5.2 - GU System Flashcards
Week 5, Tuesday
How can the presentation of cervical cancer vs ectopic pregnancy differ?
Ectopic pregnancy may cause unilateral shoulder pain (or mid and lower back)
- Bc higher up in fallopian tubes
Cervical CA is unlikely to cause shoulder pain
- Bc much lower compared to fallopian tubes
Describe the general s/sx of GU conditions
Classic Symptoms:
- Unilateral costovertebral tenderness
- LBP, flank, inner thigh pain
- Ipsilateral shoulder
Urinary changes:
- Dysuria
- Noctuira
- Hematuria
- Polyuria
- Incomplete emptying
- hesitancy
- Dyspareunia
- Sexual dysfunction
Systemic s/sx - fever, chills, fatigue, malaise, anorexia, weight loss
Describe the upper urinary vs lower urinary tract
Upper: Kidneys & ureters
Lower: Bladder & urethra
Define oliguria
Little amount of urine (<400 mL / 24hr)
Define anuria
Almost no urine (<100mL / 24hr)
Define dyspareunia
pain w/ sexual intercourse
Common upper urinary tract conditions (4)
Renal failure
Renal infections (pyelonephritis)
Glomerulonephritis
Renal necrosis, renal tuberculosis
Common lower urinary tract conditions
Bladder infection (cystitis)
Urethritis
Renal calculi
Describe symptoms in the upper vs lower urinary tract
Upper tract:
- Unilateral costovertebral tenderess
- Flank pain, ipsilateral shoulder pain
Lower tract:
- Increased urinary frequency, urgency
- LBP, pelvic pain, lower abdominal pain
Both: change in bladder habits
Describe risk factors for UTIs
Older adults
Females
Diabetes mellitus
In an older adult with mental status changes, what should be one of the first thoughts we have about what is causing this change?
UTI
Renal Calculi
What is it?
Clinical presentation
Kidney stones
Clinical Presentation:
- “Colicky” flank pain - “ebb & flow”; intense pain comes and go; pain occurs when the stone is moving
- Pain location dependent on stone location
Cystitis
What is it?
Clinical presentaiton
Inflammation of the bladder
Clinical Presentation:
- Increased urinary frequency, urgency
Bladder acts “hyperreflexic” because of irritation
Prostatitis
What is it?
Clinical Presentation
Inflammation of the prostate
Risk Factors:
- Prevalence higher in YOUNGER men <40 yo (differs from BPH)
- Multiple sex partners
- Bicycling or jogging on a regular basis
Clinical Presentation:
- Low back, inner thigh pain
- Testicular, penis pain
- Nocturia, dysuria
- Weak urine stream
- Fever, chills, malaise
Can eventually progress to overflow incontinence due to difficulty emptying the bladder
Describe how to identify prostatitis vs BPH vs prostate cancer
Prostatitis:
- Prevalence higher in YOUNG men <40 yo
- Presence of PAIN
BPH:
- OLDER men >50 yo
- Obstruction of urethra –> decreased FORCE of urinary flow; difficulty with urination (especially initiating); increased frequency
Prostate Cancer:
- HEMATURIA
- LBP
What is the hallmark symptoms of UTIs?
Dysuria
Describe risk factors for a UTI
Urinary catheterization!!!
Increased age
Diabetes
Describe the clinical presentation of a UTI in older adults
Change in MENTAL STATUS
N/v
SOB, cough
Describe the 4 types of incontinence
Stress
Urge
Overflow
Functional
Stress
- WEAK support for bladder
- Leakage w/ increased intra-abdominal pressure (laughing, sneezing, lifting)
Urge
- Involuntary contraction of the detrusor muscle
Overflow
- Acontractile or deficient detrusor –> inability to empty completely –> overdistention of the bladder
Functional
- Decreased mobility or physical impairments impair the ability to get to the bathroom in time
BPH is a common cause of __________________ incontinence.
Overflow incontinence
Describe the absolute contraindications to aerobic exercise during pregnancy
Hemodynamically significant heart disease
Restrictive lung disease
Incompetent cervix
Vaginal bleeding
placenta previta (placenta may detach)
Multiple gestation w/ risk of premature labor
Preecamplsia (high BP that occurs during pregnancy)
Rupture of membrane (“water broke”
Maternal type I diabetes
Severe anemia
Review the precautions and relative contraindications to exercise during pregnancy
Discontinue exercise and contact PCP:
Vaginal bleeding
Persistent pain
Leakage of amniotic fluid
Regular painful uterine contractions
Decreased fetal movements
Persistent SOB, irregular heartbeat
Dizziness, faintness, pain in calf, difficulty walking
Relative contraindications:
- Poorly controlled T1DB, HTN, seizure disorder, hyperthyroidism
- History of extremely sedentary lifestyle
- Overhearting
- Morbid obesity or extreme underweight
- Diastasis recti
- heavy smoker
- Arrhythmias, bronchitis
Describe how to assess for diastasis recti
Hooklying
Palpable separation of the rectus abdominis (2 cm)
A PT is treating a pregnant patient (32 wks gestation). The treatment requires the patient in supine. Which modifications to the supine position would be MOST appropriate?
Place pillows under R hip
Places patient in a semi L s/l position –> offloads the inferior vena cava that travels on the R side
When should supine be avoided during pregnancy?
Do not exceed 5 min in supine after the 1st trimester
Use a towel or wedge under the R hip instead
What other position (besides supine) should be avoided during mid-to-late pregnancy?
Prone
Why should pregnant patients be cautioned about orthostatic hypotension?
Increased BF to placenta
Describe each of the following considerations during pregnancy
Valsalva
Bladder emptying before exercise
SL exercises
Discourage / avoid Valsalva
Encourage complete bladder emptying before exercise
Limit SL exercises
- Relaxin hormone –> increased ligament laxity in pelvis
- SL exercises –> increased shear forces in pelvis / SI joint
Describe each of the following pelvic floor interventions
Contract-relax
Quick contractions
Pelvic floor relaxation
Contract-relax
- Contract pelvic floor
- Avoid valsalva maneuver
Quick contractions
- 15-20 reps of quick contractions
- Stimulate type II fibers to withstand quick pressure (sneezes, cough, etc.)
Pelvic floor relaxation
- Used for pelvic floor overactivity, dyspareunia
What muscles / movements can be used to improve recruitment of the pelvic floor musculature?
“Pelvic floor overflow recruitment”
Hip ERs & IRs
Hip adductors
What cue can be used to promote contraction of the pelvic floor?
“Stop the flow of urine”
Describe the easiest to hardest positions for pelvic contractions
Easiest –> hardest
Supine –> hooklying –> quadruped –> seated –> standing –> during activity
What is the Crede maneuver?
Application of manual downward pressure over the lower abdomen to promote bladder emptying in those w/ a flaccid bladder
What is suprapubic tapping?
Stimulates the detrusor muscle to assist w/ bladder emptying
Describe the primary interventions for each of the types of incontinence
Stress
Urge
Overflow
Functional
Stress
- Pelvic floor strengthening
Urge
- Pelvic floor strengthening
- scheduled voiding
Overflow
- Pelvic floor training
- Fluid regulation
- Improve flow (ex: surgery)
Functional:
- PT!
- Improve functional mobility
At what spinal cord level does micturition control arise from?
S2-4
How does the location of a SCI impact bladder function?
Lesion above the conus medullaris (L1 vertebral body) –> spastic / hyperreflexic bladder
- “UMN lesion”
- Reflex arc intact
- Reflexively empties w/ adequate filling pressure
Lesion below the conus medullaris –> flaccid / areflexic bladder
- “LMN lesion”
Describe the management of a spastic vs flaccid bladder
Spastic bladder:
- Suprapubic tapping
Flaccid bladder:
- Catheterization
- Valsalva maneuver straining
Describe how the location of a SCI can impact bowel function
Describe the management of each
Above conus medullaris –> spastic / reflexive bowel
- Reflex defecation when rectum fills
- Digital stimulation
Below conus medullaris - flaccid / areflexive bowel
- Manual evacuation
