Genitourinary System Flashcards
Differentiation of male and female gonads occurs at:
-6 weeks after fertilization
Testes
-production of gametes and sex hormones
Epididymis
-conducts sperm from efferent tubules to vas dererens
Scrotum
-protects testes, epididymides, spermatic cord
Penis
-delivery of sperm to female vagina and elimination of urine
Sex Hormones (Male)
-Androgens
testosterone is primary sex hormone
Pathologies of Male Reproductive System
- prostatitis
- benign prostatic hyperplasia
- prostate cancer
- orchitis
- epididymitis
- testicular torsion
- testicular cancer
- impotence
Prostatitis
- inflam/infection of prostate
- acute/chronic
- bacterial/nonbacterial
- preceded by UTI
- more pain than BPH
Diagnosis of Prostatitis
- urinalysis
- specimen analysis
- DRE
Treatment of Prostatitis
- meds
- TURP (Trans urethral prostatectomy)
Acute Prostatitis
-very painful
Chronic Prostatitis
- wax/wane over time
- some meds
Most Common Type of Prostatitis
-nonbacterial
S/Sx of Prostatitis
-table 19-1 (p966)
BPH
- benign prostatic hyperplasia
- most common in older men (>50)
- non-malignant enlargement of prostate gland
S/Sx BPH
- related to effect on lumen of urethra
- urine retention
- trouble getting flow started
- progress:
- -to UTI
- -hydroureter
- -hydronephrosis
- -renal failure
- -death
Diagnosis of BPH
- history
- palpation
- urodynamic tests
Treatment of BPH
- based on level of obstruction
- monitoring
- TURP vs TUIP
- meds
- thermotherapy (microwave/laser to destroy prostate tissue)
TUIP
-Transurethra incision of prostate
TURP
-transurethral prostatectomy
Common Questions for BPH
- do you urinate often (esp at night)?
- trouble starting or continuing urine?
- weak flow of urine or interrupted urine stream?
- feel like bladder not emptying completely?
If yes (and unexplainedLBP, pelvis, hip, upper thigh pain), refer
Prostate cancer tends to start:
- at outer edge of prostate
- gets bad before detecting b/c it starts away from urethra (silent for a while)
Most common cancer of US males
- prostate cancer
- second most common cause of male death from cancer
S/Sx Prostate Cancer
- variable
- lymph nodes in groin
- abdominal swelling
- may show up as urinary S/Sx or constitutional S/Sx
- asymptomatic until well-progressed
Prostate Cancer Metastasizes to:
- bone (usually)
- lungs
- liver
Prostate Cancer Dx
- DRE
- PSA Serum assay after age 50
- radiologic studies
- biopsy
Primary Prevention of Prostate Cancer
- increasing lycopene
- vitamine E
- selenium
- decrease fat in diet
RT-PCR
- reverse transcription-polymerase chain
- new test for Prostate Cancer
Prostate Cancer Treatment
- observation
- prostatectomy
- radition
- hormonal therapy (orchiectomy)
- pelvic floor rehab after prostate resection
BPH Risk Factors
- > 50 yo
- west (USA)>east
- Black>white
- tobacco>alcohol
Prostate Cancer Risk Factors
- > 50 yo
- USA & Scandinavia
- Black
- Alcohol
- Family History
- high-fat diet
- Environmental Cadmium
Epididymitis
-inflammatory condition of epididymis
Orchitis
-inflammatory condition of testes
Risk Factors for Orchitis & Epididymitis
- sexually active men with multiple partners
- primary infections arising elsewhere in body (esp GU)
S/Sx of Orchitis
-low abdominal pain
S/Sx Epidiydimitis
- low abdominal
- groin
- hip adductors
Treatment of Orchitis & Epididymitis
- NSAIDS
- antibiotics
- bed rest
- scrotal support
Orchitis & Epididymitis
-can be associated with pneumonia
Testicular Torsion
- abnormal twisting of spermatic cord as testes rotates
- medical emergency (surgery needed to preserve testes within 3 hours)
Testicular Torsion often concurrent with:
- congenital abnormalities
- males 8-18 years or neonates
S/Sx Testicular Torsion
- abrupt pain
- scrotal swelling
- N/V
- tachycardia
Testicular Cancer
- most common cause of cancer in young men
- second most common in 35-39 yo
Caues of Testicular Cancer
- unknown
- family history (genetic)
S/Sx Testicular Cancer
- painless enlargement of testicle
- lumbar pain
- metastasis to lungs
Testicular Cancer Metastases
- lungs
- -cough, dyspnea, bloody sputum
Early Detection of Testicular Cancer
-testicular self-exam
Diagnosis of Testicular Cancer
- palpation
- serumm assays
- US
- radiologic studies
Treatment of Testicular Cancer
- removal of mass (radiation, chemo, surgery)
- relapse not common
Impotence/ED
- increases with age
- consider Kegel Exercises
- can be warning of ischemic heart disease
Vagina
- epithelial cells responsive to hormonal changes
- protection from infection
- permits stretch during coitus/child birth
- self-cleanses
Cervix
- neck of uterus
- projects into vagina
Uterus
- muscular organ
- anchors nad protects fertilized ovum
Fallopian Tubes
-conduct ova from spaces around the ovaries to uterus
Ovaries
-produce ova and female sex hormones
Sex Hormones (Female)
-estrogens, progesterone, androgens
Cancer Screening of Female Reproductive System
- abnormal bleeding
- pelvic pain
- gastrointesintal disturbances
- urinary disturbances
- abnormal swelling
- changes in vulva/vagina
- LBP
S/Sx of Endometriosis
- pain
- inflam
- infertility
- rectal bleeding
- fatigue
S/Sx Ovarian Cancer
- silent
- vague symptoms (abdominal bloating, discomfort, fatigue, malaise, flatulence, gastritis)
- less common Sx: abn vaginal bleeding, leg pain, low back pain, pelvic pain,
Risk Factor of Ovarian Cancer
-Family History
Diagnosis of Endometriosis
- laparoscopy
- laparotomy
- US
- MRI (more sensitive)
Treatment of Endometriosis
- preservation of fertility
- pain relief
- ovulation inhibition
Diagnosis of Ovarian Cancer
- US
- Cervical smear
Treatment of Ovarian Cancer
- Surgery (local/regional)
- chemotherapy (adjuvant)
- under investigation (monoclonal antigodies, gene therapy, vaccines)
Ovarian Cystic Disease
-most are benign
-most common form of ovarian tumor
-4 Types (S/Sx dep on size/location of cyst)
-
S/Sx Ovarian Cystic Disease
- abdominal pressure, pain
- bloating
- painful urination
- bowel movements
- intercourse
- chronic pelvic pain
- episodic pain in abdomen, groin, buttocks, LBP
PCOS
-polycystic ovary syndrome
PCOS Manifestations
- obesity
- prominent facial/body hair
- severe acne
- thinning hair
- infertility
- dysmenorrhea
- impaired glucose tolerance
- obstructive sleep apnea
- fibrocystic breasts
Diagnosis of Ovarian Cystic Disease
- pelvic exam
- ultrasound
- laparoscopy
- lab tests
Treatment of Ovarian Cystic Disease
-based on age and Sx
- drainage of cyst
- surgical excision
- hormonal therapy
- DM management techniques
Uterine Fibroids
- painful growths of uterus
- primary reason TAH (total abdominal hysterectomy)
S/Sx Uterine Fibroids
- pain
- increased bleeding
- urinary frequency
- asymptomatic
Treatment of Uterine Fibroids
- meds
- surgery
- fibroid embolization ablation
- diet
Most Common Cancer of Reproductive Organs
Uterine Cancer
Risk Factors of Uterine Cancer
- age
- HTN
- DM
- Social/lifestyle (exercise is good)
S/Sx Uterine Cancer
- abnormal bleeding
- LE swelling
Treatment of Uterine Cancer
- BSO (bilateral sypingo-oophorectomy)
- TAH
- Hormonal Therapy
- radiation/chemo
Diagnosis of Uterine Cancer
- endometrial sampling
- US
Cervical cancer
- pap smear drastically reduced mortality rate
- primary cause: HPV
S/Sx Cervical cancer
- abnormal bleeding
- bowel/bladder dysfunction
(Late disease Sx)
Cervical cancer Diagnosis
- pap smear
- sentinal lymph node assessment
- CT scan
Cervical CancerTreatment
- Excision (local/regional)
- radiation
- chemo
Ectopic Pregnancy
-gynecological emergency
-
Risk Factors of Ectopic Pregnancy
-fallopian tubes
S/Sx Ectopic Pregnancy
- lower abdominal quadrant/pelvic pain
- possible Kehr’s sign
- irregular bleeding
Diagnosis of Ectopic Pregnancy
- physical exam
- US
- lab tests
- laparoscopy
treatment of Ectopic Pregnancy
- laparoscopy
- laparotomy
- possible chemo (to get rid of damaged/abnormal tissue)
Kehr’s Sign
- Left shoulder pain with splenic irritation
- usually with peritonitis
Rupture of Right Ovary refers to
-right shoulder (irritates liver)
Effects of Pregnancy
- relaxin
- center of gravity shift
- pressure on vascular structures
- increased cardiac demand/output
- increased need for folic acid
Primary Dysmenorrhea Pathophys
-excessive endometrial prostaglandin production
S/Sx Primary Dysmenorrhea
-pelvic pain with onset of menses, backage, anorexia, vomiting, diarrhea, syncope, headache
Eval/treatment of Primary Dysmenorrhea
- medical Hx
- pelvic exam
- hormonal contraceptives may relieve pn
- TENS to relieve pn
PMS Pathophys
- abnormal tissue response to normal change of menstrual cycle triggered by fluctuating estrogen and progesterone levels
- asssociated with genetic predisposition
S/Sx PMS
-over 200 physical, emotional, behavioral Sx
Pelvic Inflammatory Disease Pathophys
-pelvic infection caused by microbes ascending through cervix to infect uterus
S/Sx PID
-range from sudden and severe abdominal pain to no Sx at all, pain onset may be slow and steady or exacerbated by walking, jumping, or intercourse
PID
pelvic inflammatory disease
PID Eval
- diagnosis based on pt Hx
- Sx
- evidence of infective agents
PID Treatment
- bed rest
- avoid intercourse
- antibiotic therapy
- surgery required if pelvic adhesion
Breast cancer: more masses in____
-axillary tail than any other part of breast
female breast
-function is to provide nourishment for newborn
breast nobes
-15-20 per breast
nipple
deliver breast milk
breast nodules
-20-40 lobules per lobe
breast acini
-lined with epithelial cells capable of contracting to secrete milk
Sub-areolar structures
- fatty/fibrous tissue
- few duct-like structures in sub-areolar area
Fibrocystic Disease & Fibroadenoma
-benign changes/tumors in breast
S/Sx of Fibrocystic Disease & Fibroadenoma
- Cysts
- fibrous tissue
- bilateral pain/tenderness
- (especially as menstruation approaches)
Risk Factors for Fibrocystic Disease & Fibroadenoma
- age
- menstrual Hx
- pregnancy Hx
- prior breast biposies
Diagnosis of Fibrocystic Disease & Fibroadenoma
- physical exam
- mammography
- biopsy
- US
Treatment of Fibrocystic Disease & Fibroadenoma
- palliative
- reduce caffeine/xanthines
- low-fat diet
- analgesics
- adequate undergarment support
- synthetic androgen for severe pain
- surgical excision
Breast Cancer: Females
- most common female cancer in US
- Same risk factors as Fibrocystic Disease & Fibroadenoma
- 6 types of cancer
Breast Cancer Etiology
female
- has some genetic basse but largely unknown
- estrogen seems to be key factor in promoting disease
S/Sx Breast Cancer
- painless lump
- dimpling/retraction of breast
- nipple discharge
- local rash/ulceration
- palpable lymph nodes in axila
- bone pain (metastases in vertebrae)
Breast Cancer Diagnosis
- clinical exam
- mammography
- percutaneous needle aspiration
- biopsy
- US
- ductal lavage
- hormone receptor assays
Treatment Breast Cancer
- based on stage
- surgery
- radiation
- hormone therapy
- biologic therapy
- biologic therapy
- bone marrow transplantation in cases of metastases
Prevention of Breast Cancer
- BSE (breast self-exam) monthly
- periodic dr. performed breast exams
- mammogram every 1-2 years after 40 yo
Male Breast Cancer S/Sx
- nipple discharge
- skin retraction
- ulceration of skin over tumor
- axillary node involvement
- pattern of metastases same as females
Gynecomastia Pathophys
- overdevelopment of breast tissue in males
- 32-40% of male population
- can be made of: fat, glandular or combination
Glandular characteristics
-small button or small fingers spreading into chest fat
Eval/Treat Gynecomastia
- diagnosis on phyical exam
- monitor for malignancy
- reconstructive surgery
