

Weight loss

Nausea and vomiting

Increased urination

Strong-smelling urine

Persistent diaper rash

Failure to thrive

For Your Information (F Y I) 5

Older children with a UTI can have:

Frequent and/or painful urination

Abdominal pain

Hematuria

Fever

Chills

Bedwetting episodes in a trained child

Urine (1 of 5)

Three main steps of urine production are filtration, reabsorption, and secretion.

Urine is formed by the process of glomerular filtration and tubular reabsorption and secretion in the nephron.

95% water and 5% solid substances.

Urine is secreted by kidneys and transported by ureters to bladder, where it is stored before being discharged via the urethra.

Figure 11.7 Sites of Tubular Reabsorption and Secretion

The diagram of filtration reads as follows. • Arteries lead into the renal corpuscle. • The proximal tube connects to the renal corpuscle. • The nephron loop curves down and back up. • The distal tube connects to the nephron loop and the collecting duct. • The site of glomerular filtration, blood is filtered at the glomerulus, is the renal corpuscle. • Sites of tubular reabsorption, fluid and solutes are reabsorbed from the filtrate and returned to the blood, are proximal tube, two places in the downward curve of the nephron loop, two places in the upward curve of the nephron loop, distal tube, collecting duct. • Site of tubular secretion, Substances are secreted from the blood into the filtrate, are proximal tube, distal tube, collecting duct.

Urine (2 of 5)

An average normal adult feels the need to void when the bladder contains around 300 to 350 mL of urine.

An average of 1000 to 1500 mL of urine is voided daily.

Urine (3 of 5)

Normal urine:

Clear

Yellow to amber in color

Faintly aromatic odor

Specific gravity of 1.003 to 1.030

Slightly acid p H (hydrogen ion concentration)

For Your Information (F Y I) 6

Changes noted in the urinary system of the older adult:

Loss of muscle tone in the ureters, bladder, and urethra

Bladder capacity can be reduced by half

Frequent trips to the bathroom

Urge incontinence (or the inability to retain urine voluntarily) is a concern for older adults.

For Your Information (F Y I) 7

In men, urge incontinence can be caused by benign prostatic hyperplasia (BPH) or by prostate cancer.

Urge incontinence is most common in women and older adults.

Urine (4 of 5)

Urinalysis (U A)

Laboratory test that evaluates the physical, chemical, and microscopic properties of urine.

A freshly voided urine specimen provides for more accurate test results.

When a bacteriologic culture is to be done, the specimen is collected by catheterization.

Urine (5 of 5)

Urinalysis is a valuable diagnostic tool.

Can help detect substances or cellular material in the urine associated with different metabolic (glycosuria), kidney (proteinuria), and liver (biliuria) disorders.

Used to detect UTIs and other disorders of the urinary tract (nitrituria, proteinuria).

Table 11.2 Normal and Abnormal Constituents of Urine (1 of 3)

Constituent	Normal	Abnormal/Significance
Color	Yellow to amber	Red or reddish—due to presence of red blood cells Greenish-brown or black—caused by bile pigments Pink—due to presence of crystals The color of urine darkens upon standing.
Appearance	Clear	Milky—due to presence of fat globules, pus, bacteria Smoky—due to presence of blood cells Hazy—due to formation of crystals during refrigeration
Reaction	Between 4.6 and 8.0 pH, with an average of 6.0	High acidity—due to diabetic acidosis, fever, dehydration Alkaline—due to UTI, renal failure
Specific gravity (sp. gr.)	Between 1.003 and 1.030	Low (1.001–1.002)—due to diabetes insipidus, kidney failure, excessive fluid intake, damage to kidney tubular cells High (over 1.030)—due to diabetes mellitus, hepatic disease, congestive heart failure, dehydration (due to diarrhea or vomiting)

Table 11.2 Normal and Abnormal Constituents of Urine (2 of 3)

Constituent	Normal	Abnormal/Significance
Odor	Faintly aromatic	Fruity/sweet—due to presence of acetone, associated with diabetes mellitus Unpleasant—due to decomposition of drugs, foods, alcohol Strong/strange—due to presence of bacterial infection
Quantity	Around 1000–1500 mL per day	High—due to excessive intake of fluids, diabetes mellitus, diabetes insipidus, diuretic use Low—due to dehydration, acute nephritis, heart disease, diarrhea, vomiting None—due to uremia, end-stage renal disease (ESRD)
Protein	Negative	Positive (proteinuria)—due to renal disease, pyelonephritis, high blood pressure, kidney infection or disease, heart disease, diabetes, lupus, malaria
Glucose	Negative	Positive (glycosuria)—due to diabetes mellitus

Table 11.2 Normal and Abnormal Constituents of Urine (3 of 3)

Constituent	Normal	Abnormal/Significance
Ketones	Negative	Positive (ketonuria)—due to uncontrolled diabetes mellitus; high-protein, low-carbohydrate diet; starvation
Bilirubin	Negative	Positive (biliuria)—due to liver disease, biliary obstruction, congestive heart failure
Blood	Negative	Positive (hematuria)—due to renal disease, trauma
Nitrites	Negative	Positive (nitrituria)—due to bacteriuria
Urobilinogen	0.1–1.0	Absent—due to biliary obstruction Reduced—due to antibiotic therapy Increased—early warning of hepatic or hemolytic disease

Building Your Medical Vocabulary (1 of 6)

Albuminuria

albumin = protein

-uria = urine

Building Your Medical Vocabulary (2 of 6)

Cystectomy

cyst = bladder

-ectomy = surgical excision

Figure 11.8 Urinary calculi.

The diagram illustrating urinary calculi reads as follows. • A cross-section of a kidney shows the renal pelvis through the center and the ureter leading out of the kidney. There are no calculi in the kidney. • A cross-section of a kidney shows multiple calculi inside the chambers of the kidney. They fill the chambers and sit in the renal pelvis. • A closeup of a staghorn calculus, fills the renal pelvis, shows a tree-like structure with a trunk and several branches.

Figure 11.9 Closed urinary drainage system.

Urine being measured after it leaves patient’s body via catheter. Source: Pearson Education, Inc.

For Your Information (F Y I) 8

Cystitis

Very common; occurs in more than 3 million Americans a year.

Frequently affects sexually active women age 20 to 50.

Can also occur in those who are not sexually active or in young girls and older adults.

For Your Information (F Y I) 9

Cystitis

Females are more prone to cystitis because of shorter urethra and short distance between opening of urethra and the anus.

For Your Information (F Y I) 10

Interstitial cystitis (I C)

Painful inflammation of bladder wall.

Approximately 1.3 Americans suffer from this condition, and, of those, 90% are women.

Symptoms can vary from mild to severe.

Cause is unknown.

Does not respond well to antibiotic therapy

Building Your Medical Vocabulary (3 of 6)

Dysuria

dys- = difficult, painful

-uria = urine

Figure 11.10 Illustration of extracorporeal shock wave lithotripsy.

The diagram illustrating extracorporeal shock wave lithotripsy reads as follows. • A man’s kidney contains kidney stones. Shock waves hit the kidney. An arrow points to the following images. • A closeup shows a kidney with kidney stones. The stones fill the renal pelvis. • Focused shock waves hit the kidney. • The kidney stones are crushes and leave the kidney.

Figure 11.11 Hematuria. Note the color of urine in the specimen container.

Figure 11.12 Schematic of hemodialysis machine.

The diagram of the woman on dialysis reads as follows. • The woman sits in a chair with tubes in her wrist. • Blood moves through one tube for cleaning. • An arterial pressure monitor is attached to the tube. • A heparin infusion enters the tube. • A blood pump is attached to the tube. • An inflow pressure monitor is attached to the tube. • The tube enters the machine. • Used dialyzing solution leaves the machine. • Cellophane membranes wrap a cylinder in the dialyzer. • Fresh dialyzing solution enters the machine. • A venous pressure monitor is attached to the tube. • An air trap is attached to the tube. • Clean blood enters the body through the tube.

Figure 11.13 Hydronephrosis.

The diagram of hydronephrosis reads as follows. Bilateral hydronephrosis. • An enlarged prostate causes obstruction above the urethra. • Bladder. • The ureters dilate. • Urine collects in the renal pelvis. Unilateral hydronephrosis. • Urethra. • Bladder. • Calculus obstructs the left ureter. • The ureter dilates. • The kidney shrinks and deteriorates. • The right kidney enlarges as it compensates.

Building Your Medical Vocabulary (4 of 6)

Nephrolithiasis

nephr/o = kidney

lith = stone, calculus

-iasis = condition

Figure 11.14 Renal calculi (stones) can form in several areas within the urinary tract.

When they form in the kidney, they usually arise within the renal pelvis, forming the condition called nephrolithiasis. Stones can also form obstructions in the ureter, bladder, or urethra.

The diagram of the passage of a kidney stone reads as follows. • The stone begins in the kidney. • The stone enters the ureter. • The stones pass through the ureter. • The stone enters the bladder. • The stone enters the urethra.

Building Your Medical Vocabulary (5 of 6)

Oliguria

olig- = scanty

-uria = urine

Figure 11.15 Percutaneous ultrasonic lithotripsy.

A nephroscope is inserted into the renal pelvis, and ultrasound waves are used to fragment the stones. The fragments then are removed through the nephroscope.

A diagram illustrating percutaneous ultrasonic lithotripsy reads as follows. • The doctor looks through the eyepiece, which is shaped like a microscope. • The ultrasonic probe is attached to the eyepiece. • The irrigation drain is attached to the ultrasonic probe. • Irrigation fluid enters the probe. • The probe pierces the skin and muscle and enters the renal pelvis. • The waves hit the kidney stone.

Figure 11.16 Peritoneal dialysis.

Figure 11.17 Routes of infection for pyelonephritis.

The diagram illustrating routes of infection for pyelonephritis reads as follows. • The infection rises up the ureter from ascending urine. • Infection enters the renal pelvis. • Infection enters the kidney from the blood, descending. • Infection enters from the lymph.

Figure 11.18 Placement of transplanted kidney.

Building Your Medical Vocabulary (6 of 6)

Urologist

ur/o = urination

log = study of

-ist = one who specializes

Drug Highlights

Diuretics

Urinary tract antibacterials

Urinary tract antiseptics

Additional drugs

Diagnostic and Laboratory Tests (1 of 5)

Blood urea nitrogen (BUN)

Blood test to determine the amount of urea excreted by the kidneys

Computed tomography of kidneys, ureters, bladder (CT KUB)

X-ray information sent to computer that interprets the x-ray data and displays it in a two-dimensional (2D) form on a monitor

Diagnostic and Laboratory Tests (2 of 5)

Creatinine clearance

Urine test to determine the glomerular filtration rate

Culture, urine

Urine test to determine the presence of microorganisms

Diagnostic and Laboratory Tests (3 of 5)

Cystoscopy (cysto)

Visual examination of the bladder and urethra via a lighted cystoscope

Intravenous pyelography (pyelogram) (I V P)

Test to visualize the kidneys, ureters, and bladder, in which a radiopaque substance is intravenously injected and x-rays are taken

Diagnostic and Laboratory Tests (4 of 5)

Renal Biopsy

Removal of tissue from the kidney

Retrograde pyelography (R P)

X-ray recording of the kidneys, ureters, and bladder following the injection of a contrast medium backward through a urinary catheter into the ureters and the calyces of the pelvis of the kidneys

Figure 11.19 Retrograde pyelography.

Note the contrasting of the renal calyces, ureters, and bladder following an injection of a contrast medium. Source: CNRI/Science Source

Diagnostic and Laboratory Tests (5 of 5)

Serum creatinine

Test to determine the amount of creatinine present in the blood

Ultrasonography, kidneys

Use of high-frequency sound waves to visualize the kidneys

Abbreviations (1 of 2)

Abbreviation	Meaning	Abbreviation	Meaning
AGN	acute glomerulonephritis	H20	water
ANS	acute nephritic syndrome	IC	interstitial cystitis
BPH	benign prostatic hyperplasia	IPD	intermittent peritoneal dialysis
BUN	blood urea nitrogen	IVP	intravenous pyelogram
CAPD	continuous ambulatory peritoneal dialysis	K	potassium
CGN	chronic glomerulonephritis	mL	milliliter
CKD	chronic kidney disease	mm	millimeter
CLIA	Clinical Laboratory Improvement Amendments	Na	sodium
c m	centimeter	NaCl	sodium chloride

Abbreviations (2 of 2)

Abbreviation	Meaning	Abbreviation	Meaning
CT KUB	computed tomography of kidneys, ureters, bladder	PD	peritoneal dialysis
cysto	cystoscopy	pH	hydrogen ion concentration
ESRD	end-stage renal disease	PUL	percutaneous ultrasonic lithotripsy
ESWL	extracorporeal shock wave lithotripsy	RP	retrograde pyelography
GFR	glomerular filtration rate	sp. gr.	specific gravity
GU	genitourinary	UA	urinalysis
HCO3	bicarbonate	UG	urogenital
HD	hemodialysis	UTI	urinary tract infection