Symptomatology of genito urinary system

Symptomatology of Genitourinary

System

Dept. of Medicine

Introductory Lecture Series

III Term

Learning Objectives

• Learn definitions of some specific terms associated with genitourinary system

• Learn to localize disease from symptoms related to genitourinary disease

Symptoms- 1. Pain

Symptoms- 1. Pain

• Obstruction- stricture, calculus

• Infection

• Tumour

Symptoms- 1. Pain

• Obstruction- stricture, calculus

• Infection

• Tumour

• Immunological injury

• Trauma

Symptoms- 1. Pain

Organ Site

Upper UT Renal Flank/ Loin

Ureter Loin to Groin

Symptoms- 1. Pain

Organ Site

Upper UT Renal Flank/ Loin

Ureter Loin to Groin

Lower UT Bladder Supra-Pubic

Urethra Urethral

Symptoms- 1. Pain

Symptoms- 1. Pain

Pain related terms with localisation

• Loin Pain: Acute and Chronic



• Colics: Renal, Ureteral, Urethral

Ureteric Colic

Loin to Groin




• Dysuria: Burning pain before, during or after

Dysuria

Suprapubic Pain




• Dysuria: Burning pain before, during or after

• Strangury: Extreme pain when bladder is empty

Strangury

2. Micturition Abnormalities

• Urgency: Inability to postpone



• Frequency: Increased number of times




• Polyuria: Above + increased volume





• Oliguria: Reduced volume (<500 ml)





• Oliguria: Reduced volume (<500 ml)

• Anuria: No urine production

Urgency

Frequency

Men too!

2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow


• Slow Stream: Decreased flow



• Hesitancy: Difficulty in initiating




• Precipitancy: Inability to stop midway





• Dribbling : Leak of small amounts after





• Dribbling : Leak of small amounts after

• Incontinence: Involuntary passage of urine

– Stress Incontinence

– Urge Incontinence

Precipitancy

Dribbling

Stress Incontinence

Stress Incontinence

2. …Micturition Abnormalities

• Nocturia -During the night

• Enuresis –During sleep

Enuresis

3. Urethral Discharge, Blistering and Ulceration

• In Males

• Infection (Urethritis, genital Herpes, Syphilis, Gonorrhea)

• Females?

4. Hematuria

Definition: More than three RBCs in centrifuged urine per high-power field on microscopy

( > 3 RBC/HPF)

Normal urine:

No red blood cell or less than 3RBCs/ HPF

4. Hematuria

Types of Hematuria

• Microscopic Hematuria: normal colour on naked-

eye examination

• Gross Hematuria: tea/ cola-colored, pink/red

Hematuria

Types of Hematuria

• Continuous

• Intermittent

Types of Hematuria

• Painful

• Painless

Hematuria with Associated Symptoms

• Hematuria with renal colic: renal calculus or

ureteric calculus



ureteric calculus

• With dysuria, straining to void and strangury:

bladder or urethra stone



ureteric calculus



• Hematuria with urinary frequency, urgency

and dysuria bladder or lower urinary tract

infection or (tuberculosis or tumor)



ureteric calculus



• Hematuria with urinary frequency, urgency

and dysuria bladder or lower urinary tract

infection or (tuberculosis or tumor)

• If accompanied by high fever, chills and loin

pain: pyelonephritis

Hematuria Associations• Hematuria with edema and hypertension

glomerulonephritis

hypertensive nephropathy


glomerulonephritis


• Hematuria with mass in the kidney

neoplasm

hereditary polycystic kidney


glomerulonephritis



neoplasm


• Hematuria with hemorrhage in skin and mucosa

hematological disorders

infectious diseases


glomerulonephritis



neoplasm


• Hematuria with hemorrhage in skin and mucosa

hematological disorders

infectious diseases

• Hematuria with chyluria

filariasis

Microscopy

Microscopy

Gross Hematuria

Sediment/ Clot

Mild & Uniform Hematuria

Smoky Urine

Normal Urine

Other Genitourinary Symptoms• Females:

–Menstrual abnormalities

–Vaginal Discharge

– Fertility disturbances

Other Genitourinary Symptoms• Females:

– Menstrual abnormalities– Vaginal Discharge– Fertility disturbances

• Males– Impotence (erectile dysfunction)– Loss of libido (decreased interest)– Premature ejaculation (early seminal emission)– Retrograde ejaculation (reverse into bladder)

– Fertility disturbances

General Symptoms in Nephrology

• Fatigue and breathlessness



• Nausea & Vomiting




• Peri- orbital and leg swelling





• Itching





• Itching

• Easy bruising and bleeding





• Itching


• Bone pains, fractures and tetany





• Itching



• Headache sleep disturbances, altered consciousness and seizures





• Itching



• Headache sleep disturbances, altered consciousness and seizures

• Chest pain (HT, Pericarditis, Lipid abnormalities)

Case 1: 24 year female, Newly Married

• Fever and Pain lower abdomen

• Burning while passing urine

• Needing to go frequently to the toilet

• Cannot wait once she feels like passing urine

Case 2: 22 year old soldier2 days after unprotected sex

• Pus like discharge from urethra

• Burning pain while passing urine

• Frequent visits to the toilet

• Intense pain lower abdomen and in the urinary passage after urination

Case 3: 50 year old multipara

Case 3: 50 year old multipara

• Distressed by the smell of urine accompanying her all the time

• Does not go outdoors; Depressed

• Passage of small amounts of urine during coughing, sneezing or lifting weights

65 year old retired manager

65 year old retired manager

• Reduced stream of urine X 1 year

• Difficulty in initial passing of urine once bladder is full

• If he has to stop while passing, he cannot stop- ‘it all comes out’

• Had an episode of inability to pass urine requiring catheterization -1 month ago

19 year old student

• Pain in the right loin radiating to groin since last night

• Blood in urine

40 year old male

• Backache & continuous pain left loin X 1 M

• Painless, red colored urine last week- stopped on its own

• Painless passage of blood today

55 yr old male; After lifting a heavy weight

• Backache since

• weakness of lower limbs X 2 days

• Pain lower abdomen and Inability to pass urine X 1 day

• Leaking of urine almost all the time X 1 day

• Fever with chills right now

40 Y old executive, too much stress

Using multiple medications

Had a happy marriage until 6 months

No interest in physical relationship

Behind closed doors too..

5 Y old child; sore throat 3 weeks ago

• Swelling whole body, started around eyes X 4

• Reduced urine X 3 days

• Pinkish opaque urine X 2 Days

• No urine X 1 day

• Drowsy

• Breathless

35 year old housewife• 6 months earlier had night time urination 3 to

4 times for few weeks

• Reduced urine output X 2 months

• Progressive breathlessness and fatigue X 1 month

• Swelling of face and feet X 2 months

• Cramps in hands and feet X 1 month

Health & Medicine

Symptomatology of genito urinary system