5.2 - GU System

Question 1

How can the presentation of cervical cancer vs ectopic pregnancy differ?

Answer 1

Ectopic pregnancy may cause unilateral shoulder pain (or mid and lower back)
- Bc higher up in fallopian tubes

Cervical CA is unlikely to cause shoulder pain
- Bc much lower compared to fallopian tubes

Question 2

Describe the general s/sx of GU conditions

Answer 2

Classic Symptoms:
- Unilateral costovertebral tenderness
- LBP, flank, inner thigh pain
- Ipsilateral shoulder

Urinary changes:
- Dysuria
- Noctuira
- Hematuria
- Polyuria
- Incomplete emptying
- hesitancy

• Dyspareunia
• Sexual dysfunction

Systemic s/sx - fever, chills, fatigue, malaise, anorexia, weight loss

Question 3

Describe the upper urinary vs lower urinary tract

Answer 3

Upper: Kidneys & ureters

Lower: Bladder & urethra

Question 4

Define oliguria

Answer 4

Little amount of urine (<400 mL / 24hr)

Question 5

Define anuria

Answer 5

Almost no urine (<100mL / 24hr)

Question 6

Define dyspareunia

Answer 6

pain w/ sexual intercourse

Question 7

Common upper urinary tract conditions (4)

Answer 7

Renal failure
Renal infections (pyelonephritis)
Glomerulonephritis
Renal necrosis, renal tuberculosis

Question 8

Common lower urinary tract conditions

Answer 8

Bladder infection (cystitis)
Urethritis
Renal calculi

Question 9

Describe symptoms in the upper vs lower urinary tract

Answer 9

Upper tract:
- Unilateral costovertebral tenderess
- Flank pain, ipsilateral shoulder pain

Lower tract:
- Increased urinary frequency, urgency
- LBP, pelvic pain, lower abdominal pain

Both: change in bladder habits

Question 10

Describe risk factors for UTIs

Answer 10

Older adults
Females
Diabetes mellitus

Question 11

In an older adult with mental status changes, what should be one of the first thoughts we have about what is causing this change?

Answer 11

UTI

Question 12

Renal Calculi

What is it?
Clinical presentation

Answer 12

Kidney stones

Clinical Presentation:
- “Colicky” flank pain - “ebb & flow”; intense pain comes and go; pain occurs when the stone is moving
- Pain location dependent on stone location

Question 13

Cystitis

What is it?
Clinical presentaiton

Answer 13

Inflammation of the bladder

Clinical Presentation:
- Increased urinary frequency, urgency

Bladder acts “hyperreflexic” because of irritation

Question 14

Prostatitis

What is it?
Clinical Presentation

Answer 14

Inflammation of the prostate

Risk Factors:
- Prevalence higher in YOUNGER men <40 yo (differs from BPH)
- Multiple sex partners
- Bicycling or jogging on a regular basis

Clinical Presentation:
- Low back, inner thigh pain
- Testicular, penis pain
- Nocturia, dysuria
- Weak urine stream
- Fever, chills, malaise

Can eventually progress to overflow incontinence due to difficulty emptying the bladder

Question 15

Describe how to identify prostatitis vs BPH vs prostate cancer

Answer 15

Prostatitis:
- Prevalence higher in YOUNG men <40 yo
- Presence of PAIN

BPH:
- OLDER men >50 yo
- Obstruction of urethra –> decreased FORCE of urinary flow; difficulty with urination (especially initiating); increased frequency

Prostate Cancer:
- HEMATURIA
- LBP

Question 16

What is the hallmark symptoms of UTIs?

Answer 16

Dysuria

Question 17

Describe risk factors for a UTI

Answer 17

Urinary catheterization!!!
Increased age
Diabetes

Question 18

Describe the clinical presentation of a UTI in older adults

Answer 18

Change in MENTAL STATUS
N/v
SOB, cough

Question 19

Describe the 4 types of incontinence

Stress
Urge
Overflow
Functional

Answer 19

Stress
- WEAK support for bladder
- Leakage w/ increased intra-abdominal pressure (laughing, sneezing, lifting)

Urge
- Involuntary contraction of the detrusor muscle

Overflow
- Acontractile or deficient detrusor –> inability to empty completely –> overdistention of the bladder

Functional
- Decreased mobility or physical impairments impair the ability to get to the bathroom in time

Question 20

BPH is a common cause of __________________ incontinence.

Answer 20

Overflow incontinence

Question 21

Describe the absolute contraindications to aerobic exercise during pregnancy

Answer 21

Hemodynamically significant heart disease
Restrictive lung disease

Incompetent cervix
Vaginal bleeding
placenta previta (placenta may detach)
Multiple gestation w/ risk of premature labor
Preecamplsia (high BP that occurs during pregnancy)
Rupture of membrane (“water broke”
Maternal type I diabetes
Severe anemia

Question 22

Review the precautions and relative contraindications to exercise during pregnancy

Answer 22

Discontinue exercise and contact PCP:
Vaginal bleeding
Persistent pain
Leakage of amniotic fluid
Regular painful uterine contractions
Decreased fetal movements
Persistent SOB, irregular heartbeat
Dizziness, faintness, pain in calf, difficulty walking

Relative contraindications:
- Poorly controlled T1DB, HTN, seizure disorder, hyperthyroidism
- History of extremely sedentary lifestyle
- Overhearting
- Morbid obesity or extreme underweight
- Diastasis recti
- heavy smoker
- Arrhythmias, bronchitis

Question 23

Describe how to assess for diastasis recti

Answer 23

Hooklying

Palpable separation of the rectus abdominis (2 cm)

Question 24

A PT is treating a pregnant patient (32 wks gestation). The treatment requires the patient in supine. Which modifications to the supine position would be MOST appropriate?

Answer 24

Place pillows under R hip

Places patient in a semi L s/l position –> offloads the inferior vena cava that travels on the R side

Question 25

When should supine be avoided during pregnancy?

Answer 25

Do not exceed 5 min in supine after the 1st trimester Use a towel or wedge under the R hip instead

Question 26

What other position (besides supine) should be avoided during mid-to-late pregnancy?

Answer 26

Prone

Question 27

Why should pregnant patients be cautioned about orthostatic hypotension?

Answer 27

Increased BF to placenta

Question 28

Describe each of the following considerations during pregnancy Valsalva Bladder emptying before exercise SL exercises

Answer 28

Discourage / avoid Valsalva Encourage complete bladder emptying before exercise Limit SL exercises - Relaxin hormone --> increased ligament laxity in pelvis - SL exercises --> increased shear forces in pelvis / SI joint

Question 29

Describe each of the following pelvic floor interventions Contract-relax Quick contractions Pelvic floor relaxation

Answer 29

Contract-relax - Contract pelvic floor - Avoid valsalva maneuver Quick contractions - 15-20 reps of quick contractions - Stimulate type II fibers to withstand quick pressure (sneezes, cough, etc.) Pelvic floor relaxation - Used for pelvic floor overactivity, dyspareunia

Question 30

What muscles / movements can be used to improve recruitment of the pelvic floor musculature?

Answer 30

"Pelvic floor overflow recruitment" Hip ERs & IRs Hip adductors

Question 31

What cue can be used to promote contraction of the pelvic floor?

Answer 31

"Stop the flow of urine"

Question 32

Describe the easiest to hardest positions for pelvic contractions

Answer 32

Easiest --> hardest Supine --> hooklying --> quadruped --> seated --> standing --> during activity

Question 33

What is the Crede maneuver?

Answer 33

Application of manual downward pressure over the lower abdomen to promote bladder emptying in those w/ a flaccid bladder

Question 34

What is suprapubic tapping?

Answer 34

Stimulates the detrusor muscle to assist w/ bladder emptying

Question 35

Describe the primary interventions for each of the types of incontinence Stress Urge Overflow Functional

Answer 35

Stress - Pelvic floor strengthening Urge - Pelvic floor strengthening - scheduled voiding Overflow - Pelvic floor training - Fluid regulation - Improve flow (ex: surgery) Functional: - PT! - Improve functional mobility

Question 36

At what spinal cord level does micturition control arise from?

Answer 36

S2-4

Question 37

How does the location of a SCI impact bladder function?

Answer 37

Lesion above the conus medullaris (L1 vertebral body) --> spastic / hyperreflexic bladder - "UMN lesion" - Reflex arc intact - Reflexively empties w/ adequate filling pressure Lesion below the conus medullaris --> flaccid / areflexic bladder - "LMN lesion"

Question 38

Describe the management of a spastic vs flaccid bladder

Answer 38

Spastic bladder: - Suprapubic tapping Flaccid bladder: - Catheterization - Valsalva maneuver straining

Question 39

Describe how the location of a SCI can impact bowel function Describe the management of each

Answer 39

Above conus medullaris --> spastic / reflexive bowel - Reflex defecation when rectum fills - Digital stimulation Below conus medullaris - flaccid / areflexive bowel - Manual evacuation