genitourinary system and obstetrics Flashcards
1
Q
muscles of pelvic floor
A
- pelvic diagphragm: levator ani - pubococcygeus, puborectalis, iliococcygeus, coccygeus (ischiococcygeus)
- urogenital diaphragm: deep transverse perineal, urethrae sphincter
- urogenital triangle: female - bulbocavernosus, ischiocavernosus, superficial transverse perineal; male - bulbospongiusus, ischiocavernosus, superficial transverse perineal
- anal triangle: internal anal sphincter, external anal sphincter
2
Q
female geneital system
A
- external genitalia: provides protection and hydration of vaginal tissue and urethra
- vagina
- uterus: house fetus during development
- uterine tubes: transport for ovum from ovary fertilization and implantation within uterus
- overies
3
Q
male genital system
A
- penis
- scrotum: external sac for testes, ductus deferens, epididymis, nerves, blood vessels
- testes: produce sperm and hormons (testosterone)
- ductus/vas deferens: carries sperm from testes to seminal vesicle to form ejaculatory duct
- epididymis: encased within scrotum, stores sperm
- seminal vesicles: internal tubs that secrete thick fluid to combine sperm within ejaculatory duct
- prostate: internal organ inferior to bladder, secretes fluid to combine sperm, seminal vesicle fluid, bulbourethral gland fluid to create semen
4
Q
renal system
A
- two kidneys, two ureters, urinary bladder, urethra -> form and eliminate urine
- kidneys: remove water, salt, metabolic waste from blood through excretion of urine; contribute to homeostasis including - acid-base balance, regulation fo electrolyte concentrations, control of blood volume, regulation of BP through control of hormone secreted into blood stream
- ureters: muscular tubes connecting kidneys to urinary bladder to transport urine
- urinary bladder: temporary muscular reservoir for urine
- urethra: muscular tube for excretion of urine, semen transport during ejaculation in males
5
Q
endometriosis
A
- uterus
- development of endometrial tissue, which nomally lines uterus, in extrauterine locations within abdomen and pelvis - most commonly in uterosacral ligaments
- level of pain does not always correlate with severity of extrauterine tissue growth
- endometrial tissue bleeds during each menstrual cycle and causes subsequent scarring and adhesions
- s/s vary but typically include moderate to severe lower abd, pelvic, or BLOP before or during menstruation, irregular menstrual cycles, presmenstrual spotting, dysparenuia, pain during defecation, infertility
- treatment: TENS, pharm, surgery
6
Q
uterine prolapse
A
- descent of uterus and cervix into vagina
- Balden0walker system grades using 5-pt system ranging from no prolapse to max descent of vaginal tissue outside body
- symptoms vary - pn, incontinence
- PT: pelvic floor msucle training, kegel, core strength, surgery
7
Q
prostatitis
A
- inflammation of prostate gland
- d/t bacterial infection or backup of prostate secretions - chronic bacterial prostatitis, chronic pelvic pain syndrome, asymptomatic inflammatory prostatitis
- s/s: watery urethral discharge, urgencu, frequency, pain with ejaculation or urination
- treatment: lifestyle modifications, biofeedback, pharm, NSAIDs
8
Q
erectile dysfunction
A
- impotence, more prevalent in men with diabetes
- d/t diabetes, coronary heart disease, HTN, hypothyroidism, hypopituitarism, MS, psych, etoh, smoking, kidney, pharm side effects
- s/s: consistent inability to maintain erection for sexual intercourse
- treatment: variable, pharm, surgical, injections, kegels
9
Q
renal failure
A
- kidneys experience decrease in glomerular filtration rate and fail to adequately filter toxins and waste from blood - can be acute or chronic
- s/t DM or HTN but also from poison, trauma, genetics
- acute: damage occurs quickly
- chronic: damage occurs slowly
- end-stage: nearly total or total renal failure, dialysis required
10
Q
acute renal failure (ARF)
A
- sudden decline in renal function
- increase in BUN and creatinine
- oliguria, hyperkalemia, sodium retention
- prerenal etiology s/t decrease in blood flow
- postrenal etiology s/t obstruction distal to kidney
- intrarenal etiology s/t primary damage of renal tissue d/t toxins, intrarenal ischemia, vascular disorders
11
Q
chronic renal failure (CRF)
A
- progressive deterioration in renal function
- DM
- severe HTN
- glomerulopathies
- obstructive uropathy
- interstitial nephritis
- polycystic kidney disease
12
Q
stages of kidney disease according to national kidney foundation
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)
- s/s based on severity - N/S, lethargy, weakness, hiccups, anorexia, ulceration of GI tract, HA, neuropathy, anemia, coma)
- treatment: pharm, diuretics, nutritional support, hydration, pharmacological intervention, diuretics, nutritional support, HD, transfusions
13
Q
hemodialysis
A
- treatment process for advanced and permanent kidney failure - creates excess toxic waste, increased BP, retention of excess body fluids, decrease in RBC production
- removes blood from body along with waste, excess sodium and fluids
- cleanses blood and returns it to body
- usually 3x per week, each requires 3-5 hours to complete treatment
- side effects: anemia, renal osteodystrophy, pruitus (itching), sleep disorders (restless legs)
14
Q
neurogenic bladder
A
- damage to cerebral control that allows for urinary dysfunciton - can cause UTIs and kidney damage if urine cannot be properly release
- d/t DM, diminished bladder capacity, hyperactive detrusor muscle, CVA, infection, nerve damage
- s/s: frequent UTI, urine leakage, inability to empty bladder or loss of urge to urinate when bladder is full
- treatment: dependent on etiology
15
Q
urinary incontinence
A
- involuntary loss of urine
- general treatment: pelvic floor msucle training, lifestyle modifciations, bladder retraining, voiding programs, stretching, pharm intervention
- stress urinary incontinence (SUI): sneezing, courching, laughing
- urge urinary incontinence (UUI): sudden urge to void
- overflow urinary incontinence (OUI): bladder pressure exceeds urethra’s capacity to remain closed
- functional urinary incontinence (FUI): inability or unwillingness of person to get to bathroom before involuntary bladder relase
16
Q
stress urinary incontinence (SUI)
A
- loss of urine d.t activity that increase intra-abdominal pressure like sneezing, coughing, laughing, running, jumping
17
Q
urge urinary incontinence (UUI)
A
- loss of urine after a sudden, intense urge to void d/t detrusor muscle of bladder involuntarily contractin during bladder filling
- most common incontinence in geriatric population
- etiology: destrusor muscle overactivity, changes in smooth muscle of bladder, increased afferent activity, increased sensitivity of detrusor to ACh - also association with MS, SCI, CVA, PD
- s/s: triggered by key in lock, running water, conditioned reflex
- treatment: behavior modification, biofeedback, pelvic floor strenghtening, bladder retraining (scheduled voiding)
18
Q
overflow urinary incontinence
A
- loss of urine when intra-bladder pressure exceeds urethra’s capacity to remain closed d/t urinary retention
- caused by outflow obstruction s/t narrowed or obstructed urethra that results from prolapsed pelvic organ, stricture, enlarged prostate, chronic constipation
- s/s: difficulty initiating urine stream, eventual stram is weak and presents with post void dribble
- treatment: likely include surgical intervention if there is obstruction, strengthening if weakness, intermittent catheterization
19
Q
functional urinary incontinence (FUI)
A
- loss of urine d/t inability or unwillingness of person to use facilities prior to involuntary bladder release
- d/t decreased mental awareness or decrease in mobility - rarely seen w/o another bladder issue or neurological involvement
- s/s impaired cognition or mobility
- treatment: no urologic pathology associated with functional incontinence - address modifiable issue
- restricted mobility or dexterity, environmental barriers, mental and psychosocial disability, pharmacological intervention
20
Q
urinary tract infections (UTI)
A
- common - higher incidence in women and geriatric population
- can be uncomplicated, complicated, recurrent, or chronic
- when bacteria infiltrate in urethra (urethritis) or further into bladder (cystitis) - can spread and cause kidney infection (pyelonephritis)
- s/s increased urination frequency, pain/burning, cloudy urine, pressure, shakiness, fever, pain, fatigue
21
Q
coccydnia
A
- obstetric pathology
- aftery childbirth, joint btw coccyx and sacrum can become hypermobile causing soft tissue surrounding coccyx to become painful
- etiology: subluxation during delivery
- treatment: heat, external joint mobilization, pelvic floor muscle relaxation, postural training
22
Q
diastasis recti
A
- separation of rectus abdominis muscle along linea alba that occur during pregnancy
- testing on all pregnant women prior to prescribing exercises that require use of abdominals
- etiology: unknown, PT note how many fingers fit into seaparation (+ if > than 2 fingers when lifting head and shoulders of table)
- treatment: stabilization and support, ab stregnthening, postural awareness body mechanics
23
Q
piriformis syndrome
A
- severe radiatin LB and buttock pain spanning from sacrum to hip and post thigh
- etiology: in pregnancy, piriformis may shorten or spasm d/t postural changes and hip lateral rotation while walking
- s/s: sciatic paresthesia due to nerve entrapment as sciatic nerve passes under or through piriformis muscle
- treatment: manual techniques, heat, deep tissue, edu for body mehcanics, surrounding muscles
24
Q
sumphysis pubis pain
A
- symphysis pubis joint becomes mobile to allow joint to slightly separate during delivery
- etiology: postural adaptations, ligamentous laxiety, complications in delivery or birthing of large infant
- s/s: severe pain in symphysis pubis and SI joints, blood in urine d/t injury to bladder
- treatment: pharm internvetion for pain; stabilization exercises, use of lumbo-pelvic brace or binder
25
Q
physiological and postural changes during pregnancy
A
- weight gain btwn 25-35 lbs
- anemia
- uterus ascends into abdominal cavity becoming an abdominal organ
- ribs expand to accommodate uterine ascent
- respiratory diaphragm elevates 4 cm
- increased depth of respiration, tidal volume, minute ventilation
- increase O2 consumption (15-20%), blood volume (40-50%), cardiac output (30-60%)
- hypotension in supine position during pregnancy from pressure on inferior vena cava
- abdominals overstrethced
- ligaments become lax s/t hormonal change
- joints hypermobile
26
Q
exercise and pregnancy
A
- use 50-60% max HR for exercise, approx 30 minute session
- NWB activities preferred d/t continuous change in COG and balance
- avoid overtiring and supine position after first trimester
- pelvic floor muscle exercise:
26
Q
contraindications to exercise in pregnancy
A
- relative
- severe anemia
- unevaluated maternal cardiac dysrhthmia
- chronic bronchitis
- poorly controlled T1D
- extreme morbid obesity
- extreme underweight
- history of extremely sedentary lifestyle
- poorly controlled HTN
- ortho limitations
- poorly controlled seizure disorders
- heavy smoker
- absolute
- hemodynamically significant heart disease
- restrictive lung disease
- incompetent cervix
- multiple gestation at risk for premature labor
- persistent second or third trimester bleeding
- placenta previa
- premature labor
- ruptured membranes
- preeclampsia, pregnancy-induced HTN
27
Q
american college of obstetricians and gynecologists (ACOG) recommendations for exercises in preg and postpartum
A
- continue to exercise and derive helath benefits from mild to mod exercise routines; exercise regularly (3x per week at least)
- avoid exercise in supine after first trimester -> could lead to decreased CO
- decreased O2 available for aerobic exercise in pregnancy; avoid exhaustion
- morphologic changes affect balance and abdominal trauma avoided
- additional 300 cal/day to maintain metabolic homesotasis (adequate diet)
- augment heat dissipation by ensuring adequate hydration, appropriate clothing
- pre-pregnancy routines should be resumed gradually upon a woman’s physical capability
27
Q
guidelines for working w/ high risk pregnancy patients
A
- L sidelying is best positoin
- abdominal exercises should be modified or discontinued
- keep things slow, simple, smooth, minimal exertion
- avoid valsalva
- educate
27
Q
overactive bladder agents
A
- relieve symptoms of overactive bladder - noted by involuntary contractions of bladder (detrusor muscle)
- ditropan, detrol
28
Q
urinary anti-infective agents
A
- treat UTI but are not traditional antibiotics
- can be independently used or with other meds
- cinobac, furadantin
29
Q
anuria
A
- inadequate urine output in 24 hr period
- less than 100 ml
- severe dehydration, shock, end stage renal disease
30
Q
benign prostatic hypertrophy
A
- non-cancerous enlargement of prostate gland that is progressive
- common in males > 60 YO
- can interfere with normal voiding
31
Q
cystocele
A
- bulging of bladder into vagina
32
Q
ectopic
A
implantation of fertilized ovum outside uterus, fallopian tube is most common site of ectopic pregnancy
33
Q
endometrium
A
- inner lining of uterus shed monthly in response to hormonal influence
34
Q
glomerular filtration rate
A
- an estimate of the filtering capcity of kidneys
- volume of filtrate produced per minute by kidneys
35
Q
glomerulus
A
- specialized tuft of capillaries needed for filtration of fluid as blood passes through arterioles of kidneys
36
Q
hematuria
A
presence of blood in urine
37
Q
myometrium
A
muscular outer layer of uterus
38
Q
nephrolithiasis
A
condition of developing kidney stones
39
Q
nocturia
A
- urinary frequency at night
40
Q
oliguria
A
- inadquate urine output in 24 hour period, less than 400 ml
41
Q
polyuria
A
- large volume of urine excreted at one time
42
Q
perimetrium
A
serous peritoneal coat of uterus
43
Q
radical mastectomy
A
surgical procedure in which breast, pectoral muscles, axillary lymph nodes, some skin are removed usually secondary to breast cancer
44
Q
rectocele
A
bulging of anterior wall of rectum into vagina s/t weakening pelvic supporting structures
45
Q
seminiferous tubes
A
coiled tubes found within each lobe of testes where spermatogenesis takes place
46
Q
urea
A
major nitrogen-containing end product of protein metabolism normally cleared from body by kidney into urine
47
Q
urinary frequency
A
voiding > 8 times in 24 hour period
48
Q
urinary urgency
A
sudden desire stronger than usual to urinate, difficult to defer
