♥ GENITOURINARY SYSTEM

♥ Kidney

o Decreased weight
o Decreased total renal area, cortical area and number of glomeruli
o Although adaptive capacity decreases, sufficient reserve capacity exists to permit
the aging kidney to maintain homeostasis under stable conditions

♥ Nephrons

o Decreased number and size

o Increased interstitial connective tissue
o Fewer identifiable glomeruli
o Reduced filtering surface
o Healthy glomeruli enlarge and hyperfiltrate
o Thickened glomerular basement membrane
o Increased diverticuli in distal convoluted tubules
o Large renal blood vessels
 sclerosis
o Small renal blood vessels
 diminish cortical blood flow
o Decline in glomerular filtration rate
o Reduced baseline levels of rennin, angiotensin II, and aldosterone
o Decreased erythropoietin

♥ Bladder

o Increased fibrous connective tissues

o Formation of trabecule, diverticula , and pseudodiverticulosis
o Bladder muscle weakens
 incomplete emptying may occur
 Ability to postpone voiding declines

♥ Urethra
o Difficulty in opening and closing of the bladder outlet
 Difficulty in starting urinary stream
o Maximum urethral closure pressure declines

♥ Prostate
o Hyperplasia
 May be a factor in obstruction and urinary symptoms

♥ External Genitalia:
o Male
 Thin pubic hair
 Testicular atrophy
o Female
 Labial atrophy
 Vaginal atrophy
  Thin, inelastic vaginal walls
 Diminished secretions
 Increased vaginal pH
 Reduced length and width of vagina

♥ Sexual Response
o Male
 Increased time to achieve erection
 Greater difficulty maintaining erection
 Delayed ejaculation
 Decreased semen volume
 Prolonged refractory period
o Female
 Delayed arousal phase
 Reduced vaginal secretions and expansion
 Orgasm shorter: contractions lessened and sometimes painful

♥ COMMON GENITOURINARY DISORDERS

♥ Acute Renal Failure
o Sudden decrease in GFR caused by disease of blood vessels, glomeruli, tubules
or interstitial tissue.
o May be Prerenal ARF, Intrenal ARF, Postrenal ARF

♥ Glomerular Diseases
o Glomerulonephritis describes the inflammation of the membrane tissue in the
kidney that serves as a filter, separating wastes and extra fluid from the blood.
o Glomerulosclerosis describes the scarring or hardening of the tiny blood vessels
within the kidney.
o The signs and symptoms of glomerular disease include
 proteinuria: large amounts of protein in the urine
 hematuria: blood in the urine
 reduced glomerular filtration rate: inefficient filtering of wastes from
the blood
 hypoproteinemia: low blood protein
 edema: swelling in parts of the body

♥ Chronic Renal Failure And End stage Renal Disease

o Chronic renal failure (CRF) is the progressive loss of kidney function. The
kidneys attempt to compensate for renal damage by hyperfiltration (excessive
straining of the blood) within the remaining functional nephrons (filtering units that
consist of a glomerulus and corresponding tubule). Over time, hyperfiltration
causes further loss of function.
o End-stage kidney disease is the complete, or almost complete failure of the
kidneys to function. The kidneys can no longer remove wastes, concentrate
urine, and regulate many other important body functions.

♥ Lower Urinary Tract sympotms

o Describe problems with storage or voiding and postmicturition symptoms
 o Men may report one or any combination of the following symptoms:
 Urinary frequency
 Nocturia
 Urgency, with or without incontinence
 Hesitancy in initiating the stream
 Weak stream
 Dysuria
 Sense of incomplete bladder emptying

♥ Benign Prostatic Hyperplasia

o nonmalignant (noncancerous) enlargement of the prostate gland, a common
occurrence in older men. It is also known as benign prostatic hyperplasia and
abbreviated as BPH.
o In BPH, the prostate gland grows in size. It may compress the urethra which
courses through the center of the prostate. This can impede the flow of urine
from the bladder through the urethra to the outside. It can cause urine to back up
in the bladder (retention) leading to the need to urinate frequently during the day
and night. Other common symptoms include a slow flow of urine, the need to
urinate urgently and difficulty starting the urinary stream. More serious problems
include urinary tract infections and complete blockage of the urethra, which may
be a medical emergency and can lead injury to the kidneys

♥ Prostate Cancer
o is a malignant (cancerous) tumor (growth) that consists of cells from the prostate
gland. Generally, the tumor usually grows slowly and remains confined to the
gland for many years. During this time, the tumor produces little or no symptoms
or outward signs (abnormalities on physical examination).
o The cause of prostate cancer is unknown, but the cancer is not thought to be
related to benign prostatic hyperplasia (BPH). The risk (predisposing) factors for
prostate cancer include advancing age, genetics (heredity), hormonal influences,
and such environmental factors as toxins, chemicals, and industrial products.

♥ Bladder Cancer
o refers to any of several types of malignant growths of the urinary bladder. It is a
disease in which abnormal cells multiply without control in the bladder.
o Risk factors include smoking and industrial exposure to dye, rubber and leather
o Symptoms include painless gross hematuria, pain during urination, frequent
urination

♥ Urinary Tract Infections

o is a bacterial infection that affects any part of the urinary tract
o most common symptoms of a bladder infection are burning with urination
(dysuria), frequency of urination, an urge to urinate, without vaginal discharge or
significant pain
o Risk factors include sexual activity, gender, catheterization
o Asymptomatic Bactriuria
o is a significant number of bacteria in the urine that occurs without usual
symptoms such as burning during urination or frequent urination.

♥ Pyelonephritis
o acute pyelonephritis is a sudden inflammation caused by bacteria. It primarily
affects the interstitial area and the renal pelvis or, less often, the renal tubules.
o Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys
and may lead to chronic renal failure. This disease is most common in patients
 who are predisposed to recurrent acute pyelonephritis, such as those with urinary
obstructions or vesicoureteral reflux.

♥ Urinary Incontinence
o is loss of bladder control. Symptoms can range from mild leaking to
uncontrollable wetting. It can happen to anyone, but it becomes more common
with age.

♥ Overactive Bladder
o is a condition that results from sudden, involuntary contraction of the muscle in
the wall of the urinary bladder. Overactive bladder causes a sudden and
unstoppable need to urinate (urinary urgency), even though the bladder may only
contain a small amount of urine.
o caused by spasms of the muscles of the bladder, resulting in an urge to urinate
(hence, urge incontinence). Overactive bladder is primarily a problem of the
nerves and muscles of the bladder.

♥ Vaginitis
o term for any infection or inflammation of the vagina.
o may cause itching, irritation, or abnormal vaginal discharge

♥ Diabetic Cystopathy
o Complication of diabetes that is manifested as decreased bladder sensation,
increased bladder capacity and impaired detrusor contractility.

♥ Nocturia
o the need to get up during the night in order to urinate, thus interrupting sleep.
o Some sources indicate that less than three episodes require no intervention or
investigation

♥ Endocrine System
♥ Pituitary Gland
o Atrophy ,fibrosis decreased vascularity
o Deacreased secretion of growth hormone
o Deacreased circulating IGF- level

♥ Thyroid gland
o Adequate function even with progressive fibrosis
o Less circadian variation of serum TSH level
o Thyroid binding globulin unchanged

♥ Parathyroid Gland
o Increased serum PTH level
o Impaired response of intestinal cells of PTH

♥ Adrenal Glands
o Basal, circadian, and stimulated cortisol secretion intact
o Decreased cortisol catabolism balanced by reduced cortisol production
o Diminished synthesis of adrenal androgens
o Aldosterone secretion well preserved
♥ Pancreas
o Dilated pancreatic duct
o Flow rate of exocrine secretions diminish
o Decreased secretion of bicarbonate and enzymes

♥ Pineal Gland
o Melatonin production declines

♥ Female Sex Hormones

o Ovarian sensitivity to gonadotropins decreases
o Reduced estrogen production
o FSH and LH rise the decline 3 to 5 years after menopause
o Sized of uterus decline

♥ Male Sex Hormone

o Decreased testicular volume
o Sclerosis of testicular tubules
o Decreased in number of spermatozoa
o Ratio of estrogen to testosterone increases
o Increased LH and FSH levels
o Decline testosterone level

♥ COMMON ENDOCRINE DISORDERS

♥ Diabetes Mellitus Type 2

o formerly non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset

diabetes – is a metabolic disorder that is characterized by high blood glucose in
the context of insulin resistance and relative insulin deficiency. Diabetes is often
initially managed by increasing exercise and dietary modification. As the
condition progresses, medications may be needed
o symptoms: fatigue, generalized weakness, excessive appetite, thirst, rapid
weight loss, obesity

♥ Hyperthyroidism
o term for overactive tissue within the thyroid gland causing an overproduction of
thyroid hormones (thyroxine or "T4" and/or triiodothyronine or "T3")
o Symptoms: angina, confusion, emotional lability, weakness, fatigue, weight loss,
increased cold tolerance, decreased heat tolerance

♥ Hypothyroidism
o is a condition characterized by abnormally low thyroid hormone production
o Symptoms: decreased tolerance to cold, lethargy, constipation, muscle
weakness, pain, stiffness, loss of sense of smell,, answers questions slowly or
inappropriately.

♥ Breast Cancer
o is cancer originating from breast tissue, most commonly from the inner lining of
milk ducts or the lobules that supply the ducts with milk.
 o first noticeable symptom of breast cancer is typically a lump that feels different
from the rest of the breast tissue. More than 80% of breast cancer cases are
discovered when the woman feels a lump
o Indications of breast cancer other than a lump may include changes in breast
size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple
discharge

♥ Vaginal Cancer
o Bleeding and offensive discharge are common presenting symptoms
o Ttt include radiotherapy and vaginectomy
o Uterine Cancer
o Risk factors include: early age of coitus, multiple sexual partners, history of
sexually transmitted disease
o Offensive vaginal discharge and postmenopausal and postcoital bleeding

♥ Ovarian Cancer
o Few specific risk factors have been defined – nulliparity, history of breast or
endometrial cancer and of menstrual difficulties. Increased familial incidence has
also been reported. Pregnancy and oral contraceptives are possibly protective.
The role of exogenous hormones as a protective factor is still being studied.

♥ Erectile Dysfunction
o Based on failure in sexual encounters in at least one fourth of all attempts
o May occur in an age, but is more likely in older men
o May be attributed to physical causes, including vascular, neurologic and
endocrine disorders
o May be an early sign of heart disease, hypertension or diabetes

♥ Immune System
♥ Immunosenescence

♥ Skin and Mucous Membranes

o Decreased circulating thymus-derived lymphocytes, cytokines and epidermal
langerhans cells
o Slower less dramatic hypersensitivity

♥ Phagocytosis
o Macrophages and neutrophils less effective against bacteria
o Impaired cell adhesion
o Impaired capacity to focus mediator cells and the cytokines they express
o Decline effectiveness of chemotaxis in less vascular areas
o Fewer local T cells activated in response to infection

♥ Cell lysis
o Natural killer cell activity declines

♥ Antibody-Mediated Immunity
o Total number of peripheral blood cells is stable
o Increased autoantibody frquency
 o Increased serum IgA

♥ Cytokine Dysregulation
o Proinflammatory cytokines increases( particularly 1L-6)

♥ COMMON IMMUNE SYSTEM DISORDERS

♥ Pneumococcal Disease
o is a severe bacterial infection caused by Streptococcus pneumoniae, also called
pneumococcus. It may cause pneumonia, meningitis, or a blood stream infection
(bacteremia).

♥ Pernicious Anemia
o is a disease where large, immature, nucleated cells (megaloblasts, which are
forerunners of red blood cells) circulate in the blood, and do not function as blood
cells; it is a disease caused by impaired uptake of vitamin B-12 due to the lack of
intrinsic factor (IF) in the gastric mucosa.
o fatigue, depression, forgetfulness, difficulty concentrating, low-grade fevers,
nausea and gastrointestinal symptoms (heartburn), weight loss
o PA may affect the spinal cord, the patient may also complain of impaired
urination, loss of sensation in the feet, unsteady gait, weakness and clumsiness.
Anemia may cause tachycardia (rapid heartbeat) and cardiac murmurs, along
with a waxy pallor. In severe cases, the anemia may cause evidence of
congestive heart failure.

♥ SPECIAL SENSES
♥ Visual System
o Eyebrows and Eyelashes
 Gray
o Eyelids
 Wrinkling and loosening of skin
 Decrease in muscle tone and elasticity
 Herniation lof fat into lower lids
o Orbit
 Loss of fat
o Tears
 Diminished secretions
o Cornea
 Decrease in number of endothelial cells
 Diminished sensitivity
 Diminished corneal reflex
 Arcus senilis(grayish ring around iris)

o Colliery Body
  Decreased secretion of aqueous humor
 Atrophy of ciliary muscle
 Decreased ability to focus( presbyopia)
 Decreased visual aquity
o Lens
 Enlargement, yellowing
 Loss of elasticity
 Increased density
 Decreased ability to adapt to dark and light
 Decreased tolerance of glare
 Increased myopia or decreased hyperopia
o Iris
 Loss of pigment
o Pupil
 Smaller
 Decreased peripheral vision
o Vitreous Gel
 Liquefies and colla[se
 Condensation and debris common as “floaters”
o Retina
 Local ischemia
 Loss of neurons

♥ Hearing
o External Ear
 Skin of auricledry and wrinkled
 Itching and dryness of external auditory canal
 Cerumen drier
 Ceruminal gland decrease in number and activity
o Middle Ear
 Degeneration of bony joints
 Eardrum thickness
o Inner Ear
 Atrophy and degeneration of hair cells, suppoting, and stria vascularis
 Decrease in number of functional spiral ganglia and nerve fibers

♥ Taste
o Slower turnover of taste buds: may decrease in number
o Elevated thresholds for taste detection and recognition
o Detection of sour and bitter tastes declines most

♥ Smell
o Elevated thresholds for smell detection and recognition
o Number of olfactory cells in epithelium declines in relation to respiratory cells
o Loss of olfactory receptor neurons
♥ Touch, Vibration and Pain
o Decline in sense of touch
o Decline in sensitivity to high- frequency vibration
o Some decline in proprioception
o Decline in two- point discrimination
o Decline in balance testing
o Ability to perceive painful stimuli remains relatively intact in healthy older
persons

♥ COMMON DISORDERS
♥ Cataract

o a clouding that develops in the crystalline lens of the eye or in its envelope,
varying in degree from slight to complete opacity and obstructing the passage of
light.
o As a cataract becomes more opaque, clear vision is compromised. A loss of
visual acuity is noted.
o Cataracts develop for a variety of reasons, including long-term exposure to
ultraviolet light, exposure to radiation, secondary effects of diseases such as
diabetes, hypertension and advanced age, or trauma (possibly much earlier);
they are usually a result of denaturation of lens protein

♥ Glaucoma
o disease in which the optic nerve is damaged, leading to progressive, irreversible
loss of vision. It is often, but not always, associated with increased pressure of
the fluid in the eye
o nicknamed the "silent thief of sight" because the loss of vision normally occurs
gradually over a long period of time and is often only recognized when the
disease is quite advanced

♥ Diabetic Retinopathy
o retinopathy (damage to the retina) caused by complications of diabetes mellitus,
which can eventually lead to blindness

♥ Senile Entropion/Ectoprion
o Entropion is the complete inversion of the lower lid and is caused by a general
weakening and wasting of the muscles, fat and skin surrounding the orbit of the
eye
o Ectropion also called involutional, atonic, relaxation or senescent ectropion is an
outward turning of the yelid margin from its position of contact with the globe

♥ Presbycusis
o loss of hearing that gradually occurs in most individuals as they grow older.
Hearing loss is a common disorder associated with aging. About 30-35 percent of
adults between the ages of 65 and 75 years have a hearing loss. It is estimated
that 40-50 percent of people 75 and older have a hearing loss.

♥ Tinnitus
o perception of sound within the human ear in the absence of corresponding
external sound.
o not a disease, but a symptom resulting from a range of underlying causes that
can include: ear infections foreign objects or wax in the ear, nose allergies that
prevent (or induce) fluid drain and cause wax build-up. Tinnitus can also be
caused by natural hearing impairment (as in aging), as a side effect of some
medications, and as a side effect of genetic (congenital) hearing loss.