Chapter 7

1. Chapter 7 Genitourinary and Gynecological Disorders

2. Male Urogenital System Testicular trauma Scrotum trauma Kidneys Female Urogenital System Endometriosis Female Athletic Triad Pregnancy Areas for Pathology

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 McBurney’s 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, Kehr’s 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 > 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 - BMR=hypothalamic dysfunction • Exercise will raise cortisol levels > inhibits hypothalamus> diminished estrogen and progesterone>amenorrhea • 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 Sign’s 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 people’s 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