TERMINOLOGI 2

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

Anatomi dan Fisiologi1. Ginjal

- Pada orang dewasa ginjal panjangnya 12-13 cm, lebarnya 6 cm dan beratnya antara 120-150 gram. Ukurannya tidak berbeda menurut bentuk dan ukuran tubuh- Permukaan anterior dan posterior katup atas dan bawah serta pinggir lateral ginjal berbentuk konveks sedangkan pinggir medialnya berbentuk konkaf karena adanya hilus- Ada beberapa struktur yang masuk atau keluar dari ginjal melalui hilus antara lain arteri dan vena renalis, saraf dan pembuluh getah bening- Struktur fungsional ginjal : Nefron

Anatomi dan Fisiologi2. Ureter

- Ureter adalah tabung/saluran yang menghubungkan ginjal dengan kandung kemih. Ureter merupakan lanjutan pelvis renis, menuju distal & bermuara pada vesica urinaria. Panjangnya 25 – 30 cmPersarafan ureter oleh plexus hypogastricus inferior T11- L2 melalui neuron² simpatis. Terdiri dari dua bagian : – pars abdominalis – pars pelvina Tiga tempat penyempitan pada ureter :– uretero- pelvic junction– tempat penyilangan ureter dengan vassa iliaca sama dengan flexura marginalis – muara ureter ke dalam vesica urinaria

Anatomi dan Fisiologi3. Vesica Urinaria

• Disebut juga bladder/ kandung kemih. Vesica urinaria merupakan kantung berongga yang dapat diregangkan dasn volumenya dapat disesuaikan dengan mengubah status kontraktil otot polos di dindingnya.

• Secara berkala urin dikosongkan dari kandung kemih ke luar tubuh melalui ureter.

• Organ ini mempunyai fungsi sebagai reservoir urine (200 - 400 cc). Dindingnya mempunyai lapisan otot yang kuat.

• Vesica urinaria mempunyai bagian:• Apex: Dihubungkan ke cranial oleh urachus (sisa kantong allantois ) sampai ke umbilicus membentuk ligamentum vesico umbilicale mediale. • Corpus• Fundus Vesica urinaria dipersarafi oleh saraf otonom

4. Urethra

Merupakan saluran keluar dari urin yang diekskresikan oleh tubuh melalui ginjal, ureter, vesica urinaria.

Anatomi dan Fisiologi• Unit fungsional ginjal adalah nefron, yang pada manusia setiap ginjal

mengandung 1-1,5 juta nefron• Setiap nefron mempunyai dua komponen utama:

1) Glomerulus ( kapiler glomerulus ) yang dilalui sejumlah besar cairan yang difiltrasi dari darah.2) Tubulus yang panjang dimana cairan hasil filtrasi di ubah menjadi urin dalam perjalanannya menuju pelvis ginjal.

• Kecepatan eksresi berbagal zat dalam urin menunjukkan jumlah ketiga proses ginjal yaitu : Filtrasi glomerulus, reabsorpsi zat dari tubulus renal kedalam darah dan sekresi zat dari darah ke tubulus renal. Pembentukan urin dimulai dengan filtrasi sjumlah besar cairan yang bebas protein dari kapiler glomerulus ke kapsula Bowmen.

• Fungsi primer ginjal adalah rnempertahankan volume dan komposisi cairan ekstra sel dalam batas-batas normal

• Fungsi lain dari ginjal yaitu memproduksi renin yang berperan dalam pengaturan tekanan darah.

Key terms for Normal structure and function

Antidiuretichormone (ADH)

A hormone released from the pituitary gland that causes reabsorptionof water in the kidneys, thus concentrating the urine

angiotensin A substance that increases blood pressure; activated in the bloodby renin, an enzyme produced by the kidneys

calyx A cuplike cavity in the pelvis of the kidney; also calix (plural,calyces) (root cali, calic)

erythropoietin (EPO)

A hormone produced by the kidneys that stimulates red bloodcell production in the bone marrow

glomerular capsule

The cup-shaped structure at the beginning of the nephron thatsurrounds the glomerulus and receives material filtered out ofthe blood

glomerular filtrate The fluid and dissolved materials that filter out of the blood andenter the nephron at the Bowman capsule

glomerulus The cluster of capillaries within the glomerular capsule (plural,glomeruli) (root glomerul/o)

kidney An organ of excretion (root ren/o, nephr/o); the two kidneys filterthe blood and form urine, which contains the waste products ofmetabolism and other substances as needed to regulate the waterand electrolyte balance and the pH of body fluids

micturition The voiding of urine; urination

Key terms for Normal structure and function

nephron A microscopic functional unit of the kidney; working with bloodvessels, the nephron filters the blood and balances the compositionof urine

renal cortex The outer portion of the kidney

renal medulla The inner portion of the kidney; contains portions of thenephrons and tubules that transport urine toward the renalpelvis

renal pelvis The expanded upper end of the ureter that receives urine fromthe kidney (root pyel/o, from the Greek word for pelvis, meaning“basin”)

renal pyramid A triangular structure in the medulla of the kidney composed ofthe loops and collecting tubules of the nephrons

renin An enzyme produced by the kidneys that activates angiotensin inthe blood

tubular reabsorption

The return of substances from the glomerular filtrate to the bloodthrough the peritubular capillaries

urea The main nitrogenous (nitrogen-containing) waste product in theurine

ureter The tube that carries urine from the kidney to the bladder (rootureter/o)

urethra The tube that carries urine from the bladder to the outside of thebody (root urethr/o)

urinary bladder The organ that stores and eliminates urine excreted by thekidneys (root cyst/o, vesic/o)

urination The voiding of urine; micturition

urine The fluid excreted by the kidneys. It consists of water, electrolytes,urea, other metabolic wastes, and pigment. A varietyof other substances may appear in urine in cases of disease(root ur/o).

Roots yg berhub.dgn GinjalRoots for the Kidney

ROOT MEANING EXAMPLE DEFINITION OF EXAMPLE

ren/o kidney infrarenal below the kidney

nephr/o kidney nephrosis any noninflammatory disease condition of thekidney

glomerul/o glomerulus juxtaglomerular

near the glomerulus

pyel/o renal pelvis pyeloplasty plastic repair of the renal pelvis

cali-, calic calyx calicectasis dilatation of a renal calyx

Roots yg berhub. dgn St. perkemihan

Roots for the Urinary Tract (Except the Kidney)

ROOT MEANING EXAMPLE DEFINITION OF EXAMPLE

ur/o urine,urinary tract

urosepsis generalized infection that originates in the urinarytract

urin/o urine urination discharge of urine

ureter/o ureter ureterostenosis narrowing of the ureter

cyst/o urinary bladder cystotomy incision of the bladder

vesic/o urinary bladder intravesical within the urinary bladder

urethr/o urethra urethroscopy endoscopic examination of the urethra

Pathology of the Urinary System

Patologi St. Perkemihan1. Glomerulonefritis

peradangan pada ginjal yang dimulai dari glomerulus, ditandai dengan proteinuria dan hematuria. Dapat berkembang jd Gagal ginjal.

• Glomerulonefritis akut (GNA) adalah suatu reaksi imunologis pada ginjal terhadap bakteri atau virus tertentu.Yang sering terjadi ialah akibat infeksi kuman streptococcus , ditandai dengan timbulnya hematuria, edema, hipertensi, dan penurunan fungsi ginjalPengobatan : istirahat, diet, pembatasan cairan dan garam, antibiotik, anti hipertensi, antidiuretik bila perlu

• Glomerulonefritis kronis adl kerusakan ginjal yang terjadi selama 3 bulan atau lebih, berdasarkan kelainan patologik atau petanda kerusakan ginjal seperti kelainan pada urinalisis, dengan penurunan laju filtrasi glomerulus ataupun tidak. Ditandai dengan penurunan semua faal ginjal secara bertahap, diikuti penimbunan sisa metabolisme protein dan gangguan keseimbangan cairan dan elrektrolit.

2. Sindrom nefrotiksuatu 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. NefritisPeradangan 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 Penyakit yang timbul

Pembuluh darah Vaskulitis

Glomeruli Sindroma Nefritik Akut, Sindroma Nefritik Progresif, Sindroma Nefrotik, Sindroma Nefritik Kronis

Jaringan Tubointerstitial Nefritis Tubulointerstisialis Akut , Nefritis Tubulointerstisialis Kronis

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, dllAkut : 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 dipunggung bagian bawah, mual dan muntah,bisa terjadi pembesaran salah satu atau kedua ginjal

7. Hidronefrosispenggembungan ginjal akibat tekanan balik terhadap ginjal karena aliran air kemih tersumbat (batu, tumor, arteri atau vena yang letknya abnormal)

8. Batu Ginjal dan Uretermassa 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 Refluksaliran balik urin dari Kandung kemih ke ureter, karena kelemahan sambungan vesikoureteral, dapat menyebabkan pembesaran ureter dan ginjal.

10. Cystitisradang 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. Urethritisperadanganpada urethra (Spesifik dan Nonspesifik)

12. Striktur Urethrapenyempitan lumen uretra karena fibrosis (terbentuk jaringan ikat)pada dindingnya. Penyebab: kelainan bawaan, operasi, trauma, infeksi

DISORDERS (KELAINAN)

acidosis Excessive acidity of body fluids

bacteriuria Presence of bacteria in the urine

cast A solid mold of a renal tubule found in the urine

cystitis Inflammation of the urinary bladder, usually as a result of infection

dysuria Painful or difficult urination

glomerulonephritis Inflammation of the kidney primarily involving the glomeruli. The acuteform usually occurs after an infection elsewhere in the body; the chronicform varies in cause and usually leads to renal failure.

hematuria Presence of blood in the urine

hydronephrosis Collection of urine in the renal pelvis caused by obstruction; causes distentionand atrophy of renal tissue. Also called nephrohydrosis or nephrydrosis

hyperkalemia Excess amount of potassium in the blood

oliguria Elimination of small amounts of urine

DISORDERS..Cont’

proteinuria Presence of protein, mainly albumin, in the urine

pyelonephritis Inflammation of the renal pelvis and kidney, usually as a result ofinfection

pyuria Presence of pus in the urine

renal colic / kolik renal Radiating pain in the region of the kidney associated with the passage of astone

uremia Presence in the blood of toxic levels of nitrogen-containing substances,mainly urea, as a result of renal insufficiency

urethritis Inflammation of the urethra, usually as a result of infection

urinary stasis Stoppage or stagnation of the flow of urine

DIAGNOSIS AND TREATMENT

catheterization Introduction of a tube into a passage, such as through the urethra into thebladder for withdrawal of urine

cystoscope An instrument for examining the inside of the urinary bladder. Also usedfor removing foreign objects, for surgery, and for other forms of treatment

dialysis Separation of substances by passage through a semipermeable membrane.Dialysis is used to rid the body of unwanted substances when the kidneysare impaired or missing. The two forms of dialysis are hemodialysis andperitoneal dialysis.

hemodialysis Removal of unwanted substances from the blood by passage through asemipermeable membrane

intravenouspyelography (IVP)

Intravenous urography

intravenousurography (IVU)

Radiographic visualization of the urinary tract after intravenous administrationof a contrast medium that is excreted in the urine; also called excretoryurography or intravenous pyelography, although the latter is lessaccurate because the procedure shows more than just the renal pelvis

lithotripsy Crushing of a stone

DIAGNOSIS AND TREATMENT (Cont’..)

peritoneal dialysis Removal of unwanted substances from the body by introduction of a dialyzingfluid into the peritoneal cavity followed by removal of the fluid

retrogradepyelography

Pyelography in which the contrast medium is injected into the kidneysfrom below, by way of the ureters

specificgravity (SG)

The weight of a substance compared with the weight of an equal volume ofwater. The specific gravity of normal urine ranges from 1.015 to 1.025.This value may increase or decrease in disease.

urinalysis Laboratory study of the urine. Physical and chemical properties and microscopicappearance are included.

diuretic A substance that increases the excretion of urine; pertaining todiuresis

indwelling Foley catheter A urinary tract catheter with a balloon at one end that prevents thecatheter from leaving the bladder

lithotrite Instrument for crushing a bladder stone

SURGERY (PROSEDUR PEMBEDAHAN)

cystectomy Surgical removal of all or part of the urinary bladder

ileal conduit Diversion of urine by connection of the ureters to an isolated segment ofthe ileum. One end of the segment is sealed, and the other drains throughan opening in the abdominal wall

lithotomy Incision of an organ to remove a stone (calculus)

renal transplantation Surgical implantation of a donor kidney into a patient

Supplementary terms/istilah tambahanSYMPTOMPS AND CONDITIONS

anuresis Lack of urination

anuria Lack of urine formation

azotemia Presence of an increased amount of nitrogenous waste, especiallyurea, in the blood

azoturia Presence of an increased amount of nitrogen-containing compounds,especially urea, in the urine

cystocele Herniation of the bladder into the vagina

dehydration Excessive loss of body fluids

diabetes insipidus A condition caused by inadequate production of antidiuretic hormoneresulting in excessive excretion of dilute urine and extremethirst

enuresis Involuntary urination, usually at night; bed-wetting

epispadias A congenital condition in which the urethra opens on the dorsal surfaceof the penis as a groove or cleft; anaspadias

glycosuria Presence of glucose in the urine, as in cases of diabetes mellitus

SYMPTOMS N CONDITIONS (Cont’..)

horseshoe kidney A congenital union of the lower poles of the kidneys, resulting in ahorseshoe-shaped organ

hydroureter Distention of the ureter with urine caused by obstruction

hypoproteinemia Decreased amount of protein in the blood; may result from loss ofprotein because of kidney damage

hypospadias A congenital condition in which the urethra opens on the undersurfaceof the penis or into the vagina

hypovolemia A decrease in blood volume

incontinence Inability to retain urine. Incontinence may originate with a neurologicdisorder, trauma to the spinal cord, weakness of the pelvic muscles,urinary retention, or impaired bladder function. Term alsoapplies to inability to retain semen or feces.

neurogenic bladder Any bladder dysfunction that results from a central nervous systemlesion

SYMPTOMS N CONDITIONS (Cont’..)

nocturia Excessive urination at night (noct/o means “night”

pitting edema Edema in which the skin, when pressed firmly with the finger, willmaintain the depression produced

polycystic kidneydisease

A hereditary condition in which the kidneys are enlarged and containmany cysts

polydipsia Excessive thirst

polyuria Elimination of large amounts of urine, as in diabetes mellitus

retention of urine Accumulation of urine in the bladder because of an inability to urinat

staghorn calculus A kidney stone that fills the renal pelvis and calyces to give a“staghorn” appearance

ureterocele A cystlike dilation of the ureter near its opening into the bladder.Usually results from a congenital narrowing of the ureteral opening

SYMPTOMS N CONDITIONS (Cont’..)

urinary frequency A need to urinate often without an increase in average output

urinary urgency 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 replacementof a large amount of body fluid with pure water. Causesan imbalance in the cellular environment with edema and otherdisturbances.

Wilms tumor A malignant tumor of the kidney that usually appears in children beforethe age of 5 years

TERIMA KASIH DAN SELAMAT BELAJAR