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The Genitourinary System I U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234-6100 THE GENITOURINARY SYSTEM I SUBCOURSE MD0579 EDITION 100 DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change. ADMINISTRATION Students who desire credit hours for this correspondence subcourse must enroll in the subcourse. Application for enrollment should be made at the Internet website: http://www.atrrs.army.mil. You can access the course catalog in the upper right corner. Enter School Code 555 for medical correspondence courses. Copy down the course number and title. To apply for enrollment, return to the main ATRRS screen and scroll down the right side for ATRRS Channels. Click on SELF DEVELOPMENT to open the application; then follow the on-screen instructions. For comments or questions regarding enrollment, student records, or examination shipments, contact the Nonresident Instruction Branch at DSN 471-5877, commercial (210) 221-5877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail [email protected], or write to: NONRESIDENT INSTRUCTION BRANCH AMEDDC&S ATTN: MCCS-HSN 2105 11TH STREET SUITE 4191 FORT SAM HOUSTON TX 78234-5064 Be sure your social security number is on all correspondence sent to the Academy of Health Sciences. CLARIFICATION OF TERMINOLOGY When used in this publication, words such as "he," "him," "his," and "men" 'are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. USE OF PROPRIETARY NAMES The initial letters of the names of some products may be capitalized in this subcourse. Such names are proprietary names, that is, brand names or trademarks. Proprietary names have been used in this subcourse only to make it a more effective learning aid. The use of any name, proprietary or otherwise, should not be interpreted as endorsement, deprecation, or criticism of a product; nor should such use be considered to interpret the validity of proprietary rights in a name, whether it is registered or not. TABLE OF CONTENTS Lesson Paragraphs INTRODUCTION 1 ANATOMY AND PHYSIOLOGY OF THE GENITOURINARY SYSTEM ........................................................................................... 1-1--1-9 Exercises 2 PHYSICAL ASSESSMENT OF THE GENITOURINARY SYSTEM ........................................................................................... 2-1--2-4 Exercises 3 URINARY SYSTEM DISEASES/DISORDERS Section I Urinary Tract Infections.............................................. 3-1--3-4 Section II Kidney Diseases and Disorders ................................. 3-5--3-13 Section III Management of Kidney Diseases .............................. 3-14--3-15 Section IV Disorders of the Ureters............................................. 3-16--3-17 Section V Disorders Involving the Bladder ................................. 3-18--3-20 Section VI Disorders of the Urethra............................................. 3-21--3-22 Section VII Injuries to Organs of the Genitourinary System .......... 3-23--3-26 Section VIII Drug Therapy for Genitourinary Disease/Disorders .... 3-27--3-34 Section IX The Effects of Aging .................................................. 3-35--3-37 Exercises 4 URINARY CATHETERIZATION....................................................... 4-1--4-8 Exercises MD0579 i CORRESPONDENCE COURSE OF THE U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL SUBCOURSE MD0579 THE GENITOURINARY SYSTEM I INTRODUCTION Today, more than 8 million Americans are affected by renal-related diseases. This fact suggests that you will probably deal with renal patients often. Add to this the complex human reproductive system by which a single cell duplicates its genetic material, allowing an organism to grow and repair itself. To give patients with problems in either or both systems the best possible care, you need to know normal anatomy and physiology of the systems, specific disorders in each system, assessment methods, and treatments. Regardless of the cause or the duration of the problem, it is important for you as a combat medical specialist to be able to recognize and treat/refer for treatment any individual with genitourinary system difficulties. Subcourse Components: The subcourse instructional material consists of four lessons as follows: Lesson 1, Anatomy and Physiology of the Genitourinary System. Lesson 2, Physical Assessment of the Genitourinary System. Lesson 3, Urinary System Diseases/Disorders. Lesson 4, Urinary Catheterization. Here are some suggestions that may be helpful to you in completing this subcourse: --Read and study each lesson carefully. --Complete the subcourse lesson by lesson. After completing each lesson, work the exercises at the end of the lesson, marking your answers in this booklet. --After completing each set of lesson exercises, compare your answers with those on the solution sheet that follows the exercises. If you have answered an exercise incorrectly, check the reference cited after the answer on the solution sheet to determine why your response was not the correct one. MD0579 ii Credit Awarded: Upon successful completion of the examination for this subcourse, you will be awarded 6 credit hours. To receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. You can enroll by going to the web site http://atrrs.army.mil and enrolling under "Self Development" (School Code 555). A listing of correspondence courses and subcourses available through the Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet 350-59, Army Correspondence Course Program Catalog. The DA PAM is available at the following website: http://www.usapa.army.mil/pdffiles/p350-59.pdf. MD0579 iii LESSON ASSIGNMENT LESSON 1 Anatomy and Physiology of the Genitourinary System LESSON ASSIGNMENT Paragraphs 1-1 through 1-9. LESSON OBJECTIVES After completing this lesson, you should be able to: 1-1. Identify the structure, location, and function of the kidneys. 1-2. Identify the structure, location, and function of the kidneys. 1-3. Identify the structure, location, and function of the ureters. 1-4. Identify the structure, location, and function of the bladder. 1-5. Identify the structure, location, and function of the urethra. 1-6. Identify terminology, physiology, and important characteristics of urine. 1-7. Identify internal and external components and functions of the male genitalia. 1-8. Identify characteristics, structures, and functions of the female genital system. SUGGESTION After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you to achieve the lesson objectives. MD0579 1-1 LESSON 1 ANATOMY AND PHYSIOLOGY OF THE GENITOURINARY SYSTEM 1-1. INTRODUCTION The term "genitourinary" actually refers to two different systems. Urinary refers to the system responsible for removal of nitrogenous waste products of metabolism from the bloodstream, disposal of concentrated wastes (urine), and also water conservation. Genito refers to the genital organs and the reproductive system, which is responsible for production of succeeding generations for perpetuation of the species. 1-2. URINARY SYSTEM The urinary system's primary function is to help keep the body in homeostasis (internal environment of the body remains relatively the same, within limits) by controlling the composition and volume of blood. The urinary system does this by removing and restoring selected amounts of water and solutes. The urinary system is made up of two kidneys, two ureters, one urinary bladder, and one urethra. Each kidney, the primary organs of this system, excretes urine through a ureter. The urine is stored in the urinary bladder and finally expelled from the body through the urethra. See figures 1-1 and 1-2 for organs of the urinary system NOTE: Other systems also have a part in waste elimination from the body. These systems are the respiratory, integumentary, and digestive systems 1-3. KIDNEYS The two kidneys are reddish, bean-shaped organs. They are located on the posterior wall of the abdominal cavity between the level of the twelfth thoracic vertebra (T-12) and the third lumbar vertebra (L3). Think of these organs as being just above the waist. The term for their location is retroperitoneal, which means that they are external to the peritoneal lining of the abdominal cavity. These organs are about 11 to 12 centimeters long and 5 to 6 centimeters wide. Since the liver occupies a large space on the right side of the abdominal cavity, the right kidney is slightly lower than the left kidney. The kidneys are held in place by fat. See figure 1-3. MD0579 1-2 Figure 1-1. Organs of the male urinary system. MD0579 1-3 Figure 1-2. Urinary system organs. MD0579 1-4 Figure 1-3. External view of the right kidney. a. Functions of the Kidneys. The kidneys accomplish these functions: (1) Filter metabolic wastes. The kidneys remove wastes from the blood in the form of urine. (2) Form urine. Urine is formed by the activities of the kidneys. (3) Balance fluid and electrolytes. The kidneys are the organs that regulate the composition and volume of blood. (4) Balance acid base. (5) Influence blood pressure. To aid in regulating blood pressure, the kidneys secrete
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