VIII.

URINARY DISORDERS: with fertility because it does not allow sperm to

1. HYPOSPADIAS be deposited close to the female cervix during
-is a urethral defect in which the urethral opening coitus.
is not at the end of the penis but on the
VENTRAL( lower) aspect. vs. EPISPADIAS
- it is a common anomaly, occurring in 1:300 - urethral defects in males.
newborns. - far more severe defect.
- ETIOLOGY: a. Familial -results from defect in the DORSAL wall of the
b. Multifactorial genetic focus. urethra, resulting in a dorsally located ectopic
- TYPES: a. Glandular - most common meatus.
b. Coronal -the extreme cases in males result in a
c. Penile penopubic location of the meatus and complete
d. Penoscrotal incontinence.
e. Perineal - Kidney infection can occur from ascending
- DEGREE: a. Minimal- on the glans but inferior organisms from the open bladder.
in site. - When children with this disorder begin to walk,
b. Maximal- at the midshaft or at they may demonstrate a “WADDLING “ GAIT
the penalscrotal junction. caused by the wide pubic diastasis if they have
- many newborns with hypospadias have an not had an osteotomy with their bladder closure.
accompanying short CHORDEE- a fibrous band
that causes the penis to curve downward (often ( See photo Figure 46.8 page 1317)
called a COBRA HEAD APPEARANCE.
- often in conjunction with 2. EXISTROPHY OF THE BLADDER
CRYPTORCHIDISM(undescended testes). ⁃ is a midline closure defect that
- DIAGNOSTIC: a. Sex cell karyotyping / DNA occurs during the 10th week of pregnancy.
Analysis ⁃ as a result, at birth, the bladder lies
- obtained if the penis exposed on the anterior abdominal wall.
defect is so extensive that sex determination is ⁃ INCIDENCE: 2-3 : 100,000 live
unclear. births.
- TREATMENT: ⁃ ASESSMENT:
- a. Professional support- allow parents to talk ⁃ a. Wide pubic diastasis- hallmark
about the disorder and answer their questions of extrophy.
honestly and openly. - a pelvic bone
b. MEATOTOMY- surgical procedure in which defect in both sexes.
the urethra is extended to a usual position to b. WADDLING GAIT- due to external rotation
establish better urinary function. of the hips.
c. ANALGESIC- such as acetaminophen for
the pain. ⁃ DIAGNOSIS: a. Fetal ultrasound-
d. OXYBUTYNIN- an anticholinergic for the reveals the lack of an anterior wall of the bladder
relief of spasms that cause pain. and a lack of anterior skin covering the lower
anterior abdomen.
- Children with hypospadias should not be ⁃ TREATMENT: Surgical closure of
circumcised because at the time of the repair, the the bladder and the anterior abdominal wall and
surgeon may use the portion of the foreskin. construction of the urethra.
- When the child is older (12-18 months), ⁃ Referral to pediatric urologist-
adherent chordee can be released. because of the lifelong negative sequelae of
- If the repair will be extensive, surgery is delayed initial closure failure.
until 3-4 years of age . ⁃ Consult a WOCN ( wound, ostomy,
- [ ] TESTOSTERONE CREAM/ INJECTION- and continence nurse)- prevent the skin of the
administered until surgery to encourage penis abdomen from excoriation.
growth and make the procedure easier. ⁃ Urinary incontinence is the major
- It is important to correct hypospadias before clinical problem.
school age so the child looks and feels like other ⁃ Constant wetting of an adjacent
males. skin causes AMMONIACAL DERMATITIS
- If left uncorrected, in later years, a meatal resulting in mar discomfort.
opening at the inferior penile site may interfere ⁃ A & D ointment- topical protection.
 ⁃ Do not separate the infant’s legs to involve the kidneys( PYELONEPHRITIS) and
put on diapers, just place them under the child cause permanent damage.
instead.
⁃ Be certain to change diapers ( Photo of Box 46.4 page 1318)
promptly after defecation so that feces are not
brought forward to the open bladder. ⁃ TREATMENT:
⁃ Sponge bathe rather than tub a. Broad - spectrum antibiotics-
bathe to prevent water from entering the ureters Sulfamethoxazole- trimethoprim or Amoxicillin or
and become a source of infection. NITROFURANTOIN ( not effective for
Pyelonephritis as it does not penetrate the renal
3. URINARY TRACT INFECTION ( UTI) parenchyma or Sulfa drug.
-S/ SX: a. pain with urination b. Acetaminophen- mild analgesic to reduce pain
b. frequency and allow voiding.
c. burning c. Increase fluid intake- to “ flush “ the infection
d. hematuria- may or may not be out of the urinary tract particularly if a SULFA
present DRUG is prescribed because this can cause
e. fever with unknown etiology URINARY CRYSTALS in concentrated urine.
f. mild abdominal pain d. Cranberry juice-to acidify the urine and make it
g. diurnal or nocturnal enuresis more resistant to bacterial growth.
- if the infection progresses to ⁃ Fluids containing artificial coloring
PYELONEPHRITIS , the symptoms become and carbonation (sodas) should be avoided as
more acute, with high fever, abdominal or flank they irritate the bladder and can cause further
pain, vomiting, and malaise. discomfort.
- DIAGNOSIS: a. Urine culture- using: a. clean-
catch technique 4. HYDRONEPHROSIS
⁃ enlargement of the pelvis of the
b.suprapubic aspiration( infants) kidney with urine as a result of back pressure in
c. the ureter.
catheterization ⁃ the pressure is caused by
⁃ (+) result: bacterial count is more obstruction, either of the ureter or of the point
than 100,000 colonies per ml. where the ureter joins the bladder as with
⁃ The presence of either red or white vesicoureteral reflux.
blood cells( PYURIA) makes the urine al alkaline ⁃ most often in the first 6 months off
so the pH of the sample will be elevated( more life.
than 7). ⁃ DIAGNOSIS: a. Ultrasound during
intrauterine life or
-occurs most often in biologic females than in b. IVP- ( Intravenous
males because the urethra is shorter in females pyelogram) reveal the enlarged pelvis and the
and since it is located close to the vagina and point of obstruction.
anus. ⁃ S/ SX: Usually asymptomatic.
- urinary pathogens enter the urinary tract as ⁃ a. Repeated UTIs caused by
ascending infection from the perineum in are urinary stasis( difficult to detect in young child
Gram - negative rods such as Escherichia coli. except as general irritability or crying in voiding.
- also occurs as a healthcare- acquired ⁃ b. Elevated blood pressure caused
infection in children who have urinary catheters. by increasing tubular pressure( which activates
- changing diapers frequently can help reduce the renin- angiotensin system) may be detected
the risk of infection in infants. on a routine health assessment.
- girls should be taught early when they are ⁃ c. Flank or abdominal pain- due to
toilet- trained to wipe themselves from front to severe back pressure.
back after voiding and defecating to avoid ⁃ d. Abdominal mass( dilated kidney
contaminating the urethra. pelvis) - abdominal palpitation.
- is suggested correlation between the use of -TREATMENT: Surgical correction of the
products such as bubbles bath , feminine obstruction before glomerular or tubular
hygiene, sprays, and hot tubs, and UTI in girls. destruction occurs . Purpose is to decompress
- It is important that UTI be treated so they do the dilated urinary tract.
not damage the bladder lining and spread to a. Nephrostomy
b. Cystostomy 6. POLYCYSTIC KIDNEY
c. Ureterostomy- favored. ⁃ implies that large, fluid- filled cysts
have formed in place of normal kidney tissue.
5. ENURESIS ⁃ the most frequent type of
⁃ involuntary passage of urine past polycystic kidney seen in children is inherited as
the age when a child should be expected to have an AUTOSOMAL RECESSIVE TRAIT.
attained bladder control. ⁃ rarer type: AUTOSOMAL
⁃ this is expected at 2-3 years of age DOMINANT TRAIT.
for daytime and age 4-6 years for nighttime, ⁃ with either type, there is abnormal
enuresis is said to occur at approximately 7 development of the collecting tubules.
years. ⁃ if the disorder is bilateral, an infant
⁃ tends to be FAMILIAL. will not be able to pass urine , so that birthing
⁃ may be a. NOCTURNAL ( occurs parents will develop OLIGOHYDRAMNIOS
only at night; mostly ; FUNCTIONAL TYPE when during pregnancy.
children are exceptionally tired or troubled) , b. ⁃ ASSESSMENT:
DIURNAL ( during the day) or c. both. ⁃ a. Kidneys- grow large and feel
⁃ TYPES: a. PRIMARY- if bladder soft and spongy.
training was never achieved and is considered ⁃ b. flattened nose
ACQUIRED. ⁃ c. small jaw ( MICROGNATHIA) -
b. SECONDARY- if control was findings of POTTER SYNDROME.
established but has now been lost. ⁃ DIAGNOSIS: a. Sonogram during
⁃ ASSESSMENT: pregnancy-reveals fluid –filled cysts.
⁃ a. EVALUATION- for children older ⁃ S/SX: a. Oliguria- decreased urine
than 5 years to determine whether there is an production ( if unilateral).
organic cause for the disorder. b. Systemic hypertension- due to
⁃ b. HISTORY TAKING: how parents cystic growth that offers resistance to blood
correct the problem, stress in the family such as circulation; usually school age.
new brother or sister, uncomfortable school ⁃ the condition is associated with:
situation like bullying or marital discord. a. cerebral aneurysm
c. EEG- abnormal pattern. b. liver is filled with identical cysts.
d. Ultrasound ⁃ TREATMENT:
e. Pre- post bladder scan a.Surgical removal of the diseased kidney if only
f. Urodynamic testing- to rule out ORGANIC one is cystic.
cause. b. Renal transplantation- if both kidneys; difficult
g. Urinalysis- to rule out BACTERIURIA. in the young child because few infant kidneys are
⁃ TREATMENT: interdisciplinary available for transplantation and because of
setting: technical challenge presented by small blood
a. Medicine- DDAVP( synthetic antidiuretic vessels.
hormone) to reduce output and nocturnal diuresis ⁃ GENETIC COUNSELING-
in cases of PRIMARY NOCTURNAL ENURESIS. because inherited, parents and children need to
b. Nursing be informed that future children may have this
c. Behavioral psychology problem.
d. Nutrition - limit fluids 2 hours before bedtime
⁃ MANAGEMENT: should include 7. CHRONIC GLOMERULONEPHRITIS (
multimodal approach: GN)
a.Bowel management ⁃ although it occasionally follows
b. Timed voiding- alarm bells ACUTE GLOMERULONEPHRITIS/ NEPHROTIC
c. Hydration management SYNDROME, it also occurs as a primary
d. Improved fiber intake disease.
e. Behavioral management ⁃ may result in either diffuse or local
f. Biofeedback- mind- body technique to control nephron damage.
body functions such as heart rate, breathing ⁃ ETIOLOGY: unknown.
patterns and muscle responses; patient is ⁃ DIAGNOSIS:
connected to electrical pads that help you get ⁃ a. Urinalysis-proteinuria, red cell or
information about your body). white cell casts and occult blood, low specific
g. Drug therapy gravity ( below 1.003).
 b. Blood studies- increased BUN or creatinine c. UREMIA- extra accumulation of
levels. nitrogenous wastes in the blood, with additional
c. MRI toxic symptoms, such as cerebral irritation.
d. Renal biopsy- reveal permanent ⁃ DIAGNOSIS:
destruction of glomerular membranes. a. BUN level- rises progressively as renal
⁃ MANAGEMENT: insufficiency continues.
a. bed rest- if the child has acute symptoms of b. Urine specific gravity- fixed at 1.010.
edema, hematuria, hypertension, or oliguria. c. HYPERKALEMIA- elevated potassium level;
Children should not engage in competitive manifested by a weak , irregular pulse,
activities such as contact sports because of the abdominal cramps, lower BP and muscle
risk of kidney injury. weakness.
⁃ Therapy non-specific and directed d. ACIDOSIS- may follow shortly from the
at symptom relief rather done the disease inability of H ions to be excreted.
process, or its cause, which is unknown. e. Increased phosphorus levels-as the total
b. Hypertensive drugs- such as.HYDRALAZINE output decreases; leads to…
or with DIURETICS to increase urine output, f. HYPOCALCEMIA- Low calcium serum level
such as ETHACRYNIC ACID can be helpful. because phosphorus and calcium have an
c. Corticosteroid therapy- may reduce or halt the inverse proportional relationship.
progress of the disorder by reducing -Severe hypocalcemia leads to muscle twitching
inflammation. and seizures (TETANY).
⁃ Side effects of long- term use: -Chronic hypocalcemia leads to withdrawal of
“MOON FACE” and extra body hair( CUSHING calcium from bones ( OSTEODYSTROPHY).
SYNDROME) , increased risk for developing g. IVP
infections because of the immunosuppressive h. MRI
activity of these drugs; take the child‘s i. Radioactive uptake scan- used to substantiate
temperature. the lack of kidney function .
d. Renal transplantation- to replace the kidney. ⁃ TREATMENT:
Children can be maintained on HEMODIALYSIS a. IVF- if dehydrated from diarrhea or
while waiting for the transplant. hemorrhage; needed to replace plasma volume;
administer slowly to avoid heart failure because
8. ACUTE RENAL FAILURE the nonfunctioning kidneys cannot remove extra
⁃ often occurs because of a sudden fluid.
body insult such as severe dehydration. b. IV Calcium gluconate( as the glucose moves
⁃ CAUSES: into cells, it carries potassium with it).
a. prolong anesthesia c. Sodium polystyrene- oral administration of
b. hemorrhage cation resin.
c. shock d. dialysis
d. severe diarrhea d. Sodium bicarbonate- cause a shift of
e.sudden traumatic injury potassium from the bloodstream into cells,
f. cardiopulmonary bypass while undergoing temporary reducing circulating potassium level.
heart surgery e. Combination of IV Glucose and Insulin-
g. common antibiotics( Aminoglycosides, effective since insulin helps glucose move into
Penicillin, Cephalosporins, and Sulfonamides). cells and potassium is carried with it.
h. poison- ARSENIC ( in rat poison). f. FUROSEMIDE- diuretic to increase urine
i. MERCURY- industrial waste. production.
• All of these conditions appear to g. Diet- low in protein, potassium and sodium.
lead to RENAL ISCHEMIA,which ultimately leads - high in carbohydrate to supply enough
to ACUTE RENAL FAILURE. carries for metabolism yet limit urea production
⁃ S/ SX: and control serum levels.
⁃ a. OLIGURIA- urine output of less - limit fluid intake to prevent heart failure
than 1 ml. per kg. of the child’s body weight per due to accumulating fluid that cannot be
hour. excreted.
b. AZOTHEMIA- accumulation of nitrogenous
waste from the breakdown of protein in the ⁃ Weigh children daily( same scale,
bloodstream. same clothing, same time of day and maintain
accurate intake and output recordings to help j. Packed red cells- to correct anemia.
evaluate fluid status. k. Dialysis- effective excretion of urea why
h. TPN-if children are so ill that they cannot eat. children wait for a kidney transplant.

CHRONIC KIDNEY DISEASE IX. METABOLIC DISORDERS:

( END - STAGE KIDNEY DISEASE) 1. DIABETES INSIPIDUS
⁃ Results from developmental ⁃ disease in which there is
abnormalities, when failure becomes long term, decreased release of ADH by the pituitary gland.
or when crony kidney disease has caused ⁃ this causes less reabsorption of
extensive nephron destruction. fluid in the kidney tubules.
⁃ S/SX: ⁃ ETIOLOGY: a. X - linked dominant
a. polyuria- with loss of nephron function , the trait
ability to concentrate urine halts, manifested as b. Autosomal recessive gene
enuresis. As additional nephrons are lost,it c. Lesion, tumor or injury to
develops into… the posterior pituitary
b. anuria d. Unknown
c. dehydration- the functioning nephrons present ⁃ S/SX: a. dilute urine
cannot reabsorb enough sodium to maintain a b. polydipsia- excessive thirst
functioning serum level of body fluid. c. polyuria- bed - wetting
d. osteodystrophy-occurs as calcium is d. irritability
withdrawn from bones to compensate for the low e. weakness/ lethargy
level of calcium. f. fever
e. anemia- Erythropoietin formed by the kidneys , g. headache
stimulates red cell production but here there is a h. seizures
decreased erythropoietin production. i. weight loss- because of the large
f. pruritus- skin itching from skin irritation due to loss of fluid.
excretion of nitrogenous wastes. -DIAGNOSIS:
⁃ DIAGNOSIS: a. Urinalysis:Low urine specific gravity- 1.001-
a. acidosis- due to inability to excrete H ions. 1.005( normal: 1.010- 1.030
b. hypocalcemia and… b. CBC: Hypernatremia( increase sodium)
c. hyperphosphatemia- occur from the kidney’s c. MRI
inability to secrete phosphate. d. CT Scan
-TREATMENT: e. Ultrasound of the skull
a.low- protein, low- phosphorus, low- potassium f. VASOPRESSIN- rule out kidney disease;
diet decrease BP; alerting the kidney to retain more
= to prevent rapid urea and phosphate buildup. fluid in order to maintain vascular pressure.
-milk is not given because it is high in sodium, ⁃ TREATMENT:
potassium, and phosphate-electrolytes that ⁃ a. Surgery- if tumor is present.
children may have difficulty clearing. b. DDAVP- desmopressin, an arginine
⁃ meat is restricted and even beans vasopressin.
are eliminated. -IV if emergency,
b. aluminum hydroxide gel- take with meals to intranasally,orally.
bind phosphorus in the intestines and prevent
absorption. 2. SIADH( Syndrome of Inappropriate
c. Milk formulas- low- electrolyte, low- protein Antidiuretic Hormone)
- low sodium: LONALAC. ⁃ rare condition in which there is
d. restrict fluid intake overproduction of ADH by the posterior pituitary
e. restrict sodium intake gland.
f. Diuretics- helps children regulate, sodium and ⁃ this results in a decrease in urine
fluid levels and prevent edema. production, which leads to water intoxication.
g. Calcium- to prevent muscle cramping, ⁃ CAUSES:
rickets,tetany,or seizures. a. CNS infections- bacterial meningitis.
h. Hypertensive drug- hypertension from the b. Long- term positive pressure ventilation.
accumulating blood volume. c. Pituitary compression- due to edema or tumor.
i. Recombinant human erythropoietin- to ⁃ DIAGNOSIS:
stimulate red blood cell (RBC) formation. a. hyponatremia- lowered sodium plasma level.
-S/SX:a. weight gain- due to hyponatremia. h. dehydration- because of the loss of water and
b. concentrated urine- due to increased experience an electrolyte imbalance because of
specific gravity. the loss of potassium and phosphate in urine.
c. nausea **HYPOGLYCEMIA- medical
d. vomiting emergency;S/Sx.:low blood sugar: fast heartbeat,
e. coma and… shaking, sweating,nervousness or anxiety,
f. seizure- occurs from brain edema. irritability or confusion,dizziness,hunger;
⁃ TREATMENT: MANAGEMENT: hard candy, sodas.( important to
a. Restriction of fluid. carry candy on the pocket all the time or soda in
b. Sodium supplement- by IVF. the bag).
c. DEMECLOCYCLINE- a tetracycline antibiotic. ⁃ DIAGNOSIS:
- side effect of a. Fasting blood glucose test- greater than 126
blocking the action of ADH in renal tubules and mg per dL.( fasting after 12 midnight).
reducing resorption of water. b. Random blood glucose test- with test strips.
c. Blood samples for pH, partial pressure of
3. DIABETES MELLITUS carbon dioxide (PCO2), sodium and potassium
-TYPES: levels, WBC, Glycosylated hemoglobin (HbA1c)
a. TYPE 1- disorder that involves an absolute or evaluation.
relative deficiency of insulin. ⁃ TREATMENT:
b. TYPE 2- insulin production is only reduced. a. Oral medications- Metformin.
( Comparison at photo page 1373). b. Short- acting insulin- subcutaneous injection in
-ETIOLOGY: upper outer arm and outer aspects of the thigh ,
a. The disease results from immunologic damage 90 degrees angle); IV in emergency; rotate sites,
to Islet Cells of Langerhans. choose sites that will not exercised soon after the
b. High frequency of certain human leukocyte injection.
antigens (HLA), particularly HLA-DR3 and HLA- If same injectionsite is used repeatedly, a great
DR4, located on chromosome that may lead to deal of subcutaneous atrophy(
susceptibility so if the child in a family as LIPODYSTROPHY) can occur, causing deep
diabetes, the chance that us sibling will also pockmarks and no pain will be felt on injection(
develop the illness. SIRS- subcutaneous insulin resistance
-CARDINAL SYMPTOMS: syndrome).
a. hyperglycemia- is glucose is unable to enter ⁃ Automatic injection devices such
body because of a lack of insulin,it builds up in as pens and jet ejectors.
the bloodstream. ⁃ Insulin pumps is an automatic
b .glycosuria- As soon as the kidneys detect device approximately the size of an iPhone,it
hyperglycemia period(greater than the renal delivers insulin at a constant rate.
threshold of 160mg /dL, the kidneys attempt to ⁃ Continuous subcutaneous insulin
lower it to normal levels by excreting excess infusion ( CSII)/ Insulin pump : improve
glucose into the urine. psychosocial functioning with diabetes.
3 Ps: ⁃ Inhalation Insulin: experimental
c. POLYURIA-due to large loss of body fluid; trials.
bedwetting. ⁃ 3 spaced meals: count
d. POLYDIPSIA- due to excess fluid loss, in turn, carbohydrates.
triggers the thirst response. ⁃ c. Pancreas transplantation-
e. POLYPHAGIA- eats frequently; excessive pancreas not removed entirely because the
hunger. portion that supplies digestive enzymes is still
f. weight loss- because body cells are unable to functioning and so left in place; to reduce the
use glucose but still need a source of energy, the child’s immune response and protect against
body begins the breakdown, protein and fat. graft rejection, drug such as anti lymphocyte
g. ketonuria- ketone bodies, the acid end product globulin, cyclosporine, prednisone, or
of breakdown, begin to accumulate in the azathioprine are administered after surgery.
bloodstream(creating high serum cholesterol ⁃ COMPLICATIONS:
levels and ketoacidosis) and spill into the urine ⁃ a. Arteriosclerosis ( hardening of
as ketones. artery walls) which can lead to general poor
circulation.
b. kidney disease.
 c. thickening of retinal capillaries and cataract b. trasillumination ( the shining of the light
formation, which can lead to blindness because through the scrotal sac causes the area to glow/
of chronic hyperglycemia. TRANSLUSCENT); vs. Varicocele.
d. limb amputation- prevention: wear closed- -TREATMENT:
toes footwear. a. Sclerotherapy- injection of a drug to decrease
fluid production.
X. REPRODUCTIVE DISORDERS:
MALES:
1. CRYPTORCHIDISM 3. VARICOCELE
⁃ is failure of one or both testes to ⁃ is an abnormal dilatation the veins
descend from the abdominal cavity into the of the spermatic cord.
scrotum. ⁃ physical examination: there is “
⁃ normally, testes descend into the bag of worms “ on palpation.
scrotal sac during 7-9 months of intrauterine life. ⁃ Transillumination Test( flashlight
⁃ CAUSE: shine on scrotum: OPAQUE).
⁃ a. unclear. ⁃ important to identify in adolescents
b. low level of testosterone production- because increase heat and congestion in the
prevent descent. testicles is a possible cause of SUBFERTILITY
c. fibrous bands at the inguinal ring or or INFERTILITY.
inadequate length of spermatic vessels may ⁃ TREATMENT:
prevent descent, usually in premature or low- a. Surgical removal.
birth- weight babies.
- ASSESSMENT: 4. TESTICULAR TORSION
-Early detection of an undescended testes is ⁃ twisting of the spermatic cord.
important because the warmth of the abdominal ⁃ SURGICAL EMERGENCY: if the
cavity may inhibit development of the testes, condition is not recognized promptly ( within 4
affecting spermatogenesis ( important to wear hours) , irreversible change in the testes occur
loose- fitting underwears). from lack of circulation to the organ.
⁃ a. Palpation assessment when the ⁃ ASSESSMENT: a. palpation.
room temperature is cool, the testes retracts. ⁃ S/Sx: a. immediate severe scrotal
⁃ Excessive palpation or stroking of pain.
the inner thigh may elicit cremasteric reflex and b. nausea and
cause retraction. c. vomiting- from pain.
⁃ b. Laparoscopy- identifies whether d. tender on palpation.
and descended testes is at the inguinal ring( true e. edema
undescended testes) or ectopic ( still in the ⁃ MANAGEMENT:
abdomen). a. Reduce manually under Ultrasound guidance.
⁃ c. karyotype/ DNA Analysis-in b. Laparoscopic surgery- to reduce the torsion
ambiguous genitals, done to determine the and to reestablish circulation.
child’s chromosomal sex identification.
⁃ TREATMENT: FEMALES:
a. short course of chorionic gonadotropin 1. DYSMENORRHEA
hormone- for 5 days to see if testicular descent ⁃ is painful menstruation.
can be stimulated. ⁃ common but requires a thorough
b. Surgery ( ORCHIOPEXY) by laparoscopy. diagnostic evaluation as it can also be a
preliminary symptom of underlying disorder such
2. HYDROCELE as PID, uterine myomas( tumors) , or
⁃ When a testis descends into the endometriosis ( abnormal formation of
scrotum in utero,it is preceded by a fold of tissue, endometrial tissue).
the PROCESSUS VAGINALIS. ⁃ CAUSE:
⁃ Occasionally, fluid collects in this a. release of prostaglandin in response to tissue
fold. destruction during the ischemic phase of the
⁃ DIAGNOSIS: menstrual cycle, which leads to smooth muscle
a. ultrasound. contraction and uterine pain.
-ASSESSMENT:
 ⁃ During the first year or two of ⁃ DIAGNOSIS: Need evaluation, as
menstruation, dysmenorrhea really occurs it can be indicative of:
because early menstrual cycles are usually a. Endometriosis
ANOVULATORY( without ovulation). b. Anemia- systemic disease.
⁃ As ovulation begins, typical c. Blood dyscrasia- such as Clotting defect.
menstrual discomfort also begins. d. Uterine abnormality- such as myoma( fibroid)
⁃ 2 CATEGORIES: tumor.
⁃ a. PRIMARY-occurs In the e. Infection- PID.
absence of organic disease. f. Early pregnancy loss(abortion).
b. SECONDARY- occurs as a result of g. Breakthrough bleeding from an oral
organic disease. contraceptive.
⁃ S/Sx:a. “bloated “ feeling.
b. light cramping- 24 hours before a ⁃ TREATMENT:
menstrual flow. ⁃ a. Low-dose oral contraceptive pills
c. colicky/ sharp pain- is superimposed .
on a dull, nagging pain across the lower b. Progesterone- for those adolescents who
abdomen. is losing excessive blood because of an
d. aching, pulling sensation of the vulva anovulatory cycles, prescribed during the
and inner thighs when the flow begins. LUTEAL PHASE to prevent proliferative growth
e. mild diarrhea during this phase of the cycle.
f. mild breast tenderness c. GnRH Inhibitor- to decrease the flow .
g. abdominal distention d. Iron supplentation - to restore sufficient
h. nausea hemoglobin formation.
i. vomiting
j. headache 3. ENDOMETRIOSIS
-TREATMENT: ⁃ is the abnormal growth of
a. NSAID( Nonsteroidal anti- inflammatory drug) - extrauterine cells similar to endometrial cells,
IBUPROFEN,(ADVIL) should not be taken on an often in the cul- de - sac of the peritoneal cavity
empty stomach as they can be extremely or in the uterine ligaments or ovaries.
irritating to gastric mucosa. ⁃ is the leading cause of secondary
b. Hormones- combined estrogen and progestin dysmenorrhea and chronic pelvic pain in
oral contraceptives( COCs) - pills that relieve adolescents.
pain by preventing ovulation, which precipitates ⁃ ETIOLOGY: a. Unknown
pain. b. Familial
⁃ SIDE EFFECTS OF LONG - c. Hormonal
TERM ESTROGEN: d. Neurologic
a. thrombophlebitis e. Immunologic
b. early closure of epiphyseal lines of long bones. ⁃ S/Sx:
⁃ A patient with dysmenorrhea who a. dysmenorrhea- occurs as the extrauterine
does not have symptom relief with the use of tissue begins to slough off like the uterine lining
NSAIDs and COCs should be evaluated for in response to estrogen and progesterone
ENDOMETRIOSIS ( dysmenorrhea with stimulation and withdrawal.
nonmenstrual pelvic pain). b. inflammation of surrounding tissue in the
abdominal and a release of prostaglandins.
2. MENORRHAGIA c. dyspareunia- painful coitus.
⁃ is an abnormally, heavy menstrual - due to abnormal tissue in the
flow, greater than 80 mL per menses or a flow pelvic cul- de- sac because it puts pressure on
that soaks more than one or tampon an hour. the posterior vagina.
⁃ it tends to occur in adolescents d. subfertility/ infertility - may result if the fallopian
nearing Puberty because, without ovulation and tubes become immobilized and blocked by tissue
subsequent progesterone secretion,estrogen implants or adhesions, preventing peristaltic
secretion causes extreme proliferation of motion, and transport of ovarian.
endometrium.
⁃ there often also an unusual e. chronic, intermittent pain
amount of menstrual flow use of IUDs( f. tender, fixed ,palpable nodules displacing the
Intrauterine Devices). uterus.
 ⁃ DIAGNOSIS: b. Vitamins- Calcium, Vit. B6, Vit. D, Omega- 3
a.pelvic examination- tender, fixed, palpable fatty acids.
nodules.
b. biopsy **Most studies says that dark chocolate may help
⁃ TREATMENT: ease menstrual cramps due to its high,
a. Medical- limited efficacy; magnesium content, helps relax, muscles, and
⁃ GnRh agonist- such as stop the production of compounds that signal
LEUPROLIDE ACETATE, can reduce hormone cramps.
stimulation, and cause the same effect.
⁃ Aromatase inhibitors- reduce STI( Sexually Transmitted Infection)/ STD(
estrogen levels. Sexually Transmitted Diseases)
b. Hormones: 1. CANDIDIASIS / ORAL
-Estrogen and progesterone- based oral CANDIDIASIS/ THRUSH
contraceptives- reduce the pain but not address ⁃ CANDIDA ALBICANS is a yeast
the underlying pathology. that reproduces by budding and in well infants
⁃ DANAZOL- a synthetic androgen, oral and skin monilial or candida infections.
decreases luteinizing hormone (LH) and follicle- ⁃ CANDIDA is common normal flora
stimulating hormone (FSH). of the vagina and infants acquired this during the
c. Surgery - Laparotomy with excision: highly birth process.
invasive procedure with limited accessibility . ⁃ S/Sx:
a. white plaques on an erythematous base
4. PMS- Premenstrual Syndrome located on the buccal mucosa at the surface of
⁃ refers the physical and emotional the tongue.
symptoms that some women experience after -it resembles a MILK CURD left in recent milk
ovulation and before the start of their menstrual feeding but unlike milk curds, the thrush plaques
period. do not scrape away.
⁃ PMS symptoms can impact on b. painful.
quality of life. c. skin - severe ,bright red, sharply circumscribed
⁃ strikes 5-10 days before the rash in the diaper area; The diaper rash is
period. marked by intense erythema with a well-
⁃ Symptoms stop during or at the demarcated border surrounded by satellite
beginning of the menstrual period. lesions and goes into the skin folds.
⁃ CAUSE: happens in the days after -TREATMENT:
ovulation because estrogen and progesterone a. Antifungal drugs- for skin infections, like
levels begin falling dramatically if you are not NYSTATIN,( oral) ,CLOTRIMAZOLE ,
pregnant. KETOCONAZOLE,etc.
⁃ SYMPTOMS:
a. mood swings 2. TRICHOMONIASIS VAGINALIS
b. tender breasts ⁃ is the most prevalent, curable STI .
c. food cravings ⁃ caused by a PARASITE.
d. fatigue ⁃ incubation period: 4-20 days.
e. irritability ⁃ serious consequence: genital
f. depression inflammation help me that it makes it easier for
-PREVENTION: the person to be infected with HIV virus to pass
a. Regular exercise- 3-5x a week. the HIV to a sex partner.
b. Well- balanced diet -high in complex carbs like S/ SX:
whole - grain bread and oatmeal , pasta, cereals. a.slight vaginal discharge- FROTHY WHITE or
c. Enough sleep and rest. GRAYISH- GREEN in color.
d. Don’t smoke . b. extreme vaginal itching.
e. Don’t consume excess sodium since sodium c. the upper vagina looks reddened and may
binds with water making the bloating and water have pinpoint PETECHIAE.
retention worsen.Avoid adding table salt to your d. FISHY ODOR / musty (moldy)odor-
meals and avoid processed foods. pathognomonic.
⁃ TREATMENT: ⁃ No symptoms in males.
a. NSAIDs- Aspirin, Ibuprofen, Naproxen (take ⁃ DIAGNOSIS:
before your period starts).
a. Microscopic examination of a sample of the a. Urine culture- for the gonoccocal.
vaginal discharge: rounded, mobile structures. b. Vaginal culture
-TREATMENT: c. Urethral culture
a. Oral Metronidazole or Tinidazole d. Anal culture - because of anal sex.
(contraindication: alcohol since it causes acute e. Oral culture - because of oral sex.
nausea and vomiting). ⁃ TREATMENT:
b. Condoms- help prevent recurrence. a. One intramuscular injection of
CEFTRIAXONE.
3. CHLAMYDIA TRACHOMATIS b. 7- day regimen of oral DOXYCYCLINE.
INFECTION ⁃ added if Chlamydial infection has
⁃ incubation period: 1-5 weeks. not been excluded.
⁃ S/Sx: ⁃ Sexual partners should receive the
a. heavy, GRAYISH- WHITE DISCHARGE. same treatment.
b. vulvar itching. ⁃ Approximately 24 hours after
-DIAGNOSIS: beginning treatment, gonorrhea is no longer
a. swab- urethra or cervix. infectious.
b.urine specimen / urinalysis. ⁃ Follow - up culture after 7 days to
⁃ TREATMENT: verify that disease eradication.
a. Oral Doxycycline- for 7 days or…
b. Azithromycin- single dose. 5. SYPHILIS
⁃ There is a strong association ⁃ is a systemic disease transmitted
between Gonorrhea and Chlamydia so if a by Spirohete TREPONEMA PALLIDUM.
Chlamydial infection is documented, screening, ⁃ incubation period: 10-90 days.
and possible treatment for gonorrhea is ⁃ S/SX:
indicated. a. CHANCRE- painless, despite its size, appears
⁃ COMPLICATION : Subfertility. on the genitalia ( penis or labia), or in the vagina,
on the mouth, lips, or rectal area from oral –
4. GONORRHEA genital or genital – anal contact.
⁃ is transmitted by NEISSERIA b. Swollen lymph nodes
GONORRHEAE, a gram- positive diplodocus, ⁃ Without treatment, a chancre lasts
which thrives on the mucous membrane of the approximately 6 weeks and then fades.
vagina or penis. c. Generalized, MACULAR COPPER-
⁃ MALE SYMPTOMS: COLORED RASH.
a. urethritis- pain on urination and frequency of ⁃ appears 2-4 weeks after the
urination. CHANCRE disappears.
b. urethral discharge-which appear after 2 to 7 ⁃ It covers the soles and the palms
days incubation period. as well as extremities and the body.
-COMPLICATION: ⁃ there may be secondary symptoms
a. Permanent sterility- untreated infection of generalized illness such as low-grade fever.
spreads easily among sexual partners and may B. LATENCY STAGE: lasts from few years to
spread through the testes,scarring the tubules. several decades.
⁃ often occurs concurrently with a -SEROLOGICAL TEST: positive result.
Chlamydial infection. C. FINAL STAGE of syphilis is a destructive
⁃ S/Sx: neurologic that involves major body organs, such
a. slight yellowish vaginal discharge. as the heart, and the nervous system.
b. Bartholin glands may become inflamed and ⁃ S/Sx: a. blindness
painful. b. paralysis
⁃ If left untreated, the infection can c. mental confusion
spread to pelvic organs, notably, the fallopian d. slurred speech
tubes, and can cause PID. e. lack of coordination
⁃ In males, tubal scaring with ⁃ if identified and treated, it can
permanent sterility. become fatal.
⁃ In both males and females, if
systemic involvement occurs, arthritis or heart
disease can develop.
⁃ DIAGNOSIS: