Medical Issues Genitourinary and Gynecological Pathology

Question 1

S/S with renal/reproductive pathology

Answer 1

hematuria
changes in urinary habits
nipple discharge
hypertension
anemia
sexual dysfunction
menstrual irregularities
pain

Question 2

heamturia

Answer 2

blood in the urine
pseudohematuria
-change in urine color as a result of something you ingest
exertional hematuria
-increase in RBCs that show up in the urine after heavy exertion
-ex. marathon, swimmers
if it occurs after trauma it’s a medical emergency

Question 3

changes in urinary habits

Answer 3

dysuria
nocturia
unusual urgency
ncontinence
oliguria
anuria

Question 4

nipple discharge

Answer 4

serous
sanguineous
serosanguineous
can indicate breast cancer or benign breast conditions (gland infection or hormonal imbalances)

Question 5

kidneys and BP

Answer 5

dual control of BP
resistance exercise vs. endurance exercise
-resistance
–increase in both systolic and diastolic
-endurance
–slight increase in systolic

Question 6

anemia

Answer 6

kidney pathology may affect the production of erythropoietin (hormone that regulates RBC production)
decrease in erythropoietin leads to decrease in

Question 7

sexual dysfunction

Answer 7

impotence
painful intercouse
hemospermia
bleeding during intercourse or loss of libido

Question 8

menstrual irregularities

Answer 8

amenorrhea
-primary: don’t begin menstruating (16 y/o)
-secondary: stops menstruating (3 or less times a year or 3 consecutive months
oligomenorrhea
-3-6 cycles per year
dysmenorrhea
-disabling pain with menstruation

Question 9

pain referral patterns

Answer 9

kidney
-lower back or abdomen
-typically due to infection or trauma
bladder
-over bladder
-refer to lower back or thighs possibly
ureter
-groin

Question 10

male-specific pain referral patterns

Answer 10

prostate gland
-refers to lower back, scrotum, or perineum
-diffuse but centralized area
testicular disease
-focal
-testicles or lower abdomen

Question 11

female-specific pain referral patterns

Answer 11

uterus
-lower back
ovaries and fallopian tubes
-lower abdomen and sacrum
breast
-chest and ipsilateral shoulder

Question 12

medical history and physical examination

Answer 12

family and personal history
inspection - edema in extremities (advanced kidney pathology)
palpation
other things to consider
-age of first period
-cycle length
-sexually active

Question 13

urinalysis

Answer 13

purpose

• general evaluation of health
• metabolic disorders or systemic disease
• endocrine disorders
• diabetes
• pregnancy
• drug screening
• specific gravity
• pH
• protein
• ketones
• nitrates
• trauma to kidneys

Question 14

urinalysis methods

Answer 14

best method
-clean catch mid stream urine
-needs to be tested within the hour
-catheter can be used - comes with risks
testing
-dipstick method
-microscopic

Question 15

urinalysis abnormal results

Answer 15

cloudy
foul smelling
fruity - diabetes, starvation, and dehydration

Question 16

urinalysis abnormalities cont.

Answer 16

blood
casts
-small fibrous pieces
-protein buildup
crystals
protein
sugars

Question 17

renal pathology and pathogenesis

Answer 17

S/S

• kidney trauma
• -direct blow to middle/lower back
• -tenderness ribs 10-12
• -blood in urine (emergency referral)
• -treated with meds. not surgery
• bladder and urethral trauma
• -more common in crashes than sports (bladder)
• -pain in lower abdomen
• -traumatic impact to the urethra

Question 18

renal pathology and pathogenesis treatment and referral

Answer 18

gross observable blood in urine after a blow to the back or abdomen requires immediate referral
changes in urine or frequency requires referral

Question 19

UTI’s

Answer 19

bacterial infection
more common in sexually active females
S/S
-dysuria
-increased frequency
-scanty flow
-back pain
red flags
-gross hematuria
-abnormal vaginal bleeding
-fever

Question 20

UTI Tx and referral

Answer 20

urinalysis and referral is often needed
need to determine cause before treatment
-bacterial
-fungal
-parasite
-yeast
medications also include analgesics and antipruretics (anti-itching)
cranberry juice

Question 21

urolithiasis (kidney stones)

Answer 21

forms due to excess salt, calcium or uric acid in the kidney filtrate
when stones get big enough to block urine flow pain begins
not usually any trauma
pain in abdomen, lower back radiating to anterior thigh
vomiting, pallor, tachycardia and signs of shock
small stones treated with medication and good hydration to pass
large stones-fragmented with light sound or shock
proper diet/hydration decreases chances

Question 22

prostate disorders

Answer 22

produce symptoms due to chronic or acute inflammation (prostatitis)
likelihood increases with age
most commonly due to infection, but cancer and urogenital disease as well
symptoms - dysuria, increased volume or frequency or urination and nocturia
dull ache in low back/scrotum

Question 23

prostate cancer

Answer 23

S/S
-no reliable S/S in early prostate cancer
fatigue
weight loss
hematuria
urinary retention
urinary incontinence
back pain
Tx and RTP guidelines
-radiaton and hormone therapy
-radiation to metastasized areas as needed
-RTP during treatment is okay if they feel well enough and no significant side effects

Question 24

testicular torsion

Answer 24

spermatic cord twists, compressing veins and arteries to the testicles
S/S
-nausea and vomiting
-abdominal pain
-scrotal swelling
-tender testicle
-elevated bilaterally
Tx
-manual detorsion is successful 30-70% of the time
-6 hours from the onset of pain treatment will result in 80-100% salvage
12+ hours 0% salvage

Question 25

hydrocele

Answer 25

``` fluid collection along the scrotal sac or along spermatic cord 6% of adult men asymptomatic possible aching/fullness RTP is not limited if asymptomatic ```

Question 26

varicoceles

Answer 26

``` valves in the veins fail veins stretch, get bigger or become swollen feels like a "bag of worms" dull ache and heaviness in scrotum no participation risks ```

Question 27

testicular cancer

Answer 27

S/S -nodule in testicle is palpable -unilateral testicular swelling -pain in testicle -rare occasions - breast tenderness and heaviness and aching in the scrotum Tx -removal of testicle and spermatic cord (orchiectomy) -chemo and/or radiation therapy -RTP si based on symptoms during treatment and physician orders -wearing a cup is mandatory to protect remaining testicle

Question 28

athlete recommendation

Answer 28

get a yearly exam

Question 29

endometriosis

Answer 29

``` when endometrial tissue grows outside of the uterus between ages of 30-40 S/S -dysmenorrhea -increased discharge volume with menstruation -dysparenunia -dysuria -pain with bowel movements -back pain -leading cause of infertility Tx -hormone and pain therapy (progesterone) -occasionally surgical intevention ```

Question 30

pregnancy

Answer 30

S/S - unceplained weight gain - recurring vomiting and nausea - abdominal pain - frequent urination - hypertension - breast enlargement

Question 31

pregnancy facts

Answer 31

25-30 pounds are added during pregnancy heart rate increases up to 15 bpm hormone relaxin is secreted throughout pregnancy and makes patient more susceptible to injury

Question 32

NCAA recommendations for the pregnant athlete

Answer 32

``` avoid supine positions no heavy weight lifting discourage valsalva maneuver no activities that involve risk of falling avoid contact sports after the 14th week no hot tubs/whirlpools no scuba diving if previous medical condition (diabetes, hypertension, cervical defects) ```

Question 33

ruptured ectopic pregnancy

Answer 33

when ovum attaches outside uterus, usually in fallopian tube normal signs of pregnancy once large enough, tube ruptures causing severe hemorrhaging low back pain, low quadrant tenderness, vaginal bleeding, syncope, and shock baby will due no matter what surgery is to save the mother

Question 34

female athlete triad

Answer 34

amenorrhea (any menstrual irregularity), disordered eating (overall energy availability), and osteoporosis

Question 35

pelvic inflammatory disarders

Answer 35

``` infection of the cervix, uterus, or fallopian tubes chlamydia and gonorrhea are the most common culprits S/S -abdominal pain -high-grade fever -nausea -abnormal vaginal discharge complications -infertility -ectopic pregnancy -chronic pelvic pain treatment -antibiotics ```

Question 36

ovarian cysts

Answer 36

fibrous cysts or fluid filled sacs can form within urogenital system may cause unusual bleeding or interference with menstrual cycle and estrogen production if rupture cause internal hemorrhaging, abdominal pain, peritenosis, shock, and sometimes death

Question 37

pediatric concerns

Answer 37

primary amenorrhea kidney trauma -more frequent than spleen or liver injuries because they are more highly exposed -trauma should be screened for S/S of renal damage cryptorchidism - "undescended testes" -most common congenital abnormality -associated risk with inguinal hernia