Clin Phys 3

kidney and ureter

what comprises the upper urinary tract

bladder and urethra

what comprises the lower urinary tract

kidneys

this organ serves as an endocrine organ and is a target of endocrine action, aimed at controlling mineral and water balance

to filter waste and excess fluid from blood

what is the main function of the kidney

reduction of blood flow and nephrons resulting in decreased efficiency at waste removal and an increase in urine volume

what are aging implications for the kidneys

urethra and bladder

what can a UTI involve

bacteria enters the urinary tract and spreads

how does one acquire a UTI

sexually active females, history of UTI, frequent sexual activity, pregnant and older women, diabetics, catheterization

who is most at risk for a UTI

men have longer urethras

why are UTIs more prevalent in women than men?

urinary frequency, urgency, dysuria, nocturia

cloudy, bloody, or foul smelling urine

burning or pain during urination/intercourse

what are the classic signs and symptoms of a UTI?

drinking more water, cranberry juice

what treatments are "by the book" for UTIs (not supported by evidence)

urinalysis or history

how do we diagnose a UTI

antibiotics and increased fluid for mild infections

what are treatments for UTIs

renal cell carcinoma

kidney cancer is 3-4% of ALL cancer, but which type is 90% of kidney cancer

smoking, obesity, HTN, exposure, end stage renal disease

what are risk factors for renal cell carcinoma

flank pain

hematuria (bloody urine)

palpable abdominal mass

what are the triad of symptoms for RCC

hematuria

what is the single most common presenting symptom of RCC

silent

metastasis because it has time to spread

kidney cancers are ____________ in early stages, leading to what?

lung, liver, lymph nodes, bones

where are the most common metastases from RCC

detection of tumor and surgery

how is renal cell carcinoma usually managed

kidney stones

what are renal calculi

the ureters causing urinary obstruction and severe pain

from the kidney, where do renal calculi move to, what does this cause

men 30-60 years

who is more affected by kidney stones

dehydration

increased dietary intake of calcium, sodium sucrose, and animal protein

metabolic issues

what are some causes of kidney stones

colicky, severe flank pain radiating to the groin or perineum

symptoms consistent with UTI (urgency, fequency)

what is a classic presentation of kidney stones

increased fluid intake, decreased protein ingestion, increase consumption of fruits and vegetables (citrate)

what are dietary recommendations to prevent kidney stones

letting them pass,

stones less than 1cm can receive shock-waves to break up the stone

larger than 1cm can benefit from a ureteroscopy

what are medical management options for kidney stones?

chronic kidney disease

alteration of kidney function or structure for greater than 3 months

5

how many stages of chronic kidney disease are there?

diabetes

hypertension

glomerulonephritis

what are the three most common causes for chronic kidney disease

end-stage renal disease (ESRD)

what is the final stage of kidney disease

loss of kidney function requiring dialysis or kidney transplant

what happens with ESRD

analgesic drug use (analgesic nephropathy)

what types of over the counter drugs are associated with increased risk of renal damage

HTN and anemia

what are early clinical manifestations for chronic kidney disease

BUN, creatinine, and protein in urine

what laboratory blood values will be abnormal in a patient with chronic kidney disease

Uremia

ESRD

nausea, vomitting, anorexia, lethargy, itching, neurophathy, pericarditis, impaired heart function, asterixis (flapping), and seizures are symptoms of what? what is this process indicative of

Cardiovascular

chest pain, nausea, SOB, sweating

what other system may be affected in individuals with chronic kidney disease? what are common symptoms

bone pain and demineralization

calcification of vessels and soft tissues

how does chronic kidney disease affect the musculoskeletal system

itching

what is the outcome of the deposition of minerals in the skin

spontaneous rupture

what can be the outcome of calcification of a tendon

sleep disturbances and personality changes, confusion, peripheral changes in a stocking-glove distribution

how does chronic kidney disease effect the neurologic system

cardiovascular, neurological, musculoskeletal

what systems do chronic kidney disease effect most

diabetic neuropathy

what is the leading cause of kidney failure in the US

renal replacement therapy (dialysis)

what is the treatment of choice for ESRD

they need more rest and improvements happen slower

what considerations are important for a patient with the inability to concentrate due to chronic kidney disease

RPE

how do we as PTs gauge intensity of exercise for a pt with chronic kidney disease

those with CKD may have autonomic dysfunction which may limit their max HR

why do PTs use RPE instead of HR to gauge intensity

their blood levels will be optimal but they may be fatigued

how may a patient with chronic kidney disease feel after dialysis

SMOKING, age, caucasians, men

what are the risk factors for bladder cancer

painless hematuria

(frequency, urgency, and dysuria)

what is the most common sign of bladder cancer

clot formation blocking the urethra

what can occur due to hematuria in bladder cancer

intermittent bleeding pattern can cause pts to think bleeding is a fluke

why is diagnosis of bladder cancer often delayed

surgery

(chemotherapy and immunotherapy with recurrence)

what is the primary treatment for bladder cancer, other treatments?

brain, spinal cord, nerves to bladder

what normal structures involved in urination are disrupted with neurogenic bladder disorders

failure to store

failure to void

depending on what nerves are affected, what are two types of neurogenic bladder disorders

many neurological diagnosis (CVA, dementia, spinal cord injury)

what can cause neurogenic bladder

UTIs, kidney stones, deteriorated renal function

what are common complications of neurogenic bladder

urodynamic testing

what types of tests can be done for someone with a neurogenic bladder

preventing incontinence, bladder overdistension, UTIs, and renal damage

what are the goals of treatment for neurogenic bladder

catheterization

pharmacologic agents

bladder training

surgery

what modalities of treatment are used for neurogenic bladder

no, but because our kidneys and bladder don't function as well with age we may have to go more often

is incontinence normal as we age?

urinary incontinence

involuntary loss of urine that is sufficient enough to be a problem, occurs often when bladder pressure exceeds sphincter resistance

functional incontinence

incontinence that is secondary to factors other than the urinary tract, such as weakness or poor mobility, cognitive problems, medication etc

urge incontinence

most common incontinence characterized by abrupt urgency, frequency, and noctura

neurogenic or behavioral

what are the two possible causes of urge incontinence

stress incontinence

loss of a small amount of urine with physical activity due to an increase in intra-abdominal pressure on the bladder (2nd most common)

the combination of urge incontinence and stress incontinence

what is mixed incontinence

overflow incontinence

occurrs when the bladder is distended from urine retention

50%

what % of admissions to SNFs are as a result of urinary incontince

medications, caffeine, constipation

what factors contribute to urinary incontinece

behavioral, pharmacologic, surgical

what are the 3 categories of management for urinary incontinence

behavioral: lifestyle and dietary changes, pelvic floor exercises and stimulation, support devices

what is the first line of treatment for UI, what does this include

stress

what type of incontinence is not managed by medication

involuntary detrusor contraction

anticholinergic/muscarinic antagonists are drugs that inhibit...

smaller testes, thickening of seminiferus tubules, prostate gland enlargement, blood vessel sclerosis

what occurs to the male reproductive system with aging

multiple disorders that cause pelvic pain and discomfort

prostatitis is the diagnosis refering to...

1: acute bacterial

2: chronic bacterial

3: chronic prostatitis

4: asymptomatic inflammatory prostatitis

what are the 4 categories of prostatitis

urinalysis, prostatic specimen, digital rectal exam

what methods are used to diagnose prostatitis

prostatitis is painful

what makes prostatitis different from benign prostatic hyperplasia and prostate cancer?

benign prostatic hyperplasia

age-related nonmalignant enlargement of the prostate gland

abnormal urination or initiation of urination

unable to void all urine

what are some clinical presentations of benign prostatic hyperplasia

urine retention, incontinence, hematauria, chronic UTIs

if benign prostatic hyperplasia is mild, it is often monitored, what are some symptoms indicating disease progression

pharmacologic (shrink glandular tissue and relax smooth muscle)

surgical (transurethral resection)

thermotherapy

what are the treatments for someone with advanced BPH

prostate cancer

the most frequently diagnosed visceral malignancy in american men and the second most common cause of male death from cancer (1/5 men)

it may help to treat later when it doesn't effect them as long due to the side effects of a prostatectomy

as of recently, what has been noted about men and prostate cancer

observation, prostatectomy, radiation (post surgery), hormonal therapy

what are the most common treatments for prostate cancer

sexual dysfunction and urinary incontinence

what are the consequences of a prostatectomy that men live with 10-15 years post procedure

orchitits, epididymitis, testicular torsion, testicular cancer

what types of issues can occur with the testicles

erectile dysfunction

inability to achieve, keep or sustain an errection

age related testosterone deficiency

medications

CAD

neurological conditions

alcohol use

stress

smoking

what are risk factors for ED

psychological

usually in men under 35 years old the cause of ED is

pelvic floor

what types of exercises shave been shown to restore erectile function in some men with ED

menopause

what is the most significant age-related change associated with the female reproductive system

perimenopause

the change before the change including changes in the menstrual cycle, sleep disturbances, increased body temp, anxiety/depression/mood changes, fatigue, difficulty concentration

the permanent cessation of ovarian function

what does menopause signify

hot flashes, vaginal dryness, fatigue, anxiety, sleep disturbances, memory loss, reduced libido, mood swings, irritability

what are symptoms of menopause

loss of lean mass

increase cenatral fat mass

how does body composition change with menopause

reducing adiposity and aids in maintenance of muscle mass and bone density

how will exercise effect the female reproductive system

female athletes

what type of female is at risk for reproductive disruption

no period (amenuria)

disordered eating

poor bone health

REDS (relative energy deficiency syndrome) is the new name for the female athlete triad which is the symptoms associated with reproductive system disruption, what are the symptoms