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5 Pathology > L4 Genitourinary > Flashcards

L4 Genitourinary Flashcards

1
Q

What is the PTs role in GU disorders?

A

-recognize S/S of GU dysfunction
-understand how GU disorders impact rehab
-follow guidelines for interventions
-recognize common referral of pain areas of GU

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2
Q

Normal age related changes of GU system

A

-Decreased blood flow to kidneys
-Increased volume of urine and decreased bladder capacity
-shift toward nocturnal urine production

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3
Q

Hyponatremia

A

low level of sodium in the blood

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4
Q

Functions of kidneys

A
  1. excretion of cellular waste productions
  2. regulation of blood volume
  3. electrolyte regulation
  4. Acid-base regulation
  5. Arterial BP regulation
  6. EPO secretion
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5
Q

Common S/S of genitourinary pathology

A

Pain
Change in voiding habits

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6
Q

Pain (S/S of genitourinary pathology)

A

Varies according to origin

Pain generally described as wave-like, burning, or dull ache in abdomen, back, buttocks

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7
Q

Innervation of urinary system

A

T10-S4

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8
Q

Kidney Innervation

A

T10 to L1
Pain referral can be lumbar spine, upper abdomen
Will be the same side as the affected kidney

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9
Q

Ureter Innervation

A

T11-L2, S2-S4
Pain referral can be groin, upper/lower abdomen, scrotum, medial/proximal thigh, thoracolumbar region

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10
Q

Urinary Bladder Innervation

A

T11-L2, S2-S4
Pain referral can be in sacral apex, suprapubic region, thoracolumbar region

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11
Q

Change in voiding habits (s/s of pathology)

A

Urinary frequency
Urinary urgency
Nocturia
Polyuria
Oliguria
Dysuria
Hematuria
Decreased force of urinary flow
urinary incontinence
dyspareunia

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12
Q

Urinary frequency

A

of times a day
lower UTI

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13
Q

Urinary urgency

A

how much you need to pee
lower UTI

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14
Q

Nocturia

A

night urination
diabetes, heart failure

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15
Q

Polyuria

A

> 2.5 L per day
increased fluid intake, diabetes, chronic kidney disease

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16
Q

Oliguria

A

<400 ml a day
dehydration, renal failure

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17
Q

Anuria

A

<100 ml a day
dehydration, renal failure

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18
Q

Dysuria

A

painful
lower UTI

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19
Q

Hematuria

A

must report to MD ASAP
blood in urine
traumatic foley catheter, renal disease, cancer

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20
Q

Decreased force of urinary flow

A

prostate enlargement, urethral obstruction

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21
Q

Urinary Incontinence

A

inability to control voiding
SCI, dementia, CNS issues

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22
Q

Dyspareunia

A

pain during intercourse
more common in women
endometriosis, UTI, post menopause

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23
Q

Diagnostic tests for GU system pathology

A

Urinalysis
Creatinine Tests
Blood Urea Nitrogen

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24
Q

Urinalysis

A

Looks at color, odor, pH, specific gravity, absence of certain materials

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25
Q

Urine color

A

varies from almost colorless to dark yellow
depends on fluid, supplement, dietary intake

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26
Q

Urine odor

A

should not be strong (normal)

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27
Q

Specific Gravity

A

a measure of solutes in the urine
should be 1.002 to 1.028

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28
Q

pH of urine

A

4.6 to 8.0

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29
Q

Urine should have an absence of

A

glucose, ketones
proteins
Hb/RBcs
Bilirubin
WBCs, bacteria

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30
Q

Glucose/Ketones in urine indicates

A

diabetes or keto diet

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31
Q

Proteins in urine indicates

A

GFM damaged, kidney disease

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32
Q

Hb/RBCs in urine indicates

A

cancer, excessive exercise

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33
Q

Bilirubin in urine indicates

A

live or bile duct problems

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34
Q

WBCs/bacteria in urine indicates

A

infection

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35
Q

Plasma Creatinine

A

Increased levels are indicative of decreased renal function

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36
Q

Creatinine Clearance

A

24 hr urine test, approximates GFR

decreased Cr clearance is indicative of decreased renal function

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37
Q

Blood Urea nitrogen

A

increased BUN indicates: decreased renal function or fluid intake, increased muscle catabolism, increased protein intake, acute infection

To implicate decreased renal function, BUN levels need to be correlated with plasma Cr levels

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38
Q

Mental status and BUN

A

alterations in BUN and creatinine levels may lead to alteration in patients mental status

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39
Q

X-rays are used to diagnose

A

kidney stone

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40
Q

IVP

A

blood flow

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41
Q

Cystoscopy

A

inspection of inside of bladder

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42
Q

Uroflowmetry

A

force of flow test

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43
Q

Radioisotope studies

A

diagnosis of kidney function
mostly used for those that need to receive a kidney

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44
Q

Ultrasonagraphy

A

shape of kidney

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45
Q

UTI

A

infection within the urinary tract

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46
Q

Lower UTI

A

bladder and/or urethra

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47
Q

Upper UTI

A

kidneys and/or ureters

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48
Q

Epidemiology and Risk Factors for UTIs

A

-highest incidence in individuals in skilled nursing/extended care facilities
-most common is urinary catheterization
-Increased age, diabetes, sexually active females

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49
Q

Clinical presentation of UTI

A

altered mental status, shortness of breath, nausea/vomiting

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50
Q

Relationship to falls and UTI

A

more likely to fall with altered mental status

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51
Q

Increased age and UTIs

A

lower immune system, decreased personal hygiene, increased sedentary time

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52
Q

Diabetes and UTI

A

decreased immune response, increased bacteria, neuropathy

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53
Q

Pathogenesis of UTI

A

usually gram-negative bacteria ascending into the urinary tract from the urethra

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54
Q

Changes in voiding habits and UTI

A

frequency, urgency, dysuria, nocturia, dyspareunia

cloudy, bad-smelling urine, or hematuria

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55
Q

Pain and Lower UTI

A

generally sudden onset of symptoms
hallmark: dysuria

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56
Q

Upper UTI pain

A

typically gradual onset and systemic symptoms like fever, chills, malaise

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57
Q

general UTI pain

A

suprapubic, lower abdomen, groin, flank or back pain, shoulder pain possible

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58
Q

Shoulder strap pain

A

infectious agents and/or inflammatory mediators can diffuse locally and activate afferent endings in diaphragm

visceral pain can be referred to shoulder pain

due to the convergence of sensory neurons on the same group of dorsal horn neurons in spinal segment

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59
Q

Insidious onset of back pain complaints

A

make sure to ask about history of recent infection
ask about changes in voiding habits, systemic S/S

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60
Q

Dx and Tx of UTI

A

Dx: History and urinalysis
Tx: increased hydration, ABX
Cranberry juice is statistically insignificant for treatment, and does not prevent

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61
Q

Pyelonephritis

A

infectious, inflammatory disease presumed to be caused by bacterial invasion of renal parenchyma

Can be acute or chronic

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62
Q

Acute Pyelonephritis

A

most common cause is backwards flow of infected urine from bladder into upper urinary tract.
often called ascending UTIs
sometimes caused by blood borne pathogens

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63
Q

Chronic Pyelonephritis

A

kidneys become increasingly damaged due to repeated urinary infections

can lead to scarring and loss of kidney function

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64
Q

Acute CP of Pyelonephritis

A

fever, chills, flank pain
pain over costovertebral angle
urinary frequency, dysuria, suprapubic discomfort

physical findings can vary

65
Q

Chronic CP Pyelonephritis

A

weakness, loss of appetite, HTN, anemia, protein and blood in urine

66
Q

Pyelonephritis pain referral

A

flank

67
Q

Pain referral areas of kidneys

A

ipsilateral for involved kidney

68
Q

Kidney Stones

A

renal calculi or lithiasis

3rd most common GU disorder
Can be in the urinary tract or kidneys

Generally due to increased blood concentration and urinary excretion, infection

can cause urinary obstruction

69
Q

Composition of kidney stones

A

Dietary intake can impact reoccurrence

Calcium/calcium oxalate= 75%
Struvite = 15%
Uric acid = 6%
Cystine = 2%

70
Q

Kidney Stones RF

A

30s-50s
males
excessive calcium, oxalate, purines
dehydration

71
Q

CP of kidney stones

A

HALLMARK COMPLAINT: abrupt pain associated with urinary tract obstructions, known as renal collic

pain starts with stone leaves kidney. Generally abrupt onset

72
Q

Kidney stones pain referral

A

L side

73
Q

Dx Kidney Stones

A

urinalysis, looking for hematruia, infection, crystals.
Can identify location of stones with IVP or CT

74
Q

Tx of kidney stones

A

time, plus pain meds, hydration, ABX if needed
extracorpreal shock wave therapy (ESWL)

75
Q

Prevention of kidney stones

A

needed for high rate of recurrence
hydration, dietary change (specifically spinach to decrease oxalate)

76
Q

Glomerulonephritis

A

Group of disease that damages glomerular portion of the kidney
condition accounts for 50% of pts requiring dialysis

77
Q

RF for chronic glomerulonephritis

A

diabetes
systemic lupus
HTN

78
Q

Many types of glomerulonephritis result from

A

immunologic problems !!
drug toxin effects
vascular diseases
systemic disorders

79
Q

Patho glomerulonephritis

A

Immune: immune complexes form in the circulation and get trapped in membrane, producing inflammatory reaction and histological changes

vascular: capillaries become permeable, leading to proteinuria, hematuria, edema

80
Q

CP of Glomerulonephritis

A

HTN
proteinuria, pyuria, hematuria
edema (albumin pulls water towards it)

81
Q

Dx and Tx of Glomerulonephritis

A

Dx: urinalysis, HTN
Tx: SAIDs, dietary changes, dialysis, renal transplant. Treatment of primary disease!

82
Q

Tips for working with pts with glomerulonephritis

A

pts with DM, SLE, hepatitis, HTN, vasculitis have higher chance of chronic glomerulonephritis

be alert to NEW edema and HTN
ask about hematuria and oliguria, pts are often on diuretics

call primary physician to report new S/S

83
Q

ADRs of Diuretics

A

muscle weakness or cramps, fatigue, nausea, headache, dizziness, orthostatic hypotension, hypokalemia

84
Q

Chronic Kidney Disease

A

progressive loss of renal function with permanent loss of nephrons due to multiple causes that continues to worsen even after causes are removed

deterioration of kidney function is variable

> 30 mi americans are affected

85
Q

RF of Chronic Kidney Disease

A
  1. leading causes of new cases are DM (44%) and HTN (27%). Higher incidence in african americans
  2. Overconsumption of NSAIDs
  3. Age >65
86
Q

CP of Chronic Kidney Disease

A

5 stages, s/s depend on severity and rapidity of failure, each stage is defined by eGFR

fatigue, weight loss, metallic taste in mouth, nausea, pruritus

87
Q

End stage renal disease

A

<15% of kidney function

88
Q

Neuromusculoskeletal CP of Chronic Kidney Disease

A

mental dullness
renal osteodystrophy, bone demineralization
muscle, joint, bone pain
extraskeletal calcification
restless leg syndrome

89
Q

Cardiovascular CP of Chronic Kidney

A

dyspnea, orthopnea
edema
HTN
pericardial chest pain (nerves get bugged by edema)

90
Q

Renal osteodystrophy

A
  1. Kidney failure, decreased GFR, calcitriol
  2. Secondary hyperparathyroidism, altered calcium set point
  3. Gut absorption of Ca, decreased calcium absorption, increased phosphate retention
  4. Bone remodeling, bone resorption

Altered set point of blood calcium, it all causes increased mobilization of calcium into blood. hyper phosphate in blood

91
Q

Dx of Chronic Kidney Disease

A

S/s
Bun and Cr values (from eGFR)
imaging
serum PTH

92
Q

Prognosis of Chronic Kidney Disease

A

Mortality rate of those >65 yr on dialysis is 7x that of age matched norms not on dialysis

People >60 year who start dialysis have life expectancy of 5 yrs

93
Q

Tx options for Chronic Kidney Disease

A

Conservative: HTN tx, dietary changes, anemia control, calcitriol meds. For everyone, every stage

End stage: renal replacement, dialysis, transplant

94
Q

Functions of Vitamin D

A

Active form of vitamnin D = CALCITRIOL

Promotes mineralization of new bone
increases calcium and phosphate absorption from gut
stimulates calcium, phospahte reabsorption

overall result of Vit D: increased plasma concentrations of Ca and phosphate

95
Q

Renal Replacement

A

dialysis
renal transplant

Kidneys comprise 2/3 of organ transplant waiting list
median waiting time is 3.6 years

96
Q

Dialysis outcomes

A

71% unemployment
little improvement in survival after dialysis
no significant improvement in health related QOL

97
Q

Exercise training in adults with CKD

A

improves BP control and lipid profiles
improve glucose metabolism
increase hematocrit and hemoglobin
resistance training helps with bone density
increase functional capcity

98
Q

Research and CKD exercise

A

Benefits of exercise for CKD
26% decrease in use of antihypertensive meds after 3 months of cycling during dialysis
$885 savings annually

combined aerobic and resistance is the best for those with CKD

99
Q

Why is exercise not encouraged for those doing hemodialysis

A

lack of awareness of benefits
fear that it will cause harm

100
Q

ACSM Guidelines for CKD

A

20-60 min of continuous activity 3-5 days a week
can use 3-5 min bouts

Resistance: 65% to 75% of 1 RM. Make sure to estimate, don’t perform

101
Q

No exercise with CKD if

A

BP >200/100 mmHP
Serum K> 5 mEq
WBC <5000 or 10000 w/fever
Hct <25% or Hb <8
Platelets <20,000

102
Q

AV fistula and exercise

A

be alert to infection risk
hand-washing is essential
do not measure BP on UE

avoid placing weight or pressure on the fistula

103
Q

Potassium normal value

A

3.7 to 5.1

104
Q

RPE and Dialysis

A

use it to guide exercise intensity because HR is unreliable for this population

aim for 9-13, talk but not sing

105
Q

Exercise during dialysis

A

perform during first half to avoid hypotensive episodes

pedaling and stepping devices are common

don’t exercise arm with permanent AV access

continuous peritoneal dialysis might require fluid to be drained before exercising

106
Q

Exercise AFTER dialysis

A

generally wait 2 hours after dialysis, due to fatigue

107
Q

Renal Cell carcinoma

A

occurs in epithelial cells lining the kidneys
not common cancer, but common KIDNEY cancer

has four stages

incidence is rising, peak is 60-70 year of age, men.

108
Q

RF for RCC

A

smoking, obesity, increased red meat, decreased fruit/veggie consumption, chemical occupational exposure increase risk

109
Q

CP of RCC

A

hematuria
flank pain
palpable abdominal mass

110
Q

Staging vs Grading

A

Grading = histologic differentiation
Staging = degree of spread

111
Q

RCC Tx and Prognosis

A

Tx: surgery has better results than radiation
Prognosis: needs to be caught early for surgery to be effective

112
Q

Tip for PTs with RCC

A

if pt complains of new unexplained abdominal flank, back pain, sternal pain, cough or hematuria, contact PCP immediately

113
Q

Normal aging and male reproductive system

A
  1. shrinkage of testes
  2. thickening of seminiferous tubules (decreased sperm production)
  3. Enlargement of prostate gland, can double in size
  4. Decreases in plasma testosterone level (loss of muscle, changes in bone density)
114
Q

Sample questions to screen for GU disorders in men >50 yr of age

A
  1. Urinary frequency/nocturia
  2. Problems stopping/starting urination
  3. Weak urine flow
  4. Bladder never completely empty
115
Q

Prostatitis

A

(young man condition)
inflammation of prostate gland, can be acute or chronic. PTs are more likely to encounter pts with chronic prostatitis

116
Q

Epidemiology and RF Prostatitis

A

Prevalence higher in men <40 yrs old
Lower UTI
Urinary catheterization
multiple sex partners
strong vibrations

117
Q

Pathogenesis of Prostatitis

A

4 categories of prostatitis

most common type is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

causes are urine reflux, pelvic floor dysfunction

118
Q

Chronic Prostatitis CP and DX

A

CP: low back and perineal pain. Pain w/prolonged sitting, voiding problems, sexual dysfunction

Dx: urinalysis, digital rectal exam, differentiated from BPH and prostate CA by presence of PAIN

119
Q

Chronic Prostatitis Referral Pain

A

low back and perineal pain

120
Q

Prevention and Tx Options of Prostatitis

A

Prevention: decrease time in seated position. try different bike seats

Tx: anti inflammatories, ABX, relaxants. PT (biofeedback, stretching)

121
Q

Benign Prostatic Hyperplasia

A

age related nonmalignant enlargement of prostate gland

Men >50 yr of age
Moderate intake of alcohol has a decreased risk

122
Q

Pathogenesis of BPH

A

unknown, maybe hormonal changes

multiple nodules comprised of proliferating cells progressively narrow the urethra

123
Q

BPH CP

A

decreased force of urinary flow
urinary frequency, nocturia
untreated progression, UTI, bladder wall changes, hydroureter

124
Q

Dx of BPH

A

history
uroflowmetry
palpation

125
Q

TX of BPH

A

Monitoring
Surgery = TURP, resection of prostate

Common meds: alpha reductase inhibitors (shrinks prostate), alpha adrenergic blockers (relaxes smooth muscle)

126
Q

ADRs of alpha adrenergic blockers

A

tachycardia
dizziness
orthostatic hypotension

increased risk of falls

127
Q

Testicular Cancer

A

young man diseases

abnormal, rapid, invasive growth of malignant cells in testicles

most common cancer in males 15-35

128
Q

RF of Testicular Cancer

A

past medical history of undescended testicles, abnormal development, previous testicular cancer

family history

caucasian

129
Q

CP of Testicular Cancer

A
  1. enlargement, lump, swelling of testicle
  2. pain or feeling of heaviness in scrotum
  3. Dull ache in back/lower abdomen (may be ONLY symptom >20% of cases)
  4. Dyspnea
  5. Gynecomastia, excessive breast tissue
130
Q

Dx, Tx, Prevention of Testicular Cancer

A

Dx: urologic history and exam, painless mass in testicle in key sign

Tx: chemotherapy, radiation, ectomies

Prevention: testicular self exam every 6 months, early detection

131
Q

Testicular cancer pain referral

A

In males with this referral pattern with no mechanical source:
1. ask about testicular self-exam
2. Assess supraclavicular lymphadenopathy
3. Perform iliopsoas test
4. Refer to MD

132
Q

Menopause

A

transition when ovaries stop releasing eggs, menstrual activity decreases and eventually ceases

estrogen and progesterone decrease, 1 year without menstruation

occurs age 50

133
Q

Changes with menopause

A

labia atrophy
changed libido
hot flashes, mood changes, sleep disturbances
decrease in pelvic muscle tone

134
Q

Endometriosis

A

endometrial tissue becomes implanted outside uterus; most commonly implants form on fallopian tubes, ovaries, or tissue lining pelvis

135
Q

RF of Endometriosis

A

women of childbearing age w/out children
early menarche, short menstrual cycles, long menstrual period
family hx

136
Q

Pathogenesis of Endometriosis

A

causes is unknown, roles suggested for hormones and immune system

Common theory: mentrual blood containing endometrial cells is retrogradely flushed back through tubes into pelvic caivty

endometrial cells form implants throughout the body

137
Q

CP of Endometriosis

A

DYSMENORRHEA, DYSPAREUNIA, INFERTILITY

excessive bleeding, pain, symptoms vary on growth

138
Q

Dx of Endometriosis

A

the classic triad
laparoscopy/laparotomy

139
Q

Tx of Endometriosis

A

No cure. Goal is pain relief and preservation of fertility

NSAIDs, surgery, hyterectomy

140
Q

Endometriosis Referral of Pain

A

if pain is present regardless of sexual position, pain source is less likely to be a joint dysfunction

141
Q

Endometrial Cancer

A

cancer of uterine lining
most common cancer of female organs
incidence peaks in 60-70 yrs old

142
Q

RF of Endometrial cancer

A

increasing age
obesity
increased level of estrogen
inactivity

143
Q

CP of endometrial cancer

A

abnormal bleeding
abdominal/LE edema

144
Q

Dx and Tx of Endometrial Cancer

A

surgery
hysterectomy
salpingo-oophorectomy
hormonal therapy
radiation

usually diagnosed early

145
Q

Cervical Cancer

A

cancer that forms in cervix
pap smears help to control the amount of cases

HPV is the primary cause

146
Q

Dx and Tx of Cervical Cancer

A

dx: pap smear
tx: based on stage of disease. Pre would be excision, laser. Later would be surgery, chemo, radiation

146
Q

Pathogenesis and CP of Cervical Cnacner

A

HPV turns of cells tumor suppressing genes, allowing abnormal changes in cervical epithelium to perpetuate

CP: early stages are asymptomatic, advanced are abnormal bleeding, bowel bladder problems

147
Q

Ovarian Cancer

A

usually diagnosed late
malignant neoplasm located on the ovaries

fairly uncommon but leading cause of death in female cancers. Usually dx when it has metastizied

148
Q

RF of OVarian Cancer

A

more cycles, more risk
age >40 year
never breast fed
family history of breast, ovarian, colon

149
Q

Pathogenesis of Ovarian Cnacer

A

unknown cause
correlated with number of times a woman ovulates
spreads locally to pelvis, abdominal cavity, bladder

can spread to lymph nodes

150
Q

CP of Ovarian Cancer

A

often vague and nonspecific

sense of pelvic heaviness
vague lower abdominal bloating
unexplained back pain that worsens over time
gait disturbance due to brain metastases

151
Q

Dx and Tx of Ovarian Cancer

A

Dx: screening test, pelvic exam that can show edema in perionetal cavity

Tx: surgery, chemo. Low survival rate due to being diagnosed late

152
Q

PT and Ovarian Cancer

A

due to risk of recurrence, PT should note gait changes

153
Q

Ectopic Pregnancy

A

implantation of pregnancy in any location other than the uterus, often in fallopian tube

154
Q

RF for ectopic

A

things that disrupt fallopian tube structure

STDs, prior tubal surgery, IUD, history, pelvic inflammatory disease

155
Q

Pathogenesis of Ectopic

A

dealyed ovum transport
fertilization and implantation occurs in tube
pregnancy outgrown blood supply
possibility of ruptured fallopian tube

156
Q

CP of Ectopic

A

variable, delayed or slight vaginal bleeding
sudden, sharp, stabbing pain

157
Q

Ectopic pain referral

A

emergency call to physician is warranted

158
Q

Dx and Tx of Ectopic

A

Dx: pelvic ultrasound, elecated hCG, laparoscopy

Tx: medication, removal of egg

5 Pathology (9 decks)

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