Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 98 Urine Formation
removal of prostate gland, meds such as diuretics or sedatives 1. Incontinence—causes can range from urologic, neurologic, psychological, or environmental
Consists of 95% water and 5% solids; influenced by ADH, fluid/sodium regulation, blood pressure (BP), and nutrient intake • Elements of urine: 5% solids—urea, creatinine, metabolic acids, and sodium chloride • RBC/WBC should not be present Renal/Urinary Tract Problems Upper urinary tract infections (UUT infections): Considered more serious because they pose a direct threat to renal tissue • Renal impairment: caused by infections such as pyelonephritis Infectious Lower Urinary Tract Disorders The bladder/urine have natural defenses against bacterial invasion : Voiding, urine acidity, bladder mucosa, and so on; however, urine is a good medium for bacterial growth, although sterile, due to stagnation and PH changes • Route of bacterial entry is usually ascending • Most commonly occurs in women due to short female urethra and proximity of urethra to vagina/rectum ○ Cystitis ○ Urethritis • Signs/symptoms: Dysuria, frequency, urgency, hesitancy, appearance (cloudy, bad smelling, or bloody urine) Obstructive Disorders Can occur anywhere in UT and can be caused by primary or secondary obstructions. Obstructions result in backup of urine behind obstruction/dilatation of urinary tract structures. Muscles near affected area contract in an attempt to push urine around obstruction and pressure continues, causing renal failure due to decreased urine flow. Infection or stone formation can result. Mechanical/Neuromuscular Disorders Relate to difficulty in emptying urine from bladder—retention or incontinence • May be caused by mechanical stress, SCI/ CNS disease, UTI, obstruction, trauma,
LEARNING TIP! a. Passive—muscular weakness of pelvic floor and sphincters (stress incontinence).
b. Active—inappropriate bladder contractions (urge incontinence) c. Flaccid—caused by denervation of smooth muscle of bladder wall – Lower motor neuron (LMN) dysfunction affecting S2 through S4 – No urgency to void; must do so mechanically d. Spastic—reflex bladder activity is intact, but detrusor muscle contracts with very small amounts of urine; upper motor neuron (UMN) disorder e. Uninhibited—neither flaccid nor spastic; lack of control or sensation rendering client incontinent; originates from CVA, TBI – Any cervical pain in combination Renal Failure Exists when kidneys can no longer maintain homeostatic balances; can be acute (occurring over a period of hours/days and reversible) or chronic (irreversible and progressive) • Causes: DM and HTN are most common causes of chronic renal failure • Acute renal failure can be due to: Bilateral kidney disease, severe/prolonged circulatory shock, nephrotoxins causing tubule necrosis, mechanical obstructions • Chronic renal failure is gradual/irreversible destruction of kidneys with incontinence is red flag for SC compression—cervical manipulation contraindicated
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