URINARY SYSTEM

PTA 120

Pathophysiology

Day 18

Objectives Discuss anatomic structures and

physiologic processes related to the urinary system.

Discuss physical effects of aging on the body.

Define urinary pathological conditions including signs and symptoms of each:Renal Failure

Objectives Discuss how urinary pathologies can

adversely affect function requiring the modification of treatment intervention to protect the patient from worsening the condition and optimize treatment outcomes.

Discuss the modifications and precautions that may be required for the treatment of patients with urinary disorders.

Objectives

Demonstrate understanding of the PTA’s role in the disease process.

Textbooks

Pathology for the Physical Therapist Assistant, Ch 12

Physical Therapy Clinical Handbook for PTAs

Why does the PTA need to know the anatomy and physiology of the urinary system?

…to understand the pathological mechanisms of diseases of the urinary system.

Organs of the Urinary system

Functions of the Urinary System

Elimination of waste productsNitrogenous wastes from protein

metabolismToxinsDrugs

Water balance Electrolyte balance

Functions of the Urinary System

Acid-base balance in the blood

Blood pressure regulationProduction of renin (enzyme)Increase volume → increase BP

Red blood cell productionStimulated by erythropoietin

Functions of the Urinary System

Activation and conversion of vitamin D

Storage and transportation of urineUreters, urinary bladder, urethra

Physical Effects of Agingon the Urinary System

Physiologic Change Functional Effect

Decreased bladder capacity and incomplete bladder emptying

Urinary urgency and urinary incontinence

From: Stillerman (Ed), Modalities for Massage and Boywork, Elsevier, St Louis, 2008, in press.

Why does the PTA need to know about urinary tract diseases?

…to understand the need for monitoring vital signs and fluid intake, and how these disorders will affect function.

Renal Failure

DescriptionFailure of the kidneys to perform their

physiologic functions adequately

Acute renal failure○ Abrupt, sudden reduction in renal function○ If untreated, renal functions cease within a

couple weeks

Renal FailureChronic renal failure (end stage renal

disease)○ Insidious and gradual, irreversible○ Accompanied by dysfunction of other organs○ Glomerular filtration rate

<15 mL/min/1.73 m2

Normal is 90mL/min/1.73m2

Renal FailureTerms

○ Renal failure – significant loss of function○ Renal insufficiency – diminished to 25% of

normal function○ Uremia – accumulation of waste products in

the blood

Renal Failure

EtiologyReduced blood flow to the kidneys from

reduced cardiac outputRisk factors

○ Chronic hypertension○ Proteinuria○ Hyperlipidemia (high cholesterol)○ Smoking

Renal FailureGlomerular diseaseVascular diseaseHIV / AIDSConnective tissue and autoimmune

diseases Certain medications HeroinUrinary tract obstructions

Renal Failure

Signs and SymptomsGeneral malaise and weakness; progressing

to severe fatigueChanges in mental statusOliguria, anuriaWeight lossEdemaSensation loss in hands and feet

Renal FailureSevere bruisingAnemiaMalnutritionRenal bone disease from dysfunction of

platelets

Renal Failure

TreatmentTemporary renal dialysis until transplant

surgeryDietary adviceControl of hypertension, diabetes,

hyperlipidemiaSmoking cessation

Renal Dialysis

Process of removing toxic substances from the blood when the kidneys are unable to do so

External machine to filter blood Side effects

Hypotension, local or ischemic infection, muscle cramps, bleeding from access site

Renal Dialysis

From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 5, St. Louis, 2000, Mosby.

Implications for Physical Therapy Improve mobility Improve flexibility Strengthening Improve endurance

QUESTIONS

REPRODUCTIVE SYSTEM

PTA 120

Pathophysiology

Day 18

Objectives

Describe the anatomy, physiology, and functions of the reproductive system.

Demonstrate knowledge of reproductive disorder etiologies and pathologies including:Breast CancerPelvic floor incompetence and weakness

Objectives Discuss anatomic structures and

physiologic processes related to the reproductive systems.

Discuss physical effects of aging on the body.

Define reproductive pathological conditions including signs and symptoms of each:

Objectives Discuss how urinary and reproductive

pathologies can adversely affect function requiring the modification of treatment intervention to protect the patient from worsening the condition and optimize treatment outcomes.

Discuss the modifications and precaution that may be required for the treatment of patients with urinary and reproductive disorders.

Objectives

Demonstrate understanding of the PTA’s role in the disease process.

Textbooks

Pathology for the Physical Therapist Assistant, Ch 11

Physical Therapy Clinical Handbook for PTAs

Why does the PTA need to know the anatomy and physiology of the reproductive system?

.

The physiology of the female reproductive system has an impact on health issues experienced by women, including post-pregnancy. Women’s health has become a large part of Physical Therapy practice.

The male reproductive anatomy is closely linked with the urinary system. It is necessary to understand how these two systems fit together for communicating about disorders of either one of the systems.

Female Reproductive System

Essentials of Human Anatomy & Physiology 9th ed. Marieb

Support for the Uterus

Male Reproductive System

Essentials of Human Anatomy & Physiology 9th ed. Marieb

Functions of the Reproductive System Female reproductive

system Produces female

hormones to maintain the reproductive cycle

Produce egg cells and transport to site of fertilization

Provide safe and favorable environment for growth of embryo

Male reproductive system Produce and secrete

male sex hormones Produce, maintain

and transport reproductive cells and protective fluid

http://www.cchs.net/health/health-info/docs.asp

Physical Effects of Agingon the Reproductive System

Physiologic Change Functional Effect

Ovaries cease releasing eggs Menstrual periods stop

Decreased production of estrogen and testosterone hormones by ovaries, and by pituitary gland

Vagina walls thin and become less elastic and rigidDecreased vaginal secretions and genital tissueCessation of menstrual period, reproductive capacity lost

Prostate tissue replaced with scarlike tissue and enlarges

Slowed urination and ejaculation

http:..www.nlm.nih.gov/medlineplus

Why does the PTA need to know about diseases of the reproductive system?

.

…to understand both the implications for and precautions needed during physical therapy interventions for these disorders.

Breast Cancer

DescriptionMalignant tumors in the breastCan occur in men, but less commonTends to metastasize through lymphatic

systemACS recommends all women perform breast

self-examination each monthInflammatory breast cancer

Breast Cancer

Risk factorsIncreasing age, female sex, Caucasian race History of breast cancer in the familyHormones, nullparityHistory of hypertension, obesity, excessive

alcohol consumption, diabetesRadiation exposure to the thorax

Breast Cancer

Signs and SymptomsSmall, painless lump

○ Freely moveable that becomes fixedBreast asymmetry, palpable nodules in the

axilla, skin thickening and dimples, retraction of or discharge from the nipples

Paget’s disease of the breast○ Scaly, crusty patch on the nipple, areola and

surrounding skin; red, swollen and tender breasts

Breast Cancer

TreatmentEarly detection through breast self-exams

and mammographySurgery Radiation , chemotherapy, hormone therapy

Implications for Physical Therapy Restoring upper extremity function after

surgery, including range of motion, strengthening and positioning

Managing lymphedema through massage, compression, exercises

Pelvic floor incompetence and weakness

DescriptionPelvic floor muscles become weak and

stretched and are no longer able to support the sphincters of the urethra and anus -> decreased bladder or bowel control

Common in women

Pelvic floor

Female Male

Pelvic floor incompetence and weakness

EtiologyGeneticsPregnancy and vaginal delivery, multiple

deliveries at increased riskObesity, constant heavy lifting and strainingSurgeries, episiotomyNerve damage

Pelvic floor incompetence and weakness

Signs and SymptomsUrinary incontinenceFecal incontinence if anal sphincter

musculature is damagedStress incontinence due to increased

intraabdominal pressure onto pelvic floor○ Sneezing, coughing, laughing○ Exercising, lifting heavy weights

Implications for Physical Therapy Pelvic floor strengthening – Kegel

exercises, vaginal weighted inserts Biofeedback Electrical stimulation Patient may have urine leakage during

physical activities

Other reproductive disorders with implications for Physical Therapy

Endometriosis, Premenstrual SyndromeModalities to decrease pain

Uterine and ovarian CancerMobility and strengthening after surgery

Uterine ProlapsePelvic floor strengthening

QUESTIONS