Screening for Urogenital and Gynecologic Disease Flashcards
complaints of what may be secondary to renal or urologic origin?
- flank pain
- LBP
- pelvic pain
the urinary tract consists of what?
- Upper Urinary Tract
- kidneys
- ureters
- Lower Urinary Tract
- bladder
- urethra
S/S of genitourinary disease include:
- Constitutional symptoms
- Musculoskeletal symptoms
- Urinary symptoms
Constitutional S/S of genitourinary disease
- fever, chills
- fatigue, malaise
- anorexia, weight loss
MSK S/S of genitourinary disease
- unilateral costovertebral tenderness
- low back, pelvic, flank, inner thigh, or leg pain
- ipsilateral shoulder pain
Urinary S/S of genitourinary disease
- dysuria
- nocturia
- hematuria
- protenuria
- dribbling at the end of urination
- frequent urination
- feelings of incomplete voiding, but unable to urinate more
- hesitancy (weak or interrupted urine stream)
S/S of genitourinary disease in men
- difficulty starting or continuing stream of urine
- discharge from penis
- penile lesions
- testicular or penis pain
- swelling or mass in groin
- sexual dysfunction
S/S of genitourinary disease in women
- abnormal vaginal bleeding
- painful menstruation (dysmenorrhea)
- changes in menstrual pattern
- pelvic masses or lesions
- pain during intercourse (dyspareunia)
- may refer pain to low back, sacral, pelvic, shoulder, or abdomen
Risk factors for genitourinary disease
- age >60
- Hx of DM or HTN
- Hx of kidney disease, heart attack, or stroke
- Hx of kidney stones, UTI, lower urinary tract obstruction
- Hx autoimmune disease
- AA, Hispanic, Pacific Island, Native American descent
list sources of renal and urological pain
- Upper urinary tract
- Pseudorenal pain
- Lower urinary tract
describe the site of Upper Urinary Tract urological pain
site of pain generally corresponds to dermatomes (typically localized to T10-L1)
how is Upper Urinary Tract pain typically described?
- Aching or
- Dull
- Occasionally severe and described as Boring
T/F: Upper urinary tract (renal/ureteral) pain may result in abdominal muscle spasm
TRUE
may also have rebound tenderness on same side
what is Pseudorenal pain?
mimics renal and/or ureteral pain
occurs secondary to radiculitis or irritation of costal nerves
where is the most common site for pseudorenal pain?
T10 and T12
Pseudorenal pain is usually an acute onset associated with what?
trauma
- fall onto the buttocks
- sustained blow to costovertebral area, or
- lifting a heavy object
unlike true renal pain, pseudorenal pain is affected by ______
body position
describe the pain pattern of pseudorenal pain
- back and/or flank pain occur at same level as kidney
- affected by changing position
- lying on involved side increases pain
- prolonged sitting increases pain
- symptoms are reproduced with movements of the spine
- costovertebral angle tenderness present on palpation
list associated S/S of pseudorenal pain
- not associated with urinary S/S
- negative kidney percussion test
where is lower urinary tract urological pain typically felt?
above the pubis or in lower abdomen
can refer to back
how is lower urinary tract pain described
sharp
what is lower urinary tract pain characterized by?
- urinary urgency
- sensation to void
- dysuria
- mild stinging to intense burning with urination
What is included in the review of systems for Genitourinary?
- reduced stream, decreased output
- burning or bleeding during urination, change in urine color
- urinary incontinence, dribbling
- impotence, pain with intercourse
- hesitation, urgency
- nocturia, frequency
- dysuria
- testicular pain or swelling
- genital lesions
- penile or vaginal discharge
- impotence (males) or other sexual difficulty (males or females)
- infertility (males or females)
- flank pain
what is included in the review of systems for Gynecologic?
- irregular menses, amenorrhea, menopause
- pain with menses or intercourse
- vaginal discharge, vaginal itching
- surgical procedures
- pregnancy, birth, miscarriage, and abortion histories
- spotting, bleeding-especially for postmenopausal women 12 months after last period (w/o hormone replacement therapy)
List some urogenital pathological conditions
- Upper UTI
- Lower UTI
- Renal or ureteral stones
- Renal cancer
- Prostatitis
- Benign Prostatic Hyperplasia
- Prostate Cancer
- Incontinence
- Renal Failure
- Bladder Cancer
- Testicular cancer
- Endometriosis
- Ovarian cysts
- Ectopic pregnancy
- Ovarian Cancer
which is considered more serious, Upper or Lower UTIs?
Upper
potential to damage renal tissue itself
these include kidney or ureteral infections
Clinical S/S of Upper UTIs
- Unilateral costovertebral tenderness
- Ipsilateral shoulder pain
- flank pain
- fever and chills
- skin hypersensitivity
- hematuria, pyuria, bacteriuria
- nocturia
what do lower UTIs include?
bladder and urethral infections
are lower UTIs more common in men or women?
Women b/c
- shorter female urethra
- proximity of urethra to vagina and rectum
- rate of occurrence increases with age and sexual activity
Risk factors for lower UTIs
- DM
- Gout
- HTN
- Obstructive urinary problems
- medical procedures requiring urinary catheterization
T/F: UTIs are more common in older adults
TRUE (both men and women)
typically have non-specific symptoms like AMS, loss of appetite, N/V/abdominal pain
a staph infection of the urinary tract can cause what?
osteomyelitis in the vertebrae
- can result in degeneration/destruction of vertebral body causing collapse
- suspected with onset of nonspecific LBP that is unrelated to movement
- associated with low grade fever
Clinical S/S of lower UTIs
- LBP
- Pelvic/lower abdominal pain
- urinary frequency
- urinary urgency
- dysuria, hematuria, pyuria, bacteriuria
- pain w/intercourse
what are renal calculi?
Kidney stones
- decreased urine flow results in stagnation → stone formation can result
- urine stasis permits clumping of organic matter and minerals
- calculi primarily form in the kidney
- stones can remain in kidney or lodge anywhere downstream
describe ureteral stones
- most painful
- if stone blocks urine, pressure builds upstream in the kidney causing it to swell (hydronephrosis)
- can cause permanent kidney damage
what is the most characteristic symptom of ureteral stones?
sudden, sharp, severe pain that originates deep in the lumbar area and radiates around the side and into genitals
Clinical S/S of Kidney/Ureteral Stones
- Pain
- lumbar discomfort
- acute, spasmodic, radiating
- mild and dull flank pain
- Hyperesthesia of dermatomes T10-L1
- abdominal muscle spasms
- N/V
- palpable flank mass
- hematuria
- Fever, chills
- urge to urinate frequently
- renal impairments
- sudden or acute in development
- acute ureteral or renal blockage reported to be excruciating, spasmodic, radiating pain accompanied by severe N/V
renal tumors may be detected as _____
a flank mass combined with:
- unexplained weight loss
- fever
- hematuria
what is the primary symptom of a urinary tract neoplasm
hematuria
reports of blood in the urine ALWAYS requires MD referral
Risk factors for renal cancer
- smoking
- obesity
- HTN
- long-term dialysis
- more common in males
Clinical S/S of renal cancer
- Blood in urine
- Flank or side pain
- painful urination
- urinary frequency
- weight loss
- fever
- general fatigue
what is Prostatitis?
relatively common inflammation of the prostate causing prostate enlargement
occurs in 10% of adult male population
Clinical S/S of Prostatitis
- Low back, inner thigh, and perineal pain
- sudden moderate-high fever
- chills
- nocturia
- dysuria
- weak or interrupted stream
- unable to completely empty bladder
- sexual dysfunction
- general malaise
- arthralgia
- myalgia
what is BPH?
Benign Prostatic Hyperplasia
defined as enlarged prostate
- common occurrence in men >50 yrs
- prostate enlarges and squeezes urethra
- interferes with urination and sexual function
- if the prostate is greatly enlarged, chronic constipation may occur
Clinical S/S of BPH
- Bladder palpable above symphysis pubis
- Urinary problems
- hesitancy, weak stream, dribbling, frequency, nocturia
- lower abdominal discomfort with feeling the need to void
- low back or upper thigh pain/stiffness
- suprapubic or pelvic pain
- erectile dysfunction
- blood in urine or semen
Follow-up questions if you suspect BPH
- does it feel like your bladder is not empty when you finish urinating?
- do you have to urinate again less than 2 hours after the last time you emptied your bladder?
- do you have a weak stream of urine or find you have to start and stop urinating several times when you go to the bathroom?
- do you have to push or strain to start urinating or keep the urine flowing?
- do you have any leaking or dribbling of urine?
- do you get up more than once at night to urinate?
generally describe prostate cancer
- ⅓ of all men by age 50
- present in 50-75% of all men by age 75
- back pain and sciatica can be caused by cancer metastasis
- tumors tend to be osteoblastic vs osteolytic
Risk factors for prostate cancer
- family history (father or brother)
- more common in AA men compared to Caucasian and Hispanic
- Diet high in animal fat/meat
Symptoms of metastatic disease include:
- bone pain
- anemia
- weight loss
- lymphedema of the LEs and scrotum
- neurological changes associated with spinal cord compression
list the 5 types of incontience
- Stress
- Urge
- Mixed
- Overflow
- Functional
describe stress incontience
- primarily related to urethral or pelvic floor weakness, ligamentous and fascial laxity
- pressure applied to bladder from coughing, sneezing, laughing, lifting, or physical exertion that increases abdominal pressure
describe urge incontinence
- commonly called “overactive bladder”
- involuntary contraction of the detrusor muscle with a strong desire to void
- often idiopathic but may be caused by:
- meds, alcohol, bladder infections, bladder tumor, neurogenic bladder, bladder outlet obstruction
- high prevalence in female elite athlete population
describe mixed incontinence
a combo of stress and urge
describe overflow incontinence
- overdistention of the bladder the bladder cannot empty completely
- urine leaks or dribbles out
- client does not have any sensation of fullness or emptying
- caused by acontractile or deficient detrusor muscle
describe functional incontience
- occurs when bladder is normal but mind and body are not working together
- occur secondary to mobility or access deficits
- ie confined to wheelchair, altered mentation (AD, dementia)
List risk factors for urinary incontinence
- advanced age
- overweight/obese
- chronic cough
- chronic constipation
- Hx UTI
- DM
- Neurologic disorders
- meds
- caffeine, alcohol
- female gender
Female risk factors for urinary incontinence
- pregnancy
- vaginal birth or C-section
- pelvic trauma/radiation
- bladder/bowel prolapse
- menopause
Male risk factors for urinary incontinence
- enlarged prostate
- prostate/pelvic surgery
- radiation
what is renal failure?
exists when the kidneys can no longer maintain homeostatic balances within the body that are necessary for life
can be acute or chronic
describe acute renal failure
- abrupt cessation of kidney activity
- occurs over a period of hours to a few days
- often reversible, within 3-12 months
describe chronic renal failure
- AKA end stage renal disease (ESRD)
- irreversible
- diabetic nephropathy is the primary cause
treatments for renal failure
- dialysis
- transplant
- meds
risk factors for renal failure
- chronic intake of certain meds and OTC drugs
- acetaminophen and NSAIDs
PT considerations for renal failure
- observe for S/S of complications associated with chronic renal failure and dialysis
- dehydration
- cardiac arrhythmias
- depression
Bladder cancer is strongly linked to ______
tobacco smokers
List risk factors for bladder cancer
- age >40
- tobacco use
- highest incidence in Caucasians
- exposure to workplace carcinogens
- 3x more common in men than women
- previous hx or family hx
Clinical S/S of bladder cancer
- blood in urine
- painful urination
- urinary urgency
- feeling of urinary urgency w/o urination
*pts w/these symptoms require MD referral
Testicular cancer general info
- relatively rare but most common in white males, ages 15-35
- major risk factor is cryptorchidism - boys born with undescended testicles
- highly treatable if caught early
- monthly self-exams recommended
S/S of testicular cancer
often asymptomatic
- may present as a hard painless lump in the testicle
- swelling/enlargement of testicle
- sig loss of size of one testicle
- feeling of heaviness in scrotum/lower abdominals
- dull ache in groin, lower abdomen
- LBP (more common in late stages)
- infertility
describe endometriosis
- Pain can occur anywhere but often in back, pelvis, hip, or sacrum
- can be mistaken for a MSK, musculoligamentous or neuromuscular impairment of L/S
- key to recognition is that it is often cyclic
- may have urinary tract or bowel involvment
Clinical S/S of endometriosis
- intermittent, cyclical or constant pelvic and/or back pain
- pain during or after intercourse
- painful bowel movements/urination during period
- spotting between periods
- heavy/irregular menstrual bleeding
- fatigue
- GI problems
describe ovarian cysts
- may cause back pain
- however, lower abdominal/pelvic pain more common
- cyclical pattern associated with menstrual cycle
Clinical S/S of ovarian cysts
- abdominal pressure, pain or bloating
- discomfort with urination, bowel movements or sexual intercourse
- irregular menses, infertility
- dull aching low back, buttock or groin pain
- sudden, sharp pain with rupture or hemorrhage
describe an ectopic pregnancy
- commonly associated with shoulder pain
- may cause back, hip, sacral, abdominal, pelvic and/or shoulder pain
- most common symptoms is sudden, sharp or constant one-sided pain in lower abdomen/pelvis lasting more than a few hours
- shoulder pain usually does not occur alone w/o preceding or accompanying abdominal pain
- not a viable pregancy
T/F: ectopic pregnancies are life threatening?
TRUE
require immediate medical referral
Clinical S/S of an ectopic pregnancy
- may be accompanied with irregular bleeding or spotting after a light or late period
- diffuse, aching lower abdominal quadrant or LBP; can cause ipsilateral shoulder pain
- may progress to a sharper, intermittent type of pain
what is the 2nd most common reproductive cancer in women?
Ovarian cancer
Risk factors for ovarian cancer
- nulliparity (never being pregnant), giving birth to fewer than 2 children, giving birth for the first time after 35 yo
- personal/family hx of breast, endometrial, or colorectal cancer
- family hx of ovarian cancer
- infertility
- early menarche, late menopause, prolonged postmenopausal hormone therapy
- obesity
Clinical S/S of ovarian cancer
- persistent vague GI complaints
- pelvic/abdominal discomfort, bloating, increased abdominal or waist size
- indigestion, belching
- early satiety
- mild anorexia in women over age of 40
- vaginal bleeding
- changes in bowel or bladder habits
- constipation
- urinary frequency
- severe urinary urgency
- pelvic discomfort or pressure; back pain
Clues to screen for Renal/Urological disease
- men 45 yrs and older
- in men, back pain with burning on urination difficulty urinating and fever
- may be associated with prostatitis
- blood in urine
- change in urinary pattern (frequency, flow, nocturia, etc)
- constitutional symptoms (fever, chills, constant pain)
- pain that is unchanged with body position
- neither renal nor urethral pain is altered by position
- back pain at level of kidneys
- hx of recent bladder/kidney infection
clues to screen for gynecological disease
- pelvic pain correlated with menses or sexual intercourse
- low back/pelvic pain after first menstrual cycle is missed with shoulder pain also present
- presence of unexplained or unexpected vaginal bleeding, especially after menopause
Guidelines for immediate medical attention
- presence of cervical spine pain at same time that urinary incontinence develops
- bowel/bladder incontinence
- saddle anesthesia secondary to cauda equina lesion
