Reproductive, renal and urological systems Flashcards
What is a rectal fissure?
Tear or ulceration in the lining of the anal canal
contributing factors: large, hard stools
What is another name for hemorrhoids?
piles
What are the female sex hormones?
estrogen and progesterone
What controls the release of estrogen and progesterone?
ovaries
What controls the release of testosterone/androgens?
testes
What controls the release of 1,25-dihydroxy-vitamin D?
kidneys
What controls the release of insulin?
pancreatic islet cells
What controls the release of glucagon?
pancreatic islet cells
What controls the release of somatostatin?
pancreatic islet cells
What controls the release of the parathyroid hormone (PTH)?
parathyroid glands
What controls the release of triiothyronine?
thyroid
What controls the release of thyroxine?
thyroid
What controls the release of epinephrine and norephinephrine?
adrenal medulla
What controls the release of aldosterone (mineral corticosteroids)?
adrenal cortex
What controls the release of glucocorticoids (cortisol)?
adrenal cortex
What controls the release of adrenal androgens (dehydroepiandrosterone [DHEA])?
adrenal cortex
What controls the release of androstenedione?
adrenal cortex
What releases thyrotropin-releasing hormone (TRH)?
hypothalamus
What releases gonadotropin-releasing hormone (GnRH)?
hypothalamus
What releases growth hormone-releasing hormone (GHRH)?
hypothalamus
What releases corticotropin-releasing hormone (CRH)?
hypothalamus
What releases dopamine?
hypothalamus
What does thyrotropin-releasing hormone (TRH) do?
- Stimulates the anterior pituitary gland to release thyroid-stimulating hormone (TSH) and prolactin
What does the gonadotropin-releasing hormone (GnRH) do?
Stimulates the anterior pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH) once puberty occurs
Maintains male and female physiology
What does the growth hormone-releasing hormone (GHRH) do?
Stimulates the anterior pituitary to release growth hormone (GH)
What does corticotropin-releasing hormone (CRH) do?
stimulates the anterior pituitary to release adrenocorticotropic hormone (ACTH) in response to physical and emotional stress
What does somatostatin do?
Inhibits the release of growth hormone (GH) and thyroid stimulating hormone (TSH).
What does dopamine do?
- inhibits the release of prolactin from the anterior pituitary
- modulates motor control centers
- activates the reward centers of the brain
What does prolactin do?
- promotes lactation
- regulates reproduction, metabolism, and the immune system
What is another name of vasopressin?
Anti-diuretic hormone (ADH)
What does vasopressin (ADH) do?
facilitates the reabsorption of water (regulates water levels and influence blood bolume and pressure)
What does oxytocin do?
- stimulates contractions of the uterus at birth
- stimulates release of milk
What does orexin and ghrelin do?
increase appetite
What does leptin do?
decreases appetite
What does the parathyroid hormone (PTH) do?
Controls the level of calcium within the blood and calcium absorption within the kidneys and small intestine
What does thyroid-stimulating hormone (TSH) do?
regulates metabolism, growth, HR, and body temperature
What does cortisol do?
Stress hormone (fight v. flight response)
excessive levels causes the following:
- suppression of functions that are not necessary at that time for the response
- burst of energy and strength
What effect does estrogen have on the rate of bone reabsorption?
decreases the rate
What effect does estrogen have on the thyroid?
increases production of thyroid
What effect does estrogen have on high-density lipoproteins?
increase
protective effect against heart disease
What is the average weight gain for pregnancy?
20-30 pounds
What hormone causes ligamentous laxity?
relaxin
What type of incontinence do 80% of pregnancies experience?
stress incontinence
Increased pressure on bladder leads to increased urination, increased incidence of reflux, and UTIs
What is diastasis recti abdominis?
Separation of the rectus abdominis from the linea alba (> 2 cm is significant)
associated with loss of abdominal wall support and increased back pain
What protocol is put into effect when diastasis recti abdominis is present?
No abdominal muscle exercises until the separation is <2 cm
What are the primary causes of pelvic muscle weakness?
- overstretching during pregnancy
- further loss of elasticity and muscle tone later in life (can cause prolapse)
What is cystocele?
Herniation of the bladder into the vagina
What is rectocele?
Herniation of the rectum into the vagina
What is uterine prolapse?
herniation of the uterus into the vagina
What are the s/s of pelvic floor disorders?
- pain
- urinary incontinence
- pain with sex
Where is pain located in the presence of pelvic floor disorders?
- perivaginal
- perirectal
- lower abdomen
can radiate down posterior thigh
What are contraindications to perform pelvic floor exercises?
- recent surgery
- urinary catheter
- excessive pelvic pain
Where is pain located with SIJ dysfunction?
- posterior pelvic pain
- pain in the buttocks that may radiate to the posterior thigh or knee
What aggravates SIJ dysfunction?
.
Prolonged sitting, standing, and walking
What type of exercises may aggravate SIJ dysfunction pain?
single limb WB
What must you avoid if you have varicose veins?
crossing the legs
only elevate the legs and use compression socks
What is preeclampsia?
Acute HTN after the 24th wk of gestation that can be mild or severe
What are the s/s of preeclampsia?
- HTN
- edema
- sudden excessive weight gain
- HA
- visual disturbance
- hyperreflexia
What can be used for C-section post-operative pain around the incision site?
TENS
parallel to the incision
What exercise precautions are present with pregnancy in regard to heavy lifting?
No heavy lifting until 4-6 weeks after birth
Diagnosis
Ectopic growth and function of endometrial tissue outside of the uterus
endometriosis
(true/false) With endometriosis, the ectopic tissue can respond to hormones but cannot shed with the uterine tissue during menstruation
true
What can endometrial tissue lead to?
- cysts
- rupture
- peritonitis
- adhesions
- obstruction
s/s
- pain
- dysmenorrhea (moderate to severe pain during menstruation)
- dyspareunia (abnormal pain with sex)
- infertility
- back pain
endometriosis
What is the most common cancer in female reproductive organs?
endometrial carcinoma (uterine cancer)
What causes endometrial carcinoma?
- imbalance of estrogen and progesterone
- ovarian tumor
- hormone therapy used for breast cancer
- no hx of pregnancy
- older age
- obesity
Diagnosis s/s
- pelvic pain
- bleeding between periods
- vaginal bleeding after menopause onset
- central LBP
- posterior thigh pain and/or abdominal pain
endometrial carcinoma
What is pelvic inflammatory disease (PID)?
inflammation of the upper reproductive tract involving the uterus, fallopian tubes, or ovaries
diagnosis s/s
- lower abdominal pain that starts after the menstrual cycle
- purulent cervical discharge
- painful cervix
- fever and elevated WBCs
- increased ESR
PID
What are possible complications caused by PID?
- pelvic adhesions
- infertility
- ectopic pregnancy
- chronic pain
- abscess
What hormone initiates spermatogenesis?
follicle stimulating hormone (FSH)
What hormone regulates testosterone production?
luteinizing hormone (LH)
What are the s/s of testicular cancer?
- lump/enlargement in the testicle
- aching in the groin or abdomen
- breast enlargement
- LBP that may radiate to the groin
What is prostatitis?
inflammation and infection of the prostate
What can cause acute bacterial prostatitis?
catheterization and multiple sexual partners
Where can prostatitis pain refer to?
the low back and the sacral/genital/rectal regions
What are the s/s of acute prostatitis?
- increased frequency and urgency
- fever and chills
- arthralgia
- myalgia
- pain
- urethral discharge
- malaise
- nocturia
- dysuria
Chronic bacterial prostatitis is associated with what?
recurrent UTI
s/s
- urinary frequency and urgency
- myalgia
- arthralgia
- pain in low back and/or perineal region
diagnosis s/s
- produces pain in the penis, testicles, and scrotum
- pain with ejaculation
- LBP and/or inner thigh pain
- decreased libido
- impotence
- urinary symptoms
nonbacterial inflammatory prostatitis
What can arise from prostatitis?
obstruction of urinary flow due to the prostate circling the urethra
What is benign prostatic hyperplasia (BPH)?
Enlargement of the prostate gland
What is BPH in relation to?
- age (normally by age 60-80 y/o)
- obesity
- DM
- heart disease
Diagnosis s/s
- frequent urination
- nocturia
- difficulty with urination initiation
- inability to empty the bladder (high risk of UTI)
- oversized prostate
- bladder stones
benign prostatic hyperplasia (BPH)
Where does prostate cancer metastasize to?
bone
often to the spine
Risk factors:
- men > 80 y/o
- family Hx
- obesity
What are the symptoms of prostate cancer?
Late stage:
- frequent urination
- nocturia
- difficulty with urination initiation
- inability to empty the bladder (high risk of UTI)
- bladder stones
- blood in urine/semen
- bone and night pain
- weight loss
- Erectile dysfunction
usually no s/s in early stages
Prostate-specific antigen labs are normally (decreased/increased) in the presence of prostate cancer.
elevated
In what levels of the spine are the kidneys found?
T12-L2
multilobbular (contains > 1 million nephrons)
What does the glomerulus do?
filters blood in the kidney
definition
structure that extends from the renal pelvis to the bladder
ureter
How does the ureter move urine?
via peristaltic action
What is the glomerular filtration rate (GFR)? What is it regulated by?
a. amount of filtrate that is formed each minute as the blood moves through the glomeruli, serving as an important gauge of renal function
b. regulated by arterial BP and renal blood flow
How is GFR obtained?
creatinine levels in blood and urine samples
What is normal creatinine clearance?
115-125 mL/min
What is BUN?
Blood urea nitrogen is the amount of urea produced in the liver as a byproduct of protein metabolism that is eliminated by the kidneys
BUN levels are (decreased/increased) with increased protein intake, GI bleeding, and dehydration
increased
BUN-creatinine ratio is abnormal with ___ disease.
liver disease
What is the average pH of urine?
6
Range: 4.6-8.0
What is the normal level of serum potassium?
3.5-5.5
What heart condition can hypokalemia lead to?
supraventricular and ventricular arrythmias
some result in death
What are the symptoms of hyperkalemia?
Normally asymptomatic unless there is a very high level - observe for muscle weakness
What is the normal serum level for sodium?
135-146 mEq/L
What s/s can be observed with hyponatremia?
- confusion
- decreased alertness
- convulsions
- increased ICP
- decreased coordination
- anorexia
- fatigue
What s/s can be observed with hypernatremia?
- pitting edema
- excessive weight gain
- dyspnea
- HTN
- tachycardia
- agitation/restlessness
- convulsions
What is the normal serum level of calcium?
8.4-10.4 mg/dL
What are the possible s/s of hypocalcemia?
- cramps
- tetany
- spasms
- paresthesia
- anxiety/irritability
- convulsions
- arrhythmias
- hypotension
What s/s can be seen with hypercalcemia?
- fatigue
- depression
- confusion
- N/V
- increased urination
- arrhythmia
What is the normal serum level of magnesium?
1.8-2.4 mg/dL
What s/s can be observed with hypomagnesemia?
- confusion
- hyperirritability
- cramps in LEs
What s/s can be present with hypermagnesemia?
- hyporeflexia
- weakness
- drowsiness
- confusion
- bradycardia
- hypotension
(true/false) metabolic alkalosis and acidosis can lead to death.
true
(true/false) Respiratory alkalosis can lead to disorientation, stupor, and/or death.
FALSE (respiratory acidosis)
definition
CO2 retention with impaired alveolar ventilation
respiratory acidosis
definition
diminished CO2 with alveolar hyperventilation
respiratory alkalosis
Cystitis and urethritis are (lower/upper) UTIs
lower UTI
definition
inflammation of the bladder
cystitis
definition
inflammation of the ureter
urethritis
(true/false) Lower UTI (cystitis or urethritis) are normally secondary to ascending UTIs
true
(true/false) Lower UTIs can involve the kidneys and ureters
true
Pyelonephritis is a (lower/upper) UTI.
upper UTI
definition
inflammation and infection of one or both kidneys
pyelonephritis
diagnosis s/s
- fever and chills
- malaise
- back pain over kidneys
- Murphy’s sign
- frequent urination
- burning urination
- N/V
pyelonephritis
What is murphy’s sign?
tenderness over the costrovertebral angle
Are upper or lower UTIs more serious?
upper
What are the 4 types of renal cystic disease?
- polycystic
- medullary sponge
- acquired
- simple
diagnosis s/s
- pain
- hematuria secondary to rupture
- HTN
- fever
renal cystic disease
Simple cysts are commonly asymptomatic
What is another name for renal calculi?
kidney stones
diagnosis s/s
- pain radiating to the lower abdomen, bladder, and/or perineal region
- N/V
- cool/clammy skin
- pain is aggravated by stretching the urine collecting system
kidney stones
What is extracorporeal shock wave lithotripsy (ESWL) used for?
breaking up kidney stones
diagnosis
sudden loss of kidney function with resulting elevation in serum urea and creatinine
acute renal failure
diagnosis
progressive loss of kidney function leading to ESRD
chronic kidney disease
What can cause chronic renal failure?
- prolonged acute urinary tract obstruction and infection
- DM
- SLE
- uncontrolled HTN
diagnosis
end-stage toxic condition resulting from renal insufficiency and retention of nitrogenous waste in the blood
uremia
What causes dialysis dementia?
prolonged dialysis treatments over years
What are the signs of dialysis disequilibrium?
- N/V
- drowsiness
- HA
- seizures
What is dialysis disequilibrium a result of?
beginning dialysis
What are the risk factors for renal cancer?
- smoking
- HTN
- male african-americans
- family history
- advanced kidney disease
diagnosis s/s
- flank pain
- hematuria
- fatigue
- unexplained weight loss
renal cancer
What are the risk factors for developing bladder cancer?
- > 55 y/o
- decreased fluid intake
- male
- previous radiation/chemo
- family history
What causes stress incontinence?
- increased intra-abdominal pressure
- weakness of pelvic floor and sphincter
diagnosis
sudden release of urine
stress incontinence
diagnosis
bladder begins contracting and leaks uring after the sensation of bladder fullness is perceived
inability to delay voiding before reaching a toilet
urge incontinence
What are the causes of urge incontinence?
- detrusor muscle instability or hyperreflexia
- sensory instability: hypersensitive bladder
diagnosis
bladder continuously leaks secondary to urinary retention (overdistended bladder)
overflow incontinence
What are causes of overflow incontinence?
- obstruction
- acontractile bladder
- neurogenic bladder
diagnosis
urine leakage associated with the inability or unwillingness to toilet due to impaired cognition, physical functioning, and/or environmental errors
functional incontinence
What medications may aggravate incontinence?
- anticholinergics
- diuretics
- psychotropic drugs
