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Differential Diagnosis > Urogenital Issues > Flashcards

Urogenital Issues Flashcards

1
Q

constitutional symptoms of genitourinary disease

A

group of symptoms that can affect many different systems of the body:
Fever, chills
• Fatigue, malaise
• Anorexia, weight loss

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2
Q

musculoskeletal symptoms of genitourinary disease

A

Unilateral costovertebral tenderness
• Low back, flank, inner thigh, or leg pain
• Ipsilateral shoulder pain

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3
Q

urinary problems

A

Dysuria (painful burning or discomfort with urination)
• Nocturia (getting up more than once at night to urinate)
• Feeling that bladder has not emptied completely but unable to urinate more; straining to start a
stream of urine or to empty bladder completely
• Hematuria (blood in urine; pink or red-tinged urine)
• Dribbling at the end of urination
• Frequency (need to urinate or empty bladder more than every 2 hours)
• Hesitancy (weak or interrupted urine stream)
• Proteinuria (protein in urine; urine is foamy)

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4
Q

female symptoms

A 
Abnormal vaginal bleeding
• Painful menstruation (dysmenorrhea)
• Changes in menstrual pattern
• Pelvic masses or lesions
• Vaginal itching or discharge
• Pain during intercourse (dyspareunia)
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5
Q

male symptoms

A 
Difficulty starting or continuing a stream of urine
• Discharge from penis
• Penile lesions
• Testicular or penis pain
• Enlargement of scrotal contents
• Swelling or mass in groin
• Sexual dysfunction
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6
Q

risk factors for UTI

A

Female-shorter urethra than males

ii. Being sexually active
iii. Birth control methods such as diaphragm, spermicidal agents
iv. Completing menopause- lack of estrogen causes changes in urinary tract
v. Urinary tract abnormalities- congenital causes
vi. Blockage of urinary tract- kidney stone or enlarged prostate
vii. Suppressed immune system
viii. Using a catheter

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7
Q

possible symptoms of UTI

A

Burning with urination

ii. Strong, persistent urge to urinate
iii. Passing frequent, small amounts of urine
iv. Urine that appears cloudy, red, bright pink, or brown in color
v. Strong smelling urine
vi. Pelvic pain in women, rectal pain in men
vii. Constitutional symptoms
viii. Confusion
ix. Decreased appetite
x. Sepsis
xi. Fall risk
xii. Can possibly lead to death

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8
Q

other risk factors for kidney and urinary tract disorders

A

Age over 60
•Personal or family history of diabetes or hypertension
• Personal or family history of kidney disease, heart attack, or stroke
Personal history of kidney stones, urinary tract infections, lower urinary tract obstruction, or
autoimmune disease
• African, Hispanic, Pacific Island, or Native American descent
• Exposure to chemicals (e.g., paint, glue, degreasing solvents, cleaning solvents), drugs, or
environmental conditions
• Low birth weight

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9
Q

What causes an upper UTI

A

kidney or ureteral infections

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10
Q

what causes a lower UTI

A

cystitis (bladder infection) or urethritis (urethral infection)

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11
Q

Why is an upper UTI more serious?

A

causes threat to renal tissue which can cause renal infections, glomerulonephritis, renal papillary necrosis or renal tuberculosis

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12
Q

what are the symptoms associated with LOWER UTIs

A 
urinary urgency and frequency
 a sensation to void
dysuria (painful
urination)
Irritation of the neck of the bladder or the urethra can result in a burning sensation
localized to these areas
low back pain
hematuria
pyuria (pus or WBCs in the urine)
bacteriuria
painful intercourse
pelvic/lower abdominal pain
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13
Q

Where can you find the pain located on a body diagram?

A

over the bladder and on the lower back

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14
Q

what are the symptoms associated with UPPER UTIs?

A

Unilateral costovertebral tenderness
 Flank pain
 Ipsilateral shoulder pain
 Fever and chills
 Skin hypersensitivity (hyperesthesia of dermatomes)
 Hematuria (blood [RBCs] in urine)
 Pyuria (pus or white blood cells in urine)
 Bacteriuria (bacteria in urine)
 Nocturia (unusual or increased nighttime need to urinate)

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15
Q

Who is more common to get a LOWER UTI?

A

more common in women

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16
Q

What are some predisposing factors associated with LOWER UTIs?

A

diabetes mellitus, gout,
hypertension, obstructive urinary tract problems, and medical procedures requiring urinary
catheterization

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17
Q

Who is at an increased risk in general for UTIs?

A

older adults; both men and women

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18
Q

What is cystitis?

A

inflammation with infection of the bladder
comes with recurring pelvic pain, pressure or discomfort in the bladder and pelvic region associated with frequent urination and urgency along with a dull achy or acute stabbing
interstitial cystitis is inflammation without infection

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19
Q

what are the risk factors for kidney stones?

A

Family or personal history of kidney stones

ii. Age >40
iii. Male
iv. Dehydration
v. Diets high in protein, sodium, sugar, oxalate
vi. Being obese
vii. Digestive disorders
viii. Renal tubular acidosis
ix. Cystinuria
x. Hyperparathyroidism
xi. UTI

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20
Q

What is a kidney stone?

A

solid mass of tiny crystals

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21
Q

symptoms of kidney stones

A 
•Pain (depends on the rapidity of onset and on the location)
•Acute, spasmodic, radiating
•Mild and dull flank pain
•Lumbar discomfort with some renal diseases or renal back pain with ureteral
obstruction
Hyperesthesia of dermatomes (T10 through L1)
•Nausea and vomiting
•Palpable flank mass
•Hematuria
•Fever and chills
•Urge to urinate frequently
•Abdominal muscle spasms
•Renal impairment indicators
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22
Q

Describe some specific tests PTs can perform to rule in/out kidney stones

A

You can do Murphy’s percussion; the
physician can order CT scan, abdominal x-ray, urinalysis, urine cultures and ultrasound.

In clinic, can do costovertebral test (same as Murphey’s; just tells you the location of where to hit)

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23
Q

What action can a PT take if a kidney stone is suspected?

A

encourage water intake and refer to PCP

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24
Q

List some primary obstructive disorders

A

congenital malformations, renal or ureteral calculi (stones), polycystic kidney disease,
or neoplasms or the urinary tract (bladder, kidney)

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25
Q

list some secondary obstructive disorders

A

BPH, malignant prostatic enlargement, AAA, PID, endometriosis, pregnancy,
neoplasms of pelvic or abdominal structures

26
Q

What is nephrolithiasis?

A

kidney stone and can travel to become ureteral stone (very painful); both cause
sudden, sharp, severe pain (renal or ureteral colic)

27
Q

Where can renal pain refer to on a body diagram?

A

renal pain sensation is aching and dull but can occasionally be a severe, boring type of pain
can refer to ipsilateral shoulder, iliopsoas and mid back

28
Q

Renal and ureteral pain can be felt through which dermatomes?

A

T10 to L1

29
Q

What causes ureteral pain?

A

a ureteral obstruction from a urinary calculus or “stone” consisting of mineral salts that causes spasm that produces intermittent or constant severe colicky pain until the stone is passed

30
Q

what is benign prostatic hyperplasia?

A

enlarged prostate commonly seen in men over 50
it interferes with normal urine flow
they have difficulty urinating
there is straining to empty the bladder which stretches it causing it to be less efficient
if urine collects in the bladder a UTI can occur

31
Q

risk factors for BPH

A

Men
 Increases with age (by 55 one in four men, by 75 half of men show symptoms)
 Family history: Brother or father with prostrate problems
 Obesity
 American/Australian men vs Chinese/Japanese/Indian men
 Erectile dysfunction
 Lack of physical activity

32
Q

possible symptoms of BPH

A 
Weak urine stream
 Difficulty starting urination
 Stopping and starting while urinating
 Dribbling at the end of urination
 Frequent or urgent need to urinate/difficulty postponing urination
 Nocturia
 Straining while urinating
 Not being able to completely empty the bladder
 UTI
 Formation of stones in the bladder
 Reduced kidney function
 Back/side/abdominal pain
 Worse in cold weather or as a result ofphysical or emotional stress
33
Q

Questions to ask patient if you suspect BPH?

A

Have you had any pain or discomfort while urinating?
 Have you been urinating more frequently without an increase in fluid intake?
 Have you experienced any pain in your abdomen, groin, orgenital area?
 Have you had to wake up more frequently at night to urinate?

34
Q

What would you find in a systems review for someone with BPH?

A

Back/side/abdominal pain that doesn’t change with any movements

35
Q

What is urinary incontinence?

A

involuntary leakage of urine

36
Q

What are the risk factors for UI?

A

Advancing age
 Alzheimer’s disease or dementia
 Arthritis or other musculoskeletal problems
 Overweight/obese
 Chronic cough
 Chronic constipation
 History of recurrent urinary tract infections
 History of sexually transmitted diseases
 Enlarged abdomen (e.g., ascites, pregnancy, obesity, tumor)
 Diabetes mellitus
 Neurologic disorders
 Medications
caffeine and alcohol

37
Q

What meds can increase the risk of UI?

A 
Sedatives
o Diuretics
o Estrogens
o Anticholinergics
o Antibiotics
o Alpha-adrenergic blockers (antihistamines, decongestants)
o Calcium channel blockers
o Antipsychotics
o Antidepressants
o Antiparkinsonian drugs
o Laxatives
o Opioids
o Vincristine
o Angiotensin-converting enzyme (ACE) inhibitors
38
Q

what risk factors are specific to women?

A 
Pregnancy (multiparity)
 Vaginal or cesarean* birth
 Previous bladder or pelvic surgery
 Pelvic trauma or radiation
 Bladder or bowel prolapse
 Menopause (natural or surgically induced; estrogen deficiency)†
 Tobacco use
39
Q

what risk factors are specific to men?

A

Enlarged prostate gland
 Prostate or pelvic surgery
 Radiation (acute and late complications), especially when combined with brachytherapy

40
Q

how might incontinence impact a person’s life?

A
  • restrict activities for fear of urine loss and odor
  • decreased psychological health
  • skin breakdown
  • UTIs
41
Q

4 types of incontinence

A

stress incontinence
urge incontinence
overflow incontinence
mixed incontinence

42
Q

what is stress incontinence?

A

occurs when the support for the bladder or urethra is weak or
damaged, but the bladder itself is normal. With stress incontinence, pressure applied to the
bladder from coughing, sneezing, laughing, lifting, exercising, or other physical exertion
increases abdominal pressure, and the pelvic floor musculature cannot counteract the
urethral/bladder pressure
causes 75% of UI cases

43
Q

what is urge incontinence?

A

involuntary
contraction of the detrusor muscle (smooth muscle of the bladder wall) with a strong desire to
void (urgency) and loss of urine as soon as the urge is felt

44
Q

what is mixed incontinence?

A

combination of urge and stress

45
Q

what is overflow incontinence?

A

overdistention of the bladder and the bladder cannot empty
completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or
emptying

46
Q

What are PT interventions for stress and urge incontinence?

A

Biofeedback, Kegel exercises, vaginal cones, pelvic floor exercises; behavioral modification

47
Q

Risk factors for prostate cancer

A

Most common cancer among men and second leading cause of death in men
 Very rare under age 40
 Rises rapidly in men over 50
 60% of cases are over age 65
 Men of African descent are at a higher risk
 Asian or Hispanic men have less of a chance of getting it than Caucasian males.
 Most common in North America, northwestern Europe, Australia, and the
Caribbean.
 Least common in Asia, Africa, Central America, and South America
 Relative with prostate cancer doubles your odds, more relatives with cancer= higher
risk
 Men with high red meat/ fat/ dairy diet increases your risk
 Workplace exposure to toxic combustion products (firefighters)
 Inflammation of the prostate increases risk

48
Q

signs and symptoms of prostate cancer

A 
Problems passing urine
 Hematuria
Impotence
 Pain in hips, back, chest, or other areas from cancer spread to bone
 Weakness or numbness in legs/feet
 Bowel/Bladder Incontinence
 Lymphedema of the scrotum
49
Q

what would you find in systems review that would suggest immediate referral for prostate cancer?

A

Report of change in urination, blood in urine
 No change in pain with lumbar movements
 Unsteadiness during walk and turn
 Smell of urine

50
Q

What is the prostate pain pattern?

A

pain in bladder and prostates/penis

referred to lower back

51
Q

risk factors for renal cancer

A

Smoking (two times the risk as nonsmokers)
 Obesity
 Hypertension
 Long-term dialysis
 Von Hippel-Lindau (VHL) syndrome (genetic, familial syndrome)
 Occupation (coke oven workers in the iron and steel industry; asbestos and cadmium
exposure)
 Gender (men twice more likely than women)

52
Q

signs and symptoms including regions of pain for renal caner

A 
blood in the urine,
pain in the side that does not go away
 a lump or mass in the side or
abdomen,
weight loss
 fever
 general fatigue or feeling of poor health
swollen lymph nodes
swollen legs/feet/scrotum, anemia
back pain just below ribs that doesn’t go away
53
Q

signs and symptoms of bladder cancer

A

Blood in the urine
• Pain during urination
• Urinary urgency

54
Q

risk factors for testicular cancer

A 
HIV/AIDS Infection
 Carcinoa in Situ
 Age: peak 20-34 years
 Race + Ethnicity:
 4/5x White>black
 3xWhite>Asian American
 Body Size: tall men
55
Q

signs and symptoms of testicular cancer

A

A lump or nodule in either testicle
 An enlarged (swollen) testicle
 A dull ache in the lower abdomen or groin
 A sudden gathering of fluid in the scrotum
 Feeling of heaviness in the scrotum
 Low back pain
 Swollen breasts

56
Q

What is the most important risk factor for bladder cancer

A

Smoking: the most important risk factor for bladder cancer. Smokers are at least 3 times as
likely to get bladder cancer as nonsmokers. Smoking causes about half of the bladder
cancers in both men and women. When smokers inhale, some of the carcinogens (cancer causing
chemicals) in tobacco smoke are absorbed from the lungs and get into the blood.
From the blood, they are filtered by the kidneys and concentrated in the urine. These
chemicals in urine can damage the cells that line the inside of the bladder, which increases
the chance of cancer developing.

57
Q

What are other risk factors for bladder cancer

A

Workplace exposures: Certain industrial chemicals
Race and ethnicity: Whites are about twice as likely to develop bladder cancer as African
Americans.
Age: 9 out of 10 people with bladder cancer are older than 55.
Gender: more common in men
Chronic bladder irritation and infections: Urinary infections, kidney and bladder stones,
bladder catheters left in place a long time, and other causes of chronic bladder irritation
have been linked.
Personal history of bladder or other urothelial cancer: having a cancer in the lining of any
part of the urinary tract puts you at higher risk of having another tumor.
Bladder birth defects
Genetics and family history: family members with bladder cancer have an increased risk of
getting it themselves.
Chemotherapy and radiation therapy: Long-term use of the chemotherapy drug
cyclophosphamide (Cytoxan) can irritate the bladder and increase the risk of bladder cancer;
people who are treated with radiation to the pelvis are more likely to develop bladder
cancer.
Certain medicines or herbal supplements: pioglitazone (Actos) for diabetes for more than
one year may be linked with an increased risk of bladder cancer; dietary supplements
containing aristolochic acid (mainly in herbs from the Aristolochia family) have been linked
with an increased risk of urothelial cancers, including bladder cancer.
Low fluid consumption: Drinking more fluids and emptying bladders often keeps chemicals
from lingering in their bodie

58
Q

most common treatment for bladder cancer

A

Tansureal Resection

59
Q

risk factors for chronic kidney disease

A 
advancing age
diabetes
HTN
smoking
obesity
high cholestrol
NOT white
family history
> 65 years
kidney transplant
certain OTC drug intake
60
Q

What is a consideration of someone with end-stage renal disease?

A

Fluid Restriction: patients with ESRD need to restrict their fluid intake to control BP and prevent
CHF

61
Q

follow-up questions if you suspect prostatisis?

A

do you ever have burning pain or discomfort during urination?
does it feel like your bladder is not empty when you finish urinating
do you have to go to the bathroom every 3 hours or more?
do you ever have pain in your testicles, penis?
do you have any discomfort during or after sexual climax?

62
Q

guidelines for immediate medical attention for urogenital disease

A

presence of any blood in the urine
presences of cervical spine pain at the same time as urinary incontinence
saddle anesthesia secondary to cauda equina lesion

Differential Diagnosis (1 decks)

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