TERMINOLOGI 2PATOLOGI SISTEM PERKEMIHAN (TRACTUS URINARIUS)

By:Sarah Suzanna,dr.Farida Gustini, drg

Sistem perkemihanSistem yang menghasilkan urin untuk mengeluarkan produk2 sisa dari tubuhTerdiri atas sepasang Ginjal, sepasang Ureter, sebuah Kandung kemih, dan sebuah Urethra

Anatomi dan FisiologiGinjal- 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 FisiologiUreter

- 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 neuron 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 FisiologiUnit fungsional ginjal adalah nefron, yang pada manusia setiap ginjal mengandung 1-1,5 juta nefronSetiap 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 normalFungsi 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 urineangiotensinA substance that increases blood pressure; activated in the bloodby renin, an enzyme produced by the kidneyscalyxA 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 marrowglomerular capsuleThe cup-shaped structure at the beginning of the nephron thatsurrounds the glomerulus and receives material filtered out ofthe bloodglomerular filtrateThe fluid and dissolved materials that filter out of the blood andenter the nephron at the Bowman capsuleglomerulusThe cluster of capillaries within the glomerular capsule (plural,glomeruli) (root glomerul/o)kidneyAn 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 fluidsmicturitionThe voiding of urine; urination

Key terms for Normal structure and function

nephronA microscopic functional unit of the kidney; working with bloodvessels, the nephron filters the blood and balances the compositionof urinerenal cortexThe outer portion of the kidneyrenal medullaThe inner portion of the kidney; contains portions of thenephrons and tubules that transport urine toward the renalpelvisrenal pelvisThe expanded upper end of the ureter that receives urine fromthe kidney (root pyel/o, from the Greek word for pelvis, meaningbasin)renal pyramidA triangular structure in the medulla of the kidney composed ofthe loops and collecting tubules of the nephronsreninAn enzyme produced by the kidneys that activates angiotensin inthe bloodtubular reabsorptionThe return of substances from the glomerular filtrate to the bloodthrough the peritubular capillariesureaThe main nitrogenous (nitrogen-containing) waste product in theurineureterThe tube that carries urine from the kidney to the bladder (rootureter/o)urethraThe tube that carries urine from the bladder to the outside of thebody (root urethr/o)

urinary bladderThe organ that stores and eliminates urine excreted by thekidneys (root cyst/o, vesic/o)urinationThe voiding of urine; micturitionurineThe 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 Ginjal

Roots for the KidneyROOTMEANINGEXAMPLEDEFINITION OF EXAMPLEren/okidneyinfrarenalbelow the kidneynephr/okidneynephrosisany noninflammatory disease condition of thekidneyglomerul/oglomerulusjuxtaglomerularnear the glomeruluspyel/orenal pelvispyeloplastyplastic repair of the renal pelviscali-, caliccalyxcalicectasisdilatation of a renal calyx

Roots yg berhub. dgn St. perkemihan

Roots for the Urinary Tract (Except the Kidney)ROOTMEANINGEXAMPLEDEFINITION OF EXAMPLEur/ourine,urinary tracturosepsisgeneralized infection that originates in the urinarytracturin/ourineurinationdischarge of urineureter/oureterureterostenosisnarrowing of the uretercyst/ourinary bladdercystotomyincision of the bladdervesic/ourinary bladderintravesicalwithin the urinary bladderurethr/ourethraurethroscopyendoscopic examination of the urethra

Pathology of the Urinary System

Patologi St. PerkemihanGlomerulonefritisperadangan 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 perluGlomerulonefritis 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 luasNefritisPeradangan 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 timbulPembuluh darah VaskulitisGlomeruliSindroma Nefritik Akut, Sindroma Nefritik Progresif, Sindroma Nefrotik, Sindroma Nefritik KronisJaringan TubointerstitialNefritis 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 di punggung 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)acidosisExcessive acidity of body fluidsbacteriuriaPresence of bacteria in the urinecastA solid mold of a renal tubule found in the urinecystitisInflammation of the urinary bladder, usually as a result of infectiondysuriaPainful or difficult urinationglomerulonephritisInflammation 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.hematuriaPresence of blood in the urinehydronephrosisCollection of urine in the renal pelvis caused by obstruction; causes distentionand atrophy of renal tissue. Also called nephrohydrosis or nephrydrosishyperkalemiaExcess amount of potassium in the bloodoliguriaElimination of small amounts of urine

DISORDERS..ContproteinuriaPresence of protein, mainly albumin, in the urinepyelonephritisInflammation of the renal pelvis and kidney, usually as a result ofinfectionpyuriaPresence of pus in the urinerenal colic / kolik renalRadiating pain in the region of the kidney associated with the passage of astoneuremiaPresence in the blood of toxic levels of nitrogen-containing substances,mainly urea, as a result of renal insufficiencyurethritisInflammation of the urethra, usually as a result of infectionurinary stasis Stoppage or stagnation of the flow of urine

DIAGNOSIS AND TREATMENT catheterizationIntroduction of a tube into a passage, such as through the urethra into thebladder for withdrawal of urinecystoscopeAn instrument for examining the inside of the urinary bladder. Also usedfor removing foreign objects, for surgery, and for other forms of treatmentdialysisSeparation 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.hemodialysisRemoval of unwanted substances from the blood by passage through asemipermeable membraneintravenouspyelography (IVP)Intravenous urographyintravenousurography (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 pelvislithotripsyCrushing of a stone

DIAGNOSIS AND TREATMENT (Cont..)peritoneal dialysisRemoval of unwanted substances from the body by introduction of a dialyzingfluid into the peritoneal cavity followed by removal of the fluidretrogradepyelographyPyelography in which the contrast medium is injected into the kidneysfrom below, by way of the uretersspecificgravity (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.urinalysisLaboratory study of the urine. Physical and chemical properties and microscopicappearance are included.diureticA substance that increases the excretion of urine; pertaining todiuresisindwelling Foley catheterA urinary tract catheter with a balloon at one end that prevents thecatheter from leaving the bladderlithotriteInstrument for crushing a bladder stone

SURGERY (PROSEDUR PEMBEDAHAN)cystectomySurgical removal of all or part of the urinary bladderileal conduitDiversion 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 walllithotomyIncision of an organ to remove a stone (calculus)renal transplantationSurgical implantation of a donor kidney into a patient

Supplementary terms/istilah tambahan

SYMPTOMPS AND CONDITIONSanuresisLack of urinationanuriaLack of urine formationazotemiaPresence of an increased amount of nitrogenous waste, especiallyurea, in the bloodazoturiaPresence of an increased amount of nitrogen-containing compounds,especially urea, in the urinecystoceleHerniation of the bladder into the vaginadehydrationExcessive loss of body fluidsdiabetes insipidusA condition caused by inadequate production of antidiuretic hormoneresulting in excessive excretion of dilute urine and extremethirstenuresisInvoluntary urination, usually at night; bed-wettingepispadiasA congenital condition in which the urethra opens on the dorsal surfaceof the penis as a groove or cleft; anaspadiasglycosuriaPresence of glucose in the urine, as in cases of diabetes mellitus

SYMPTOMS N CONDITIONS (Cont..)horseshoe kidneyA congenital union of the lower poles of the kidneys, resulting in ahorseshoe-shaped organhydroureterDistention of the ureter with urine caused by obstructionhypoproteinemiaDecreased amount of protein in the blood; may result from loss ofprotein because of kidney damagehypospadiasA congenital condition in which the urethra opens on the undersurfaceof the penis or into the vaginahypovolemiaA decrease in blood volumeincontinenceInability 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 bladderAny bladder dysfunction that results from a central nervous systemlesion

SYMPTOMS N CONDITIONS (Cont..)

nocturiaExcessive urination at night (noct/o means nightpitting edemaEdema in which the skin, when pressed firmly with the finger, willmaintain the depression producedpolycystic kidneydiseaseA hereditary condition in which the kidneys are enlarged and containmany cystspolydipsiaExcessive thirstpolyuriaElimination of large amounts of urine, as in diabetes mellitusretention of urineAccumulation of urine in the bladder because of an inability to urinatstaghorn calculusA kidney stone that fills the renal pelvis and calyces to give astaghorn appearanceureteroceleA 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 frequencyA need to urinate often without an increase in average outputurinary urgencySudden need to urinatewater intoxicationExcess 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 tumorA malignant tumor of the kidney that usually appears in children beforethe age of 5 years

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