Screening for Urogenital & Gynecological Disease (Exam 2) Flashcards
Complaints of flank pain, low back pain or pelvic pain may be secondary to?
renal or urologic origin
What is considered upper urinary system? Lower?
Upper Urinary Tract
- Kidneys
- Ureters
Lower Urinary Tract
- Bladder
- Urethra
What are the MSK signs and symptoms of genitourinary disease?
◦Unilateral costovertebral tenderness
◦Low Back, pelvic, flank, inner thigh, or leg pain
◦Ipsilateral shoulder pain
what are the constitutional signs/symptoms of genitourinary disease?
◦Fever, chills
◦Fatigue, malaise
◦Anorexia, weight loss
What are signs and symptoms of urinary disease? (8)
- Dysuria
- Nocturia
- Feelings of incomplete voiding, but unable to urinate more
- Hematuria
- Dribbling at the end of urination
- Frequent urination (more than every 2 hrs)
- Hesitancy (weak or interrupted urine stream)
- Protenuria
men specific signs and symptoms of genitourinary disease (6)
- Difficulty starting or continuing stream of urine
- Discharge from penis
- Penile lesions
- Testicular or penile pain
- Swelling or mass in groin
- Sexual dysfunction
Women specific signs and symptoms of genitourinary disease
- 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 (6)
- Age > 60
- hx diabetes or HTN
- hx kidney disease, heart attack, or stroke
- hx kidney stones, UTI, lower urinary tract obstruction
- hx autoimmune disease
- AA, Hispanic, Pacific Island, Native American descent
Upper Urinary Tract (Renal/Ureteral)
Where does the site of pain usually correspond to?
Is it localized?
What are the pain quality descriptors?
Site of pain generally corresponds to dermatomes
Typically localized to T10-L1
- Renal and ureteral nociceptors enter spinal cord at these levels
Described typically as
- Aching or
- Dull
- Occasionally severe and described as Boring
Both may result in abdominal muscle spasm with rebound tenderness on same side
Pseudorenal Pain
What does it occur secondary to?
What are the most common sites?
What is the usual MOI?
What affects the pain?
- Mimics renal and/or ureteral pain
- Occurs secondary to radiculitis or irritation of costal nerves
- Most common sites are T10 and T12
- Usually an acute onset associated with trauma (fall onto the buttocks, sustained blow to the costovertebral area, or lifting a heavy object)
- Usually affected by body position
- True renal pain is seldom affected by position
Pain pattern for 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
associated signs and symptoms of pseudorenal pain
- Not associated with urinary signs and symptoms
- Negative kidney percussion test
Urological Pain:
Lower Urinary Tract (Bladder/Urethra)
Where is it felt?
Where can it refer?
What is it described as?
Characterized by? (4)
Felt above the pubis or in lower abdomen
Can refer to the back
Described as sharp
Characterized by
- Urinary urgency
- Sensation to void
- Dysuria
- Mild stinging to intense burning with urination
what are the types of urogenital pathologies? (15)
- Upper Urinary Tract Inflammation/infection
- Lower Urinary Tract Inflammation/infection
- 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
Upper Urinary Tract Inflammation/Infection
Considered to be more serious (vs lower UTI)
- Potential to damage renal tissue itself
- Include kidney or ureteral infections
Clinical signs and symptoms of upper UT inflammation/infection (7)
- Ipsilateral shoulder pain
- Unilateral costovertebral tenderness
- Flank Pain
- Fever and chills
- Skin hypersensitivity
- Hematuria, Pyuria or Bacteriuria
- Nocturia
Lower Urinary Tract Inflammation/Infection
what does this include?
Who is it more common in and why?
- Includes bladder or urethral infections
- More common in women because:
- Short female urethra
- Proximity of urethra to vagina and rectum
- Rate of occurrence increases with age and sexual activity
Risk factors for lower UTI?
◦Diabetes Mellitus
◦Gout
◦HTN
◦Obstructive urinary problems
◦Medical procedures requiring urinary catheterization
Who are lower urinary tract infections/inflammations more common in?
What are some signs and symptoms of UTI’s in an older adult?
More common in women
- Short female urethra
- Proximity of urethra to vagina and rectum
- Rate of occurrence increases with age and sexual activity
UTI are more common in older adults (men and women)
- Non specific symptoms
- Altered mental status
- Loss of appetite
- Nausea/vomiting/abdominal pain
what might cause osteomyelitis in the vertebrae regarding a lower UTI?
What might this result in?
When would you suspect it?
What sign/symptom is associated with it?
Staph infection of urinary tract may cause osteomyelitis in the vertebrae
◦Can result in degeneration/destruction of vertebral body causing collapse
◦Suspected with onset of nonspecific low back pain that is unrelated to movement
◦Associated with low grade fever
Clinical signs and symptoms of lower UTI (6)
- LBP
- Pelvic/lower abdominal pain
- Urinary frequency
- Urinary urgency
- Dysuria, hematuria, pyuria, bacteriuria
- Pain with intercourse
Renal Calculi (Kidney Stones)
What can the stone formation result in?
Where do the calculi primarily form in?
- 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
Ureteral Stones
- Most painful
- If stone blocks urine, pressure builds upstream in the kidney causing it to swell (hydronephrosis)
- Can cause permanent kidney damage
-Most characteristic symptom is sudden, sharp, severe pain
- Originates deep in the lumbar area and radiates around the side and into genitals
Kidney/Ureteral Stones
- what type of pain?
- what spinal cord levels?
- what are the signs and symptoms?
-Pain
- Acute, spasmodic, radiating
- Mild and dull flank pain
- Lumbar discomfort
-Hyperesthesia of dermatomes (T10-L1)
- Nausea and vomiting
- Palpable flank mass
- Hematuria
Clinical Signs and Symptoms of Kidney/Uretal Signs
Fever and chills
Urge to urinate frequently
Abdominal muscle spasms
Renal impairments
Sudden or acute in development
Acute ureteral or renal blockage reported to be excruciating, spasmodic, radiating pain accompanied by severe nausea and vomiting
Renal Cancer
Renal tumors may be detected as flank mass combined with
- Unexplained weight loss
- Fever
- Hematuria
Hematuria is primary symptom of urinary tract neoplasm
- Reports of blood in urine ALWAYS requires MD referral
Renal Cancer Risk Factors
- Smoking
- Obesity
- HTN
- Long-term dialysis
- More common in males
Renal Cancer Clinical Signs and Symptoms (7)
- Blood in urine
- Flank or side pain
- Painful Urination
- Urinary Frequency
- Weight Loss
- Fever
- General fatigue
Kidney Fist Percussion
Procedure:
◦Patient Position: Sitting
◦Examiner Position: Standing to side of pt
◦Dummy Hand: Over costovertebral angle
◦Percuss with fist on dorsum of dummy hand
Abnormal Findings: Tenderness with percussion
Prostatitis
- Relatively common inflammation of the prostate causing prostate enlargement
- 10% of the adult male population
- Chronic pain and discomfort
- Voiding complaints
- Difficulty stopping/starting urine flow
Prostatitis clinical signs and symptoms (11)
- 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
Benign Prostatic Hyperplasia (BPH)
- Defined as an enlarged prostate
- Common occurrence in men > 50 yrs
- Prostate enlarges and squeezes the urethra
- Interferes with urination and sexual function
- If the prostate is greatly enlarged, chronic constipation may occur
Clinical Signs and Symptoms Benign Prostatic Hyperplasia (BPH)
◦Low back or upper thigh pain/stiffness
◦Suprapubic or pelvic pain
◦Erectile dysfunction
◦Blood in urine or semen
◦Bladder palpable above symphysis pubis
◦Urinary problems
- Hesitancy, weak stream, dribbling, frequency, nocturia
◦Lower abdominal discomfort with feeling the need to void
Benign Prostatic Hyperplasia (BPH) Follow Up Questions (6)
- 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?
Prostate Cancer
what might cancer metastasis cause?
1/3 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 (bone forming) vs osteolytic (bone lysing)
Risk factors for prostate cancer (3)
- Family history (father or brother)
- More common in African American men compared to Caucasian and Hispanic
- Diet high in animal fat/meat
symptoms of metastatic disease (on prostate cancer slide) (5)
- Bone pain
- Anemia
- Weight loss
- Lymphedema of the LEs and scrotum
- Neurological changes associated with spinal cord compression
Stress incontinence
◦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
Urge Incontinence
◦Commonly called “overactive bladder”
◦Involuntary contraction of the detrusor muscle with a strong desire to void
◦Often idiopathic but can be caused by meds, alcohol, bladder infections, bladder tumor, neurogenic bladder, bladder outlet obstruction
◦High prevalence in female elite athletic population
Mixed Incontinence
Combination of urge and stress incontinence
Overflow Incontinence
◦Overdistention of the bladder and 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
Functional Incontinence
◦Occurs when bladder is normal but mind and body are not working together
◦Occurs secondary to mobility or access deficits
◦Ie Confined to wheelchair, altered mentation
Risk Factors for Urinary Incontinence (10)
- Advanced age
- Overweight/obese
- Chronic cough
- Chronic constipation
- Hx UTI
- Diabetes
- Neurologic Disorders
- Medications
- Caffeine, alcohol
- Female Gender
Male Risk factors for urinary incontinence
◦Enlarged prostate
◦Prostate/pelvic surgery
◦Radiation
Female risk factors for urinary incontinence (5)
◦Pregnancy
◦Vaginal birth or C-section
◦Pelvic Trauma/Radiation
◦Bladder/Bowel prolapse
◦Menopause
renal failure
Exists when the kidneys can no longer maintain homeostatic balances within the body that are necessary for life
Treatment includes dialysis, transplant, or medications
acute renal failure
◦Abrupt cessation of kidney activity
◦Occurs over a period of hours to a few days
◦Often reversible, within 3-12 months
chronic renal failure
what is the primary cause?
◦AKA end stage renal disease (ESRD)
◦Irreversible
◦Diabetic nephropathy is the primary cause
Renal Factors Risk Factors
◦Chronic intake of certain meds and OTC drugs
◦Acetaminophen and NSAIDs
PT Considerations for Renal Failure
◦Observe for signs and symptoms of complications associated with chronic renal failure and dialysis
- Dehydration
- Cardiac arrhythmias
- Depression
Bladder Cancer is strongly linked to what risk factor?
Strongly linked to tobacco smokers
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 history or family history
Bladder Cancer Signs and Symptoms
- Blood in urine
- Painful urination
- Urinary urgency
- Feeling of urinary urgency without urination
Patients with these symptoms require MD referral
Testicular Cancer
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
Signs and Symptoms Testicular (7)
Often asymptomatic
- May present as a hard painless lump in the testicle
- Swelling/enlargement of testicle
- Significant loss of size of one testicle
- Feeling of heaviness in scrotum/lower abdominals
- Dull ache in groin, lower abdomen
- Low back pain (more common in late stages)
- Infertility
Endometriosis
◦Pain can occur anywhere but often in back, pelvis, hip or sacrum
◦Can be mistaken for a MSK, musculoligamentious or neuromuscular impairment of lumbar supine
◦Key to recognition is that it is often cyclic
◦May have urinary tract or bowel involvement
Endometriosis Clinical Signs and Symptoms (7)
- 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
Ovarian Cysts
◦May cause back pain
◦However, lower abdominal/pelvic pain more common
◦Cyclical pattern associated with menstrual cycle
Clinical Signs and Symptoms of Ovarian Cysts (5)
- 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
Ectopic Pregnancy
- Commonly associated with shoulder pain
- May cause back, hip, sacral, abdominal , pelvic and/or shoulder pain
- Most common symptom 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 without preceding or accompanying abdominal pain
- Not a viable pregnancy
- Life threatening and requires immediate medical referral
T/F: Females of childbearing age that are sexually active and present with clinical signs and symptoms of an ectopic pregnancy require immediate medial referral
True
Clinical Signs and Symptoms of an Ectopic Pregancy
- May be accompanied with irregular bleeding or spotting after a light or late period
- Diffuse, aching lower abdominal quadrant or low back pain; can cause ipsilateral shoulder pain
- May progress to a sharper, intermittent type of pain
ovarian cancer
2nd most common reproductive cancer in women
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 or family history of breast, endometrial or colorectal cancer
◦Family history of ovarian cancer
◦Infertility
◦Early menarche, late menopause, prolonged postmenopausal hormone therapy
◦Obesity
ovarian cancer clinical signs and symptoms
- Persistent vague GI complaints
- Pelvic/abdominal discomfort, bloating, increased abdominal or waist size
- Indigestion, belching
- Early satiety
- Mild anorexia in women over age 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 (8)
- 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
- History of recent bladder/kidney infection
Clues to Screen for Gynecologic Disease (3)
- 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 (3)
- Presence of cervical spine pain at same time that urinary incontinence develops
- Bowel/Bladder incontinence
- Saddle anesthesia secondary to cauda equine lesion
Guidelines for Physician Referral (6)
- Combo of systemic signs and symptoms
- Accident, injury, assault, or trauma to musculoskeletal structures surrounding the kidney and urinary tract
- Back or shoulder pain accompanied by abnormal urination (change in color, odor, amount, flow of urine)
- Positive kidney percussion test, especially with recent hx of renal or urologic infection.
- Postmenopausal women reporting spotting/bleeding
- Presence of any amount of blood in urine
