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PATOLOGI SISTEM PERKEMIHAN (TRACTUS URINARIUS) By: Sarah Suzanna,dr. Farida Gustini, drg
Sistem perkemihan
Sistem yang menghasilkan urin untuk mengeluarkan produk2 sisa dari tubuh Terdiri atas sepasang Ginjal, sepasang Ureter, sebuah Kandung kemih, dan sebuah Urethra
4. Urethra
Merupakan saluran keluar dari urin yang diekskresikan oleh tubuh melalui ginjal, ureter, vesica urinaria.
erythropoietin (EPO)
glomerular capsule glomerular filtrate glomerulus kidney
A hormone produced by the kidneys that stimulates red blood cell production in the bone marrow
The cup-shaped structure at the beginning of the nephron that surrounds the glomerulus and receives material filtered out of the blood The fluid and dissolved materials that filter out of the blood and enter the nephron at the Bowman capsule The cluster of capillaries within the glomerular capsule (plural, glomeruli) (root glomerul/o) An organ of excretion (root ren/o, nephr/o); the two kidneys filter the blood and form urine, which contains the waste products of metabolism and other substances as needed to regulate the water and electrolyte balance and the pH of body fluids The voiding of urine; urination
micturition
renal pelvis
ureter
urethra
The tube that carries urine from the kidney to the bladder (root ureter/o)
The tube that carries urine from the bladder to the outside of the body (root urethr/o)
urinary bladder
urination urine
The organ that stores and eliminates urine excreted by the kidneys (root cyst/o, vesic/o)
The voiding of urine; micturition The fluid excreted by the kidneys. It consists of water, electrolytes, urea, other metabolic wastes, and pigment. A variety of other substances may appear in urine in cases of disease (root ur/o).
glomerul/o pyel/o
juxtaglomerul ar pyeloplasty
cali-, calic
calyx
calicectasis
vesic/o
urethr/o
urinary bladder
urethra
intravesical
urethroscopy
2. Sindrom nefrotik suatu sindroma (kumpulan gejala-gejala) yang terjadi akibat berbagai penyakit yang menyerang ginjal dan menyebabkan: - proteinuria (protein di dalam air kemih) - menurunnya kadar albumin dalam darah - penimbunan garam dan air yang berlebihan - meningkatnya kadar lemak dalam darah. bisa terjadi akibat berbagai glomerulopati atau penyakit menahun yang luas 3. Nefritis Peradangan ginjal, ditandai dengan hematuria (darah di dalam air kemih), proteinuria (protein di dalam air kemih) dan kerusakan fungsi ginjal, yang tergantung kepada jenis, lokasi dan beratnya reaksi kekebalan.
Daerah yg terkena Pembuluh darah Glomeruli Penyakit yang timbul Vaskulitis Sindroma Nefritik Akut, Sindroma Nefritik Progresif, Sindroma Nefrotik, Sindroma Nefritik Kronis Nefritis Tubulointerstisialis Akut , Nefritis Tubulointerstisialis Kronis
Jaringan Tubointerstitial
5. Gagal Ginjal (Renal Failure) suatu penyakit dimana fungsi organ ginjal mengalami penurunan hingga akhirnya tidak lagi mampu bekerja sama sekali dalam hal penyaringan pembuangan elektrolit tubuh, menjaga keseimbangan cairan dan zat kimia tubuh seperti sodium dan kalium didalam darah atau produksi urine. Penyebab : Hipertensi, Diabetes, Sumbatan saluran kencing (batu, tumor), Kanker, Kista, Glomerulonefritis, dll Akut : Bengkak mata, kaki, nyeri pinggang hebat (kolik), kencing sakit, demam, kencing sedikit, kencing merah/darah, sering kencing. Kelainan Urin: Protein, Darah/Eritrosit, Sel Darah Putih/Lekosit, Bakteri. Kronik: Lemas, tidak ada tenaga, nafsu makan kurang, mual, muntah, bengkak, kencing berkurang, gatal, sesak napas, pucat/anemi. 6. Pyelonefritis infeksi bakteri pada salah satu atau kedua ginjal.Disebabkan oleh Escherichia coli (paling sering). Gejala biasanya timbul secara tiba-tiba berupa demam, menggigil, nyeri di punggung bagian bawah, mual dan muntah,bisa terjadi pembesaran salah satu atau kedua ginjal
7. Hidronefrosis penggembungan ginjal akibat tekanan balik terhadap ginjal karena aliran air kemih tersumbat (batu, tumor, arteri atau vena yang letknya abnormal) 8. Batu Ginjal dan Ureter massa keras seperti batu yang terbentuk di sepanjang saluran kemih dan bisa menyebabkan nyeri, perdarahan, penyumbatan aliran kemih atau infeksi. Batu ini bisa terbentuk di dalam ginjal (batu ginjal) maupun di dalam kandung kemih (batu kandung kemih). Proses pembentukan batu ini disebut urolitiasis (litiasis renalis, nefrolitiasis). 9. Vesikoureteral Refluks aliran balik urin dari Kandung kemih ke ureter, karena kelemahan sambungan vesikoureteral, dapat menyebabkan pembesaran ureter dan ginjal. 10. Cystitis radang kandung kemih. Sebagian besar peradangan disebabkan oleh infeksi bakteri, selain itu penggunaan alat semprot pembersih genital wanita atau penggunaan kateter dalam jangka waktu lama. Cystitis dapat juga terjadi sebagai komplikasi penyakit lain.
11. Urethritis peradanganpada urethra (Spesifik dan Nonspesifik) 12. Striktur Urethra penyempitan lumen uretra karena fibrosis (terbentuk jaringan ikat)pada dindingnya. Penyebab: kelainan bawaan, operasi, trauma, infeksi
DISORDERS (KELAINAN)
acidosis
bacteriuria cast cystitis
dysuria
glomerulonephritis
hematuria
hydronephrosis
Collection of urine in the renal pelvis caused by obstruction; causes distention and atrophy of renal tissue. Also called nephrohydrosis or nephrydrosis
Excess amount of potassium in the blood Elimination of small amounts of urine
hyperkalemia oliguria
DISORDERS..Cont proteinuria pyelonephritis Presence of protein, mainly albumin, in the urine Inflammation of the renal pelvis and kidney, usually as a result of infection Presence of pus in the urine Radiating pain in the region of the kidney associated with the passage of a stone Presence in the blood of toxic levels of nitrogencontaining substances, mainly urea, as a result of renal insufficiency
uremia
urethritis
urinary stasis
DIAGNOSIS AND TREATMENT catheterization Introduction of a tube into a passage, such as through the urethra into the bladder for withdrawal of urine An instrument for examining the inside of the urinary bladder. Also used for removing foreign objects, for surgery, and for other forms of treatment Separation of substances by passage through a semipermeable membrane. Dialysis is used to rid the body of unwanted substances when the kidneys are impaired or missing. The two forms of dialysis are hemodialysis and peritoneal dialysis. Removal of unwanted substances from the blood by passage through a semipermeable membrane Intravenous urography
cystoscope
dialysis
Radiographic visualization of the urinary tract after intravenous administration of a contrast medium that is excreted in the urine; also called excretory urography or intravenous pyelography, although the latter is less accurate because the procedure shows more than just the renal pelvis
Crushing of a stone
lithotripsy
DIAGNOSIS AND TREATMENT (Cont..) peritoneal dialysis Removal of unwanted substances from the body by introduction of a dialyzing fluid into the peritoneal cavity followed by removal of the fluid Pyelography in which the contrast medium is injected into the kidneys from below, by way of the ureters The weight of a substance compared with the weight of an equal volume of water. The specific gravity of normal urine ranges from 1.015 to 1.025. This value may increase or decrease in disease. Laboratory study of the urine. Physical and chemical properties and microscopic appearance are included. A substance that increases the excretion of urine; pertaining to diuresis A urinary tract catheter with a balloon at one end that prevents the catheter from leaving the bladder Instrument for crushing a bladder stone
urinalysis
diuretic
lithotrite
azotemia
azoturia
SYMPTOMS N CONDITIONS (Cont..) horseshoe kidney A congenital union of the lower poles of the kidneys, resulting in a horseshoe-shaped organ Distention of the ureter with urine caused by obstruction Decreased amount of protein in the blood; may result from loss of protein because of kidney damage A congenital condition in which the urethra opens on the undersurface of the penis or into the vagina A decrease in blood volume Inability to retain urine. Incontinence may originate with a neurologic disorder, trauma to the spinal cord, weakness of the pelvic muscles, urinary retention, or impaired bladder function. Term also applies to inability to retain semen or feces.
hydroureter hypoproteinemia
hypospadias
hypovolemia incontinence
neurogenic bladder
Any bladder dysfunction that results from a central nervous system lesion
SYMPTOMS N CONDITIONS (Cont..) nocturia pitting edema Excessive urination at night (noct/o means night Edema in which the skin, when pressed firmly with the finger, will maintain the depression produced A hereditary condition in which the kidneys are enlarged and contain many cysts
polydipsia
polyuria retention of urine staghorn calculus
Excessive thirst
Elimination of large amounts of urine, as in diabetes mellitus Accumulation of urine in the bladder because of an inability to urinat A kidney stone that fills the renal pelvis and calyces to give a staghorn appearance A cystlike dilation of the ureter near its opening into the bladder. Usually results from a congenital narrowing of the ureteral opening
ureterocele
SYMPTOMS N CONDITIONS (Cont..) urinary frequency urinary urgency A need to urinate often without an increase in average output Sudden need to urinate
water intoxication
Excess intake or retention of water with decrease in sodium concentration. May result from excess drinking, excess ADH, or replacement of a large amount of body fluid with pure water. Causes an imbalance in the cellular environment with edema and other disturbances.
A malignant tumor of the kidney that usually appears in children before the age of 5 years
Wilms tumor