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TERMINOLOGI 2 PATOLOGI SISTEM PERKEMIHAN (TRACTUS URINARIUS) By: Sarah Suzanna,dr. Farida Gustini, drg.

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Presentasi berjudul: "TERMINOLOGI 2 PATOLOGI SISTEM PERKEMIHAN (TRACTUS URINARIUS) By: Sarah Suzanna,dr. Farida Gustini, drg."— Transcript presentasi:

1 TERMINOLOGI 2 PATOLOGI SISTEM PERKEMIHAN (TRACTUS URINARIUS) By: Sarah Suzanna,dr. Farida Gustini, drg

2 Sistem perkemihan Sistem yang menghasilkan urin untuk mengeluarkan produk2 sisa dari tubuh Terdiri atas sepasang Ginjal, sepasang Ureter, sebuah Kandung kemih, dan sebuah Urethra

3 Anatomi dan Fisiologi 1.Ginjal - Pada orang dewasa ginjal panjangnya cm, lebarnya 6 cm dan beratnya antara 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

4 Anatomi dan Fisiologi 2.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 cm Persarafan 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

5 Anatomi dan Fisiologi 3. 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 ( 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.

6 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.

7 Key terms for Normal structure and function Antidiuretic hormone (ADH) A hormone released from the pituitary gland that causes reabsorption of water in the kidneys, thus concentrating the urine angiotensinA substance that increases blood pressure; activated in the blood by renin, an enzyme produced by the kidneys calyxA 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 blood cell production in the bone marrow glomerular capsule The cup-shaped structure at the beginning of the nephron that surrounds the glomerulus and receives material filtered out of the blood glomerular filtrateThe fluid and dissolved materials that filter out of the blood and enter the nephron at the Bowman capsule glomerulusThe cluster of capillaries within the glomerular capsule (plural, glomeruli) (root glomerul/o) kidneyAn 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 micturitionThe voiding of urine; urination

8 Key terms for Normal structure and function nephronA microscopic functional unit of the kidney; working with blood vessels, the nephron filters the blood and balances the composition of urine renal cortexThe outer portion of the kidney renal medullaThe inner portion of the kidney; contains portions of the nephrons and tubules that transport urine toward the renal pelvis renal pelvisThe expanded upper end of the ureter that receives urine from the kidney (root pyel/o, from the Greek word for pelvis, meaning “basin”) renal pyramidA triangular structure in the medulla of the kidney composed of the loops and collecting tubules of the nephrons reninAn enzyme produced by the kidneys that activates angiotensin in the blood tubular reabsorption The return of substances from the glomerular filtrate to the blood through the peritubular capillaries ureaThe main nitrogenous (nitrogen-containing) waste product in the urine ureterThe tube that carries urine from the kidney to the bladder (root ureter/o) urethraThe tube that carries urine from the bladder to the outside of the body (root urethr/o)

9 urinary bladderThe organ that stores and eliminates urine excreted by the kidneys (root cyst/o, vesic/o) urinationThe voiding of urine; micturition urineThe 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).

10 Roots yg berhub.dgn Ginjal Roots for the Kidney ROOTMEANINGEXAMPLEDEFINITION OF EXAMPLE ren/okidneyinfrarenalbelow the kidney nephr/okidneynephrosisany noninflammatory disease condition of the kidney glomerul/oglomerulusjuxtaglomerul ar near the glomerulus pyel/orenal pelvispyeloplastyplastic repair of the renal pelvis cali-, caliccalyxcalicectasisdilatation of a renal calyx

11 Roots yg berhub. dgn St. perkemihan Roots for the Urinary Tract (Except the Kidney) ROOTMEANINGEXAMPLEDEFINITION OF EXAMPLE ur/ourine, urinary tract urosepsisgeneralized infection that originates in the urinary tract urin/ourineurinationdischarge of urine ureter/oureterureterostenosisnarrowing of the ureter cyst/ourinary bladdercystotomyincision of the bladder vesic/ourinary bladderintravesicalwithin the urinary bladder urethr/ourethraurethroscopyendoscopic examination of the urethra

12 Pathology of the Urinary System

13 Patologi St. Perkemihan 1.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 ginjal Pengobatan : 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.

14 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 terkenaPenyakit yang timbul Pembuluh darahVaskulitis GlomeruliSindroma Nefritik Akut, Sindroma Nefritik Progresif, Sindroma Nefrotik, Sindroma Nefritik Kronis Jaringan TubointerstitialNefritis Tubulointerstisialis Akut, Nefritis Tubulointerstisialis Kronis

15 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

16 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.

17 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

18 DISORDERS (KELAINAN) acidosisExcessive acidity of body fluids bacteriuriaPresence of bacteria in the urine castA solid mold of a renal tubule found in the urine cystitisInflammation of the urinary bladder, usually as a result of infection dysuriaPainful or difficult urination glomerulonephritisInflammation of the kidney primarily involving the glomeruli. The acute form usually occurs after an infection elsewhere in the body; the chronic form varies in cause and usually leads to renal failure. hematuriaPresence of blood in the urine hydronephrosisCollection of urine in the renal pelvis caused by obstruction; causes distention and atrophy of renal tissue. Also called nephrohydrosis or nephrydrosis hyperkalemiaExcess amount of potassium in the blood oliguriaElimination of small amounts of urine

19 DISORDERS..Cont’ proteinuriaPresence of protein, mainly albumin, in the urine pyelonephritisInflammation of the renal pelvis and kidney, usually as a result of infection pyuriaPresence of pus in the urine renal colic / kolik renalRadiating pain in the region of the kidney associated with the passage of a stone uremiaPresence in the blood of toxic levels of nitrogen- containing substances, mainly urea, as a result of renal insufficiency urethritisInflammation of the urethra, usually as a result of infection urinary stasisStoppage or stagnation of the flow of urine

20 DIAGNOSIS AND TREATMENT catheterizationIntroduction of a tube into a passage, such as through the urethra into the bladder for withdrawal of urine cystoscopeAn instrument for examining the inside of the urinary bladder. Also used for removing foreign objects, for surgery, and for other forms of treatment dialysisSeparation 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. hemodialysisRemoval of unwanted substances from the blood by passage through a semipermeable membrane intravenous pyelography (IVP) Intravenous urography intravenous urography (IVU) 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 lithotripsyCrushing of a stone

21 DIAGNOSIS AND TREATMENT (Cont’..) peritoneal dialysisRemoval of unwanted substances from the body by introduction of a dialyzing fluid into the peritoneal cavity followed by removal of the fluid retrograde pyelography Pyelography in which the contrast medium is injected into the kidneys from below, by way of the ureters specific gravity (SG) The weight of a substance compared with the weight of an equal volume of water. The specific gravity of normal urine ranges from to This value may increase or decrease in disease. urinalysisLaboratory study of the urine. Physical and chemical properties and microscopic appearance are included. diureticA substance that increases the excretion of urine; pertaining to diuresis indwelling Foley catheterA urinary tract catheter with a balloon at one end that prevents the catheter from leaving the bladder lithotriteInstrument for crushing a bladder stone

22 SURGERY (PROSEDUR PEMBEDAHAN) cystectomySurgical removal of all or part of the urinary bladder ileal conduitDiversion of urine by connection of the ureters to an isolated segment of the ileum. One end of the segment is sealed, and the other drains through an opening in the abdominal wall lithotomyIncision of an organ to remove a stone (calculus) renal transplantationSurgical implantation of a donor kidney into a patient

23 Supplementary terms/istilah tambahan SYMPTOMPS AND CONDITIONS anuresisLack of urination anuriaLack of urine formation azotemiaPresence of an increased amount of nitrogenous waste, especially urea, in the blood azoturiaPresence of an increased amount of nitrogen-containing compounds, especially urea, in the urine cystoceleHerniation of the bladder into the vagina dehydrationExcessive loss of body fluids diabetes insipidusA condition caused by inadequate production of antidiuretic hormone resulting in excessive excretion of dilute urine and extreme thirst enuresisInvoluntary urination, usually at night; bed-wetting epispadiasA congenital condition in which the urethra opens on the dorsal surface of the penis as a groove or cleft; anaspadias glycosuriaPresence of glucose in the urine, as in cases of diabetes mellitus

24 SYMPTOMS N CONDITIONS (Cont’..) horseshoe kidneyA congenital union of the lower poles of the kidneys, resulting in a horseshoe-shaped organ hydroureterDistention of the ureter with urine caused by obstruction hypoproteinemiaDecreased amount of protein in the blood; may result from loss of protein because of kidney damage hypospadiasA congenital condition in which the urethra opens on the undersurface of the penis or into the vagina hypovolemiaA decrease in blood volume incontinenceInability 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. neurogenic bladderAny bladder dysfunction that results from a central nervous system lesion

25 SYMPTOMS N CONDITIONS (Cont’..) nocturiaExcessive urination at night (noct/o means “night” pitting edemaEdema in which the skin, when pressed firmly with the finger, will maintain the depression produced polycystic kidney disease A hereditary condition in which the kidneys are enlarged and contain many cysts polydipsiaExcessive thirst polyuriaElimination of large amounts of urine, as in diabetes mellitus retention of urineAccumulation of urine in the bladder because of an inability to urinat staghorn calculusA kidney stone that fills the renal pelvis and calyces to give a “staghorn” appearance ureteroceleA cystlike dilation of the ureter near its opening into the bladder. Usually results from a congenital narrowing of the ureteral opening

26 SYMPTOMS N CONDITIONS (Cont’..) urinary frequencyA need to urinate often without an increase in average output urinary urgencySudden need to urinate water intoxicationExcess 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. Wilms tumorA malignant tumor of the kidney that usually appears in children before the age of 5 years

27 TERIMA KASIH DAN SELAMAT BELAJAR


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