Screening for GU Disease Flashcards by Jenn Cantilli

what organs are involved in the GU system

renal/kidneys
ureters
bladder
urethra

females - ovaries, uterus
males - prostate, testicles

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where is pain referred to from kidneys

low back
low abdomen
outer hips/outer upper thighs
inner upper thighs

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where is pain referred to from ureter

makes a small U between AIIS levels

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where is pain referred to from urinary bladder

oval centered b/w ASIS levels on abdomen

small circle below oval, AIIS level, above ureter “U”

circle below PSIS

ovals from inner gluteal folds to posterior upper inner thighs (angled in)

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what are common GU sx (9)

back pain
groin pain
dysuria
nocturia
unable to empty bladder
hematuria
incontinence
polyuria
proteinuria

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what do GU constitutional sx look like

like flu sx

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what are male specific GU sx (4)

difficulty w start/stop of urine flow
testicular pain
swelling or mass in groin
sexual dysfunction

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what are female specific GU sx (3)

dysmenorrhea
pain w intercourse
abnormal bleeding or discharge

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what usually causes polyuria

diuresis

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how might proteinuria present

foamy, if lot of protein

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what are screening Qs

urinary/renal specific sx
- changes in bowel and/or bladder function?
- recent infections?

GU specific dx or family hx
- DM I / II
- kidney dz
- gout

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what are follow up questions if someone says there has been some bladder changes (5)

incontinence/retention
urine color
frequency/urgency
pain
sexual dysfunction

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what followup question should you ask if someone has had a recent infection

UTI

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what is a consideration if there was an infection w the bladder

could impact the kidneys also

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what are risk factors for renal and urinary problems

> 65yo
African, Hispanic, pacific island, native american descent

hx:
- DM, HTN
- kidney dz, cardiac issues, stroke
- kidney stones, UTI, lower tract obstruction, autoimmune dz

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what is a primary risk factor for end stage renal dz

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who should be screened (6)

men over 45 (prostate)
hematuria
change in urinary flow
constitutional sx
pain unchanged by mechanical changes
pseudorenal pain is neg

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what sx shoul make you suspicious of prostate involvement when doing a preliminary screen of a man >45yo

back pain w dysuria

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what are red flag and urgent sx

back pain w urinating
hematuria
constitutional sx

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what could cause pseudorenal pain

T10 and T12 distribution pain related to irritation of costal nerves

may look like renal colic (associated w kidney stone)

trauma related

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how do you r/o pseudorenal pain

fist percussion over kidneys
GU screen

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how could you r/i pseudorenal pain

A/P joint mob over costo-vertebral angle reproduces sx

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upper UTI vs lower UTI

upper - kidney, ureteral
lower - bladder, urethra

upper presents w more constitutional sx and will be a more urgent referral

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what are sx of upper UTI (6)

flank pain
fever/chills
hematuria
pyuria
nocturia

ill/constitutional sx

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what are sx of lower UTI (7)

polyuria inc urgency LBP, pelvic pain dysuria hematuria pyuria more localized than systemic effect

upper vs lower GU obstructions

upper - kidney tumor, kidney stones lower - bladder tumor, BPH, prostate CA

what are sx of upper GU obstruction (5)

renal colic - pain comes and goes n/v hematuria fever/chills inc urge tends to be sicker, more constitutional sx

why do you see n/v w upper GU obstructions

d/t significant, inc high pain

what are signs of upper GU obstruction

urinalysis - RBC, WBC present (urgent referral)

what are lower GU obstruction sx

can't empty bladder incontinence (overflow)

inc pt population at risk for BPH

men >50yo 50% of men in 60s 80% of men in 70s and 80s

sx of BPH (4)

same as prostate cancer bladder never empties frequent urination (q2hours) straining causes less elasticity of bladder inc risk of UTI

incidence of prostate cancer

2nd most common type of cancer 1/3 of all CA dx for men very slow growing

what are risk factors of prostate cancer

men who are: >65yo family hx diet African American inc risk

sx of prostate cancer

same as BPH bladder never empties frequent urination (q2hours) straining causes less elasticity of bladder inc risk of UTI

r/o prostate cancer

blood screening marker (PSA) - prostate screening antigen lot of false positives, but only quick screening tool

what are 4 types of urinary incontinence

stress urge overflow mixed

what is a common misnomer of urinary incontinence

not a normal part of aging not a normal part of post partum ms dysfunction ^^

what population has an inc prevalence of urinary incontinence

elite female athletes - strong cores inc abdominal pressure - can override pelvic floor

what should you think if you see urinary incontinence w C-spine pain

could have cord compression - cauda equina compression - conus medullary compression

what is stress incontinence

support of bladder or urethra is damaged, normal bladder

how common is stress incontinence

75% of women have this

what can cause stress incontinence

weak pelvic floor ligamentous and fascia laxity lot can happen post partum

what is urge incontinence

overactive bladder

what can cause urge incontinence

involuntary contraction of detrusor mm neurological in nature

what is overflow incontinence

over distention of bladder bladder can't fully empty

who do you see overflow incontinence in

SCI - UMN problem causing bladder retention prostate - blocked cauda equina

what is mixed incontinence

combination of any of the stress, urge, overflow

acute vs chronic renal failure

acute = reversible chronic = non reversible - can lead to end stage renal dz

what is acute renal failure often related to

major medical event critical illness

what is a common sx of acute renal failure

severe dehydration - important education point

what is 40% of ESRD associated w

diabetic neuropathy

risk factors for chronic renal failure (5)

DM HTN chronic UTI kidney transplant chronic use of OTC (tylenol, NSAIDS) w caffeine and/or codeine use

what are general skin manifestations of ESRD (8)

fatigue weakness dec alertness inability to concentrate pallor ecchymosis pruritus dry skin and mucus membranes

what are hematological/body fluid manifestations of ESRD (9)

anemia tendency to bleed easily polyuria nocturia dehydration hyperkalemia metabolic acidosis hypocalcemia hyperphosphatemia

what are EENT manifestations of ESRD (2)

metallic taste in mouth pale conjunctiva

what are pulmonary manifestations of ESRD (3)

dyspnea rales pleural effusion

what are CV manifestations of ESRD (2)

DOE HTN

what are GI manifestations of ESRD (3)

anorexia n/v GI bleed

what are GU manifestations of ESRD (3)

impotence amenorrhea loss of libido

what are skeletal manifestations of ESRD (4)

osteomalacia osteoporosis bone pain edema

what are neurologic manifestations of ESRD (7)

memory loss sz ms tremors paresthesias ms weakness restless leg cramping

renal vs bladder cancers

similar but bladder is worse

what are risk factors for bladder cancer (3)

smoking men>women occupational exposure to carcinogens

what are sx of bladder cancer (3)

hematuria dysuria urgency

what are risk factors for renal cancer (5)

smoking obesity HTN men > women long term dialysis

what are sx of renal cancer (7)

same as bladder - hematuria - dysuria - urgency flank pain wt loss fever fatigue

pt population you typically see testicular cancer in

males 15-35yo

what is key w testicular cancer

early dx

what are risk factors for testicular cancer (4)

family hx occupational exposure to carcinogens HIV ethnicity - caucasians 5-10xs > African americans

what are sx of testicular cancer (3)

lump in either testicle fatigue LBP

what sx make you think conus medullaris compression

UI w saddle anesthesia

what sx make you think cauda equina compression

UI w LE paraparesis, radicular pain, numbness

what are 3 immediate referrals

hematuria sx of conus medullaris compression sx of cauda equina compression

what are soon referrals (2)

fist percussion is positive back pain w change in urine