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362 Cards in this Set
- Front
- Back
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serous membrane that lines the abdominal cavity and forms a protective cover for many structures
|
peritoneum
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double folds of peritoneum around the stomach constitute:
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greater and lesser omentum
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fan like fold of peritoneum that covers most of the small intestine and anchors it to post abd wall
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mesentery
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length of alimentary tract?
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27 ft
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functions of GI: (3)
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ingest/digest food
absorb nutrients, electrolytes and water excrete waste products |
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esophagus lies ____ to the trachea
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posterior
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3 sections of the stomach
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fundus
body pylorus |
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does a lot of absorption occur in the stomach?
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no
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length of sm intest
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21 ft
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what increases sm intest functional SA?
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circular folds and villi
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length of lg intest
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4.5-5 ft
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where does most water absorption occur?
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lg intest
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putrefaction is:
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decomposition of undigested food redsidue, unabsorbed aas, cell debris and dead bacteria by live bacteria in the lg intest
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normal weight of adult liver
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3 lb
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how many lobes in the liver?
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4
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what is the functional unit of liver?
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lobule
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what is at the center of each lobule?
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central vein
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____ carries oxy blood to liver while ___ carries deoxy blood
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hepatic A; portal vein
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what hormone signals release of bile from gallbladder? where is it produced?
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cholecystokinin; duodenum
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describe pancreas in relation to stomach
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pancreas lies behind and beneath the stomach
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another name for pancreatic duct
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duct of Wirsung
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what constitutes the majority of the spleen?
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white pulp (lymphoid tissue)
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vertebral span of the kidneys:
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T12-L3, right kidney slightly lower than left
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what is the functional unit of the kidney?
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nephron
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to where does the distal tube of kidney empty?
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collecting tubule
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kidney receives what fraction of the cardiac output? through what artery?
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1/8th; renal artery
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glomerulus filter rate for men and women:
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men: 125 mL/min; women: 110 mL/min
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most filtered material (glucose, electrolytes, etc) is resorbed where?
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proximal tubule
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what can be actively secreted in distal tubule?
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organic acids
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what carefully controls urinary volume?
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ADH
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what is the endocrine function of the kidney?
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production of renin, epo, Vit D and prostaglandins
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what is renin important for?
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control of aldosterone production
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what is another name for the inguinal ligament?
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Poupart ligament
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what landmark denotes the branching of the aorta into the common iliac arteries?
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umbilicus
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during what week to the pancreatic buds, liver and gallbladder start to form?
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4 weeks gestation
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during what week can the fetus swallow amniotic fluid?
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17 weeks gestation
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by what weeks is the GI system capable to support extrauterine life?
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36-38 weeks
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at what age do the GI's elasticity, musculature and control reach maturity?
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2-3 yr
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by what week does the liver start to form blood cells?
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6 weeks gestation
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by what week does the liver start to produce glycogen
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9 weeks
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by what week does the liver start to produce bile?
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12 weeks
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by what week are the pancreatic islet cells developed?
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12 weeks
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During what month does nephrogenesis begin?
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2nd
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by how many weeks are the kidney's able to produce urine?
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12 weeks
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when does development of new nephrons end?
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36 weeks
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what causes kidney growth after birth?
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growth in size of nephrons, not number
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line of pigmentation at the midline of a pregnant abdomen:
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linea nigra
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separation of rectus abdominis muscles
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diastasis recti
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why is heartburn a common pregnancy complaint?
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incompetence of pyloric sphincter
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what increases the chance of gallstones in a pregnant woman? (2)
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gallbladder stasis and secretion of lithogenic bile
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what increases the chance of pyelonephritis and urinary stasis in a preg woman? (2)
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dilated renal pelvis and ureters, elongated ureters with angulations
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renal function is most efficient if woman lies in what position?
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lateral recumbent because it helps prevent compression of vena cava and aorta
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what causes an increased risk of microhematuria in preg women?
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deepening and widening of trigone
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in which direction does the colon displace during preg?
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laterally, upward and posteriorly
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why are bowel sounds diminished in preg women? (2)
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peristaltic activity decreases and water absorption increases
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in which direction does the appendix displace during preg?
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upward and laterally (to the right)
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why is hemorrhoid formation common in preg women? (2)
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blood flow to pelvis is increased and venous pressure is increased
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why is GI motility altered in old age? (3)
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changes in neurons of CNS, changes in collagen (increased resistance to stretch) and reduced circulation
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why does secretion of enzymes and mucous decreased in old age? (2)
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epithelial atrophy and lesser differentiation of mucosal cells
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what happens to the bacteria flora in old age?
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less active
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at what age does liver size start to decrease?
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50 yo
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why does hepatic blood flow decrease in old age?
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decreased CO
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what 2 diseases put an older person at risk for nonalcoholic steatohepatitis?
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obesity and DM2
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is the size of pancreas effected by old age?
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no
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what occurs to the acinar cells in old age?
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atrophy with fibrous tissue and fatty deposits in pancreas
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why are older people at increased risk for gallstones?
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increase in biliary lipid production
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risk factors for Hep A (5)
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1 contact with infected person (sex/house)
2 unimmunized travel to high prevalence area 3 living in area of increased prevalence 4 men who have sex with men 5 IV and nonIV drug users |
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risk factors for Hep B (8)
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1 multiple sex partners/dx with STI
2 men who have sex with men 3 IV drug users 4 contact with infected person (sex/house) 5 infants of infected moms 6 infants/kids of immigrants from area with high prevalence 7 health care/public safety workers 8 hemodialysis pts |
|
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risk factors for Hep C (9)
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1 IV drug users
2 recipient of clotting factors before 1987 3 hemodialysis pt 4 recipient of blood/organ before 1992 5 undx liver prob 6 infant of infected mom 7 health care/public safety workers 8 multiple sex partners 9 sex with infected partner |
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risk factors for colorectal CA (10)
|
1 > 50 yo
2 fam hx of colon CA, familial adenomatous polyposis (FAP), familial hereditary nonpolyposis colorectal CA, Gardner syndrome 3 person hx of colorectal CA, intestinal polyps, chronic IBD, Gardner syndrome 4 personal hx of ovarian, endometrial or breast CA 5 Ashkenazi, Jewish descent 6 high beef, animal fat, low fiber diet 7 obesity 8 smoking 9 physical inactivity 10 increased amts of EtOH |
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what are the lines of demarcation for the 9 region method of describing abdomen?
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horiz lines: lowest edge of costal margin and iliac crest
vert lines: midclavicular to middle of inguinal ligament |
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above the umbilicus venous return should be toward the ____; below it should be toward the ____
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head; feet
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Dx: glistening taut appearance of abdomen
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ascites
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Dx: areas of redness of abdomen
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inflammation
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Dx: bluish periumbilical discoloartion; what is this called?
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intraabdominal bleeding; Cullen sign
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GI diseases often produce what that is impt to visual part of exam?
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secondary skin changes?
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Dx: pearl-like enlarged umbilical node
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intraabdominal lymphoma
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|
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presence of scarring should alert you to the possibility of what?
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internal adhesions
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abdominal profile from rib margin to pubis, viewed on horizontal plane
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contour
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expected contours?
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flat, rounded, scaphoid
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where should the max height of the abdomen be located?
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umbilicus
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9 Fs of distention
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fat, fluid, feces, fetus, flatus, fibroid, full bladder, false preg, fatal tumor
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Dx: generalized symmetric distention (4)
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obesity, enlarged organs, fluid, gas
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Dx: distention from umbilicus to symphysis (4)
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ovarian tumor, preg, uterine fibroids and distended bladder
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Dx: distention of upper half (3)
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carcinoma, pancreatic cyst, gastric dilation
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Dx: asymmetric distention or protrusion (5)
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hernia, tumor, cysts, bowel obstruction, enlargement of organs
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Dx: distention, hypoactive/absent bowel sounds, no particular pain, no masses, hypoactive reflexes, use of diuretics
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hypokalemia
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caused by defect in abd musculature that develops after surgical incision
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incisional hernia
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environment in which umbilical hernias usually develop (3)
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preg, long standing ascites, increased intrathoracic pressure (COPD)
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this type of hernia contains fat and is felt as a small tender nodule
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hernia of linea alba
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males exhibit primarily ___ movement with respiration; females exhibit ___
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abdominal; costal
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Dx: limited abdominal movement associated with resp in males (2)
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peritonitis or disease
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Dx: surface motion from peristalsis
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mostly obstruction
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Dx: marked pulsation (2)
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increased pulse pressure or abd aortic aneurysm
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range of normal bowel sounds
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5-35/min
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loud prolonged gurgles are also called
|
borborygmi
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Dx: increased bowel sounds (3)
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gastroenteritis, early intestinal obstruction, hunger
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Dx: high pitched tinkling sounds (2)
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intestinal fluid or air under pressure (early obstruction)
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Dx: decreased bowel sounds (2)
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peritonitis and paralytic ileus
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absence of bowel sounds is established after how many mins of listening?
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5 min
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friction rubs are heard in association with what?
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respiration
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Dx: friction rub over liver or spleen (3)
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inflam from tumor, infection, infarct
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Dx: venous hum
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increased collateral circulation between portal and systemic venous system
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predominant sound of percussion
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tympany because air is present in stomach and intestines
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distended bladder produces what sound on percussion?
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dullness in suprapubic area
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Dx: lower liver border more than 2-3 cm below coastal margin (2)
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enlarged liver or downward displacement of diaphragm
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upper border of percussed liver usually begins where?
|
5th-7th ICS
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what can cause upward displacement of liver? (2)
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ascites and fluid
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usual liver span
|
6-12 cm
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what diseases can cause an error in percussion measurement of liver? (3)
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pleural effusion, lung consolidation, gas in colon
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upon taking deep breath and holding it, the liver should descend how many cm?
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2-3
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usual liver span at midsternal line
|
4-8 cm
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where do you percuss the spleen?
|
posterior to midaxillary line on left side
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where is a normal area of spleen dullness heard?
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6th-10th ribs
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what may mimic an enlarged spleen? (2)
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full stomach or feces-filled intestine
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where do you percuss for gastric air bubble? (2)
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left lower anterior rib cage and left epigastric region
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to what depth should light palpation be?
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no more than 1 cm
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what causes rigidity?
|
peritoneal irritation
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moderate palpation is useful for what?
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assessing tenderness, assessing organ movement with respiration
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deep pressure may evoke tenderness in normal person over which 4 organs?
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cecum, sigmoid colon, aorta and midline near xiphoid
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superficial masses are located where?
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abdominal wall
|
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how do you differentiate between superficial and intraabdominal masses?
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have person lift head which contracts the abd muscles during which time on (mostly) superficial masses are palpable
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when should the scratch test be used?
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to palpate liver when abd is distended or muscles are tense
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Dx: palpable, tender gallbladder
|
cholecystitis
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Dx: palpable, nontender gallbladder
|
common bile duct obstruction
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pain above deep palpation during inhalation of gallbladder is called:
|
Murphy sign
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describe difference in percussion sounds of enlarged spleen and enlarged kidney
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spleen: dull because spleen displaces bowel
kidney: resonant because it is deeply situated behind bowel |
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which kidney is more commonly palpable?
|
right
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in which direction should the aortic pulse be?
|
anterior
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Dx: diminished abd reflex (2)
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obese, stretched muscles
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Dx: absent abd reflex (1)
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pyramidal tract lesion
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Dx: continuous, unrelieved and radiating abd pain
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pancreatitis
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vomitus smell: fetid
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GI obstruction
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vomitus smell: kerosene
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hydrocarbon ingestion
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vomitus smell: violets
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turpentine
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vomitus smell: garlic
|
arsenic
|
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peritonitis mneumonic
|
Pain (front, back, sides, shoulders)
Electrolytes fall Rigidity Immobile Tenderness (rebound) Obstruction Nausea/vomiting Increasing pulse, decreasing BP Temperature falls then rises Increasing girth Silent |
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4 common actions of pts who have abdominal pain
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will tell you about pain
shows on their face no hunger closed eyes (nonspecific) or open eyes (organic causes_ |
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further the pain is from the navel, the more likely it will be due to organic cause
|
Apley rule
|
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Dx: RUQ pain (5)
|
duodenal ulcer
hepatitis hepatomegaly pneumonia cholecystitis |
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Dx: RLQ pain (9)
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appendicitis
salpingitis ovarian cyst ruptured ectopic preg renal/ureteral stone strangulated hernia Meckel diverticulitis regional ileitis perforated cecum |
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Dx: periumbilical pain (6)
|
intestinal obstruction
acute pancreatitis early appendicitis mesenteric thrombosis aortic aneurysm diverticulitis |
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Dx: LUQ pain (5)
|
ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pneumonia
|
|
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Dx: LLQ (9)
|
sigmoid diverticulitis
salpingitis ovarian cyst ruptured ectopic preg renal/ureteral stone strangulated hernia perforated colon regional ileitis ulcerative colitis |
|
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to where might pain from cholecystitis and biliary stones be referred?
|
right subscapular area
|
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to where might pain from pancreatitis and splenic rupture be referred?
|
left shoulder
|
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on what side is pain from salpingitis usually the worst?
|
left
|
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Dx: increased pain on activity
|
PID
|
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Dx: pain radiating down left side, esp after eating, may be referred to back
|
diverticulitis
|
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Dx: pain referred to epigastrium, umbilicus
|
intestinal obstruction
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Dx: pain in flank and extending to groin/genitals
|
renal calculi
|
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Dx: pain that increases with cough or motion
|
ruptured ovarian cyst
|
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Dx: pain that may worsen with foot of bed elevated
|
splenic rupture
|
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Dx: pain related to menses, intercourse
|
uterine fibroids
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Dx: burning gnawing pain in mid-epigastrium, worsens with recumbency
|
GERD
|
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Dx: burning gnawing pain
|
peptic ulcer
|
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Dx: constant burning pain in epigastrium
|
gastritis
|
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Quality and onset of pain: burning
|
peptic ulcer
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Quality and onset of pain: cramping (2)
|
biliary colic, gastroenteritis
|
|
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Quality and onset of pain: colic (2)
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appendicitis with impacted feces, renal stone
|
|
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Quality and onset of pain: knifelike
|
pancreatitis
|
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Quality and onset of pain: ripping, tearing
|
aortic dissection
|
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Quality and onset of pain: gradual onset
|
infection
|
|
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Quality and onset of pain: sudden onset (4)
|
duodenal ulcer, acute pancreatitis, obstruction, perforation
|
|
|
findings in peritoneal irritation (9)
|
invol rigidity
tenderness/guarding absent bowel sounds + obturator, ilopsoas rebound tenderness abd pain on walking + heel jar test RLQ pain, intensified by palpation |
|
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Sx or sign: shock (2)
|
acute pancreatitis, ruptured tubal preg
|
|
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Sx or sign: mental status deficit (2)
|
hemorrhage, abd epilepsy
|
|
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Sx or sign: HTN (5)
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aortic dissection, abd aortic aneurysm, renal infarction, glomerulonephritis, vasculitis
|
|
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Sx or sign: orthostatis hypotension
|
hypovolemia
|
|
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Sx or sign: pulse deficit/asymmetric pulses
|
aortic dissection, aortic aneurysm or thrombosis
|
|
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Sx or sign: bruits (4)
|
aortic dissection, aortic aneurysm, dissection or aneurysm of other arteries
|
|
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Sx or sign: low output cardiac sx, atrial fib
|
ischemia of mesentery
|
|
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Sx or sign: valvular disease, CHF
|
embolus
|
|
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Sx or sign: pleural effusion (3)
|
esophageal rupture, pancreatitis, ovarian tumor
|
|
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Sx or sign: flank tenderness (5)
|
renal inflam, pyelonephritis, renal stone, renal infarct, renal vein thrombosis
|
|
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Sx or sign: leg edema (3)
|
iliac obstruction, pelvic mass, renal disease
|
|
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Sx or sign: lymphadenopathy (3)
|
renal vein thrombosis, hepatitis, lymphoma
|
|
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Sx or sign: jaundice (2)
|
mono, liver-biliary disease
|
|
|
Sx or sign: dark yellow or brown urine (6)
|
excessive hemolysis, liver-biliary disease, blood resulting from kidney stone, infarct, glomerulonephritis or pyelonephritis
|
|
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Sx or sign: fever and chills (3)
|
peritonitis, pelvic infection, cholangitis
|
|
|
Sx or sign: WBC ct > 10K (6)
|
pyelonephritis, appendicitis, acute cholecystisis, localized peritonitis, bowel strangulation, bowel infarction
|
|
|
rebound tenderness maneuver is used to determine what?
|
peritoneal irritation
|
|
|
if rebound tenderness maneuver produces sharp stabbing pain, what is this called?
|
+ Blumberg sign
|
|
|
when should you do the iliopsoas muscle test?
|
when you suspect appendicitis
|
|
|
when should you preform the obturator test?
|
when you suspect ruptured appendix or pelvic abscess
|
|
|
when should you use ballottement?
|
to assess a floating mass (like head of a fetus)
|
|
|
pain or distress occurs in area of pt's heart of stomach on palpation of McBurney point; name disease
|
Aaron sign; appendicitis
|
|
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fixed dullness to percussion in left flank, dullness in right flank that disappears on change of positiion; name disease
|
Ballance; peritoneal irritation
|
|
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rebound tenderness; name disease
|
Blumberg; peritoneal irritation, appendicitis
|
|
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ecchymosis around umbilicus; name disease
|
Cullen; hemoperitoneum, pancreatitis, ectopic preg
|
|
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absence of bowel sounds in RLQ; name disease
|
Dance; intussusception
|
|
|
ecchymosis of flanks; name disease
|
Grey Turner; hemoperitoneium, pancreatitis
|
|
|
abd pain radiating to left shoulder; name disease
|
Kehr; spleen rupture, renal calculi, ectopic preg
|
|
|
pt stands with straightened knees, raises up on toes, relaxes and allows heels to hit floor, jarring body, causes abd pain
|
Markle (heel jar); peritoneal irritation, appendicitis
|
|
|
abrupt cessation of inspiration on palpation of gallbladder; name disease
|
Murphy; cholecystitis
|
|
|
pain down medial aspect of thigh to knees; name disease
|
Romberg-Howship; strangulated obturator hernia
|
|
|
RLQ pain intensified by LLQ abd palpation; name disease
|
Rovsing; peritoneal irritation, appendicitis
|
|
|
what does a scaphoid abd in an infant suggest?
|
displacement of contents into thorax
|
|
|
are pulsations in epigastric region normal in infancy?
|
yes
|
|
|
spider nevi in infants may indicate what?
|
liver disease
|
|
|
what does a thick umbilical cord suggest?
|
well nourished fetus
|
|
|
describe the vessels that should be present in the umbilical cord:
|
2 arteries and 1 vein
|
|
|
single umbilical A suggests
|
congenital anomalies
|
|
|
intestinal structure in umbilical cord or protruding into umbilical area suggests
|
omphalocele
|
|
|
serous or serosanguineous discharge from umbilical cord suggests
|
granuloma
|
|
|
how do you determine the size of an umbilical hernia in infant?
|
measure the size of the opening rather than contents
|
|
|
visualization of peristaltic waves in infants suggests
|
intestinal obstruction (pyloric stenosis)
|
|
|
how soon after birth should bowel sounds be heard?
|
1-2 hr
|
|
|
Dx: high freg and soft bruit in infant
|
renal stenosis
|
|
|
Dx: continuous bruit in infant
|
arteriovenous fistula
|
|
|
will there be more or less tympany in infant than adult? why?
|
more; because they swallow air when crying/eating
|
|
|
upper edge of liver in infant
|
within 1 cm of 5th ICS at right MCL
|
|
|
before 2 yo, do males or females have a larger liver?
|
females
|
|
|
spleen should be palpable where in infant
|
1-2 cm below left costal margin
|
|
|
Dx: increased spleen size in infants
|
blood dyscrasias or septicemia
|
|
|
lower edge of liver in infants is palpable where?
|
1-3 cm below right costal margin MCL
|
|
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Dx: hepatomegaly in infants (3)
|
infection, cardiac failure or liver disease
|
|
|
infant of uncontrolled diabetic mother may present with what finding?
|
hepatomegaly
|
|
|
what should you do if you palpate a mass near the kidney?
|
stop palpating, otherwise you could cause mets
|
|
|
Dx: sausage shaped mass in LLQ in infant
|
feces in sigmoid colon assoc with constipation
|
|
|
Dx: midline suprapubic mass in infant
|
Hirschsprung disease
|
|
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Dx: sausage shaped mass in L or RUQ in infants
|
intussusception
|
|
|
Dx: almond shaped mass in RUQ immed after infant vomits
|
pyloric stenosis
|
|
|
What are the majority of palpable masses in infants?
|
renal
|
|
|
Dx: firm, dome shaped bladder in infant (2)
|
urethral obstruction, CNS defects
|
|
|
ABCDEF of intussusception in infants
|
Abdominal/anal sausage
Blood from rectum (red currant jelly) Colic Distention, dehydration, shock Emesis Face pale |
|
|
at what age do respirations stop being abdominal?
|
6-7 yo
|
|
|
at what age does the abd begin to be convex?
|
5 yo
|
|
|
abd respirations beyond 6-7 yo suggests
|
thoracic probs
|
|
|
by when does diastasis rectus usually resolve?
|
6 yo
|
|
|
assessment of abd in preg women includes: (5)
|
gestational age, fetal growth, position of fetus, fetal well being, presence of uterine contractions
|
|
|
Naegele rule for determining estimated date of delivery
|
add 7 days to first day of last normal period and count back 3 mo
|
|
|
how do you measure fundal height?
|
measure from upper part of pubis symphysis to superior fundal uterus over mid portion of fundus
|
|
|
at how many weeks is the fundal height closest to gestational age?
|
20-30 weeks
|
|
|
what is the expected pattern of fundal height growth?
|
1 cm increase per week
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|
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McDonald rule for estimating duration of preg from fundal height
|
divide height of fundus by 3.5 = duration of preg in lunar mo
|
|
|
factors that can affect fundal height measurement (6)
|
obesity, amniotic fluid amt, myomata, multiple gestation, fetal size, attitude/position of uterus
|
|
|
assessment of fetal well being includes
|
measurement of fetal HR, movements, kick counts
|
|
|
how do you determine FHR?
|
count FHR or impulse for 1 min and compare to mother's pulse during that time; also note quality and rhythm
|
|
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How do you chart a FHR on the 2 line figure?
|
mark an x or write the FHR at the point on the mom's abdomen at which max impulse was heard
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|
|
in which position should the woman be to determine fetal movements?
|
left lateral
|
|
|
standard fetal movement counts
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10 times/hr to 10 times/12 hr
|
|
|
Leopold maneuvers
|
means of assessing fetal position
|
|
|
what does palpation of cephalic prominence on the same side of the small parts (hands etc) suggest? why is this important?
|
suggests head is flexed and vertex is presenting; optimal position for delivery
|
|
|
what is the attitude of the fetal head?
|
flexed or extended
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|
|
what do record in regards to fetal position?
|
presenting part, the lie (relationship of long axis of fetus) and attitude of fetal head
|
|
|
how early do contractions often occur? what are these called?
|
third month; Braxton Hicks contractions
|
|
|
regular occurrence of how many contractions per hour before week 37 warrants eval?
|
4-6
|
|
|
mild contraction classification
|
slightly tense fundus easy to indent with fingertips
|
|
|
moderate contraction classification
|
firm fundus that is difficult to indent with fingertips
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|
|
strong contraction classification
|
rigid/hard boardlike fundus or one that doesn't indent with fingertips
|
|
|
causes of constipation mneumonic
|
Congenital - Hirschsprung
Obstruction Neoplasm Stricture of colon Topical - hemorrhoids/fissure Impacted feces Prolapse of rectum Anorexia, depression Temperature high, dehydration Endocrine - hypothyroid Diet, diverticulitis, drugs |
|
|
why is an older person's abd more round?
|
loss of muscle tone
|
|
|
what are some causes of GI obstruction? (3)
|
hypokalemia, MI, infections
|
|
|
Sx of GI obstruction (4)
|
vomiting, distention, diarrhea, constipation
|
|
|
Dx: acute onset of diarrhea in previously healthy adult without signs/sx
|
infection, commonly viral
|
|
|
what causes GERD?
|
relaxation or incompetence of lower esophagus
|
|
|
2 sx of GERD in kids
|
regurgitation and vomiting
|
|
|
Dx: burning chest pain, localized behind breastbone that moves up toward neck/throat, hoarseness
|
GERD
|
|
|
GERD can also cause what? (2)
|
resp probs from aspiration and bleeding from esophagitis
|
|
|
Dx: abd pain, bloating, constipation, diarrhea (often alternating), mucus in stool
|
IBS
|
|
|
IBS is more common in which sex and presents in what age group most often?
|
women; late adolescence/early adulthood
|
|
|
part of stomach has passed through esophageal hiatus in diaphragm
|
hiatal hernia
|
|
|
hiatal hernia is most common in which 2 groups?
|
women and older people
|
|
|
what 4 factors are associated with hiatal hernia?
|
obesity, preg, ascites, use of tight fitting clothes/belts
|
|
|
when is hiatal hernia clinically significant?
|
when it's accompanied by acid reflux, producing esophagitis
|
|
|
Dx: epigastric pain/heartburn that worsens when lying down; relieved by sitting up or using antacids; water brash; dyphasia
|
hiatal hernia
|
|
|
mouth fills with fluid from esophagus
|
water brash
|
|
|
Dx: sudden onset of vomiting, epigastric pain, complete dysphagia
|
incarcerated hiatal hernia
|
|
|
most common form of peptic ulcer
|
duodenal ulcer
|
|
|
what is a common cause of duodenal ulcer?
|
H pylori infection with subsequent increased acid production
|
|
|
who is at highest risk for duodenal ulcer?
|
men
|
|
|
Dx: epigastric pain that occurs on empty stomach but gets better upon eating or use of antacids
|
duodenal ulcer
|
|
|
Dx: hematemesis, melena, dizziness or syncope, decreased BP, increased HR, decreased hematocrit
|
duodenal ulcer that is bleeding
|
|
|
are anterior or posterior duodenal ulcers more likely to perforate? which are more likely to bleed?
|
anterior; posterior
|
|
|
chronic inflam disorder of GI tract that produces ulcerations, fibrosis and malabsorption
|
Crohn disease
|
|
|
2 most common sites for Crohn disease
|
terminal ileum and colon
|
|
|
Dx: cobblestone appearance upon colonoscopy; fissure and fistula formation
|
Crohn disease
|
|
|
Dx: cheilitis, gingival redness and swelling, mouth sores, diarrhea, arthritis, iritis
|
Crohn disease
|
|
|
chronic inflam disorder of colon and rectum that produces mucosal friability and areas of ulceration; minimal fibrosis
|
ulcerative colitis
|
|
|
Dx: bloody, frequent and watery diarrhea; weight loss, fatigue
|
ulcerative colitis
|
|
|
ulcerative colitis predisposes a person to
|
colon carcinoma
|
|
|
inflam and transmural bowel wall thickening
|
crohn disease
|
|
|
inflam confined to mucosa
|
UC
|
|
|
mucosa ulcerated and denuded with granulation tissue
|
UC
|
|
|
where are gastric carcinomas most commonly found?
|
lower half of stomach
|
|
|
from where do gastric carcinomas arise?
|
epithelial cells of mucous membrane
|
|
|
Dx: loss of appetite, feeling of fullness, weight loss, dysphagia, persistent epigastric pain
|
gastric carcinoma
|
|
|
Dx: LLQ pain, anorexia, nausea, vomiting, altered bowel habits (constipation)
|
diverticulitis
|
|
|
where does colorectal CA usualy occur? (3)
|
rectum, sigmoid or lower descending colon
|
|
|
earliest sign of colorectal CA
|
occult blood in stool
|
|
|
perianal skin tags are a sign of what?
|
crohn disease
|
|
|
third leading cause of CA death in US
|
colorectal CA
|
|
|
screening tests for those at average risk for colorectal CA
|
annual fecal occult blood test, flexible sigmoidoscopy every 5 years, both, double contrast barium enema every 5-10 years, screening colonoscopy every 10 years
|
|
|
inflam process of liver characterized by diffuse or patchy hepatocellular necrosis
|
hepatitis
|
|
|
Dx: jaundice, hepatomegaly, anorexia, abd and gastric discomfort, clay colored stools, tea colored urine
|
hepatitis
|
|
|
small focal areas of hepatic necrosis and inflam, usually caused by virus
|
reactive hepatitis
|
|
|
Hep D occurs only in people also infected with what?
|
Hep B
|
|
|
self limited type of hepatitis that may occur after natural disasters because of fecal-contaminated water or food
|
Hep E
|
|
|
destruction of liver parenchyma
|
cirrhosis
|
|
|
hepatitis type(s) transmitted by fecal-oral, food/water
|
Hep A and E
|
|
|
hepatitis type(s) transmitted by blood and body fluids (sex)
|
Hep B, C, D
|
|
|
what type of hepatitis accounts for 50% of acute sporadic hepatitis in kids and adults in high endemic areas?
|
Hep E
|
|
|
which hepatitis type(s) have vaccines?
|
Hep A and B
|
|
|
what population has greatest risk to develop gallbladder disease?
|
Native Ams
|
|
|
if cholecystitis is NOT associated with stone formation, what else can cause it?
|
any condition that affects regular emptying and filling of gallbladder
|
|
|
Dx: pain in RUQ with radiation around midtorso to right scapular region
|
cholectystitis
|
|
|
Dx: unremitting abd pain, epigastric tenderness, weight loss, steatorrhea, glucose intolerance
|
chronic pancreatitis
|
|
|
Dx: abd pain that radiates from epigastrium to upper quadrants or back, weight loss, anorexia, jaundice
|
pancreatic CA
|
|
|
Dx: pain in LUQ with radiation to left shoulder, hypovolemia and peritoneal irritation
|
splenic rupture
|
|
|
inflam of capillary loops of renal glomeruli
|
glomerulonephritis
|
|
|
Dx: nausea, malaise, arthralgia, hematuria
|
glomerulonephritis
|
|
|
dilation of renal pelvis from back pressure of urine due to ureter obstruction
|
hydronephrosis
|
|
|
Dx: flank pain, bacteriuria, pyuria, dysuria, nocturia and frequency
|
pyelonephritis
|
|
|
localized infection within cortex of kidney
|
renal abscess
|
|
|
Dx: chills, fever, flank pain, tenderness upon fist percussion
|
renal abscess
|
|
|
renal calculus formation is associated with what?
|
obstruction and infection of urinary tract
|
|
|
renal calculi are composed of (4)
|
Ca salts, uric acid, cystine, struvite
|
|
|
is alkaline or acidic environment more conducive to stone formation?
|
alkaline
|
|
|
Dx: fever, hematuria, flank pain that might extend to groin/genitals
|
renal calculi
|
|
|
is chronic renal failure reversible?
|
no
|
|
|
Urine smell: maple syrup
|
maple syrup urine disease
|
|
|
Urine smell: mousy, musty
|
phenylketonuria
|
|
|
Urine smell: dead fish
|
fish odor syndrome (trimethylaminuria)
|
|
|
Urine smell: cat's urine
|
cat syndrome
|
|
|
Urine smell: yeastlike, celery
|
oasthouse urine disease (methionine)
|
|
|
Urine smell: fishy, musty
|
tyrosinemia/tyrosinosis
|
|
|
Urine smell: rancid butter
|
rancid butter syndrome (hypermethioninemia)
|
|
|
Urine smell: ammonia
|
urea-splitting bacteria (esp Proteus)
|
|
|
Urine smell: rotting fish
|
uremia (di-, trimethylamines)
|
|
|
Urine smell: stale water
|
acute tubular necrosis
|
|
|
Urine smell: violets
|
turpentine ingestion
|
|
|
Urine smell: medicinal
|
antibiotics: penicillin, cephalosporins
|
|
|
prolapse of part of intestine into another
|
intussusception
|
|
|
in what population does intussusception usually occur?
|
3-12 mo
|
|
|
Dx: acute intermittent abd pain, distention, vomiting, passage at first normal brown stool
|
intussusception
|
|
|
what causes pyloric stenosis?
|
hypertrophy of circular muscle of pylorus, leading to obstruction during first mo
|
|
|
lower intestinal obstruction caused by thickening and hardening of meconium in lower intestine
|
meconium ileus
|
|
|
meconium ileus is often a manifestation of what disease?
|
CF
|
|
|
congenital obstruction or absence of some or all bile duct system
|
biliary atresia
|
|
|
outpouching of ileum that is most common congenital anomaly of GI tract
|
Meckel diverticulum
|
|
|
inflam disease of GI mucosa that is assoc with prematurity and immaturity of GI tract
|
necrotizing enterocolitis
|
|
|
Dx: distention, occult blood in stool, resp distress, perforation
|
necrotizing enterocolitis
|
|
|
common solid malignancy in early childhood occuring in adrenal medulla or anywhere along craniospinal axis
|
neuroblastoma
|
|
|
Dx: malaise, loss of appetite, weight loss, protrusion of 1 or both eyes
|
neuroblastoma
|
|
|
most common intraabdominal tumor of childhood; occurs at what age usually?
|
Wilms tumor (nephroblastoma); 2-3 yr
|
|
|
which tumor usually crosses the midline: nephroblastoma or neuroblastoma?
|
neuroblastoma
|
|
|
most common cause of acute renal failure in kids
|
hemolytic uremic syndrome
|
|
|
Dx: decreased or absent urine output, fever, irritability, bloody diarrhea in kid; previous episodes of diarrhea or resp infection
|
hemolytic uremic syndrome
|
|
|
#1 cause of hemolytic uremic syndrome in US is
|
E. Coli 0157:H7
|
|
|
excessive quantity of amniotic fluid in preg woman
|
hydraminos (polyhydraminos)
|
|
|
reduced amount of amniotic fluid in preg woman
|
oligohydramnios (less than 5% for gest age)
|
|
|
3 major causes of fecal incontinence in older people
|
fecal impaction, underlying disease, neurogenic disorder
|
|
|
can you have diarrhea and constipation at the same time?
|
yes
|
|
|
most common types of urinary incontinence in older people
|
stress, urge, overflow and functional
|
|
|
leakage of urine due to increased intraabd pressure
|
stress incontinence
|
|
|
common cause of stress incontinence
|
child birth
|
|
|
inability to hold urine once the urge to void occurs
|
urge incontinence
|
|
|
uninhibited bladder contractions and no urge to void
|
reflex incontinence
|
|
|
mechanical dysfunction resulting from overdistended bladder
|
overflow incontinence
|
|
|
intact urinary tract but factors like cognitive function, immobility or musculoskeletal impairment lead to incontinence
|
functional incontinence
|
|
|
reversible causes of incontinence (DRIP)
|
Delirium, dehydration
Retention, restricted mobility Impaction, infection Polyuria, pharm, psych |
