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PSP > Urinary Frequency > Flashcards

Urinary Frequency Flashcards

1
Q

How aging effects GU system in specifically women and what are the symptoms resulting

A

. Atrophy of labia causing dec. lubrication and dyspareunia

. Weakening of pelvic floor muscles causing urinary incontinence

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2
Q

How aging affects GU system in specifically men and what results?

A

Enlarged prostate causing urinary incontinence/urgency/ or dribbling due to BPH

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3
Q

How aging affects GU system in all genders

A

. Dec. renal salt retention/regulation, dec. ADH secretion at night, decline in Renal function
. Causes potential orthostatic hypotension, inc. nocturia,and changes in medication metabolism and excretion

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4
Q

Basic activities of daily living

A 
. Eating
. Bathing/toileting
. Ambulating
. Dressing
. Maintaining personal hygiene
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5
Q

Instrumental activities of daily living

A 
. Managing finances
. Managing transportation
. Preparing food
. Shopping
. Managing meds
. Housekeeping
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6
Q

Common causes of transient urinary incontinence

A

. Delirium (common in hospitalized patients)
. Infection
. Atrophic urethritis/vaginitis (physical exam finding)
. Meds
. Severe depression
. Excessive urine output from diuretics/metabolic abnormalities
. Restricted mobility
. Stool impaction

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7
Q

Urge incontinence

A

. Detrusor (smooth muscle under ANS) overactivity
. Causes uninhibited bladder contractions
. Most common
. Idiopathic
. Treatment: schedule voiding and other behavioral exercises

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8
Q

Stress incontinence

A

. Urethral incompetence
. Seen in men after prostatectomy
. Instantaneous leakage of urine in response to stress maneuver (laughing, coughing, lifting)
. Coexists w/ detrusor overactivity
. Women can be caused by pelvic muscle weakness/vaginal atrophy from menopause
. Treatment in women: kegels to strengthen pelvic floor

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9
Q

Urethral obstruction

A

. Prostatic enlargement, urethal stricture, bladder neck contracture, prostate cancer
. Outflow obstruction

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10
Q

Overflow incontinence

A

. Detrusor underactivity
. Least common
. Frequent leakage of small amts of urine
. Elevated postvoid residual urine (over 450 cc) when normal postvoid residual is <50 cc
. Mechanical obstruction (BPH)
. Treatment: surgery/meds

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11
Q

Metabolic issues causing urinary frequency

A

. Diabetic ketoacidosis (poorly controlled diabetes causing osmolar diuresis)

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12
Q

Infections that can cause urinary frequency

A

. STD
. UTI
. Cystitis

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13
Q

Anatomical reasons that could cause urinary frequency

A

. Benign prostate hyperplasia (BPH)

. Bladder malignancy/Prostate malignancy

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14
Q

Polyuria

A

Urine output higher than 3L per day

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15
Q

T/F urinary frequency can exist w/o polyuria

A

T

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16
Q

Symptoms of frequent urination

A

. Burning on urination, sometimes w/ hematuria (injection, stones, tumors, UTI)
. Urinary urgency w/ neurologic symptoms like weakness/paralysis from stroke
. Hesitancy to start urinary stream, straining to void, reduced size/force of stream, dribbling during or end of urination (BPH, urethral stricture, obstructive lesion)

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17
Q

Muscles of anal canal

A

. External and internal anal sphincter

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18
Q

Where does angle of anal canal lie?

A

Line between anus and umblilicus

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19
Q

What nerve supply goes to anal canal?

A

Somatic sensory nerves

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20
Q

External anal sphincter is under ___ control while internal anal sphincter is under ___ control

A

. Voluntary

. Involuntary

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21
Q

Differences in muscle type in internal and external anal sphincters

A

. Internal is extension of muscular coat of rectal wall

. External is strained muscle under voluntary control

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22
Q

Function of anal sphincter

A

Hold anal canal closed

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23
Q

Anorectal junction (pectinate/dentate line)

A

Serrated line btw anal canal and rectum

. Boundary btw somatic and visceral nerve supplies

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24
Q

Rectum location

A

. From rectosigmoid junction ant. To S3 vertebra to anorectal junction at tip of coccyx

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25
Q

Appearance of external margin of anal canal

A

Moist hairless different from surrounding perinatal skin

26
Q

Rectum characteristics

A

. 12 cm long
. Rectal ampulla store flatus/feces
. Wall has 3 transverse fold (Houston valves)
. Prox. End is continuous w/ sigmoid colon
. Ant. Side lies in contact w/ vagina in females (rectovaginal septum) and against prostate gland in males

27
Q

Prostate characteristics

A

. Round, heart shaped
. 2.5 cm long
. Surround urethra ant. To bladder
. Inc. 5x in size btw puberty and end of teen yrs

28
Q

What parts of prostate are palpable on exam?

A

. Lat. lobes and median sulcus

29
Q

Nonpalpable parts of prostate

A

. Ant. And central areas

. Seminal vesicles above prostate

30
Q

Important ROS for prostate

A

. Freq/urgent need to urinate
. Inc. Freq. of urination at night (nocturia)
. Difficulty starting urination
. Weak urine stream/stream that stops and starts
. Dribbling at end of urination
. Straining while urinating
. Inability to completely empty bladder

31
Q

Prostate cancer

A

. Most frequently diagnosed non skin cancer
. Second leading cause of cancer death in men
.

32
Q

PSA

A

Prostate-specific-antigen

Screening tool

33
Q

Risk of prostate cancer rates from 1985 and now

A

Inc. from 9% to 15%

34
Q

Lifetime risk of dying from prostate cancer

A

3%

35
Q

Risk factors for prostate screening

A

. Age (>50, med. age of diagnosis 66)
. Ethnicity (AA highest incident and mortality rate, higher % diagnosed before 50, present w/ more advance stage)
. Family history (1 1st degree relative inc. chance 2 fold, 2/3 1st degree inc. risk 5-11 fold, BRCA1/2)
. Agent orange exposure
. Diets high in animal fat
. Obesity
. Smoking

36
Q

T/F BPH is risk factor for prostate cancer

A

F, it is NOT

37
Q

Patient positioning for rectal exam

A

. Laying of left side
. Hips and knees flexed
. Do after female genitalia exam in lithotomy position
. Keep patient draped as much as possible

38
Q

Things to note during rectal exam

A

. Sphincter tone
. Tenderness
. Induration (area of firmness/dimpled)
. Irregularities or nodules

39
Q

What can cause inc. sphincter tone

A

. Anxiety
. Inflammation
. Scarring

40
Q

What can cause dec. in sphincter tone

A

. Neurologic diseases/spinal cord lesions

41
Q

What can cause induration?

A

. Inflammation
. Scarring
. Malignancy

42
Q

Things to note when examining prostate

A 
. Size
. Shape
. Consistency
. Nodules
. Tenderness
43
Q

Pilonidal cyst

A

. Usually idiopathic
. May have drainage
. Concern for abscess formation
. Might have little hair tuft on it

44
Q

External hemorrhoids

A

. Dilated hemorrhoid veins below pectinate line

. Thrombosis causes pains

45
Q

Internal hemorrhoids

A

Enlargement of vascular cushion above pectinate line
. May cause bright red bleeding
. Can prolapse (get larger and move it external side of anal canal), gets worse w/ straining and can be larger if it involves entire bowel

46
Q

Anal fissure

A

. Painful
. Ulceration of anal canal
. May have sentinel tag below it

47
Q

Anorectal fistula

A

. Tract that opens at one end into the anaconda/rectum and into the skin at the other end

48
Q

Polyps of rectum

A

. Common
. Difficult to palpate
. Soft, usually benign
. Biopsied upon colonoscopy

49
Q

Cancer of the rectum

A

. Firm
. Nodular
. Rolled edges
. Biopsied

50
Q

Rectal shelf

A

. Sign of peritoneal metastasis
. Firm.hard nodular area
. Can be hard to distinguish from nodule inside actual canal

51
Q

Prostatitis

A

. Tender, swollen, boggy

. Consider Neisseria gonorrhea and Chlamydia trachomatis in men <35

52
Q

Prostate cancer feeling on exam

A

Area of hardness/nodularity

53
Q

BPH feeling on exam

A

. Enlargement

54
Q

Common diagnostic tests done when patient has frequent urination

A 
. Thorough history 
. Pregnancy test
. Urinalysis 
. BMP
. PSA 
. Post void residual testing 
. Renal imaging 
. Voiding diary
55
Q

Urinalysis

A

Evaluates for infection, glucose in urine

. Most common in primary care

56
Q

BMP in relation of frequency urination

A

. Screens for diabetes
. Assesses renal function
. Checks electrolytes

57
Q

Post void residual testing

A

. Screen for BPH or prostate cancer

58
Q

Renal imaging

A

Checks for anatomic abnormalities or kidney stones

59
Q

Functional incontinence

A

. Person unable to get to bathroom for any reason
. Occurs in physically/mentally handicapped patients
. Patients w/ dementia
. Treatment: environmental modification (bedside commodes)

60
Q

Diagnostics/labs for dementia

A 
. Depression screening
. Thyroid testing
. Electrolytes
. Thiamine
. Vit. B12
. Electrolytes
. Brain imaging

PSP (35 decks)

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