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362 Cards in this Set

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serous membrane that lines the abdominal cavity and forms a protective cover for many structures
peritoneum
double folds of peritoneum around the stomach constitute:
greater and lesser omentum
fan like fold of peritoneum that covers most of the small intestine and anchors it to post abd wall
mesentery
length of alimentary tract?
27 ft
functions of GI: (3)
ingest/digest food
absorb nutrients, electrolytes and water
excrete waste products
esophagus lies ____ to the trachea
posterior
3 sections of the stomach
fundus
body
pylorus
does a lot of absorption occur in the stomach?
no
length of sm intest
21 ft
what increases sm intest functional SA?
circular folds and villi
length of lg intest
4.5-5 ft
where does most water absorption occur?
lg intest
putrefaction is:
decomposition of undigested food redsidue, unabsorbed aas, cell debris and dead bacteria by live bacteria in the lg intest
normal weight of adult liver
3 lb
how many lobes in the liver?
4
what is the functional unit of liver?
lobule
what is at the center of each lobule?
central vein
____ carries oxy blood to liver while ___ carries deoxy blood
hepatic A; portal vein
what hormone signals release of bile from gallbladder? where is it produced?
cholecystokinin; duodenum
describe pancreas in relation to stomach
pancreas lies behind and beneath the stomach
another name for pancreatic duct
duct of Wirsung
what constitutes the majority of the spleen?
white pulp (lymphoid tissue)
vertebral span of the kidneys:
T12-L3, right kidney slightly lower than left
what is the functional unit of the kidney?
nephron
to where does the distal tube of kidney empty?
collecting tubule
kidney receives what fraction of the cardiac output? through what artery?
1/8th; renal artery
glomerulus filter rate for men and women:
men: 125 mL/min; women: 110 mL/min
most filtered material (glucose, electrolytes, etc) is resorbed where?
proximal tubule
what can be actively secreted in distal tubule?
organic acids
what carefully controls urinary volume?
ADH
what is the endocrine function of the kidney?
production of renin, epo, Vit D and prostaglandins
what is renin important for?
control of aldosterone production
what is another name for the inguinal ligament?
Poupart ligament
what landmark denotes the branching of the aorta into the common iliac arteries?
umbilicus
during what week to the pancreatic buds, liver and gallbladder start to form?
4 weeks gestation
during what week can the fetus swallow amniotic fluid?
17 weeks gestation
by what weeks is the GI system capable to support extrauterine life?
36-38 weeks
at what age do the GI's elasticity, musculature and control reach maturity?
2-3 yr
by what week does the liver start to form blood cells?
6 weeks gestation
by what week does the liver start to produce glycogen
9 weeks
by what week does the liver start to produce bile?
12 weeks
by what week are the pancreatic islet cells developed?
12 weeks
During what month does nephrogenesis begin?
2nd
by how many weeks are the kidney's able to produce urine?
12 weeks
when does development of new nephrons end?
36 weeks
what causes kidney growth after birth?
growth in size of nephrons, not number
line of pigmentation at the midline of a pregnant abdomen:
linea nigra
separation of rectus abdominis muscles
diastasis recti
why is heartburn a common pregnancy complaint?
incompetence of pyloric sphincter
what increases the chance of gallstones in a pregnant woman? (2)
gallbladder stasis and secretion of lithogenic bile
what increases the chance of pyelonephritis and urinary stasis in a preg woman? (2)
dilated renal pelvis and ureters, elongated ureters with angulations
renal function is most efficient if woman lies in what position?
lateral recumbent because it helps prevent compression of vena cava and aorta
what causes an increased risk of microhematuria in preg women?
deepening and widening of trigone
in which direction does the colon displace during preg?
laterally, upward and posteriorly
why are bowel sounds diminished in preg women? (2)
peristaltic activity decreases and water absorption increases
in which direction does the appendix displace during preg?
upward and laterally (to the right)
why is hemorrhoid formation common in preg women? (2)
blood flow to pelvis is increased and venous pressure is increased
why is GI motility altered in old age? (3)
changes in neurons of CNS, changes in collagen (increased resistance to stretch) and reduced circulation
why does secretion of enzymes and mucous decreased in old age? (2)
epithelial atrophy and lesser differentiation of mucosal cells
what happens to the bacteria flora in old age?
less active
at what age does liver size start to decrease?
50 yo
why does hepatic blood flow decrease in old age?
decreased CO
what 2 diseases put an older person at risk for nonalcoholic steatohepatitis?
obesity and DM2
is the size of pancreas effected by old age?
no
what occurs to the acinar cells in old age?
atrophy with fibrous tissue and fatty deposits in pancreas
why are older people at increased risk for gallstones?
increase in biliary lipid production
risk factors for Hep A (5)
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
risk factors for Hep B (8)
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
risk factors for Hep C (9)
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
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
what are the lines of demarcation for the 9 region method of describing abdomen?
horiz lines: lowest edge of costal margin and iliac crest
vert lines: midclavicular to middle of inguinal ligament
above the umbilicus venous return should be toward the ____; below it should be toward the ____
head; feet
Dx: glistening taut appearance of abdomen
ascites
Dx: areas of redness of abdomen
inflammation
Dx: bluish periumbilical discoloartion; what is this called?
intraabdominal bleeding; Cullen sign
GI diseases often produce what that is impt to visual part of exam?
secondary skin changes?
Dx: pearl-like enlarged umbilical node
intraabdominal lymphoma
presence of scarring should alert you to the possibility of what?
internal adhesions
abdominal profile from rib margin to pubis, viewed on horizontal plane
contour
expected contours?
flat, rounded, scaphoid
where should the max height of the abdomen be located?
umbilicus
9 Fs of distention
fat, fluid, feces, fetus, flatus, fibroid, full bladder, false preg, fatal tumor
Dx: generalized symmetric distention (4)
obesity, enlarged organs, fluid, gas
Dx: distention from umbilicus to symphysis (4)
ovarian tumor, preg, uterine fibroids and distended bladder
Dx: distention of upper half (3)
carcinoma, pancreatic cyst, gastric dilation
Dx: asymmetric distention or protrusion (5)
hernia, tumor, cysts, bowel obstruction, enlargement of organs
Dx: distention, hypoactive/absent bowel sounds, no particular pain, no masses, hypoactive reflexes, use of diuretics
hypokalemia
caused by defect in abd musculature that develops after surgical incision
incisional hernia
environment in which umbilical hernias usually develop (3)
preg, long standing ascites, increased intrathoracic pressure (COPD)
this type of hernia contains fat and is felt as a small tender nodule
hernia of linea alba
males exhibit primarily ___ movement with respiration; females exhibit ___
abdominal; costal
Dx: limited abdominal movement associated with resp in males (2)
peritonitis or disease
Dx: surface motion from peristalsis
mostly obstruction
Dx: marked pulsation (2)
increased pulse pressure or abd aortic aneurysm
range of normal bowel sounds
5-35/min
loud prolonged gurgles are also called
borborygmi
Dx: increased bowel sounds (3)
gastroenteritis, early intestinal obstruction, hunger
Dx: high pitched tinkling sounds (2)
intestinal fluid or air under pressure (early obstruction)
Dx: decreased bowel sounds (2)
peritonitis and paralytic ileus
absence of bowel sounds is established after how many mins of listening?
5 min
friction rubs are heard in association with what?
respiration
Dx: friction rub over liver or spleen (3)
inflam from tumor, infection, infarct
Dx: venous hum
increased collateral circulation between portal and systemic venous system
predominant sound of percussion
tympany because air is present in stomach and intestines
distended bladder produces what sound on percussion?
dullness in suprapubic area
Dx: lower liver border more than 2-3 cm below coastal margin (2)
enlarged liver or downward displacement of diaphragm
upper border of percussed liver usually begins where?
5th-7th ICS
what can cause upward displacement of liver? (2)
ascites and fluid
usual liver span
6-12 cm
what diseases can cause an error in percussion measurement of liver? (3)
pleural effusion, lung consolidation, gas in colon
upon taking deep breath and holding it, the liver should descend how many cm?
2-3
usual liver span at midsternal line
4-8 cm
where do you percuss the spleen?
posterior to midaxillary line on left side
where is a normal area of spleen dullness heard?
6th-10th ribs
what may mimic an enlarged spleen? (2)
full stomach or feces-filled intestine
where do you percuss for gastric air bubble? (2)
left lower anterior rib cage and left epigastric region
to what depth should light palpation be?
no more than 1 cm
what causes rigidity?
peritoneal irritation
moderate palpation is useful for what?
assessing tenderness, assessing organ movement with respiration
deep pressure may evoke tenderness in normal person over which 4 organs?
cecum, sigmoid colon, aorta and midline near xiphoid
superficial masses are located where?
abdominal wall
how do you differentiate between superficial and intraabdominal masses?
have person lift head which contracts the abd muscles during which time on (mostly) superficial masses are palpable
when should the scratch test be used?
to palpate liver when abd is distended or muscles are tense
Dx: palpable, tender gallbladder
cholecystitis
Dx: palpable, nontender gallbladder
common bile duct obstruction
pain above deep palpation during inhalation of gallbladder is called:
Murphy sign
describe difference in percussion sounds of enlarged spleen and enlarged kidney
spleen: dull because spleen displaces bowel
kidney: resonant because it is deeply situated behind bowel
which kidney is more commonly palpable?
right
in which direction should the aortic pulse be?
anterior
Dx: diminished abd reflex (2)
obese, stretched muscles
Dx: absent abd reflex (1)
pyramidal tract lesion
Dx: continuous, unrelieved and radiating abd pain
pancreatitis
vomitus smell: fetid
GI obstruction
vomitus smell: kerosene
hydrocarbon ingestion
vomitus smell: violets
turpentine
vomitus smell: garlic
arsenic
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
4 common actions of pts who have abdominal pain
will tell you about pain
shows on their face
no hunger
closed eyes (nonspecific) or open eyes (organic causes_
further the pain is from the navel, the more likely it will be due to organic cause
Apley rule
Dx: RUQ pain (5)
duodenal ulcer
hepatitis
hepatomegaly
pneumonia
cholecystitis
Dx: RLQ pain (9)
appendicitis
salpingitis
ovarian cyst
ruptured ectopic preg
renal/ureteral stone
strangulated hernia
Meckel diverticulitis
regional ileitis
perforated cecum
Dx: periumbilical pain (6)
intestinal obstruction
acute pancreatitis
early appendicitis
mesenteric thrombosis
aortic aneurysm
diverticulitis
Dx: LUQ pain (5)
ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pneumonia
Dx: LLQ (9)
sigmoid diverticulitis
salpingitis
ovarian cyst
ruptured ectopic preg
renal/ureteral stone
strangulated hernia
perforated colon
regional ileitis
ulcerative colitis
to where might pain from cholecystitis and biliary stones be referred?
right subscapular area
to where might pain from pancreatitis and splenic rupture be referred?
left shoulder
on what side is pain from salpingitis usually the worst?
left
Dx: increased pain on activity
PID
Dx: pain radiating down left side, esp after eating, may be referred to back
diverticulitis
Dx: pain referred to epigastrium, umbilicus
intestinal obstruction
Dx: pain in flank and extending to groin/genitals
renal calculi
Dx: pain that increases with cough or motion
ruptured ovarian cyst
Dx: pain that may worsen with foot of bed elevated
splenic rupture
Dx: pain related to menses, intercourse
uterine fibroids
Dx: burning gnawing pain in mid-epigastrium, worsens with recumbency
GERD
Dx: burning gnawing pain
peptic ulcer
Dx: constant burning pain in epigastrium
gastritis
Quality and onset of pain: burning
peptic ulcer
Quality and onset of pain: cramping (2)
biliary colic, gastroenteritis
Quality and onset of pain: colic (2)
appendicitis with impacted feces, renal stone
Quality and onset of pain: knifelike
pancreatitis
Quality and onset of pain: ripping, tearing
aortic dissection
Quality and onset of pain: gradual onset
infection
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
Sx or sign: shock (2)
acute pancreatitis, ruptured tubal preg
Sx or sign: mental status deficit (2)
hemorrhage, abd epilepsy
Sx or sign: HTN (5)
aortic dissection, abd aortic aneurysm, renal infarction, glomerulonephritis, vasculitis
Sx or sign: orthostatis hypotension
hypovolemia
Sx or sign: pulse deficit/asymmetric pulses
aortic dissection, aortic aneurysm or thrombosis
Sx or sign: bruits (4)
aortic dissection, aortic aneurysm, dissection or aneurysm of other arteries
Sx or sign: low output cardiac sx, atrial fib
ischemia of mesentery
Sx or sign: valvular disease, CHF
embolus
Sx or sign: pleural effusion (3)
esophageal rupture, pancreatitis, ovarian tumor
Sx or sign: flank tenderness (5)
renal inflam, pyelonephritis, renal stone, renal infarct, renal vein thrombosis
Sx or sign: leg edema (3)
iliac obstruction, pelvic mass, renal disease
Sx or sign: lymphadenopathy (3)
renal vein thrombosis, hepatitis, lymphoma
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
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
fixed dullness to percussion in left flank, dullness in right flank that disappears on change of positiion; name disease
Ballance; peritoneal irritation
rebound tenderness; name disease
Blumberg; peritoneal irritation, appendicitis
ecchymosis around umbilicus; name disease
Cullen; hemoperitoneum, pancreatitis, ectopic preg
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
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
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
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
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
in which position should the woman be to determine fetal movements?
left lateral
standard fetal movement counts
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
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
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