1Nursing 3366 Pathologic Processes: Implications for Nursing Lecture Notes: Disorders of the Genitourinary and Renal SystemsObjectives /outcomes for this subject:1. the relationship between key aspects of normal genitourinary function and the pathophysiology involved in select genitourinary-related conditions, including:- female-specific disorders: endometriosis, ovarian cancer, PID, UTIs.- male-specific disorders: testicular cancer, benign prostatic hyperplasia, prostate cancer- nongender-specific problems: STIs, urologic obstructions 2. the relationship between key aspects of normal renal function and the pathophysiology involved in select renal conditions, including:- hydronephrosis.- glomerulonephritis - acute kidney injury (AKI; previously known as ARF—acute renal failure) and chronic kidney disease 3. signs and symptoms related to above pathological conditions, including significance of diagnostic test results used to evaluate and monitor renal and genitourinary function, such as:- PSA- BUN, creatinine, urinalysis, creatinine clearance4. basic treatment modalities of the above pathologies. **********************************Outline:I. Disorders of genitourinary functionA. Male-specific GU problems1. BPH 2. prostate cancer3. testicular cancer 4. infectionB. Female-specific GU problems1. menopause2. uterine-related problems3. ovarian cancer4. infection—PID, UTIC. Non-gender-specific issues1. STIs [HOME STUDY]2. urologic obstructive disordersII. Renal disordersA. Overview of normal kidney purpose and function1. the kidneys have dozens of “jobs”2. maintenance of balance / homeostasis of fluid & solute status of body3. maintenance of certain metabolic functionsB. The spectrum of renal compromiseC. Chronic kidney disease~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I. Disorders of genitourinary (GU) function (Note: because the A&P of many of the following reproductive structures overlap with those of the urologic system, they are often “lumped” together with terms such as “genitourinary” or “urogenital.” )A. Male-specific1. BPH— _________________________________________ —“enlarged prostate”2a. proliferation of prostate glandular tissue that is a common age-related change-- begins at age 40-45 and continues until death; by age 60, 60% of men have an enlarged prostate. b. S&S1) as the gland enlarges it can compress the urethra where it passes through the prostate, resulting in varying degrees of obstruction to urinary flow.2) S/S include urgency, delay in starting urine flow, decrease in flowof urine, urine retentionc. diagnosis 1) history of S&S 2) enlarged prostate is felt on digital rectal exam (should be done yearly beginning at age 50). 3) sometimes PSA elevated.d. treatment1) certain meds geared towards decreasing size of prostate2) also surgery to decrease size—TURP (transurethral resection of the prostate); a certain amount of hyperplastic tissue is “resected,” meaning “surgically removed.”2. prostate cancera. malignant neoplastic condition of the prostate gland b. the most common cancer in American males.c. risk factors include age over 50, family history, a diet high in saturated fat, high testosterone levels (promotes tumor growth). d. S&S similar to BPH; may not be present until the disease is advancede. often dx’d by elevated PSA –prostate-specific antigen1) tumor marker that is specific to the prostate gland and will be elevated when there is an inflammatory or malignant process of the prostate occurring. 2) this is measured yearly in men over 50 to screen for prostate cancer. f. yearly routine screening should be done, starting between age 40-50, with PSA and rectal examination of the prostate.3. testicular cancera. malignant neoplastic condition of the testicle. b. occurs most commonly in age range 15-35; higher incidence in males withunresolved ___________________________ (undescended testes) because a testis that remains in the abdomen cannot be checked regularly for signs of cancer (testicular cancer can be detected early when regular self-exam done)c. S&S1) painless testicular mass is the usual presenting sign. 2) may have testicular heaviness or dull ache in the lower abdomen.d. detection / treatment1) has a cure rate of 95% when caught early; testicular self-exam should be done monthly, for early detectionSometimes PSA is elevated in BPH, but more commonly, a high PSA is related to cancerous injury of32) surgery, radiation, or chemotherapy 4. infectiona. urethritis —inflammation, discomfort in penis, sometimes dysuria, occasionally a discharge b. prostatitis —inflammation / infection of prostate— same S&S as above- urgency, delay in starting urine flow, decrease in flow of urine, urine retention. c. both most often caused by sexually transmitted infections (STIs) such as Chlamydia & gonorrhea.d. treatment: antibioticsB. Female-specific1. uterine-related problemsa. general flow disturbances:1) dysmenorrheaa) general term for menstruation that is more painful, frequent, and/or larger in bleeding volume than is normal.b) most often cause by hormonal disturbances but variety of other causes.2) amenorrhea--absence of menses due to variety of causes (ex—anorexia, over-exercising); in later life can mean onset of menopauseb. _ ______________________ _-- presence of functioning endometrium outside the uterus. 1) affects 15% of women of reproductive age and can cause infertility. 2) caused by retrograde menstruation: in addition to being sloughed off with the menstrual blood via cervix & vagina, which is normal, endometrial tissue can abnormally escape into pelviccavity via fallopian tubes3) this _________________ (out of place) endometrium responds to themenstrual hormones by proliferating and bleeding wherever it implants itself, just as if it is still in the uterus. 4) S&S include dyspareunia (pain during intercourse), dysmenorrhea, pelvic pain. 5) treatment usually involves hormonal therapy and/or surgery. 2. ovarian cancer—malignant neoplastic condition of the ovaries with unknown etiology. a. causes the most cancer deaths related to the female reproductive system-- by the time someone is diagnosed the cancer is often advanced and treatment is difficult.b. early S&S very vague—bloating, mild abdominal discomfort, constipation1) for this reason, if not found early during yearly pelvic exams often metastasizes before can be diagnosedclassic: “I feel bloated & my pants have