Pathophysiology Exam 2: Genitourinary & Reproductive System

What is urolithiasis (urinary calculi/nephrolithiasis)?

A condition characterized by a development of renal calculi (kidney stones); hard crystals composed of minerals that the kidneys normally excrete in renal pelvis, ureters, or bladders.

What are the etiologies of urolithiasis?

Calcium w/ oxalate & phosphate formation because of struvite, uric acid, or cystine, dietary factors (decreased calcium intake, increased oxalate intake, increased animal protein intake, increased sodium intake, or decreased fluid intake), and increased urinary levels of calculi-forming substances (hypercalciuria, hyperoxaluria) or statsis from urinary filterate.

What are the signs/symptoms of urolithiasis?

Intense, sudden flank or abdominal pain (renal colic) that may radiate to lower back, hematuria, dysuria, urgency, frequency, nausea/vomiting, diaphoresis (sweating), and restlessness.

What are the manifestations associated with urolithiasis?

Pain (severe & shooting localized in lower back), colic pain (acute, intermittent, radiating, & excruciating), noncolic pain (dull & deep), hemauria, bacteruria (bacteria in urine), dysuria, urgency—if fever & chills occur (signs of infection) notify provider immediately.

What are the cues of urolithiasis?

Family history of kidney/urinary stones, low urine volume, high dietary intake of calculi-forming minerals (calcium, oxalate, uric acid), and signs of infection (fever & chills).

What is Polycystic Kidney Disease (PKD)?

A condition characterized by growth of grape-like clusters, fluid-filled cysts in kidney tissue bilaterally (both kidneys), leading to progressive loss of nephrons; cysts enlarge the kidneys while compressing & eventually replacing the functional kidney tissue.

What is the etiology of PKD?

Inheritance or acquired—genetic autosomal dominant (most common inherited form; 90% of PKD cases), genetic autosomal recessive, acquired.

What are the manifestations associated with PKD?

Earliest manifestation-hypertension; from compression of renal vessels & subsequent activation of the renin-angiotensin-aldosterone system (RAAS), flank pain, headaches, nausea/anorexia, UTI’s, liver & pancreatic disease, renal calculi, diverticular disease. As renal function worsens—accumulation of nitrogenous wastes, altered fluid/electrolyte balance, & impaired function in multiple organ systems.

What is urinary tract infection (UTI)?

A condition that occurs anywhere along the urinary tract, from the urethral meatus (urethritis) to the bladder (cystitis); ascending—microorganisms enter at distal urethra & move up toward bladder—bacteria attaches to urinary tract epithelium, resulting in an acute inflammation response.

What is the etiology of UTI?

Escherichia coli (E.coli)-most common microorganism implicated-when gaining access to the urinary tract, E.coli causes infection, mechanical obstruction of the urinary tract (renal calculi/kidney stones), enlarged prostate (males), & introduction of urinary catheters into the urethra and bladder. Women are vulnerable bc of short urethra & close proximity b/w urethra & anus.

What are the manifestations associated with UTIs?

Tissues in UT become edematous & hyperemic (blood filled) causing dysuria, urgency, & frequency, tissue destruction causes hematuria, & inflammatory response to bacteria produces purulent exudate (cloudy urine).

What is pyelonephritis?

A condition referred to infection & resulting inflammation of the renal parenchyma resulting in scarring-can be acute or chronic.

What is acute pyelonephritis?

A condition resulting from bacterial infection of the renal parenchyma.

What is the etiology of acute pyelonephritis?

Ascending UTI (E.coli) usually by direct bacterial invasion of the lower urinary tract.

What are the manifestations associated with acute pyelonephritis?

Kidneys become grossly edematous & fill with exudate, compressing renal artery & develops abscesses & necrosis, flank pain, dysuria, frequency, hesitancy, lower abdominal pain, urgency, hematuria, and fever.

What are the complications associated with acute pyelonephritis?

Renal failure, recurrent UTI, and sepsis.

What is chronic pyelonephritis?

A condition that occurs almost exclusively in patients with renal anatomic abnormalities, such as in children with vesicoreteral reflux, a condition characterized by an incompetent ureterovesical valve allowing retrograde urine flow.

What is chronic renal failure?

A condition characterized by polycystic kidney disease (PKD) progression.

What functions of the kidneys become altered because of chronic renal failure?

Sodium & water balance, potassium balance, elimination of nitrogenous wastes, erythropoietin production, acid-base balance, activation of vitamin D, and phosphate elimination.

What are the manifestations associated with chronic renal failure?

Hypertension, hyperkalemia, increased vascular volume, anemia, edema, acidosis, heart failure, pericarditis, hypocalcemia, hyperparathyroidism, and osteodystrophies.

What is pelvic inflammatory disease (PID)?

A condition resulted from a sexually transmitted infection of the female reproductive tract; bacteria usually ascends from the vagina-can be acute or chronic.

What is the etiology of PID?

STIs (gonorrhea & chlamydia)—sexual intercourse propels microorganisms into vagina where infection ascends into cervix, uterus, uterine tubes, ovaries, and peritoneal cavity.

What are the manifestations associated with PID?

Early infection often asymptomatic (increased likelihood of transmission to others); as infection ascends & inflammatory & immune responses become more intensified—pelvic & lower abdominal pain, purulent cervical discharge, cervical motion tenderness, fever, and malaise.

What are the subjective cues associated with PID?

Low-grade to moderate fever, chills, malaise, fatigue, anorexia, tachycardia, and abdominal discomfort beyond pelvis.

What are the objective cues associated with PID?

Lower abdominal/pelvic tenderness-bilaterally-guarding on palpation, cervical motion tenderness, purulent vaginal discharge, elevated temperature, and sepsis.

What is main complication associated with PID?

Ectopic pregnancies

What is polycystic ovarian syndrome (PCOS)?

A condition characterized by excess androgen production from the ovaries.

What the etiology and pathophysiology of PCOS?

Exact cause is unknown-genetic predisposition implication.

Pathophysiology: pituitary gland secretes high levels of LH & ovaries make excess androgen; continued presence of FSH allows for follicle development, but maturation of follicles does not occur—no ovulation occurs=infertility. Chronic anovulation leads to bilaterally distended & cystic ovaries.

What are the manifestations associated with PCOS?

Menstrual irregularities, excess androgen production, and polycystic ovaries. Excess androgen production causes hirsutism, ache, & male-pattern baldness. Acanthosis nigricans (darkened, velvety discoloration of skin) can occur as a result of insulin resistance.

What are the systemic cues associated with PCOS?

Menstrual irregularities, infertility/difficulty conceiving, weight gain/obesity, acanthosis nigricans, mood changes (anxiety, depression), and fatigue/low energy.

What are the objective cues associated with PCOS?

Hirsuitum, ache or oily skin, androgenic alopecia (male-pattern baldness), obesity/increased abdominal girth, and pelvic ultrasound showing multiple small ovarian cysts.

What is ovarian cancer?

Cancer of the ovaries that arises due to combination of genetic and environmental risk factors.

What is the etiology of ovarian cancer?

Genetic predisposition/family history of a first degree relative (mother, sister)—BRCA1 & BCRA 2 genes, infertility, excessive estrogen exposure, and increased trauma to ovaries.

What are the manifestations associated with ovarian cancer?

It is often asymptomatic in early stages—vague abdominal bleeding may be only early sign; as cancer spreads, large tumors cause abdominal distention, pressure, or pain.

What are the subjective cues associated with ovarian cancer?

Abdominal/pelvis discomfort, abdominal distention or bloating , changes to bowel or bladder habits (constipation, frequency, or urgency), unexplained weight loss, malaise, and menstrual irregularities.

What are the objective cues associated with ovarian cancer?

Palpable abdominal/pelvic mass, abdominal enlargement, enlarged lymph nodes, anemia/malnutrition, and decreased bowel sounds of abdominal tenderness.

What is true regarding ovarian cancer?

Pregnancy and oral contraceptives (birth control pills) have been shown to lower the risk for ovarian cancer in women with BRCA mutations.

What is perimenopause?

The 4-5 year gradual transition between predictable reproductive cycles and menopause; subtle changes in bleeding patterns is the earliest manifestation.

What is menopause?

A normal condition characterized by complete cessation of ovarian activity—marks the end of a woman’s reproductive life.

What the etiology of menopause?

Age—aging ovaries are no longer able to produce estrogen & progesterone.

What are the manifestations associated with menopause?

Menstrual cycle cessation, breast tenderness, atrophy of breast tissue, moodiness, hot flashes, vaginal dryness, sleep disturbances, dyspareunia (painful sex), and bone demineralization.

What are the subject cues associated with menopause?

Hot flashes & night sweats, sleep disruption, fatigue/decreased energy, mood changes (irritability, depression), decreased libido/sexual interest, vaginal dryness/dyspareunia, and irregular menstrual cycles.

What are the objective cues associated with menopause?

Thinning of vaginal mucosa & loss of elasticity, atrophy of breast tissue, dry & pale vaginal & cervical tissue, bone density reduction, and dryness & thinning of skin & hair.

What is erectile dysfunction (ED)?

A condition characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

What is the etiology of erectile dysfunction?

Psychological, nervous system, and hormonal factors.

What are the main manifestations associated with erectile dysfunction?

Hormonal factors: hypogonadism, hypothyroidism, or adrenal cortical hormone dysfunction, resulting in inadequate hormonal “priming” of sexual centers of the brain. Impaired veno-occlusive ability: the ability to trap blood within the corpora cavernosa.

What are the subjective cues associated with erectile dysfunction?

Inability to achieve or maintain an erection, reduced sexual desire (libido), anxiety, stress, or depression, relationship strain or psychosocial distress, and nocturnal/morning erection changes.

What are the objective cues associated with erectile dysfunction?

Decreased perineal sensation, penile deformity or atrophy, and increased blood pressure.

What is prostate cancer?

Cancer of the prostate; most common cancer in men; slow-growing tumor with unknown cause, as it grows, it obstructs urethra.

What is the etiology of prostate cancer?

Exact cause in unknown—history of STIs, family history, high-fat diets, and androgen hormone therapy indicated.

What are the manifestations associated with prostate cancer?

Often asymptomatic at first; as tumor expands & obstructs to urethra—urinary frequency, dribbling, hesitancy, incontinence, urgency, and retention occur; pain as tumor spreads to bone.

What are the subjective cues associated with prostate cancer?

Difficulty initiating urination, hesitancy, dribbling, and incomplete bladder, urinary frequency & nocturia, hematuria or hematospermia, pain/burning with urination, and lower back, pelvic, or hip pain.

What are the objective cues associated with prostate cancer?

Hard, nodular, or irregularly enlarged prostate, anemia, hematuria, and malignancy on prostate biopsy.

What is benign prostatic hyperplasia (BPH)?

A common, nonmalignant enlargement of prostate gland that occurs as men age; may result in urinary stasis and UTIs.

What is the etiology of BPH?

Exact cause is unknown—declining testosterone and increased estrogen levels though to cause prostatic stormal cell proliferation, enlarging prostate. As prostate expands, it presses against the urethra and obstructs urine flow; producing urinary hesitancy, causing incomplete bladder emptying.

What are the manifestations associated with BPH?

Urinary frequency, dribbling, hesitancy, incontinence, urgency, and retention. Complete obstruction causes acute urinary retention and inability to urinate—severe pain; can progress to renal failure and death if untreated.

BPH & prostate cancer can clinically present very similar, when it doubt, cut it out—diagnosis required.

What is true regarding BPH?

Patients over age 50 have a higher risk of developing UTIs due to an enlarged prostate, and recurrent UTIs can result in chronic bacterial prostatitis.

What are the subjective cues associated with BPH?

Urinary hesitancy, frequency, and urgency, weak urinary stream, incomplete bladder emptying, prolonged effort to begin/maintain urination, and lower abdominal discomfort.

What is the objective cues associated with BPH?

Enlarged, smooth, & firm prostate, urinary retention, decreased urinary flow rate, and renal function changes.

What is testicular cancer?

An uncommon, but treatable & curable cancer most common in 20-40 year old men; affecting one or both testicles-can be slow-growing (seminoma) or fast-growing (nonseminoma) tumor.

What is the etiology of testicular cancer?

Cryptorchidism (when one or both testes do not descend from the abdomen to the scrotum prior to birth), family history, infection, and trauma.

What are the manifestations associated with testicular cancer?

Small, painless testicular mass, slight enlargement of the testicle, heaviness or enlargement of scrotum, and mild testicular discomfort.

What are the subjective cues associated with testicular cancer?

Painless enlargement or swelling of one testicle, heaviness/dull ache in lower abdomen, scrotum, or groin region, back/abdominal pain, fatigue, weight loss, or malaise, and dyspnea (if metastasis).

What are the objective cues associated with testicular cancer?

Palpable testicular mass or nodule, asymmetry of scrotum, enlarged/tender lymph nodes, anemia/metabolic abnormalities with advanced disease.

Which statement about testicular cancer metastasis is true?

The most common place of metastasis is the lungs.

What are the general manifestations of altered urinary elimination?

Altered volume of urine (increased of decreased), pain, anuria (absent urine production), hematuria (frank bleeding or clots); stretching induced by distention causes dull, persistent pain; descending urinary system causes intermittent, sharp pain.

What is urine?

A waste product produced by kidneys, stored in bladder, and excreted via the urethra through a complex interplay between motor, neural, and hormonal mechanisms.

What are the basic functions of the renal system?

Regulation of body fluid volume & composition, elimination of metabolic wastes, synthesis of hormones (erythropoietin, renin, vitamin D), and regulation of blood pressure (changes in fluid volume=changes in BP).

What is a nephron?

The functional unit of the kidneys “washing machines” and is composed of renal corpuscle (glomerulus & Bowman capsule). Functions/roles include: filtration of water-soluble substances from blood, reabsorption of filtered nutrients, water, & electrolytes, & secretion of waste.

What is the glomerular filtration rate (GFR)?

The rate of blood flow through the glomerulus—best indicator of renal function.

What is the role of the renin-angiotensin-aldosterone system (RAAS)?

It regulates blood pressure, aided by water & electrolyte regulation in the kidneys.

What are the ureters?

Smooth muscle fibers that propel urine to the bladder by process of peristalsis.

What is the urinary bladder?

A muscular organ lined with translational epithelium and innervated by pelvic nerves. As urine volume in bladder increases, urine exerts pressure on the 2 bladder sphincters (internal & external) & stretch receptors in the bladder.

Properly functioning neuronal impulses are needed to allow for muscle to react appropriately.

What is the urethra’s role in urine removal?

It transports urine from the bladder to the urinary meatus—shorter urethras in women.

What are the characteristics of urine?

It is a clear yellow fluid composed primarily of water and wastes. Total volume produced depends on fluid intake, medications, & underlying health conditions. Concentrated, dark, & strong-smelling urine=dehydration. Dilute, pale-colored urine=increased fluid volume.

What is urinary incontinence?

A condition characterized by accidental or involuntary urination.

What is the etiology of urinary incontinence in females?

Relaxation of pelvic structures may occur, especially after pregnancy.

What is the etiology of urinary incontinence in males?

Mechanical obstruction by prostate on the prostatic urethra.

What is the etiology of urinary incontinence in both sexes?

Neurologic diseases (Parkinson’s disease, multiple sclerosis, spinal cord injury, & stroke); advancing age, obesity, & loss of mobility & dexterity (inability to disrobe properly).

What is enuresis (pediatric urinary incontinence)?

Involuntary urination by a child after 4-5 years of age caused by trauma (psychological) and anatomical structures.

What is nocturnal enuresis?

Bed-wetting.

What is stress incontinence?

Loss of urine from pressure exerted on the bladder by exertional stimulus (coughing, sneezing, laughing, exercising, or lifting something heavy). Occurs when sphincter muscle of the bladder is weakened (pelvic floor muscles)—impaired urethral sphincter function & control is the issue. Contributing factors: pregnancy, childbirth, prostate removal, obesity, & chronic coughing.

What is urge incontinence (overactive bladder)?

Sudden, intense urge to urinate (urgency), followed by y an involuntary loss of urine used by overactive detruser muscle.

What are some other causes of urge incontinence (overactive bladder)?

UTIs, bladder irritants, bowel conditions, smoking, injury, and nervous system damage (Detruser muscle).

What is nocturia?

Waking up in the night to urinate.

What is frequency?

Needing to urinate many times during the day.

What is reflex incontinence?

Urinary incontinence caused by trauma or damage of the nervous system; urgency is generally absent.

What is detrusor hyperreflexia?

Increased detrusor muscle contractility that occurs even though there is no sensation to void.

What is mixed incontinence?

Occurs when symptoms of more than one type of urinary incontinence are experienced.

What is overflow incontinence?

Inability to empty the bladder or retention (feels bladder is full but cannot empty it—urine volume exceeds bladder capacity. It often results in detrusor muscle under activity or bladder outlet obstruction.

What if functional incontinence?

Characterized by normal bladder control coupled with an impaired ability to transport to toilet facilities such as with impaired mobility; often occurs in many older adults, especially people in nursing homes, who have a physical or mental impairment that prevents toileting in time (cannot get to restroom fast enough).

What is transient incontinence?

Urinary incontinence resulting from a temporary condition—ex. Delirium (clinical manifestations of UTI in elderly).

What is infertility?

The inability to achieve pregnancy after 1 year of unprotected regular intercourse; exact cause is not determined in most cases.

What are some factors involved in altered reproductive function?

Hormonal imbalances causing the absence of, or infrequent ovulation, which impairs oocyte development & release; low testosterone levels impair sperm production. Motility impairment caused by adhesions or obstructions, leading to problems with oocyte or sperm transit & blocks joining of these cells. Immune problems caused by antibodies to male sperm that quickly destroys sperm, making it unable to reach oocyte.

What are some manifestations of altered reproductive function?

Infertility, amenorrhea (caused by emotional stress or prolonged stenous exercise), anovulation, pain; testicular/scrotal pain (males) and pelvic pain (females), dysmenorrhea (pain with menstrual periods), and dyspareunia (pain with intercourse).

What is cryptorchidism?

Failure of the testes to descend into scrotum or excessive heat to scrotum.

Describe breast cancer.

Most common malignancy in women; caused by genetic predisposition (defects of the BRCA1 & BRCA2 genes); painless lump is the 1st clinical manifestation.

Describe cervical cancer.

Almost all cervical cancers are caused by HPV (genital warts); manifestations include abnormal uterine bleeding (AUB) between menstruation, after intercourse, and after menopause; prevention includes HPV vaccine.

What is priapism?

Prolonged, painful erection, which is a urologic, medical emergency if lasting longer than 4 hours; not a result of sexual stimulation—too much blood shunting within corpus cavernosum or blood trapping in penis.

What is testicular torsion?

Abnormal rotation of testes on the spermatic cord; medical emergency; manifestations include sudden scrotal edema & pain.