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Genitourinary Flashcards

1
Q

Muscles of the Pelvic diaphragm of the Pelvic Floor

A

Levator ani: pubococcygeus, puborectalis, iliococcygeus, and coccyges (ischiococcygeus)

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2
Q

Muscles of the Urogenital diaphragm of the Pelvic Floor

A

Deep transverse perineal, urethrae sphincter

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3
Q

Muscles of the Urogenital triangle of the Pelvic Floor

A

Female: bulbocavernosus, ischiocavernosus, superficial transverse perineal
Male: bulbospongiosus, ischiocavernosus, superficial transverse perineal

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4
Q

Prostate

A
  • Internal organ lying inferior to the bladder
  • Produces and secretes fluid to combine with sperm, seminal vesicle fluid, and bulbourethral gland fluid to create semen
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5
Q

Kidneys Function in the Renal System

A

*Remove water, salt, and metabolic waste from the blood through excretion of urine
* Contribute to homeostasis including: acid-base balance, regulation of electrolyte concentrations, control of blood volume, and regulation of blood pressure through the control of hormones secreted into the bloodstream

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6
Q

Ureters Function in the Renal System

A
  • Muscular tubes connecting the kidneys to the urinary bladder to transport urine
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7
Q

Urinary Bladder Function in the Renal System

A
  • Muscular tube for excretion of urine
  • Semen transport during ejaculation in males
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8
Q

Which hormone, produced by the hypothalamus, stimulates the kidneys to conserve water?

A

Antidiuretic hormone

When blood pressure falls to dangerously low levels, antidiuretic hormone (ADH) helps to restore arterial pressure by causing intense vasoconstriction.

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9
Q

Skeletal muscle that surrounds the urethra as it extends through the pelvic floor is known as the:

A

external urinary sphincter

There are two urethral sphincters, specifically the internal and external urinary sphincters. The external urinary sphincter provides a second means of stopping the escape of urine from the body. This sphincter is under voluntary control.

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10
Q

The structure that connects the kidney to the urinary bladder is the:

A

ureter

The ureter is a tube that carries urine from the kidney to the urinary bladder. There are two ureters, one attached to each kidney. The upper half of the ureter is located in the abdomen and the lower half is located in the pelvic area.

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11
Q

What is the name of the male sex gland that surrounds the neck of the bladder and the urethra?

A

Prostate
The prostate is a gland within the male reproductive system that is located just below the bladder. The chestnut-shaped prostate surrounds the beginning of the urethra and makes fluid that is a component of semen.

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12
Q

What reflex stimulates the impending need to urinate when the bladder is filling?

A

vesical reflex

The vesical reflex refers to the sensation of a need to urinate when the bladder is moderately distended.

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13
Q

Anuria:

A
  • Inadequate urine output in a 24-hour period;
  • less than 100 mi (e.g., severe dehydration, shock, end-stage renal disease).
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14
Q

Benign prostatic hypertrophy:

A
  • A non-cancerous enlargement of the prostate gland that is progressive.
  • Common in males over 60 and can interfere with normal voiding.
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15
Q

Cystocele:

A

Bulging of the bladder into the vagina.

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16
Q

Ectopic:

A
  • Implantation of a fertilized ovum outside of the uterus.
  • The fallopian tube is the most common site of an ectopic pregnancy.
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17
Q

Endometrium:

A

The inner lining of the uterus that is shed monthly in response to hormonal influence.

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18
Q

Glomerular filtration rate:

A
  • An estimate of the filtering capacity of the kidneys;
  • volume of filtrate produced per minute by the kidneys.
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19
Q

Glomerulus:

A

The specialized tuft of capillaries that are needed for the filtration of fluid as blood passes through the arterioles of the
kidneys.

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20
Q

Hematuria:

A

Presence of blood in the urine (e.g., cancer, faulty catheterization, serious disease).

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21
Q

Impotence:

A

Impairment with ejaculation, orgasm, erection, and/or libido.

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22
Q

Myometrium:

A

The muscular outer layer of the uterus.

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23
Q

Nephrolithiasis:

A

The condition of developing kidney stones. There are various types of crystal formations that create stones.

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24
Q

Nocturia:

A

Urinary frequency at night (e.g., diabetes mellitus, congestive heart failure).

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25
Q

Oliguria:

A

Inadequate urine output in a 24-hour period; less than 400 ml (e.g., acute renal failure, diabetes mellitus).

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26
Q

Polyuria:

A

Large volume of urine excreted at one time (e.g., diabetes mellitus, chronic renal failure).

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27
Q

Perimetrium:

A

The serous peritoneal coat of the uterus.

28
Q

Radical mastectomy:

A

A surgical procedure in which the entire breast, pectoral muscles, axillary lymph nodes, and some skin are removed usually secondary to breast cancer.

29
Q

Rectocele:

A

The bulging of the anterior wall of the rectum into the vagina secondary to weakening of the pelvic supporting structures.

30
Q

Seminiferous tubules:

A

Coiled tubes found within each lobe of the testes where spermatogenesis takes place.

31
Q

Urea:

A

Major nitrogen-containing end product of protein metabolism normally cleared from the blood by the kidney into the urine.

32
Q

Urinary frequency:

A

Voiding more than eight times in a 24-hour period. Etiology may include overactive bladder, reduced bladder capacity, painful bladder syndrome or increased urine output caused by uncontrolled diabetes mellitus.

33
Q

Urinary urgency:

A

The sudden desire to urinate that is stronger than usual and difficult to defer. Etiology may include detrusor overactivity, bladder infection, inflammation or the presence of a foreign body such as stones or tumors. Urgency may lead to urinary urge incontinence.

34
Q

Thinning of the cervix is most accurately called:

dilation
effacement
lochia
menstruation

A

effacement

Effacement is the process by which the cervix prepares for the birthing process. Specifically, the term refers to the shortening or thinning of a tissue.

35
Q

Pus in the urine should be documented as:

A

pyuria

Pyuria is the presence of pus or white blood cells in the urine. This condition is often indicative of a urinary system infection.

36
Q

Which term is used to identify pain with urination?

A

dysuria

Dysuria refers to pain, discomfort or burning when urinating. It is more common in women than in men. Urinary tract infections are one of the leading causes of painful urination.

37
Q

Coccydynia

A
  • After childbirth the joint between the coccyx and sacrum can become hypermobile causing the soft tissue surrounding the coccyx to become painful.
  • Etiology - Subluxation during delivery, adherence to tear or episiotomy scar.
  • Signs and symptoms -
  • Difficulty sitting on hard surfaces,
  • referred pain to the low back, sacroiliac joint, hip, buttock, groin or rectum areas,
  • pain with bowel movements,
  • dyspareunia (painful intercourse),
  • formation of hemorrhoids.
  • Treatment - Treatment may include heat, external joint mobilization, myofascial release, muscle energy techniques, biofeedback for pelvic floor muscle relaxation, postural training, abdominal strengthening exercises, stretching exercises for surrounding muscles, and the use of a cushion for sitting.
38
Q

Diastasis Recti

A
  • separation of the rectus abdominis muscle along the linea alba that can occur during pregnancy.
  • Testing for diastasis recti should be performed on all pregnant women prior to prescribing exercises that require the use of the abdominals.
  • Etiology - The exact cause is unknown, however, theories indicate biomechanical and hormonal changes in women may cause the separation.
  • The therapist must note how many fingers fit into the separation and modify treatment accordingly.
  • Signs and symptoms - Therapist detects a separation greater than the width of two fingers when the woman lifts her head and shoulders off the plinth (Figs. 7-6, 7-7).
  • Treatment -
  • stabilization and support with abdominal strengthening exercises,
  • postural awareness exercises,
  • body mechanics training.
  • A newborn can also have diastasis recti secondary to incomplete development, however, in infants this condition usually resolves itself without intervention.
39
Q

Endometriosis

A
  • development of endometrial tissue, which normally lines the uterus, in extrauterine locations within the abdomen and pelvis.
  • most common location at the uterosacral ligaments. The level of pain does not always correlate with the severity of extrauterine tissue growth.
  • Etiology - The exact etiology of endometriosis is unknown.
  • During each menstrual cycle the endometrial tissue bleeds causing subsequent scarring and adhesions.
  • Signs and symptoms - Symptoms can vary,
  • moderate to severe lower abdominal, pelvic or low back pain before or during menstruation,
  • irregular menstrual cycles,
  • premenstrual spotting,
  • dyspareunia (pain with intercourse),
  • pain during defecation, and infertility.

*Treatment -
- manual techniques such as myofascial release, visceral mobilization and soft and deep tissue massage to break up scar tissue and adhesions.
- Mobility exercises are performed to sustain elongation of tissues.
- Relaxation exercises such as breathing routines and restorative poses are performed to regulate the pain cycle.
- TENS is also indicated.
- Pharmacological intervention may be indicated to alter hormonal balance using oral contraceptives and antigonadotropins.
- Surgery to remove extrauterine endometrial tissue, scarring, and adhesions; and a total hysterectomy may be recommended when pregnancy is no longer desired.

40
Q

Erectile Dysfunction

A
  • AKA impotence,
  • more prevalent in men with diabetes when compared to the general population,
  • Onset of ED in individuals with diabetes usually occurs 10-15 years earlier than in men without diabetes.
  • Etiology - There are various causative factors for ED. Diabetes is a primary etiology, while other risk factors include coronary heart disease, hypertension, hypothyroidism, hypopituitarism, multiple sclerosis, psychiatric disorders, excessive alcohol consumption, smoking, vessel disease, kidney disease, pharmacological side effects, and hormonal imbalances.
  • Signs and symptoms - The primary symptom is the consistent inability to maintain an erection adequate for sexual intercourse.
  • Treatment - Treatment varies and includes pharmacological intervention, surgical intervention, injections directly to the penis, and Kegel exercises.
41
Q

Neurogenic Bladder

A
  • damage to the cerebral control that allows for urinary dysfunction.
  • If the urine cannot be properly released, there may be an increase in UTI and kidney damage.
  • Etiology -
  • The etiology of neurogenic bladder can include diabetes, diminished bladder capacity, hyperactive detrusor muscle, CVA, other disease processes, infection, and nerve damage.
  • Signs and symptoms -
  • frequent UIT,
  • leakage of urine,
  • inability to empty the bladder or loss of the urge to urinate when the bladder is full.
  • Diagnosis should include an evaluation by a physician, X-rays, and urodynamics to assist with diagnosis.
  • Treatment - Management is dependent on the actual etiology with a goal of preventing bladder overdistention, UTIs, and renal damage.
  • Patient education, bladder techniques, lower abdominal massage, temporary catheterization, pharmacological intervention, and a timed urination program may be indicated.
42
Q

Piriformis Syndrome

A
  • persistent, severe radiating low back and buttock pain spanning from the sacrum to the hip and posterior thigh.
  • Controversy exists over piriformis syndrome’s efficacy as an accurate diagnosis.
  • Etiology - During pregnancy the piriformis may shorten or spasm due to postural changes and hip lateral rotation while walking.
  • Signs and symptoms - The primary symptom is sciatic paresthesia due to nerve entrapment as the sciatic nerve passes under or through the piriformis muscle.
  • Treatment -
  • Manual techniques for correcting pelvic or sacral alignment such as muscle energy techniques, joint mobilization, self-correction techniques for alignment, heat application, deep tissue massage, myofascial release, strain-counterstrain, abdominal strengthening, stretching exercises for both the piriformis and surrounding muscles, body mechanics, and postural education.
43
Q

Prostatitis

A
  • Prostatitis is an inflammation of the prostate gland.
  • Etiology - bacterial infection or the backup of prostate secretions within the gland.
  • Classification of prostatitis includes acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic pelvic pain syndrome (III), and asymptomatic inflammatory prostatitis (IV).
  • Signs and symptoms -
  • watery urethral discharge,
  • urgency,
  • frequency,
  • discomfort with urination,
  • pain with ejaculation.
  • Chronic pelvic pain syndrome manifests as pain in the perineum, rectum, prostate, penis, testicles, and abdomen.
  • Asymptomatic inflammatory prostatitis is characterized by prostate inflammation in the absence of genitourinary tract symptoms.
  • Treatment - Management includes lifestyle modifications, biofeedback training, stretching exercises, myofascial techniques, and bladder retraining. Pharmacological intervention such as antibiotics, alpha blockers or nonsteroidal anti-inflammatory medication for pain may be indicated.
44
Q

Renal Failure

A
  • kidneys experience a decrease in glomerular filtration rate and fail to adequately filter toxins and waste from the blood.
  • Etiology - Renal pathology typically occurs secondary to diabetes mellitus or hypertension, but can also occur from poison, trauma, and genetics. The nephrons are usually damaged and they lose their ability to filter the blood.
  • Renal failure can be classified as:
  • Acute (damage occurs quickly)
  • Chronic (damage occurs slowly)
  • End-stage (nearly total or total renal failure, dialysis required)
  • Signs and symptoms -
  • N/V
  • lethargy,
  • weakness,
  • hiccups,
  • anorexia,
  • ulceration within the Gl tract,
  • sleep disorders,
  • headache,
  • peripheral neuropathy,
  • anemia,
  • pruritus,
  • osteomalacia,
  • ecchymosis,
  • pulmonary edema,
  • seizures and coma.
  • Treatment - management of primary etiology, pharmacological intervention, diuretics, nutritional support, hydration, hemodialysis and/or transfusions if applicable.
  • conservative management and renal replacement therapy. Assists with slowing the process and assisting the body in its compensation.
  • Nutritional support, hydration, avoidance of protein, and pharmacological intervention are usually the primary basis of intervention.
  • Renal replacement therapy includes some form of hemodialysis and/or organ transplant.
  • Peritoneal dialysis is a form of renal replacement therapy that uses the peritoneal cavity as a semi-permeable membrane between the dialysate fluid and blood vessels of the abdominal cavity.
45
Q

Acute Renal Failure (ARF)

A
  • Sudden decline in renal function
  • Increase in BUN and creatinine
  • Oliguria, hyperkalemia, sodium retention
  • Prerenal etiology is secondary to a decrease in blood flow typically due to shock, hemorrhage, burn or pulmonary embolism
    Postrenal etiology is secondary to obstruction distal to the kidney due to neoplasm, kidney stone or prostate hypertrophy
  • Intrarenal etiology is secondary to primary damage of renal tissue due to toxins, intrarenal ischemia or vascular disorders
46
Q

Chronic Renal Failure (CRF)

A
  • Progressive deterioration in renal function
  • Diabetes mellitus
  • Severe hypertension
    *Glomerulopathies
  • Obstructive uropathy
  • Interstitial nephritis
  • Polycystic kidney disease
47
Q

Stages of Renal Failure

A

Stage 1 kidney damage with normal GFR (90 or greater)
Stage 2 mild decrease in GFR (60-89)
Stage 3 moderate decrease in GFR (30-59)
Stage 4 severe reduction in GFR (15-29)
Stage 5 kidney failure (GFR less than 15)

48
Q

Symphsis Pubis Pain

A
  • To prepare for delivery, the symphysis pubis joint becomes mobile in order to allow the joint to slightly separate during delivery.
  • Etiology - Postural adaptations, ligamentous laxity, and complications during delivery or birthing of a large infant can result in more severe injury to the soft tissues surrounding the joint.
  • Signs and symptoms - Severe pain in the symphysis pubis and sacroiliac joints as well as blood in the urine due to injury to the urethra or bladder neck.
  • Treatment -
  • Medical treatment includes pharmacological intervention for pain and surgical intervention based on the degree of separation in the joint.
  • Treatment may also include heat or ice if acute, manual techniques for correcting pelvic or sacral alignment such as muscle energy techniques, self-correction techniques for alignment, education on positioning, postural training, gait training, pelvic and lumbar stabilization exercises, and the use of a lumbo-pelvic brace or binder.
49
Q

Urinary Incontinence

A
  • involuntary loss of urine that is great enough to be problematic for the person and typically occurs when bladder pressure exceeds sphincter resistance.
  • General treatment includes pelvic floor muscle training using biofeedback, lifestyle modifications, bladder retraining, prompted voiding programs, urge suppression strategies, myofascial release, visceral mobilization, body mechanics, abdominal strengthening, and stretching exercises of surrounding muscles.
  • Pharmacological intervention to address urgency, injection therapy of a “bulking” agent, and surgical intervention for urethral and bladder positioning may also be indicated. These interventions may not apply to all types of urinary incontinence and should be determined on a per patient basis.

Etiology - The most common etiologies are detrusor muscle overactivity, overactive bladder also known as “urgency-frequency” syndrome, changes in the smooth muscle of the bladder, increased afferent activity, increased sensitivity of the detrusor to acetylcholine, and idiopathic.
- There is also association with the following neurological disorders: multiple sclerosis, spinal cord injury, cerebrovascular accident, and Parkinson’s disease.

Signs and symptoms -
- triggered by certain events due to a conditioned reflex.
- Two of the most common triggers are “key-in-the-lock” when arriving home and running water.

  • Treatment - Behavior modification is the primary goal of treatment for this condition. Biofeedback, pelvic floor strengthening, and bladder retraining (scheduled voiding) are key components in resolving UUI. Pharmacological intervention may also be warranted.
50
Q

Stress Urinary Incontinence (SUI)

A
  • loss of urine due to activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, running, and jumping.
  • typically it is less than 50 mL.
  • other manifestations: dribbling of urine, urgency, frequency, nocturia, and weak stream while voiding.
  • Risk factors: pregnancy, vaginal deliver, episiotomy, prostate or pelvic surgery, aging, DM, CNS and PNS dysfunction, and recurrent UTI
51
Q

Urge Urinary Incontinence (UUI)

A
  • Loss of urine after a sudden, intense urge to void due to the detrusor muscle of the bladder involuntarily contracting during bladder filling.
  • UUI is the most common incontinence in the geriatric population and among residents in long-term care facilities.
  • For some triggered by certain events and a conditioned reflex (key-in-lock or running water)
  • Treatment: behavior modification is the main one. biofeedback, pelvic floor strengthening, and bladder retraining.
  • MS, SCI, CVA, and PD are diagnoses that may have this
52
Q

Overflow Urinary Incontinence

A
  • loss of urine when the intra-bladder pressure exceeds urethra’s capacity
  • typically from prolapsed pelvic organ, stricture, enlarged prostate, chronic constipation or neurological disorder
  • difficulty initiating the stream of urine. Once initiated weak and has post void dribble.
53
Q

Functional Urinary Incontinence

A
  • inability or unwillingness of person to use the bathroom.
  • impaired mobility or cognition.
54
Q

Urinary Tract Infection (UTI)

A
  • very common and occur within the general population,
  • higher incidence in women and the geriatric population.
  • UTIs can be classified as uncomplicated, complicated, recurrent or chronic.
  • Etiology - bacteria infiltrate the urethra (termed urethritis) or further into the bladder itself (cystitis).
  • Untreated can spread and cause a kidney infection (ovelonephritis).
  • Diagnosis is confirmed with urinalysis.
  • Frequent UTIs may require ultrasound, intravenous pyelogram, and cystoscopy to further assess the function of the bladder.
  • Signs and symptoms -
  • increased frequency of urination, pain and/or burning with urination, cloudy urine, pressure above the pubic bone in women, shakiness, fever, back pain, and fatigue.
  • Treatment - Early treatment has the best results; delay in treatment may allow for serious infection to occur. Pharmacological treatment includes bacteria-specific antibiotics based on the bacteria found in the bladder. Patients are also encouraged to drink an excess of fluids to assist with treatment of the infection.
55
Q

Uterine Cancer

A
  • aka endometrial cancer. malignant growth of any cells that comprise of the uterus
  • Elevated levels of estrogen (without balancing progesterone) increase risk
  • Risk factors: advanced age, obestiy, DM, family history of uterine cancer, radiation thearpy to pelvis, medication (estrogen, tamoxifen), early onset of menstruation or late onset of menopasue, and nulliparity

S&S:
- unexpected vaginal bleeding
- abnormal menstrual cycles (premenopausal women)
- vaginal discharge (postmenopausal women)
- pelvic or lower abdominal pain
- painful urination
- painful intercourse

56
Q

Uterine Prolapse

A
  • descent of the uterus and cervix into the vagina.
  • The Baden-Walker System is the most widespread classification of prolapse using a five-point grading system ranging from no prolapse to maximum descent of vaginal tissue outside of the body.
  • Etiology - The etiology typically consists of genetics, enervation or direct muscle trauma (i.e., labor and delivery).
  • Signs and symptoms -
  • pelvic pressure that increases with exertion,
  • urgency, frequency, urinary incontinence,
  • incomplete bladder emptying,
  • discomfort,
  • vaginal dryness or irritation,
  • dyspareunia,
  • lower back pain that is relieved by lying down.
  • Treatment - Physical therapy treatment may include pelvic floor muscle training using biofeedback, Kegel exercises, core strengthening exercises, body mechanics, and symptom dependent lifestyle modifications.
  • In more severe cases, an intravaginal mechanical support device called a pessary may be indicated. The patient may require reconstructive or obliterative surgery, if conservative treatment fails.
57
Q

Where do kidney stones present with pain at?

A

Kidney stones typically present with right or left lower quadrant pain.

58
Q

Dysfunction of the detrusor muscle is a common cause of:

A

Urge incontinence

Urge incontinence is characterized as a sudden urge to void the bladder. It is often caused by an involuntary contraction of the detrusor muscle.

59
Q

Which type of incontinence would be demonstrated by a patient with a recent total hip arthroplasty being unable to make it to the bathroom in a timely manner?

A

functional incontinence

Functional urinary incontinence is the loss of urine due to the inability or unwillingness of a person to use the bathroom facilities prior to involuntary bladder release. A decreased level of mental awareness or a decrease in mobility are the two primary causative factors for functional urinary incontinence

60
Q

Kidney stones are most commonly treated via:

electrical stimulation
shock wave lithotripsy
Doppler ultrasonography
short wave diathermy

A

shock wave lithotripsy

Shock wave lithotripsy is a non-invasive attempt to break up the kidney stone by using sound waves. It is highly desirable compared to surgery because of its effectiveness and non-invasive nature.

61
Q

The most common sign of kidney disease is:

sodium retention
elevated blood urea nitrogen (BUN) levels
development of metabolic acidosis
inability to dilute or concentrate urine

A

elevated blood urea nitrogen (BUN) levels

Increased blood urea nitrogen (BUN) is usually an early indicator of decreased renal function. In general, a value of 7 to 20 mg/dL is considered normal.

62
Q

Which of the following causes the majority of urinary tract infections in patients who have been hospitalized?

decreased fluid intake
inadequate perineal care
catheterization procedures
immunosuppression

A

Catheterization procedures

Invasive procedures, such as catheterization, can introduce bacteria into the urinary tract. A lack of fluid intake could cause concentrated urine, but would not necessarily lead to urinary tract infection.

63
Q

Which of the following has signs and symptoms that can mimic an abdominal aortic aneurysm?

renal colic
nephritis
uremia
phimosis

A

renal colic

Renal colic is a type of pain caused by kidney stones. Kidney stones (urolithiasis) are crystals that form from chemicals in the urine. Signs and symptoms can mimic an abdominal aneurysm including abdominal pain, pulsating sensation near the umbilicus, and back pain.

64
Q

What physiological change would cause an older individual to have urinary incontinence for the past year?

A
  • decreased urge sensation
    bladder becomes full but bladder has decreased sensitivity.

Other options:
- decreased kidney filtration capacity: true but not primary reason. Responsible for incomplete excretion of waste

65
Q

How often in normal voiding (in the elderly and those younger)?

A

Elderly every 2 hours
Younger every 3-5 hours

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