Genitourinary and Gynecological Disorders

1
Chapter 7

• Genitourinary and Gynecological Disorders

2
Areas for Pathology

• Male Urogenital System
• Testicular trauma
• Scrotum trauma
• Kidneys

• Female Urogenital System
• Endometriosis
• Female Athletic Triad
• Pregnancy

3
Anatomy Review

• Kidneys
• Filtration
• ph balance
• Right Kidney assoc with liver
• Left Kidney assoc with adrenal gland, stomach,
  spleen, pancreas, bowel, descending colon
• Ureter ducts that carry urine from kidney to
  bladder
• Bladder muscular sac that stores urine

4
Pathological Conditions

• Kidney Stones
• condition that occurs when urine becomes
  supersaturated with a salt that then forms
  crystals (kidney stones)
• More common in males (5 of adult population)
• 80-85 of stones pass spontaneously
• S/S
• Intense unilateral pain, radiating down to the
  groin
• Nausea, vomiting
• Once stone enters the bladder, pain subsides

5
Other Kidney Injuries

• Kidney Contusion
• Etiology blow to the back, rigidity
• S/S shock, nausea, vomiting, hematuria,
  referred pain
• Management instruct athlete to urinate 2 3
  times check color
• Refer immediately if discolor or significant
  rigidity

6
Assessment

• Urinalysis
• Hematuria blood in urine
• Proteinuria excess protein in urine
• Glucosuria excess glucose in urine
• Urine Color
• Yellowish is normal
• Darkens with decrease amount of fluids
• Red/brown contains blood or other metabolic
  protein
• Milky indicates infection (accompanied with
  strong odor

7
Renal Disorders

• Renal Failure
• Cause ingestion of toxins or an obstruction in
  the ureter (complication of diabetes,
  hypertension)
• S/S sudden weight gain, generalized edema,
  hypertension, left-sided heart failure
• Treatment chronic renal failure is not
  treatable (kidney cells do not re-generate)

8
Liver Contusion

• Etiology blunt trauma, blow to the rib cage
• ( worsened if disease present such as ?)
• S/S hemorrhaging, shock, referred pain to right
  scapula/shoulder or anterior aspect of left chest
• Management life threatening, refer to
  MD/hospital

9
Appendicitis

• Etiology can be chronic or acute, brought on by
  fecal obstruction, lymph swelling. Most common
  in males between 15 25. Can be confused with
  gastric pain, bacterial infection if rupture
  present
• S/S pain in lower abdomen, low grade fever,
  nausea, pain on right side, tenderness at
  McBurneys Point
• Management surgical removal

10
Spleen Rupture

• Etiology rare disorder, direct blow to UL
  quadrant, infection (mono)
• S/S history of bow, rigidity, shock, nausea,
  vomiting, Kehrs Sign
• Management medical emergency

11
Sports Hematuria

• Blood in the urine that is directly associated
  with sports activity generally asymptomatic
• Related to the intensity and duration of the
  activity
• Usually resolves itself in about 3 days
• Sports commonly seen
• Swimming, lacrosse, track, football
• S/S - dysuria

12
Male Urogenital Disorders

• Ruptured Testicle
• S/S
• Extreme Tenderness
• Edema
• Discoloration
• Medical Emergency

13
Testicular Torsion

• Usually occurs in males who are 12-18 yrs of age
• Generally affects the left testicle
• S/S
• Severe unilateral scrotal pain and swelling
• One testicle is elevated and swollen
• Medical emergency (if left untreated for gt 12
  hrs, testicle is permanently damaged)

14
Varicocele

• Dilation of the internal spermatic vein (varicose
  veins)
• Predominantly found on left side (most common in
  adolescents)
• Increased pain (especially in standing) or with
  Valsalva Maneuver
• Often associated with testicular torsion
• No treatment, however, surgical intervention is
  sometimes warranted

15
Scrotal Contusion

• Etiology blunt trauma
• S/S hemorrhage, effusion, muscular spasm
• Management place on back and push knees to
  chest, place in seated position lift 3-4 inches
  off ground and DROP (to reduce spasm),
  cryotherapy (protect with layer of towel),
  protection from further trauma

16
Testicular Cancer

• Most common cancer among males between 16 24
• Usually affects single testicle
• High cure rate
• Common Signs
• Painless swelling
• A Growth
• Painful testicle
• Prevention regular self exam

17
Male Urogenital Disorders

• Gynecomastia over development of the male
  breast, usually seen in early adolescents or with
  steroid use.
• Undescended testicle Cryptorchidism usually
  tx by age of one risk factor to cancer,
  testicular torsion
• High rate of inguinal hernias
• Monorchidism absence of one testicle

18
Amenorrhea

• Lack of a menstrual cycle 2 types
• Primary
• No history of menarche by age 14 and has not
  developed secondary sex characteristics
• No history of menarche by age 16 and has
  developed secondary sex characteristics
• What are the secondary sex characteristics
• Secondary
• A 3-month absence of menstrual cycle with
  previous regular menses

19
Exercise Induced Amenorrhea

• Pathology not well defined
• Possibly linked to a low caloric diet and high
  energy demands of the sport - ?BMRhypothalamic
  dysfunction
• Exercise will raise cortisol levels gt inhibits
  hypothalamusgt diminished estrogen and
  progesteronegtamenorrhea
• Causes can include intense exercise, poor diet,
  steroids, stress, low body fat
• Either theory demonstrates that these athletes
  are prone to ovarian dysfunction due to
  amenorrhea decreased estrogen levels bone
  loss (osteoporosis)

20
Oligomenorrhea

• Preliminary step toward amenorrhea
• Menstrual cycles lasting more than 40 days
• Irregular menstrual bleeding
• Can be due to an enzyme deficiency (polycystic
  ovary syndrome PCOS)
• Common in the obese
• Should diagnosed by MD

21
Dysmenorrhea

• Most common menstrual disorder
• Painful menses
• 2 types
• Primary
• secondary

22
Primary Dysmenorrhea

• Most common, effecting over 90 of women
• Cause elevated production of endometrial
  prostaglandins
• Increased frequency and strength of uterine
  contractions seen at beginning of menstrual
  period
• Tx NSAIDS, heat, ? stress, ? activity, BCP

23
Secondary Dysmenorrhea

• Rarely diagnosed
• Causes
• Pelvic inflammatory disease, ovarian cysts,
  endometriosis
• Tx treat the underlying causes

24
Amenorrhea

• Treatment
• Rule out pregnancy
• Alter training regimes
• Increase food intake
• Hormone therapy
• Menses usually returns after these treatments or
  activity has ended

25
Premenstrual Syndrome

• Pain occurring 10 14 days prior to menses
• S/S
• Abdominal cramps, feeling of fluid retention,
  tenderness in the breasts, food cravings,
  depression, agitation
• Tx - symptomatic

26
Pelvic Inflammatory Disease

• Infection of the fallopian tubes and adjacent
  tissue
• Usually secondary to spread of cervical
  gonorrheal or chlamydial infection
• Treatment - antibiotics

27
Endometriosis

• Endometrial tissue growth outside the uterus. In
  time these implants thicken and develop into scar
  tissue which become quite painful
• Common in women between 30 40
• Painful menstruation
• Increased volume of menstrual discharge, pain
  with intercourse, LBP
• Possible infertility
• TX hormone therapy or surgery

28
Endometriosis

• The attachment of endometrial cells on tissue
  outside of the uterus on nearby tissue
  (implants). In time these implants thicken and
  develop into scar tissue which become quite
  painful
• Tx once diagnosed, NSAIDS, hormones (BCP),
  surgery

29
Vaginitis

• Commonly seen in the sexually active (not an
  STD), females on antibiotics
• Infection of vagina usually brought on by change
  in pH
• Bacterial vaginosis, trichomoniasis, candidiasis
• S/S
• Vaginal discharge, vaginal itching
• Tx - metronidazole

30
Contusion to Female Genitalia

• Etiology direct trauma
• S/S edema, reddness
• Management cryotherapy (protect with layer of
  towel), protection from further trauma

31
Female Urogenital Disorders

• Female Athletic Triad
• Eating disorder amenorrhea osteoporosis
  (usually in an otherwise healthy female)
• Early recognition is best, psychologist often
  needed to be included in medical team treatment

32
Warning Signs forEating Disorders

• Obsession with calories and body weight
• Expression of being fat when in fact he or she
  is not
• Consuming inappropriate amounts of food, high or
  low
• Compulsive exercise
• Expresses concern about other peoples eating
• Greater than 5 change in body weight in 4 weeks
• Sudden changes in mood or personality

33
Exercise and Pregnancy

• Areas of concern
• Increase in BW inc. demands for glucose
• Hormones impact joint laxity (progesterone)
• Balance issues COG moves forward up
• OK up to 5th month
• Increased needs of rest
• Psychological impact

34
Pregnancy Complications

• Ectopic Pregnancy
• Fertilized ovum attaches outside the uterus,
  usually in the fallopian tube
• Ruptured ectopic pregnancy
• S/S acute abdominal pain in lower quadrants due
  to internal hemorrhaging, vaginal bleeding,
  syncope, shock
• Fatal to the mother unless surgery is performed

35
Breast Disorders

• Nipple irritation
• Dermatitis
• Bruising
• Cysts
• Use of proper support (sports bra) protection if
  necessary depending on sport