Western+DIagnosis+-+Genitourinary+System

Chronic Renal Failure Acute Nephritic Syndrome Nephrotic Syndrome Urinary Calculi Cystitis Urethritis Prostatitis Epididymitis Benign Prostatic Hypertrophy (BPH) Enuresis (Bedwetting) Kidney Cancer Bladder Cancer Prostate Cancer Testicular Cancer

kidneys, ureters, bladder, urethra
1. kidneys retroperitoneal a. T12-L3 b. 2 major functions ---excrete most of the end products of body metabolism body metabolism - urea, creatinine, uric acid ---control concentrations of most of the constituents of body fluids - Na, K, Cl, H c. nephron ---glomerulus for filtration ---tubule for secretion 2. bladder posterior to pubis, anterior to rectum ---anterior to uterus in females

prostate gland in males
1. inferior and posterior to bladder ---at outlet of bladder surrounding urethra

History
A. frequency of urination B. polyuria, dysuria, hematuria, nocturia C. urgency, hesitancy, incontinence ---trouble starting, stopping, or holding the flow of urine D. frequent urinary infections E. hx of kidney stones F. male genitalia ---testicular pain or masses ---hernias ---penile discharge, sores, masses ---hx of sexually transmitted diseases G. past, or present, hx ---hypertension, DM, SLE, RF, trauma to GU system H. family hx of any renal diseases

kidneys
1. palpation a. pt. supine, stand on pts. right side b. left hand under patient between rib cage and lilac crest c. right hand inferior to costal margin d. press hands together e. reach over pt. with left hand and perform same maneuvers for left kidney f. now palpate internal and external inguinal rings i. hernias - masses, tenderness - direct through external ring - indirect through internal ring ii. Valsalva to make possible hernia stand out 2. CVA (costovertebral angle tenderness a. patient seated b. pound firmly just lateral to transverse process of T12-L1

Penis
1. inspection a. ulcers, nodules, discharge 2. palpation a. gloves b. tenderness, masses, induration

Scrotum
a. edema, inflammation, nodules a. if mass present, auscultate for bowel sounds a. structures b. tenderness, masses, edema c. hernias ---loose scrotal skin with finger up to slit-like opening of external inguinal ring ---pt strains down or coughs a. shine light through scrotum if enlarged or mass present b. blood or tissue does not transilluminate
 * inspection**
 * auscultation**
 * palpation**
 * transillumination**

Laboratory
1. chem screen changes not specific 2. serum creatinine 3. BUN - blood urea nitrogen 4. usually together as BUN/creatinine ratio 1. chem strip ---pH, leukocytes, nitrites, specific gravity, protein, glucose, ketones, blood 2. microscopic exam of urinary sediment ---urine centrifuged, sediment looked at ---leukocytes, erythrocytes, epithelial cells ---crystals ---casts - cylindrical outlines of renal tubules - **ALWAYS BAD SIGN** 1. GFR: creatinine clearance PSA - Prostae Specific Antigen: 4.0 considered upper limit of safe levels
 * Serum**
 * Urinalysis**
 * urine cultures**
 * renal function tests**
 * Prostate tests**

Imaging
A. KUB - kidney, ureter, bladder plain film of abdomen B. IVU (IVP) - intravenous urography (pyelography) ---visualizes kidney and lower urinary tract ---contrast agent outlining kidney, ureters, bladder ---retrograde pyelogram, cystogram C. US D. CT E. angiography, venography F. MRI G. renal biopsy

Emergencies
A. only a few situations in GU that are true emergencies 1. blood or protein in urine 2. acute uti with fever, chills, dysuria, flank pain 3. inability to void urine

hematuria
1. microscopic or gross 2. without pain - enal, bladder, prostatic disease --- Bl or Ki tumor, renal stones, polycystic Ki, renal cysts, sickle cell disease, BPH 3. with pain - ureteral stone, cystitis 4. with RBC casts: Glomerular nephritis 5. always refer to primary care provider if hematuria

proteinuria
1. protein in urine seen on chem strip - also creates thick & cloying bubbles (foamy) urine 2. causes ---inc plasma proteins ---inc tubular secretion of protein ---dec tubular resorption of filtered proteins ---inc of filtered proteins due to altered glomerular permeability 3. refer for evaluation

Emergency - Acute Bacterial Pyelonephritis
A. acute pyogenic infection of the kidney B. 20% of bacteremias from pyelonephritis

Etiology
1. ascending infection predisposed by obstruction: strictures, calculi, tumors, BPH, neurogenic Bladder, vesicoureteral reflux 2. elderly, DM, girls, after Bladder instrumentation 3. E. coli in 75%

Pathology
1. Ki enlarged with tissue destruction by inflammation 2. leukocytes, necrosis

Signs & Symptoms
1. rapid onset 2. chills, fever, flank pain, N, V 3. dysuria, frequency in 1/3 of patients 4. CVA tenderness 5. tender Ki 6. possible abdominal rigidity

diagnosis
1. clinical 2. urinalysis: bacteria, casts 3. urine culture with sensitivity

treatment
1. refer for antibiotics