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Chapter 8 Cardiovascular and Respiratory Systems 171
The entry of system-specic data typically begins
with the patient’s health and family histories. As you
can see below, the General Medical History section of
The General Family History section likewise provides many selections related to cardiovascular disease.
the History application of CareTracker features many
different cardiovascular diseases.
Findings details windows allow even more detailed
information to be recorded.
172 Section II Anatomy and Physiology
All data entered into the History application in
CareTracker appear in the HX (history) tab of the
patient’s Progress Note. The primary care provider
can then enter additional patient data gathered during
the physical examination into the ROS (review of systems), PE (physical examination), TESTS PROC (tests
and procedures), DX (diagnoses), and PLAN (treatment
plan) tabs of the Progress Note. On the DX tab, below,
note that you can select a preloaded diagnosis from
the template form or search for and select the diagnosis, using either a description or an ICD code, using the
search feature.
All selected diagnoses are summarized at the bottom
of the DX tab.
The PLAN tab features a section devoted to cardiacrelated interventions that may be selected.
The and applications allow you to enter cardiovascular-related medication prescriptions and laboratory/diagnostic orders, respectively.
You’ll get a chance to practice this task in Case Study
7: Cardiovascular Patient Practicum.
To access Case Study 7, go to http://thepoint.lww.
com, log in using your username and password, search
for The Complete Medical Assistant, click on “Student
Resources,” nd the Harris CareTracker materials, and
click on “Case Study 7.”
Urinary and Reproductive
9
Systems
Chapter Objectives
● List the urinary system organs and the function of
each.
● Explain the kidney’s role in maintaining
homeostasis.
● Describe the function of the nephron.
● Explain the process of urine formation.
● Explain the process of urination.
● Discuss various types of urinary system
disorders.
● Explain the purpose of renal dialysis.
● List the organs of the male and female reproductive
systems.
● Describe the function of the male and female
reproductive organs.
● Describe a spermatozoon and describe the function
of semen.
● Identify the hormones that regulate the male and
female reproductive organs.
● Discuss various types of male and female
reproductive system disorders.
● Explain the changes during and after menopause.
● Describe the process of fertilization.
● Explain the main process of fetal development.
● List the stages of labor.
CAAHEP & ABHES Competencies
CAAHEP
● Describe structural organization of the human body.
● Identify body systems.
● List major organs in each body system.
● Describe the normal function of each body system.
● Identify common pathology related to each body
system including signs, symptoms, and etiology.
● Analyze pathology for each body system including
diagnostic measures and treatment modalities.
ABHES
● List all body systems, their structure, and functions.
● Describe common diseases, symptoms, and
etiologies as they apply to each system.
● Identify diagnostic and treatment modalities as they
relate to each body system.
173
174 Section II Anatomy and Physiology
Chapter Terms
Abortion
Cesarean section
Cryptorchidism
Cystitis
Dialysis
Dysmenorrhea
Endometriosis
Endometrium
Enuresis
Episiotomy
Excretory
Glomerulonephritis
Glycosuria
Hematuria
Abbreviations
ADH
BPH
EDC
ESWL
Case Study
Ms. Williams, a patient who was treated a month
ago for a urinary tract infection, is returning to see
the physician because she continues to have pain
with urination and a sense of urgency to urinate
frequently. During her rst visit, the physician
FSH
HPV
HRT
LH
Hydronephrosis
Incontinence
Lithotripsy
Mammogram
Micturition
Ovulation
Pyelonephritis
LMP
PID
PMS
PSA
ordered an antibiotic and instructed her to drink
plenty of water. As the medical assistant, Robin,
is preparing Ms. Williams to see the physician, the
patient asks Robin if it is normal to still have an
infection.
Pyuria
Uremia
Ureterocele
Urethritis
Viable
STI
TAH
UTI
C
O
G
The urinary system is another vital system in the body
that helps to maintain homeostasis by regulating uid
and electrolyte balance. The urinary system is also called
the
nary system include the following:
r
r
r
r
system.
THE URINARY SYSTEM
excretory system. The major structures of the uri-
Kidneys—two kidneys, one on the right and one on
the left side, lter the waste products from the blood
and balance uids by eliminating excess water.
Ureters—one leading from each kidney; serve as
tubes to transport the urine from the kidneys to the
bladder.
Urinary bladder—collects and holds the urine until it
is excreted from the body.
Urethra—tube that transports the urine from the
bladder to the outside of the body.
Figure 9-1 shows the major structures of the urinary
The Kidneys
The kidneys are located in the upper abdomen behind
the peritoneum (retroperitoneal). They are at the level of
the lower thoracic and upper lumbar region. The right
kidney is slightly lower than the left one because of the
location of the liver on the right side. Each kidney is
wrapped in a membrane of brous connective tissue
called the renal capsule. A protective layer of fat (adipose) also surrounds each kidney. The inner portion of
the kidney is called the renal medulla. This is the location
of the functional area of the kidney. The kidney resembles the shape of a kidney bean and is approximately
the size of a st. On the inner curve of the kidney, the
Case Question
A
F
F
What can Robin say to the patient that
will reassure her?
Chapter 9 Urinary and Reproductive Systems 175
Main vein to
heart carries
cleaned blood
Right kidney
Ureter carries urine
Bladder collects
ine
ur
Muscle to keep
bladder closed
Urethra
Figure 9-1 Major structures of the urinary system.
(Image from Shutterstock.com.)
Main artery
from heart
brings blood
with wastes
Left kidne
Ureter
Nerve that tells
brain the bladder
is full
Nerve that tells
bladder to open
y
renal vein and renal artery connect with the kidney. The
renal artery branching off the abdominal aorta carries
blood to the kidney for ltering. The renal vein returns
blood to the inferior vena cava and back to the heart. In
the renal medulla, the urine is formed and ows into the
region shaped like a funnel, the renal pelvis.
The Nephrons
The nephron is the microscopic, functional unit of the
kidney and the structure that actually produces the urine.
Each kidney has approximately 1 million nephrons.
The nephron receives blood into the capillary system
at the glomerular capsule, called the Bowman capsule.
From there, the blood is further ltered in the tiny renal
tubules. The tubules have specic areas where the uid
is transformed into urine. The tubule structure begins
with the proximal convoluted tubule, the nephron loop,
called the loop of Henle, and then ends at the distal convoluted tubule. The glomerulus is supplied with blood
from the afferent arteriole and leaves through the efferent arteriole. Figure 9-2 shows the main structures of
the nephron.
Study Skill
The terms afferent and efferent are used in describing structures in body systems. It is easy to remember that afferent starts with an “a” and can be
associated with the word arriving. The word efferent starts with “e” and can remind you with the
word exiting. So in the nephron, the afferent arteriole is arriving to the glomerulus and the efferent
arteriole is exiting.
The Ureters
The two ureters are muscular tubes that connect the
kidneys with the bladder. They do not change the
composition of the urine as it is transported from the
kidney to the bladder. The ureters connect to the bladder on the posterior side of the bladder. They have a
one-way valve so urine does not ow back once it is
Kidney
Glomerular capsule
Glomerulus
Loop of Henle
(nephron loop)
Collecting duct
Figure 9-2 The structure of a nephron. (Image from Shutterstock.com.)
Proximal convo
Distal convoluted tube
luted tube
176 Section II Anatomy and Physiology
in the bladder. Urine ows downward out of the kidney assisted by gravity; however, the smooth muscle
also uses peristaltic motion to move the urine along
the tubes.
The Urinary Bladder
The bladder is a temporary holding or storage sac for
the urine. It is located behind the pubic symphysis.
When the bladder is empty, the inside has folds called
rugae. The rugae allow for expansion of the bladder as
it lls with urine. It is a smooth muscle that is capable of
stretching. The bladder can hold about one-half liter of
urine when moderately full.
The Urethra
The urethra is the tube that leads from the bladder
to the outside of the body. Its only function is to
transport the urine. It does not change the composition of the urine. In the female, it is short, approximately 1½ inches, and opens at the urinary meatus
anterior to the vaginal opening. In the male, the urethra extends through the length of the penis. It carries
urine and also acts as a transport tube for semen with
spermatozoa.
Kidney Function and Urine Production
The kidneys are responsible for several functions including the following:
Elimination of waste and toxins; one of the waste
r
products is urea, nitrogen waste that is a by-product
of amino acid metabolism.
Maintaining homeostasis of body uids—control
r
water and sodium (salt) balance.
Production of hormones—produce erythropoietin,
r
which encourages red cell production in the bone
marrow.
Regulation of blood pressure—renin, an enzyme,
r
affects the ltration and reabsorption of sodium helping to regulate the blood pressure.
Urine Production
The primary function of the kidneys is to eliminate
waste products and excess uid from the body; however, it is a very delicate balance to ensure that too
much uid is not excreted. The kidneys are constantly
ltering blood, as much as 180 L of plasma (liquid part
of the blood) each day. Almost 99% of the ltrate is
reabsorbed back into the blood, which leaves about 1.5
to 2 L of urine produced each day. Substances that are
reabsorbed are put back into the circulatory system.
Any substances that are not reabsorbed are excreted
in the urine.
Study Skill
As you study subjects in the medical eld, you will
discover that the metric measurements are frequently used. It might be easy for you to picture a
quart or gallon of liquid like milk but what about the
liter measurement for liquids? The body produces
approximately 1½ to 2 L of urine per day. Think of
the 2-L bottles of soda that you purchase. It is the
same as lling one of those bottles each day.
An antidiuretic hormone (ADH) is released by the
posterior pituitary gland and controls the reabsorption
of water. The ADH affects the ability of the collecting
duct in the nephron to reabsorb the water. This protects
the body from too much water loss through the kidneys.
Urine
The chapter that presents urinalysis will provide greater
detail about the composition of normal and abnormal
urine and the laboratory examination of urine. Urine
is 95% water, and the rest of it is dissolved solids and
gases. Normal urine contains nitrogenous waste products, electrolytes, and a pigment, urochrome, a substance that gives the urine its yellow color. The color of
the urine can change from ingestion of specic foods,
such as beets, certain vitamins, and some drugs.
Abnormal substances in the urine include the
following:
Glucose—glycosuria or glucosuria, usually indicates
r
diabetes mellitus
Albumin (protein)—albuminuria; this protein passes
r
through the nephron instead of being reabsorbed into
the blood; caused by damage in the glomerulus
Blood (RBC)—hematuria, indicates injury or disease
r
in the urinary system
Blood Cells (WBC)—indicates possible infection
r
in the bladder or kidneys; when pus is present, it is
called
pyuria
Ketones—ketonuria, result from the breakdown of
r
fat, usually seen in diabetes mellitus and starvation
when the body is using the fat reserve for energy
Urine can also be examined for the presence of drugs
and hormones and may be cultured to determine the
type of bacteria that might be causing an infection.
Urination
Now that the urine has formed, it needs to be eliminated
from the body. Urination is also called micturition.
Voiding is a term used to describe the process of expelling the urine. The bladder has two sphincter muscles that
regulate the retention and excretion of urine. An internal,
involuntary sphincter is located near the bladder where
Chapter 9 Urinary and Reproductive Systems 177
the urethra exits and an external, voluntary sphincter is
a muscle formed by the pelvic muscles. The process of
urination involves nerve impulses sent from receptors in
the bladder to the spinal cord and then the brain. The
bladder wall contracts as the urethral sphincters relax
allowing the urine to ow out of the bladder.
Urinary Incontinence
Incontinence refers to an involuntary loss of urine,
which may result from a nerve disorder, malfunction of
the bladder, or weakness of the muscles in the pelvis.
Incontinence may occur during certain types of activity
that put stress on the bladder such as coughing, sneezing, lifting heavy objects, and while exercising. An overactive bladder results when the person perceives that
the bladder is full and loses control of the contractions.
Enuresis is another form of involuntary urination usu-
ally occurring at night. We know it as bedwetting.
C
O
G
DISORDERS OF THE
URINARY SYSTEM
As with the other body systems, the urinary tract from the
kidneys to the urethra can be affected by infections, structural problems, and cancer. The medical assistant may
encounter patients with symptoms associated with these
conditions, which include pain with urination, abdominal
pain, fever, and increased or decreased urine output.
Structural and Blockage Disorders
When there is a problem with a blocked passageway in
the urinary system, it can cause the urine to be retained
in the kidney or bladder. Hydronephrosis is the term
used to describe the accumulation of uid in the kidney.
Unresolved, this condition can leave the kidney permanently damaged. Physicians need to determine where the
blockage is located and open the blocked area. The most
common cause of an obstruction is renal calculi, known
as a kidney stone. These are made of substances that are
found in the blood but are ltered out instead of staying in the blood. The most common substances are uric
acid and calcium salts. These stones can be very small
and pass easily with the urine through the urinary tract
or may be so large that they remain in the renal pelvis
of the kidney, unable to pass through the ureter. Most
people experience intense pain trying to pass the stone.
The formation of kidney stones might be due to dehydration and urinary tract infections (UTIs). Younger
men usually have a higher incidence of development of
kidney stones than do women. If kidney stones cannot
be passed, a procedure called
lithotripsy, extracorporeal
shock wave lithotripsy (ESWL), can be used to crush
the stones into small pieces that are able to be passed
through the urinary tract. Figure 9-3 demonstrates how
the process of lithotripsy works.
Another type of treatment is surgical removal of the
stones using a laparoscopic technique. A small incision
is made for insertion of the endoscope, and instruments
are used to remove the stones.
The urinary tract can also have structural defects
that may affect the ability to produce urine or eliminate
it from the body. Some of these conditions include the
following:
Congenital abnormalities—renal hypoplasia, under-
r
developed or abnormally small kidneys; renal dysplasia, the nephrons are malformed and unable to
adequately lter the blood and produce urine.
Ureterocele—a type of herniation of the ureter as it
r
enters the bladder.
Hypospadias—in the male, the urethral opening is on
r
the underside of the penis instead of the end of the penis.
Ultrasound
shock waves
Smaller pieces that
then can easily pass
through the ureters
Kidney stones
Ureter
Figure 9-3 Extracorporeal
shock wave lithotripsy
(ESWL) for kidney stones.
(Image from Shutterstock.
com.)
178 Section II Anatomy and Physiology
Infection and Inammation Disorders
Urinary tract infections (UTIs) are probably the most
common condition affecting the urinary tract. The system may become contaminated with bacteria or might
be the result of underlying conditions that cause retention of urine. Most UTIs begin at the urethra typically caused from contamination and are frequently a
problem affecting females due to the shorter urethra
in the female. The contamination may come from the
Escherichia coli bacteria found in the bowel.
inammation of the urethra, migrates from the urethra
to other structures in the urinary tract. Most of the infections respond well to antibiotic therapy. These infections
include the following:
Cystitis—inammation of the bladder due to infec-
r
tion and retention of urine in the bladder; may
be caused by enlarged prostate in men; symptoms
include burning with urination and urgency and frequency of urination.
Pyelonephritis—inammation of the renal pelvis
r
lower portion of the kidney; may be a chronic condition due to persistent or multiple bacterial infections.
See Figure 9-4, which shows the location and effects
of pyelonephritis.
Glomerulonephritis—frequently diagnosed in chil-
r
dren following strep throat infection; the antibodies
formed in response to the streptococci bacteria remain
in the glomerulus causing damage to the structures;
the malfunctioning glomeruli cause increased protein and red blood cells in the urine, albuminuria and
hematuria.
Urethritis,
Case Study
The patient Ms. Williams nished her appointment with the physician and now is instructed
by Robin, the medical assistant, to obtain a sterile urine specimen. The physician has ordered
a urine culture and sensitivity. Ms. Williams
inquires about the urine test and is upset that she
has to have another urine test.
Case Questions
A
F
F
was seen a month ago?
sensitivity?
How can Robin explain to the patient
that a urine C&S is different from the
routine urine test performed when she
Why would the physician need a culture and
Benign and Malignant Tumors
The urinary tract is also susceptible to the development of growths that may be cancerous or noncancerous. They can develop in the bladder or kidney. When
the growth is a malignant tumor in the kidney, there
may not be any treatment other than removal of the
kidney. Bladder tumors are more frequently found in
Major
calyces
Renal
pelvis
Ureter
Cortex
Pyramid
Minor
calyces
Scarring
Atrophy
of cortex
Inflammation
PyelonephritisNormal kidney
Pus
Figure 9-4 Pyelonephritis.
(Image from Shutterstock.com.)
Chapter 9 Urinary and Reproductive Systems 179
men over the age of 50. These also may be benign or
malignant.
In order to visualize the inside of the bladder, a cystoscope is used. It is a lighted endoscope that is inserted
through the urethra into the bladder. After the growth
is identied, it can be surgically removed, and if malignant, radiation or chemotherapy may be indicated. If the
bladder has suffered too much damage or involvement,
removal of the bladder is required, a cystectomy. In this
case, the ureters are rerouted to the small intestine.
Other Urinary System Disorders
There are several other specic disorders of the urinary
tract that include the following:
Polycystic kidney disease—genetic disorder resulting
r
in development of uid-lled sacs (cysts) in the kidney; the sacs put pressure on the nephrons causing
renal failure, which results in the need for renal dialysis and kidney transplant.
Kidney (renal) failure—kidneys fail to function
r
properly.
Acute renal failure—may be a complication of a seri-
r
ous illness or due to toxins entering the body.
Chronic renal failure—loss of nephrons over a period
r
of time.
Blood from
dialysis machine
Blood to dialysis machine
Arteriovenous fistula
Vein
Artery
Figure 9-5 Fistula in a dialysis patient’s arm. (Image
from Shutterstock.com.)
to leave the body for the machine and the reentry of
the blood from the machine after it has been ltered.
Kidney transplant—removing the affected kidney and
r
replacing it with a donor kidney; many patients have
had a family member donate one of their kidneys; this
is a better way to ensure a good tissue match.
With renal failure, usually chronic type, there are
associated symptoms including the following:
Edema—accumulation of uid in the tissues; the kid-
r
neys lose the ability to lter excess water.
Uremia—excess of nitrogen waste substances in the
r
blood; the kidneys lose the ability to properly lter
the blood.
Dehydration—excessive uid loss; the kidneys lose
r
the ability to concentrate the urine and lter too
much water out of the body.
In addition to the above symptoms, patients may
develop hypertension due to the water retention and
electrolyte imbalance. Anemia may also be present due
to the kidney’s inability to produce the hormone necessary to activate red blood cell production in the bone
marrow.
Kidney Treatments
After conrmation of a diagnosis of a kidney disorder,
there may be a need for more aggressive treatments to
help resolve the condition, these include the following:
Dialysis—also called hemodialysis; it uses a dialysis
r
machine to lter the blood; patients may have a stula that connects their blood vessel to the machine’s
ltering system. Figure 9-5 is a diagram of a stula in
a dialysis patient’s arm. Notice the exit for the blood
C
O
G
The reproductive system is located in close proximity
to the urinary system. There are primary and accessory
organs. The primary male sex glands are the testes, and
the female glands are the ovaries. Another term for sex
glands is gonads. We will examine the male and female
reproductive systems separately.
C
O
G
The male reproductive system produces the sperm and
delivers it to the female in order to fertilize the female
ova (eggs) resulting in reproduction of the human species. Figure 9-6 is a diagram of the major structures of
the male reproductive system.
THE REPRODUCTIVE
SYSTEM
MALE REPRODUCTIVE
SYSTEM
The Testes
The testes are the male gonads (sex glands). They are
located in the scrotum, an external sac between the
thighs. Prior to birth, the testes are formed in the abdomen and then normally descend into the scrotum through
the inguinal canal. They are suspended into the scrotum
180 Section II Anatomy and Physiology
Urinary bladder
Pubic bone
Urethra
Penis:
Prepuce
(foreskin)
Testis
Figure 9-6 Male reproductive system. (Reprinted from Cohen BJ. Memmler’s The Human Body in Health and Disease.
13th ed. Philadelphia, PA: Wolters Kluwer; 2014.)
Ductus deferens
Epididymis
Scrotum
Ureter
Seminal vesicle
Ejaculatory
Prostate
Bulbourethral
gland
Rectum
Anus
duct
by the spermatic cord. The scrotal sac provides a good
environment, out of the abdomen, where the testes are
maintained at an ideal temperature for the production
and maturing of the sperm. In the testis are seminiferous tubules where the sperm are nourished and develop.
Also, the testes secrete testosterone, the male hormone.
Spermatozoa
Males begin to produce sperm during puberty. This is a
constant process, which begins to decrease as the male
approaches 40 years of age. Some men continue to produce sperm as late as 70 to 90 years of age.
Each sperm has a head, midsection, and a tail. The
head, the acrosome, contains enzymes that help the
sperm to penetrate the female egg. The midsection contains mitochondria, also necessary to provide energy
for the sperm’s movement. The agellum (tail) is used
to propel the sperm as it swims in the semen headed
for the female egg. See Figure 9-7, a diagram of a single
spermatozoa.
Male Accessory Organs
The testes are the primary reproductive organs; however, there are additional structures necessary to support
the process of reproduction transferring the sperm to
the female body. After the sperm are produced in the
testis (singular), the sperm are delivered to the epididymis, a coiled tube, where they will mature and become
very motile and capable of the long journey from the
male body to the female. The sperm travel from the epididymis to the vas deferens, a long tube that leads to
the seminal vesicle, then to the ejaculatory duct where
they nally empty into the urethra. The urethra from
the bladder serves two functions, to transport urine and
semen with sperm.
Head
Neck
Midpiece
Tail (flagellum)
Figure 9-7 Spermatozoa. (Reprinted from Cohen BJ.
Memmler’s The Human Body in Health and Disease.
13thed. Philadelphia, PA: Wolters Kluwer; 2014.)
Mitochondria
Acrosome
Nucleus