Genitourinary System Flashcards

Genitourinary System Terminology

  • Ectopic Pregnancy: Development of a fertilized egg outside the uterus, such as in the fallopian tube or peritoneal cavity.
  • Hematuria: Presence of blood in the urine.
  • Micturition: The process of expelling urine from the body.
  • Urology: The branch of medicine focused on the urinary or urogenital organs.
  • Pyuria: Presence of pus in urine.
  • Renal Calculi (Kidney Stones): Stones formed in the kidney pelvis due to physiochemical processes associated with obstruction and infections in the urinary tract.
  • Urinary Incontinence: The inability to retain urine.
  • Urinary Retention: Failure to void urine due to obstruction, nervous contraction of the urethra, or absence of the sensation of needing to urinate.
  • Urethra: A tube connecting the bladder to the vagina or penis for urine excretion.

Anatomy and Physiology of the Genitourinary System

  • The medical study of the urinary system is known as Urology.

Urinary System

  • Consists of two kidneys, two ureters, one urinary bladder, and one urethra.
  • Kidneys filter blood plasma, returning most of the water and dissolved substances (e.g., sodium, potassium) to the bloodstream.
  • The remaining water and dissolved substances form urine.
  • Urine is excreted from each kidney through its ureter and stored in the urinary bladder until expelled via the urethra.
Kidneys
  • Paired reddish organs located just above the waist, between the peritoneum and the posterior wall of the abdomen.
  • Shaped like kidney beans.
  • Located retroperitoneally (behind the peritoneum).
  • Positioned between the last thoracic and third lumbar vertebrae, partially protected by ribs 11 and 12.
  • Fractured lower ribs can puncture the kidneys, causing significant damage.
  • Functions:
    • Filter blood.
    • Excrete waste products.
    • Maintain fluid balance.
  • Urinalysis: Analysis of the volume and physical, chemical, and microscopic properties of urine to reveal information about the state of the body.
  • Blood screening tests for kidney function:
    • Blood urea nitrogen.
    • Plasma creatinine.
Urinary Bladder
  • Urine is expelled from the bladder through micturition (urination or voiding).
  • When the urine volume in the bladder reaches 200−400200-400 ml, stretch receptors initiate a spinal micturition reflex.
  • Older children and adults can voluntarily initiate or inhibit micturition.
  • Normal 24-hour urine volume range: 800800 to 20002000 milliliters, with a normal fluid intake of about 2 liters per day.
Urethra
  • Function: discharge urine from the body.
  • In males, it also serves as the duct for ejaculation of semen.
  • Incontinence: Lack of voluntary control over micturition.
  • Retention: Failure to void urine completely or normally.

Reproductive System

Male Reproductive System
External Genitalia
  • Penis: The male erectile organ for reproduction, through which urine and semen are discharged.
  • Scrotum: External pouch that contains the testes.
  • Epididymis: A system of ducts emerging posteriorly from the testis that holds sperm until maturation and forms a coiled mass before uniting into a single coiled duct.
Internal Genitalia (Accessory Organs)
  • Vas Deferens: Duct that conveys sperm from the testicle to the urethra.
  • Seminal Vesicles: A pair of glands that open into the vas deferens near its junction with the urethra and secretes many components of semen.
  • Prostate: A muscular gland (about the size of a small apricot) located at the base of the bladder that secretes ejaculatory fluid.
Female Reproductive System
External Genitalia (Vulva)
  • Vulva (or vulvae): Composed of eight parts:
    • Mons pubis
    • Labia majora
    • Labia minora
    • Clitoris
    • Vestibular glands
    • Vaginal vestibule
    • Vaginal orifice
    • Vaginal opening
Internal Genitalia
  • Vagina:
    • Carries menstrual flow from the uterus.
    • Serves as the terminal portion of the birth canal.
    • The receptive organ for the penis during sexual intercourse.
  • Uterus:
    • An inverted pear-shaped, muscular organ for containing and nourishing the developing young prior to birth (also known as the womb).
    • Located in the pelvic cavity between the bladder and the rectum.
  • Fallopian Tubes:
    • Insert into the upper portion of the uterus and extend laterally to the ovaries.
  • Ovaries:
    • Pair of oval organs.
    • Secrete estrogen and progesterone, hormones that regulate the menstrual cycle and support pregnancy.

Genitourinary System Assessment

  • As a General Duty Corpsman, your primary role is to assist the Medical Provider in obtaining information and conducting procedures related to the chief complaint.

History of Present Illness (HPI) - Female

  • Collect a full patient Past Medical History, Family History, and Personal and Social History and Review of Systems during the interview.
  • Findings will aid in determining the patient's diagnosis.
  • Certain symptoms or the Chief complaint presented by the patient pertaining to the female Genitourinary system are described below:
    1. Abnormal bleeding: postmenopausal bleeding, menstrual abnormalities
    2. Pain
    3. Vaginal discharge
    4. Premenstrual symptoms
    5. Menopausal symptoms
    6. Infertility
    7. Urinary symptoms: dysuria, burning on urination, frequency, urgency

History of Present Illness (HPI) - Male

  • Collect a full patient Past Medical History, Family History, and Personal and Social History and Review of Systems during the interview.
  • Findings will aid in determining the patient's diagnosis.
  • Certain symptoms or the Chief complaint presented by the patient pertaining to the male Genitourinary system are described below:
    1. Discharge or lesion on the penis
    2. Swelling in inguinal area
    3. Testicular pain or masses
    4. Irregular curvature of penis in any direction with erection (aka Peyronie's Disease)
    5. Persistent erections unrelated to sexual stimulation
    6. Difficulty with ejaculation
    7. Difficulty achieving or maintaining erection
    8. Infertility

Documentation of Selected Genitourinary Abnormalities and Emergencies

Urinary System

Urinary Tract Infection (UTI)
  • Pathophysiology: A bacterial infection of the lower urinary tract, more common in females. The second most common infection in the body.
  • Subjective:
    1. Urge to urinate frequently.
    2. Fever, tiredness, or shakiness.
    3. Dysuria.
    4. Sensation of incomplete bladder emptying.
    5. Abdominal pain or pressure.
    6. Hematuria.
    7. Offensive urine odor.
  • Objective:
    1. Suprapubic tenderness.
    2. Pyuria.
    3. Hematuria.
  • Assessment:
    1. Urinary Tract Infection.
    2. Differential Diagnoses:
      • Vaginitis
      • Sexually transmitted infection
      • Hematuria from causes other than infection
  • Plan:
    1. Collect urine specimen for urinalysis and possible urine culture.
    2. Assist provider in administering antibiotics and medications for symptom relief.
    3. Patient education on maintaining good hydration and good hygiene.
  • Prehospital considerations
    • Prepare patient to transport to advanced level of care
Pyelonephritis
  • Pathophysiology: An acute infection of the kidneys (upper urinary tract infection).
  • Subjective:
    1. Fever.
    2. Nausea and vomiting.
    3. Malaise (feeling of general discomfort).
    4. Dysuria, urinary frequency, and urgency.
  • Objective:
    1. Pre-Hospital Considerations
      • Fever
      • Suprapubic tenderness
      • Patient may present with signs of shock
    2. Inpatient/Outpatient
      • Fever.
      • Suprapubic tenderness.
      • Costovertebral Angle (CVA) tenderness. (To assess, place the palm of your hand over the CVA and strike it with a fist of your other hand. Pain indicates pyelonephritis.)
      • Hypotension and shock, particularly in complicated cases with obstruction.
  • Assessment:
    • Pyelonephritis
  • Differential Diagnoses:
    • Appendicitis
    • Pelvic Inflammatory Disease
    • Ectopic pregnancy
    • Renal calculi
  • Plan:
    1. Treat symptoms of shock if present
    2. Pre hospital considerations
      • Prepare patient to transport to advanced level of care.
    3. Inpatient/Outpatient considerations
      • Collect urine specimen for urinalysis.
      • Assist provider in administering antibiotics and medications for symptom control.
      • Administer IV fluids as needed for dehydration.
Renal Calculi (Kidney Stones)
  • Pathophysiology:
    1. Hard deposits made from minerals and salts that form inside the kidneys. These stones form when urine becomes concentrated, allowing minerals to crystalize and stick together. This often leads to obstruction or blockages in the urethra and/or bladder.
    2. Much more prevalent in men than in women.
  • Subjective:
    1. Fever and chills.
    2. Persistent need to urinate.
    3. Dysuria.
    4. Cloudy or foul-smelling urine.
    5. Pink, red, or brown urine.
    6. Hematuria.
    7. Renal colic: severe cramping flank pain with nausea and vomiting; as the stone passes through the ureter, the pain typically moves from the flank to the groin and then to the scrotal or labial area.
  • Objective:
    1. Fever (suggests an infection).
    2. CVA tenderness.
    3. Diaphoresis.
  • Assessment:
    1. Differential diagnosis:
      • Pyelonephritis
      • Appendicitis
      • Ectopic pregnancy
  • Plan:
    1. Collect urine specimen for urinalysis.
    2. Assist provider in administering pain control medications.
    3. Assist provider in obtaining imagery (x-ray, CT scan).
    4. Administer IV fluids.
    5. Patient education of diet changes.
    6. Pre-Hospital considerations
      • Prepare patient to transport to advanced level of care.

Reproductive System - Female

Ectopic Pregnancy
  • Pathophysiology:
    1. Development of a fertilized egg elsewhere than in the uterus (as in the fallopian tube or the peritoneal cavity). An ectopic pregnancy happens in 1 out of 50 pregnancies.
    2. Can be caused by an infection or scar tissue in the fallopian tube, which leads to a blockage thus not allowing the egg to descend into the uterus.
    3. A ruptured ectopic pregnancy can be life-threatening and is considered a surgical emergency.
  • Risk factors:
    1. Maternal age of 35−4435-44 years.
    2. Previous ectopic pregnancy.
    3. Pelvic Inflammatory Disease (PID).
    4. Smoking.
  • Subjective:
    1. Abnormal vaginal bleeding.
    2. Low back pain.
    3. Mild cramping on one side of the pelvis.
    4. Pain in the lower abdomen or pelvic area.
    5. If the area of the abnormal pregnancy ruptures and bleeds, symptoms may worsen.
    6. Feeling lightheaded or syncope.
    7. Pain felt in the shoulder area.
    8. Severe, sharp, and sudden pain in the lower abdomen.
  • Objective:
    1. Marked pelvic tenderness, with tenderness and rigidity of the lower abdomen.
    2. Signs of shock may be present if it has ruptured. Tachycardia and hypotension reflect hemorrhage of a ruptured tubal pregnancy into the peritoneal cavity and impending cardiovascular collapse.
  • Assessment:
    1. Ectopic Pregnancy
    2. Differential Diagnosis:
      • UTI
      • Appendicitis
      • Pelvic Inflammatory Disease
  • Plan:
    1. Blood draw for lab evaluation
    2. Assist provider in administering medications
    3. Prepare patient for possible surgery
    4. Pre-Hospital considerations
      • Treat shock if present
      • Transport to advanced level of care.
Pelvic Inflammatory Disease (PID)
  • Pathophysiology: Inflammation of the female reproductive tract (such as the fallopian tubes and ovaries) that occurs especially as a result of a sexually transmitted disease (e.g., chlamydia or gonorrhea) and is the leading cause of infertility in women. PID affects nearly 1 million women each year.
  • Subjective:
    1. Lower abdominal pain
    2. Fever and chills
    3. Vaginal discharge with odor
    4. Painful intercourse
  • Objective:
    1. Fever
    2. Abdominal pain during palpation
  • Assessment:
    1. Pelvic Inflammatory Disease
    2. Deferential diagnosis:
      • Ectopic pregnancy
      • Appendicitis
  • Plan:
    1. Pregnancy test
    2. Assist provider in obtaining cervical culture
    3. Assist provider in conducting an ultrasound
    4. Assist provider in administering antibiotics
    5. Pre-Hospital Consideration
      • Prepare patient to transport to advanced level of care