Week 10- Urogenital & Gynecologic Disease Flashcards
1
Q
PART 1
A
PART 1
2
Q
Common areas of pain that are secondary to renal/urologic origin? (3)
A
- flank
- low back
- pelvic
3
Q
- Parts of the Upper Urinary Tract? (2)
- Parts of the Lower Urinary Tract? (2)
A
- Kidneys, Ureter
- Bladder, Urethra
4
Q
S/Sx related to genitourinary disease divided into what (3) areas?
A
- Constitutional
- MSK
- Urinary
5
Q
Genitourinary Constitutional S/Sx. (3)
A
- Fever, chills
- Fatigue, malaise
- Anorexia, weight loss
6
Q
Genitourinary MSK S/Sx. (3) ***
A
- Unilateral costovertebral tenderness
- Low Back, pelvic, flank, inner thigh, or leg pain
- Ipsilateral shoulder pain
7
Q
Genitourinary Urinary S/Sx. (8)
A
- Dysuria (painful/difficult urination)
- Nocturia (wake up due to need to urinate)
- Feelings of incomplete voiding, but unable to urinate more
- Hematuria (blood in urine)
- Dribbling at the end of urination
- Frequent urination
- Hesitancy (weak/interrupted urine stream)
- Proteinuria
8
Q
Other S/Sx (Men): -Difficulty starting/continuing \_\_\_\_\_\_\_\_\_\_\_\_. Discharge from penis. -Penile \_\_\_\_\_\_\_. -\_\_\_\_\_\_/\_\_\_\_\_\_\_ pain. -\_\_\_\_\_\_/\_\_\_\_\_\_ in groin. -\_\_\_\_\_\_\_\_ dysfunction.
A
- stream of urine
- lesions
- testicular/penile pain
- swelling/mass
- sexual dysfunction
9
Q
Other S/Sx (Women):
- Abnormal vaginal _________.
- Painful menstruation (____________).
- Changes in menstrual pattern.
- Pelvic masses/lesions.
- Pain during intercourse (____________).
- May refer pain to what areas?
A
- bleeding
- (dysmenorrhea)
- (dyspareunia)
- low back, sacral, pelvic, shoulder, or abdomen
10
Q
Genitourinary Risk Factors. (6)
A
- 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
11
Q
PART 2
A
PART 2
12
Q
What are (3) specific things we can break down renal and urologic pain into?
A
- ) Upper Urinary Tract Pain
- ) Pseudorenal Pain
- ) Lower Urinary Tract Pain
13
Q
Upper Urinary Tract:
- What are the 2 structures of the Upper Urinary Tract?
- Site of pain generally corresponds to dermatomes ___-___.
- How is this pain described? (3)
- Both dysfunction in the kidneys and ureters can result in abdominal muscle spasms with rebound tenderness on the _________ side.
A
- Kidneys, Ureters
- T10-L1
- Aching, dull, boring
- same side
14
Q
Pseudorenal Pain:
- What does this mean?
- Occurs secondary to what (2) things?
- Most common sites are ___ and ___.
- Usually an _______ onset associated with ______.
- What is one way we can tell the difference between this and true renal pain?
A
- Mimics renal and/or ureteral pain.
- Radiculitis or irritation of costal nerves.
- T10 and T12
- acute onset associated with trauma
- Pseudorenal pain is usually affected by BODY POSITION (true renal pain is seldom affected by position).
15
Q
What is the pain pattern of pseudorenal pain? (2)
A
- ) Back and/or flank pain occurs at same level as kidney.
- ) Affected by changing position. (lying on involved side increases, prolonged sitting increases, reproduced with movements of spine, costovertebral angle tenderness on palpation)
16
Q
- Are pseudorenal S/Sx associated with urinary S/Sx?
- Will these patients have a + or - kidney percussion test?
A
- No
- Negative
17
Q
Lower Urinary Tract:
- What are the 2 structures of the Lower Urinary Tract?
- Where is pain generally reported where? (3)
- Pain is described as _______.
- How is it characterized? (4)
A
- Bladder, Urethra
- pubis or lower abdomen, back
- sharp
- urinary urgency, sensation to void, dysuria, mild stinging to intense burning with urination
18
Q
What would we perform if we note cluster of S/Sx associated with genitourinary or gynecologic?
A
Review of Systems
19
Q
PART 3: UROGENITAL PATHOLOGIES
A
PART 3: UROGENITAL PATHOLOGIES
20
Q
List of Urogneital Pathologies. (15)
A
- 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
21
Q
Upper vs Lower UTI:
- Structures of Upper and Lower Urinary Tracts?
- Which urinary tract inflammation is considered to be more serious and why?
- Which is more common in women and why?
- UTIs are more common in older adults (men and women) and have non specific symptoms such as what? (3)
- Staph infection of urinary tract may cause _________ in the vertebrae.
A
- Upper (kidney, ureter), Lower (bladder, urethra)
- Upper UTI more serious due to potential damage to renal tissue itself.
- Lower UTI more common in women due to; short female urethra, proximity of urethra to vagina/rectum, rate of occurrence increases with age and sexual activity.
- ALTERED MENTAL STATUS***, loss of appetite, N/V/ab pain
- osteomyelitis
22
Q
Upper UTI S/Sx. (7)
A
- Unilateral costovertebral tenderness***
- Ipsilateral shoulder pain***
- Flank pain
- Fever and chills
- Skin hypersensitivity**
- Hematuria, Pyuria, or Bacteriuria
- Nocturia
23
Q
Lower UTI S/Sx. (5)
A
- LBP
- Pelvic/lower abdominal pain
- Urinary frequency/urgency
- Dysuria, hematuria, pyuria, bacteriuria
- Pain with intercourse
24
Q
Lower UTI Risk Factors:
- _____
- Gout
- HTN
- _______ urinary problems
- Medical procedures requiring urinary __________
A
- DM
- obstructive
- urinary catheterization
25
What is the biggest sign we are looking for indicating a patient has a Lower UTI?
ALTERED MENTAL STATUS
26
Renal Calculi (Kidney Stones):
- Decreased urine flow results in ________.
- This can then result in stone formation (calculi). Where do calculi primarily form?
- Do stones remain in kidney or travel downstream?
- stagnation
- kidney
- Either remain in kidney or move downstream
27
Ureteral Stones:
- _____ painful.
- If stone blocks urine, pressure builds upstream in the kidney causing it to ______ (_____________).
- Can it cause permanent kidney damage?
- Most characteristic symptom is ______/_______/______ pain that originates deep in the ______ area and radiates around side and into ________.
- Most painful
- swell (hydronephosis)
- Yes
- SUDDEN/SHARP/SEVERE pain originating deep in LUMBAR area and radiating around side and into GENITALS.
28
Kidney/Ureteral Stones S/Sx. (11)
- Pain (acute/spasmodic/radiating, mild/dull flank pain, LUMBAR DISCOMFORT)***
- Hyperesthesia of dermatomes (T10-L1)***
- Abdominal muscle spasms***
- Acute ureteral/renal blockage reported as excruciating, spasmodic, radiating pain with severe N/V***
- N/V
- Palpable flank mass
- Hematuria
- Fever/chills
- Urge to urinate frequently
- Renal impairments
- Sudden/acute in development
29
Renal Cancer:
- Renal tumors may be detected as flank mass combined with what (3) things?
- What is the primary symptom of urinary tract neoplasm?
- Is it more common in males or females?
- Unexplained weight loss, fever, hematuria
- Hematuria (blood in urine ALWAYS requires MD referral)
- Males
30
Renal Cancer Risk Factors. (5)
- Smoking
- Obesity
- HTN
- Long-term dialysis
- Most common in males
31
Renal Cancer S/Sx. (7)
- Hematuria (blood in urine)***
- Flank/side pain***
- Painful urination
- Urinary frequency
- Weight loss
- Fever
- General fatigue
32
What test can we perform if there concern for problem with kidneys causing patient symptoms?
Kidney Fist Percussion Test
33
Prostatitis:
- What is it?
- Happens in ___% of the adult male population.
- ______ pain and discomfort.
- Patients have ______ complaints.
- Relatively common inflammation of the prostate causing enlargement.
- 10%
- chronic pain/discomfort
- voiding complaints (difficulty stopping/starting urine flow)
34
Prostatitis S/Sx. (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
35
Benign Prostatic Hyperplasia (BPH):
- What is it?
- Common occurrence in men >___yo.
- Prostate enlarges and squeezes into _______.
- Interferes with _______/________ function.
- If the prostate is greatly enlarged, chronic _________ may occur.
- Defined as enlarged prostate.
- >50yo
- urethra
- urinary/sexual function
- constipation
36
BPH S/Sx. (7)
- Low back or upper thigh pain/stiffness***
- Bladder palpable above pubic symphysis
- Urinary problems (hesitancy, weak, dribbling, frequency, nocturia)
- Lower abdominal discomfort w/ feeling need to void
- Suprapubic/pelvic pain
- Erectile dysfunction
- Blood in urine/semen
37
What are some BPH follow-up questions?
- 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?
38
Prostate Cancer:
- __/__ of all men by age ___.
- Present in 50-75% of all men by age ___.
- _____ pain and _______ can be caused by cancer metastasis.
- Tumors tend to be _________ vs __________.
- 1/3 by age 50
- 5--75% by age 75
- back pain and sciatica
- osteoblastic (bone forming) vs osteolytic (bone lysing)
39
Prostate Cancer Risk Factors. (3)
- Family Hx
- More common in AA compared to caucasian or hispanic
- Diet high in animal fat/meat
40
Prostate Cancer S/Sx. (5)
- Bone pain
- Anemia
- Weight loss
- Lymphedema of the LEs and scrotum
- Neurological changes associated with spinal cord compression
41
What are the (5) types of incontinence?
1. ) Stress
2. ) Urge
3. ) Mixed
4. ) Overflow
5. ) Functional
42
Stress Incontinence:
- Primarily related to ______ or _________ weakness, ligamentous and fascial laxity.
- Pressure applied to bladder from coughing, sneezing, laughing, lifting, or physical exertion that increases ________ _________.
- urethral or pelvic floor weakness
| - increases abdominal pressure
43
Urge Incontinence:
- Commonly called "_______ _______"
- Involuntary contraction of the _________ muscle with a strong desire to void.
- Often _________ but can be caused by meds, alcohol, bladder infections/tumor, neurogenic bladder, bladder outlet obstruction.
- High prevalence in what population?
- "overactive bladder"
- detrusor muscle
- female elite athletic population
44
Mixed Incontinence:
| -Combination of ______ and ______ incontinence.
-urge and stress
45
Overflow Incontinence:
- _____________ of the bladder and it cannot empty completely.
- Urine ______/_________
- Client does not have any sensation of _______/________.
- Caused by acontractile or deficient _________ muscle.
- overdistention
- leaks/dribbles
- fullness/emptying
- detrusor muscle
46
Functional Incontinence:
- Occurs when bladder is _______, but mind/body are not working together.
- Occurs secondary to mobility or access difficulty.
-normal
47
Incontinence Risk Factors. (10)
- Advanced age
- Overweight/obese
- Chronic cough
- Chronic constipation
- Hx UTI
- Diabetes
- Neurologic Disorders
- Medications
- Caffeine, alcohol
- Female Gender
48
Incontinence Female (5) vs. Male (3) Risk Factors.
Female
- Pregnancy
- Vaginal birth or C-section
- Pelvic Trauma/Radiation
- Bladder/Bowel prolapse
- Menopause
Male:
- Enlarged prostate
- Prostate/pelvic surgery
- Radiation
