YOU WERE LOOKING FOR: Chapter 26 Urinary System Test Answers
How to code tumor embolization. Code as chemotherapy when patient has chemoembolization. Definition of chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically and anticancer drugs are administered...
Code as other therapy code 1 when the only information is that the patient had tumor embolization. Radiation therapy: How to code seeds? When the only information available is that the patient was referred to a radiation therapist, oncologist, etc....
How important is this information? This information is becoming more important. The number of bilateral mastectomies has been increasing since a genetic marker was identified for breast cancer. There is a need to educate data collectors about the meaning of these codes. Does the number of nodes removed affect whether you would code a simple mastectomy or a modified radical mastectomy? For example, if the patient had only a sentinel node biopsy, would the procedure be coded as a simple mastectomy or a modified radical mastectomy?
Updated July Code a simple mastectomy when sentinel nodes are the only nodes removed. Breast reconstruction may be delayed for valid reasons e. When a tissue expander is inserted at the time of surgery, code reconstruction. Bladder primary site surgery reconstruction codes apply to males. Can we agree to drop reference to males and use same codes for all? What about intravesical and BCG installation? Should donor lymphocyte infusion be coded as treatment? Code as immunotherapy. The lymphocyte donation from the original donor creates an immune reaction to the cancer cells. Should aspirin and phlebotomies still be coded as treatment for hematopoietic neoplasms? Please see the Hematopoietic and Lymphoid Neoplasm Database for the most current instructions. Yes, continue with current instructions.
How is neo-adjuvant therapy coded for a second primary discovered at surgery? For example, a patient had neo-adjuvant chemo for rectal ca. An A-P resection revealed intramucosal ca in adenomatous polyp in descending colon which was a second primary. The neo-adjuvant chemotherapy is recorded for both primaries. For the second primary, use the date of diagnosis as the date of systemic therapy. How should high intensity focused ultrasound HIFU used to treat prostate cancer be coded? Assign surgical code 17 - other method of local tumor destruction. When a chemo agent is used for radio-sensitizing, should it be coded as chemotherapy?
For example, Cisplatin used for radio-sensitization. Do not code as chemotherapy when documented as being used for radio-sensitization. How is the cumulative result of multiple surgeries coded? The second procedure: re-excision left mastectomy with left completion axillary dissection 14 nodes removed. There is a question about the code because the nipple is kept intact. Should this type of scenario be coded to cumulative modified radical mastectomy even though the nipple was not removed?
Code modified radical mastectomy - sparing the nipple is for cosmetic purposes only. Nipple sparing may be done to facilitate immediate reconstructive surgery. Suggest adding one or more new codes for subcutaneous mastectomy because it is being used increasingly for breast cancer patients, and it is used specifically in conjunction with immediate reconstruction to take advantage of sparing the skin.
The current instructions identify the procedure as "rarely used for malignancies", and the current code structure does not allow for recording reconstruction. The code for subcutaneous mastectomy is 30, and the other codes in the 30s range are not in use for breast. Is the following interpretation of first course of treatment correct? She is informed of a breast cancer diagnosis a few days later. She does not comply with her treatment plan, and the physician loses contact with her. The case is coded as follows: The first surgical event is the lymph node biopsy.
In the system, it looks like she started treatment in February when she didn't have any treatment until May. This is correct at the present time. It may be evaluated in the future. In most cases, bone marrow is not the primary site for B-cell lymphomas. However there are a number of B-cell lymphomas and since it is unknown to which B-cell lymphoma you are referring, we will assume that the primary site is not BM.
Code the BM biopsy 01 - biopsy of other than primary site. Post-transplant patients may develop a malignant myeloproliferative neoplasm. When immunosuppression drugs are stopped, the myeloproliferative neoplasm usually subsides. Is the elimination of immunosuppression treatment codable as other treatment? Do not code as a treatment.
In addition, the kidneys perform two important endocrine functions: production of erythropoietin, which is a regulator of red blood cell quantity, and activation of vitamin D, which is a cofactor for intestinal calcium absorption. Most individuals have two kidneys, each containing approximately one million nephrons, which provide a large renal reserve. The nephron is the functional unit of the kidney, performing all filtration, reabsorption, and secretory functions. Thus, clinical findings may not be evident until late in the course of chronic kidney disease. A number of laboratory and diagnostic tests are used to assess renal structure and function and to identify disease processes. These are briefly described at the end of this chapter. Kidney diseases, renal failure, and abnormalities of the bladder are discussed in Chapters 27 , 28 , and 29 , respectively. A discussion of fluid and electrolyte imbalances and acid-base disturbances can be found in Chapters 24 and 25 , respectively.
The essentials of kidney structure and nephron function are presented in this chapter. Renal Anatomy The urinary system consists of the kidneys, ureters, urinary bladder, and urethra Figure The kidneys are located in the retroperitoneal space in the posterior abdomen. One kidney is on each side of the vertebral column between the level of the twelfth thoracic and third lumbar vertebrae.
The costovertebral angle CVA , the point at which the bottom of the rib cage meets the spine, is commonly used as an external landmark for finding kidney position during physical examination. The kidneys are located in the retroperitoneal space in the posterior abdominal cavity, in contact with the diaphragm and covered on the upper portions by ribs. The kidneys are protected and surrounded by strong back and flank muscles, fascia, and fat. The kidneys are somewhat mobile and can be injured by high-impact activities, such as bouncing along on horseback or on a mountain bike, or by direct trauma, as might occur from falls or blunt trauma. Kidney hemorrhage results in bleeding into the retroperitoneal space but not into the peritoneal cavity.
The kidneys drain urine into the ureters by gravity flow and the ureters provide peristaltic action to move urine along to the bladder where it is stored. The two principal parts of the bladder are the body and the neck. The body stores urine and is made up of smooth muscle known as detrusor muscle. Detrusor muscle extends in all directions throughout the bladder and contracts as a unit in response to initiation of action potentials. The urinary bladder collects to ml before stretch receptors signal a need for bladder emptying. Urine is drained from the bladder by the urethra when the internal and external sphincters are relaxed. Innervation and control of bladder function are discussed in detail in Chapter Renal Parenchyma On cross-section, the kidney is seen to contain three principal areas: the pelvis, the medulla, and the cortex Figure The renal pelvis is a large collecting area for the urine that drains from the many collecting ducts of the nephrons.
The minor smaller calices collect urine as it drains from the papilla of the renal pyramids. The normal kidney has 8 to 18 minor calices and 2 to 3 major calices. Normal kidneys have 8 to 18 renal pyramids and a corresponding number of minor calices. The major calices drain urine into the ureter. Blood vessels, lymphatic vessels, and nerves enter and exit through the hilum. B, The arterial blood supply to the kidney is derived from the renal arteries, which branch from the abdominal aorta and enter the kidney through the hilus. The renal artery branches to form several interlobar arteries, which travel toward the cortex in the renal columns. The interlobar arteries branch to form the arcuate arteries, which divide further to form the interlobular arteries.
The medulla contains 8 to 18 renal pyramids, the bases of which are adjacent to the outer cortex, whereas the apices open into the minor calices. The pyramids consist of collecting tubules, collecting ducts, long loops of Henle, and vasa recta. The papillae are the openings at the tips of the renal pyramids through which urine exits the collecting ducts. The renal cortex, which is the outer rim of the kidney, is about 1 cm thick. Fifteen percent of nephrons send their loops of Henle deep into the medulla and are called juxtamedullary nephrons.
Columns of cortical tissue are found between the medullary pyramids and provide the passageway for the interlobar arteries.
Reduces inflammation that may interfere with osteoblast function Hormones and Bone Tissue The endocrine system produces and secretes hormones, many of which interact with the skeletal system. These hormones are involved in controlling bone growth, maintaining bone once it is formed, and remodeling it. The pituitary gland secretes growth hormone GH , which, as its name implies, controls bone growth in several ways. It triggers chondrocyte proliferation in epiphyseal plates, resulting in the increasing length of long bones. GH also increases calcium retention, which enhances mineralization, and stimulates osteoblastic activity, which improves bone density.
GH is not alone in stimulating bone growth and maintaining osseous tissue. Thyroxine, a hormone secreted by the thyroid gland promotes osteoblastic activity and the synthesis of bone matrix. During puberty, the sex hormones estrogen in girls, testosterone in boys also come into play. They too promote osteoblastic activity and production of bone matrix, and in addition, are responsible for the growth spurt that often occurs during adolescence.
They also promote the conversion of the epiphyseal plate to the epiphyseal line i. Additionally, calcitriol, the active form of vitamin D, is produced by the kidneys and stimulates the absorption of calcium and phosphate from the digestive tract. Aging and the…Skeletal System Osteoporosis is a disease characterized by a decrease in bone mass that occurs when the rate of bone resorption exceeds the rate of bone formation, a common occurrence as the body ages. Figure 6. Women lose bone mass more rapidly than men. While osteoporosis can involve any bone, it most commonly affects the proximal ends of the femur, vertebrae, and wrist.
As a result of the loss of bone density, the osseous tissue may not provide adequate support for everyday functions, and something as simple as a sneeze can cause a vertebral fracture. When an elderly person falls and breaks a hip really, the femur , it is very likely the femur that broke first, which resulted in the fall. Histologically, osteoporosis is characterized by a reduction in the thickness of compact bone and the number and size of trabeculae in cancellous bone. This occurs because 50 is the approximate age at which women go through menopause. Not only do their menstrual periods lessen and eventually cease, but their ovaries reduce in size and then cease the production of estrogen, a hormone that promotes osteoblastic activity and production of bone matrix.
Thus, osteoporosis is more common in women than in men, but men can develop it, too. Anyone with a family history of osteoporosis has a greater risk of developing the disease, so the best treatment is prevention, which should start with a childhood diet that includes adequate intake of calcium and vitamin D and a lifestyle that includes weight-bearing exercise. These actions, as discussed above, are important in building bone mass. Promoting proper nutrition and weight-bearing exercise early in life can maximize bone mass before the age of 30, thus reducing the risk of osteoporosis. For many elderly people, a hip fracture can be life threatening. The fracture itself may not be serious, but the immobility that comes during the healing process can lead to the formation of blood clots that can lodge in the capillaries of the lungs, resulting in respiratory failure; pneumonia due to the lack of poor air exchange that accompanies immobility; pressure sores bed sores that allow pathogens to enter the body and cause infections; and urinary tract infections from catheterization.
Minimizing the risk of falls, for example, by removing tripping hazards, is also an important step in managing the potential outcomes from the disease. Hormones That Influence Osteoclasts Bone modeling and remodeling require osteoclasts to resorb unneeded, damaged, or old bone, and osteoblasts to lay down new bone. Two hormones that affect the osteoclasts are parathyroid hormone PTH and calcitonin. PTH stimulates osteoclast proliferation and activity. As a result, calcium is released from the bones into the circulation, thus increasing the calcium ion concentration in the blood. PTH also promotes the reabsorption of calcium by the kidney tubules, which can affect calcium homeostasis see below. The small intestine is also affected by PTH, albeit indirectly. Because another function of PTH is to stimulate the synthesis of vitamin D, and because vitamin D promotes intestinal absorption of calcium, PTH indirectly increases calcium uptake by the small intestine.
Calcitonin, a hormone secreted by the thyroid gland, has some effects that counteract those of PTH. Calcitonin inhibits osteoclast activity and stimulates calcium uptake by the bones, thus reducing the concentration of calcium ions in the blood. As evidenced by their opposing functions in maintaining calcium homeostasis, PTH and calcitonin are generally not secreted at the same time. Table 6.
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