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238 Cards in this Set
- Front
- Back
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Stable Angina Def/Pres
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(coronary atherosclerosis ischemia b/c HIGH DEMAND)
CP <10-15 min -w/ exertion/emotion -relieved by NTG |
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Unstable Angina Def/Pres
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(large stenosis poor coronary flow NL DEMAND)
CP increasing in frequency/duration/intensity Angina at rest Severe new-onset angina that is worsening |
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Variant/Prinzmetals Angina Def/Pres
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(transient coronary vasospasm 2/2 fixed lesion)
Episodic Angina at rest w/ ventricular dysrhythmia EKG – ST elevation |
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MI Def/Pres
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(myocardium necrosis 2/2 coronary occlusion)
CP (crushing) – R neck/arms/back +/- dyspnea, diaphoresis, weakness, N/V, syncope ASx – DM, post-op, elderly |
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CHF Def/Pres
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(inability to meet nl perfusion needs)
Pulm backup – dyspnea, orthopnea, PND, nocturnal cough Confusion/memory impairment Diaphoresis at rest (severe) Cool extremities at rest (severe) Displaced PMI S3 S4 Crackles/rales at lung base Peripheral Edema Nocturia JVD Hepatomegaly Ascites |
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PACs Def/Pres
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(early beat w/in atria)
EKG – early P wave w/ abnl morphology, nl QRS ASx +/- palpitations +/- PSVTs |
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PVCs Def/Pres
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(early beat w/in ventricle)
EKG – wide QRS ASx +/- Sx/palpitations Risk of VFib if also CAD |
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AFib Def/Pres
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(multiple atrial foci firing chaotically)
EKG – irregularly irregular, rapid, wavy baseline, no P-wave Fatigue Exertional dyspnea +/- palpitations +/- angina +/- syncope Irregularly irregular pulse Development of thrombi (blood stasis) |
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AFlutter Def/Pres
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(irritable/rapid atrial foci atrial contractions)
EKG – sawtooth baseline (II, III, aVF) Often seen w/ COPD ASx/Sx similar to AFib? |
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MAT Def/Pres
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(? Many rapid irritable atrial foci causing contractions ?)
EKG – 3+ P-wave morphologies Often seen w/ COPD |
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Paroxysmal SVT Def/Pres
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(AV reentrant tachycardia)
EKG – narrow QRS ? |
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WPW Def/Pres
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(accessory AV conduction premature ventricular excitation)
EKG – narrow tachy, short PR, delta wave Can lead to AFib/flutter |
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Ventricular Tachycardia Def/Pres
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(? Rapid ventricular firing ? pathway through bundle of His ?)
EKG – 3+ PVCs in a row w/ HR 100-250 w/ sinus P waves. Wide/bizarre QRS Sx if sustained (>30s), ASx if unsustained Unsustained can lead to SCD w/ CAD/LVF Syncope/near syncope (palpitations, dyspnea, lightheadedness, angina) S/Sx cardiogenic shock Cannon a waves in the neck |
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VFib Def/Pres
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(multiple ventricular foci quiver and no CO)
Begin w/ VT or ischemia… No BP, pulse, heart sounds Unconscious Will lead to SCD |
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Sinus Bradycardia Def/Pres
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Rate < 60
ASx Fatigue Inability to exercise Angina Syncope |
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Sick Sinus syndrome Def/Pres
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(SA node dysfxn)
Spontaneous sinus bradycardia Dizziness Confusion Syncope Fatigue CHF |
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1st Degree AV block Def/Pres
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(block in AV node)
EKG – prolonged PR, QRS follows each P wave |
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2nd Degree AV block – type 1 Def/Pres
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(block in AV node)
EKG – progressive PR prolongation until no P wave |
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2nd Degree AV block – type 2 Def/Pres
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(block in His-Purkinje)
EKG – sudden absent P wave, sudden QRS drop |
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3rd Degree AV block Def/Pres
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(no AV conduction)
EKG – AV dissociation |
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Dilated Cardiomyopathy Def/Pres
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(LV contractility/systolic dysfxn)
CHF (left and right) S/Sx S3, S4 TR, MR murmurs |
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Hypertrophic Cardiomyopathy Def/Pres
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(stiff ventricle + high diastolic pressure diastolic dysfxn)
DOE Angina Syncope w/ exertion/valsalva Palpitations Arrhythmia CHF SCD Sustained PMI Loud S4 Systolic ejection murmur at LLSB, decreases w/ squatting, decreases w/ handgrip Bisferious pulse |
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Restrictive Cardiomyopathy Def/Pres
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(myocardial infiltrate decreased compliance ( high pressures?) diastolic failure)
Dyspnea Exercise intolerance Right-sided CHF |
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Myocarditis Def/Pres
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(inflammation of myocardium)
ASx Fatigue Fever CP Pericarditis CHF Death |
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Acute Pericarditis Def/Pres
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(? Inflammation of pericardium ?)
CP – pleuritic, positional (better sitting up/forward) +/- fever, cough Pericardial friction rub |
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Constrictive Pericarditis Def/Pres
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(fibrous scarring of pericardium, restricts diastolic filling)
Appear ill Early on – RHF Sx (ascites, edema) Later – LHF Sx (cough, orthopnea) JVD (prominent x and y) Kussmauls sign (JVD same w/ inspiration) Pericardial knock |
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Pericardial Effusion Def/Pres
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(fluid in pericardial sac)
Muffled heart sounds Soft PMI Dullness at left lung base +/- pericardial friction rub |
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Cardiac Tamponade Def/Pres
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(rate/amt fluid in pericardial sac impaired diastolic filling)
JVD/↑JVP Narrow pulse pressure Pulsus paradoxus (drop in BP >10mm w/ inspiration) Muffled heart sounds Cardiogenic shock Sx – tachypnea, tachycardia, HoTN |
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Mitral Stenosis Def/Pres
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(narrowing of mitral valve often 2/2 RHD)
Diastolic rumble (preceeded by opening snap and ends w/ loud S1) Pulm congestion Sx – exertional dyspnea, orthopnea, PND Palpitations CP Hemoptysis Thromboembolism +/- RHF and Sx |
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Aortic Stenosis Def/Pres
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(LV outlet obstruction LVH, ↓CO)
Harsh crescendo-decrescendo systolic murmur Often ASx Angina Syncope LHF Sx Parvus et tardus (delayed carotid upstroke) |
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Aortic Regurgitation Def/Pres
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(backflow LVH, ↑EDV/dilation)
Diastolic decrescendo murmur LHF Sx Palpitations Angina +/- cyanosis/shock Widened pulse pressure |
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Mitral Regurgitation Def/Pres
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(backflow LAE, pulm backflow, ↓CO)
Holosystolic murmur LHF Sx Palpitations Pulm edema Can AFib |
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Tricuspid Regurgitation Def/Pres
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(backflow often caused by RV dilation)
Blowing holosystolic murmur RHF Sx Pulsatile liver Usually AFib |
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Mitral Valve Prolapse Def/Pres
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(excessive MV tissue prolapses into LA during systole)
Mid/late systolic click Mid/late systolic murmur – decreased w/ squatting, increased w/ handgrip Rare Sx MR Palpitations TIAs/emboli |
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Rheumatic Heart Dz Def/Pres
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(Autoimmune attack 2/2 Strep A pharyngitis)
MAJOR (need 2 or 1+2 minor) Migratory polyarthritis Erythema marginatum Cardiac Dz Chorea Subcutaneous nodules MINOR Fever ↑ESR Polyarthralgias PMHx Prolonged PR Evidence of Strep A |
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Infective Endocarditis Def/Pres
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(infxn of valve cusps)
MAJOR (2, 1+3, 5) Sustained bacteremia Endocardial involvement (Echo, new murmur) MINOR Predisposing condition Fever Vascular phenomena – including janeway lesion Immune phenomena – including osler nodes, roth spots Positive blood Cx (not nl bug) Positive Echo (not endo issue?) |
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ASD Def/Pres
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(LA RA flow RA/RV dilation, ↑pulm flow/BP)
Wide, fixed S2 ASx until 40 Pulm Sx – exercise intolerance, DOE, fatigue |
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VSD Def/Pres
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(LV->RV flow ↑Pulm flow/BP)
Harsh holosystolic murmur w/ thrill, louder if smaller defect No Sx if small CHF Growth failure Recurrent LRI Reversal/Eisenmonger = SOB, DOE, CP, cyanosis |
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Coarctation of Aorta Def/Pres
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(narrowing of aorta usually near L. subclavian ↑afterload)
HTN in upper extremities w/ HoTN in lower extremeties Well developed upper body w/ underdeveloped lower half Midsystolic murmur over back HA Cold extremities Claudication w/ exercise Leg fatigue |
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Patent Ductus Arteriosus Def/Pres
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(Aorta/PA communication = L->R shunt vol overload)
Continuous machinery murmur (LUSB) May be ASx Late cyanosis LVH, RVF, pulm HTN Wide pulse pressure Lower extremity clubbing |
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Hypertensive Emergency Def/Pres
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(BP >220/>120 & end organ damage)
Severe HA Visual disturbances AMS/confusion |
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Hypertensive Urgency Def/Pres
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(BP >220/>120 & no end organ damage)
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Aortic Dissection Def/Pres
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(intimal tear of aorta)
Severe tearing pain of chest/back Diaphoresis HTN or HoTN Pulse/BP asymmetry Aortic regurgitation Hemiplegia/hemianesthesia |
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Abdominal Aortic Aneurysm Def/Pres
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(localized dilation of aorta)
Often ASx Sense of fullness Pulsatile abd mass Impending Rupture Sx -sudden onset severe abd pain that radiates down -grey turner, Cullen signs (ecchymosis of back, flanks, umbilicus) |
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Ruptured AAA Def/Pres
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Abdominal pain
HoTN Palpable pulsatile abd mass |
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Peripheral Vascular Dz Def/Pres
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(occlusive atherosclerotic dz of lower extremities)
Intermittent claudication – cramping leg pain relieved by rest Rest pain Diminished pulses Muscular atrophy Decreased hair Thick toenails Cool skin Ischemic ulceration Pallor/rubor |
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Acute Arterial Occlusion Def/Pres
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(acute occlusion of A. often Femoral and by embolization)
~6Ps Pain (acute) Pallor Polar (cold) Paralysis Parasthesias Pulselessness |
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Cholesterol Embolization syndrome Def/Pres
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(showers of cholesterol crystals from atherosclerotic plaque triggered by XRT/surgery/tPA)
Small areas of ischemia Blue/black toes Renal insufficiency Abd pain/bleeding |
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Mycotic Aneurysm Def/Pres
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(aortic aneurysm 2/2 infxn)
S/Sx infxn? S/Sx AAA? |
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Luetic Heart Def/Pres
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(aortic arch aneurysm 2/2 Syphilis)
HO syphilis AR Sx? |
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DVT Def/Pres
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(thrombus of deep veins 2/2 virchow triad)
Lower extremity pain/swelling Homan sign Palpable cord Fever |
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Chronic Venous Insufficiency Def/Pres
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(destruction of venous valve often 2/2 DVT venous HTN)
Leg swelling – worse w/ sitting, relieved w/ leg elevation Skin changes – thin, atrophic, shiny, cyanotic Venous ulcers (less painful than arterial insufficiency) |
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Superficial thrombophlebitis Def/Pres
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(inflammation of superficial vein?)
Site of IV infusion (if UE) Site of varicose vein (if LE) Pain, tenderness Erythema along course of vein +/- tender, palpable cord |
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Shock (gen) Def/Pres
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(underperfusion of tissues)
Lactic acidosis Anuria/oliguria AMS Pale cool skin Tachycardia HoTN |
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Cardiogenic shock Def/Pres
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(underperfusion 2/2 heart dz ↓CO)
Shock Sx Engorged neck veins Pulmonary congestion |
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Hypovolemic shock Def/Pres
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(underperfusion 2/2 volume loss)
Shock Sx |
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Septic Shock Def/Pres
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(HoTN 2/2 sepsis, persists despite fluid resuscitation)
Shock Sx Sepsis Sx – pneumonia, UTI, peritonitis SIRS Sx |
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SIRS Def/Pres
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(systemic inflammatory response syndrome)
Fever RR > 20 HR > 90 ↑WBC |
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Neurogenic shock Def/Pres
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(underperfusion 2/2 vasodilation/↓SVR 2/2 SNS failure)
Warm skin ↓/nl UOP Bradycardia HoTN Nl CO ↓SVR/PCWP |
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Atrial Myxoma Def/Pres
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(benign growth near IA septum)
Fatigue Fever Syncope Palpitations Malaise Diastolic plop |
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COPD Def/Pres
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(chronic bronchitis: excess mucous + inflammation/scarring of airways obstruction)
(emphysema: destruction of alveolar walls (2/2 elastase > antiprotease) obstruction) Cough Sputum production Dyspnea Prolonged forced expiratory time |
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Chronic Bronchitis Def/Pres
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(excess mucous + inflammation/scarring of airways obstruction)
Overweight Cyanotic Chronic cough Sputum Nl RR No apparent distress/use of accessory muscles |
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Emphysema Def/Pres
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(destruction of alveolar walls (2/2 elastase > antiprotease) obstruction)
Thin Lean forward when sitting Barrel chest Tachypnea Distress/use of accessory muscles |
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Asthma Def/Pres
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(airway inflammation, hyperresponsivenesss and reversible obstruction often 2/2 atopy rxn)
Intermittent Sx (often trigger) SOB Wheezing Chest tightness Cough Sx worse at night |
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Bronchiectasis Def/Pres
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(infxn abnl dilation/destruction bronchial walls cilia damage excess sputum?)
Chronic cough w/ large amt mucopurulent foul-smelling sputum Dyspnea Hemoptysis Recurrent/persistent pneumonia |
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Cystic Fibrosis Def/Pres
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(AR Dz of defect chloride transport thick secretions in multiple systems)
Obstructive lung disease Chronic pulm infections (pseudomonas) Pancreatic insufficiency GI complications |
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Lung Cancer Def/Pres
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Local/airway Sx – cough…
Constitutional Sx – weight loss… Local invasion – SVC/nerves/horners… Mets Paraneoplastic Sx – SIADH… -- Cough Hemoptysis Obstruction Wheezing Dyspnea Recurrent pneumonia Constitutional Sx SVC syndrome Phrenic N. palsy Recurrent laryngeal N. palsy Horner syndrome/pancoast tumor SIADH Ectopic ACTH PTH-like secretion Hypertrophic pulmonary osteoarthropathy Eaton-Lambert Digital clubbing |
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SVC syndrome Def/Pres
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Facial fullness
Facial/arm edema Dilated veins in upper torso, JVD |
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Mediastinal Masses Def/Pres
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(mets or primary cancer split up by anterior/middle/posterior…Sx from compression)
Often ASx Cough (trachea/bronchi) Hemoptysis CP Dyspnea Post-obstructive pneumonia Dysphagia (esophagus) SVC syndrome (SVC) Hoarseness (recurrent laryngeal N.) Horners (SNS ganglia) Diaphragm paralysis (phrenic N.) |
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Pleural Effusion Def/Pres
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(fluid in pleural space 2/2 transudate or exudate)
Often ASx DOE, orthopnea, PND Peripheral edema Dullness to percussion Decreased BS Decreased tactile fremitus |
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Empyema Def/Pres
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(pus in pleural space often 2/2 untreated pleural effusion exudate)
Sx depend on cause Often Sx of pneumonia |
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Pneumothorax Def/Pres
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(air in pleural space. Spontaneous or traumatic)
Often s/p thoracentesis or central line or transthoracic needle aspiration sudden onset unilateral CP dyspnea cough decreased unilateral BS hyperressonance decreased/absent tactile fremitus mediastinal shift TOWARD affected side |
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Tension Pneumothorax Def/Pres
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(air in pleural space where tissues dont allow escape lung collapse, vein compression)
Often s/p mechanical ventilation or CPR or trauma HoTN Distended neck veins Tracheal shift AWAY from affected side Decreased BS Hyperressonance |
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Malignant Mesothelioma Def/Pres
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(cancer of mesothelium = lung lining?)
Often s/p asbestos exposure Dyspnea Weight loss Cough Bloody effusion |
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Interstitial Lung Disease Def/Pres
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(alveolar inflammation scarring impaired gas exchange)
Dyspnea Nonproductive cough Fatigue Rales at lung base Digital clubbing S/Sx pulmonary HTN/cyanosis – advanced |
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Sarcoidosis Def/Pres
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(granulomatous ILD: noncaseating granulomatous dz of multiple organs)
Often AAF < 40yo Constitutional Sx – weight loss, fever… Lung – dry cough, dyspnea/DOE Skin – erythema nodosum, nodules/eruptions Eyes – Anterior Uveitis Heart MSK – arthralgias CNS – bells palsy |
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Histiocytosis X Def/Pres
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(granulomatous ILD: chronic interstitial pneumonia 2/2 abnl proliferation of histiocytes)
Dsypnea Nonproductive cough Often HO smoking |
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Wegeners Granulomatosis Def/Pres
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(granulomatous ILD: necrotizing granulomatous vasculitis multiple organs)
URI LRI Glomerulonephritis Pulmonary nodules |
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Churg-Strauss Def/Pres
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(granulomatous ILD: granulomatous vasculitis w/ asthma)
HO asthma? Pulmonary infiltrates Rash Eosinophilia Skin/muscle/nerve lesions |
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Coal Worker pneumoconiosis Def/Pres
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(ILD: accumulation of dust in lung. Can fibrosis)
Often ASx |
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Asbestosis Def/Pres
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(ILD: asbestos fibers diffuse interstitial fibrosis)
15-20 yrs after asbestos exposure Non-specific/ILD Sx |
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Silicosis Def/Pres
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(ILD: localized/nodular peribronchial fibrosis)
Acute or 15 yrs after exposure Exposure = mining, stone cutting, glass manufacturing Exertional dyspnea Cough w/ sputum |
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Berylliosis Def/Pres
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(ILD: cross between silica and sarcoid)
Chronic form = Granuloma Skiin lesion Hypercalcemia |
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Hypersensitivity pneumonitis Def/Pres
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(ILD: Ag alveoli immune pneumonitis)
Acute form = Fever Chills Cough Dyspnea |
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Eosinophilic pneumonia Def/Pres
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(ILD: ?)
Fever Peripheral eosinophila |
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Goodpasture syndrome Def/Pres
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(ILD: anti-GBM and alveolar BM IgG (type II hypersensitivity)
Hemoptysis Dyspnea - Hemorrhagic pneumonitis Glomerulonephritis renal failure |
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Pulmonary alveolar proteinosis Def/Pres
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(ILD: alveolar accumulation of surfactant-like protein, phospholipids)
Dry cough Dyspnea Hypoxia Rales |
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Idiopathic pulmonary fibrosis Def/Pres
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(ILD: ?)
Gradual onset Progressive dyspnea Nonproductive cough |
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Cryptogenic organizing pneumonitis Def/Pres
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(ILD: inflammatory lung dz similar to pneumonia)
Cough Dyspnea Flu-like Sx |
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Radiation pneumonitis Def/Pres
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(ILD: interstitial pulmonary inflammation)
s/p XRT for lung/breast/lymphoma/thymoma (5-15%) low fever cough chest fullness dyspnea pleuritic chest pain hemoptysis acute respiratory distress |
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Acute Respiratory Failure Def/Pres
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(inadequate oxygenation of blood and/or inadequate elimination of CO2/ventilation)
Dyspnea Cough Inability to speak Tachypnea Tachycardia Cyanosis Impaired mentation |
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ARDS Def/Pres
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(inflammatory process of both lungs 2/2 another dz often infxn w/ increased capillary permeability shunting (no exchange))
Increased work of breathing – dyspnea, tachypnea, tachycardia Hypoxemia not responsive to O2 (PaO2:FiO2 < 200) Difficult to ventilate |
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Pulmonary HTN Def/Pres
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(PulmA BP > 25mmHg 2/2 ↑flow or ↑resistance 2/2 blockage, constriction)
DOE Fatigue Exertional CP Exertional syncope – advanced Loud S2 (P component) Eventual RHF Sx |
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Primary Pulmonary HTN Def/Pres
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(Pulm HTN in absence of heart or lung dz. ↑resistance thickened walls)
Often young/middle-aged female DOE Fatigue Exertional CP Exertional syncope – more common Loud S2 (P component) Subtle lift of sternum Eventual RHF Sx? |
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Cor Pulmonale Def/Pres
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(RVH/F 2/2 pulmonary HTN (↑afterload))
Pt often has COPD ↓exercise tolerance Cyanosis Digital clubbing RHF Sx Parasternal lift Polycythemia if COPD |
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Pulmonary Embolism Def/Pres
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(thrombus embolizes RV PulmA pulmonary vascular tree/veins.
↑pulm resistance/RV afterload, blood flow decrease/dead space) Dyspnea Pleuritic CP Cough Hemoptysis +/- DVT Sx Tachypnea Rales Tachycardia S4 Increased P2 Shock – if massive Low temp ↓ BS Dullness to percussion |
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Pulmonary Aspiration Def/Pres
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(depends on aspirate)
HO predisposing factor - ↓consciousness, EtOH, extubation, vomiting, tube feeding Can acute respiratory distress Eventual respiratory dysfunction Cough SOB Fever Tachypnea Hypoxemia Frothy sputum |
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Colon Cancer Def/Pres
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(self-explanatory)
(Sx 2/2 mass effect, cancer metabolism) General Sx – bowel obstruction, weight loss, blood in stool R. Sx (larger diameter, farther from anus) – melena, anemia/weakness, RLQ mass L. Sx (smaller diamger, close to anus) – hematochezia, obstruction, smaller caliber stools |
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Rectal cancer Def/Pres
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Hematochezia
Tenesmus Rectal mass |
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Diverticulosis Def/Pres
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(pouches in colon wall 2/2 increased pressure 2/2 low fiber)
(often in the sigmoid colon = LLQ, near anus) ASx Vague LLQ discomfort Painless Rectal bleeding |
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Diverticulitis Def/Pres
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(infxn of diverticula 2/2 fecal impaction)
( erosion, microperforation) (can abscess, fistula, obstruction, perforation) LLQ pain Leukocytosis +/- change in bowel habits |
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Angiodysplasia (Colon) Def/Pres
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(cause???)
(dilated veins of R. colon submucosa) GI bleeding >60yo |
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Acute Mesenteric Ischemia Def/Pres
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(compromised blood supply to SMA 2/2 embolus/thrombus/vasoconstriction/venous thrombus)
!Severe abd pain (disproportionate) Anorexia Vomiting GI bleeding ?HoTN, tachypnea, lactic acidosis |
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Chronic Mesenteric Ischemia Def/Pres
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(atherosclerotic occlusive Dz of celiac/SMA/IMA bowel ischemia)
Dull post-prandial pain (abd angina, demand greatest after meal) Weight loss (b/c pain w/ eating) |
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Ogilvie Syndrome Def/Pres
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(Pseudo LBO (no mech obstruction) 2/2 surgery, medical illness, medications)
S/S LBO (???) |
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Pseudomembranous Colitis Def/Pres
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(C diff overgrowth and toxin production (???) 2/2 ABx)
(most common ABx = clind, amp, cephs…Sx w/in 1st wk of Tx) Watery diarrhea Crampy abd pain Can toxic megacolon/perforation |
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Volvulus Def/Pres
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(twisting of intestine around mesenteric attachment site obstruction and/or vascular compromise)
(often in sigmoid colon = LLQ) (sigmoid in older, cecum in younger) Acute colicky (???) abd pain Obstipation Distension Anorexia N/V |
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Cirrhosis Def/Pres
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(chronic liver disease. Fibrotic tissue replaces hepatocytes disrupted architecture)
( portal HTN ascites, varices, etc.) ( hepatocellular failure ↓albumin, ↓clotting factors, etc.) (often caused by alcohol, and HBV/HCV, many other causes) Varicies/Bleeding Ascites/SBP Hepatic Encephalopathy – asterixis, rigid hyperreflexia, fetor hepaticus Hepatorenal syndrome – azotemia, oliguira, hyponatremia, HoTN Hyperestrinism (↑estrogen) – spider hemangioma, palmar erythema, gynecomastia, testicular atrophy Coagulopathy - ↑PT, PTT HCC |
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Spontaneous Bacterial Peritonitis Def/Pres
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(infxn of ascetic fluid often 2/2 E. coli, Klebsiella, S. pneumo)
Abd pain Fever Vomiting Rebound tenderness |
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Wilson Dz Def/Pres
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(defect of copper metabolism 2/2 ↓ceruloplasmin copper accumulation)
(hepatocytes die copper leakage kidney, cornea, brain) (AR genetics…ages 5-35) Liver Dz Kayser-Fleicher rings Extrapyramidal signs – PD Sx, chorea, incoordination Psychiatric disturbance Renal problems – aminoaciduria, nephrocalcinosis |
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Hemochromatosis Def/Pres
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(excessive iron absorption ↑accumulation in…liver, pancreas, heart, joints, skin)
(iron free radicals fibrosis) (AR genetics) ASx S/Sx liver dz Fatigue Arthritis Impotence/amenorrhrea Abd pain Arrhythmia - Cirrhosis Cardiomyopathy DM Arthritis Hypogonadism Hypothyroidism Hyperpigmentation/bronze |
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Hepatocellular Adenoma Def/Pres
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(benign liver tumor often in women 2/2 OCP or anabolic steroids)
Incidental Rads finding RUQ pain Fullness CAN RUPTURE – hemoperitoneum, hemorrhage |
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Cavernous Angioma Def/Pres
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(vascular liver tumor – benign)
(increases in size 2/2 OCPs or pregnancy) RUQ pain RUQ mass Rare rupture w/ complications |
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Focal Nodular Hyperplasia Def/Pres
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(benign liver tumor in women of reproductive age NOT 2/2 OCPs)
ASx Hepatomegaly |
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Hepatocellular Carcinoma Def/Pres
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(malignant liver malignancy, often 2/2 cirrhosis 2/2 HBV/HCV, but other RF as well)
Mass effect – Abd pain Cancer metabolic effect – weight loss, anorexia, fatigue Chronic Liver Dz – portal HTN, ascites, jaundice, splenomegaly Paraneoplastic – erythrocytosis, carcinoid, hypoglycemia?? |
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Non-alcoholic Steatohepatitis Def/Pres
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(path same as EtOH liver diseae but NOT 2/2 EtOH use)
(pt often w/ obesity, DM) ASx Cirrhosis in 10-15% Incidental lab |
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Hemobilia Def/Pres
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(blood draining in CBD to duodenum often 2/2 trauma, tumor, infxn)
GI bleed Jaundice RUQ pain |
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Polycystic Liver cysts Def/Pres
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(AD, associated w/ adult PCKD, rarely liver fibrosis/failure)
ASx Abd pain Abd mass |
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Hydatid liver cysts Def/Pres
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(liver cyst 2/2 tapeworm often in right lobe)
(Echinococcus granulosis > Echinococcus mulilocularis) Small cysts – ASx Large cysts – RUQ pain, rupture anaphylactic shock |
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Pyogenic Liver Abscess Def/Pres
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(pus w/in liver parenchyma 2/2 GI anerobe infxn – E. Coli, Kleb, proteus, entero, anaerobes)
(often 2/2 Bile tract obstruction, GI infxn, gunshot, surgery) Fever Malaise Anorexia/weight loss N/V RUQ pain Jaundice Appear Ill |
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Amebic Liver abscess Def/Pres
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(Pus in liver parenchyma 2/2 entamoeba often in MSM and travel in portal vein)
Fever RUQ pain N/V Hepatomegaly DIARRHEA Mexico Connection? |
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Budd-Chiari Syndrome Def/Pres
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(occlusion of hepatic venous outflow liver dz 2/2 congestion, microvascular ischemia)
Cirrhosis-like Sx Jaundice RUQ pain |
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Biliary Colic Def/Pres
|
(temporary obstruction of cystic duct by gallstone)
(pain from GB contraction against obstruction) RUQ/epigastrium pain – 30 min Pain after eating or at night Referred pain to R. supscapula (Boas sign) |
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Acute Cholecystitis Def/Pres
|
(obstruction of cystic duct inflammation of GB wall)
RUQ pain +/- Rsubscapula N/V, anorexia RUQ TTP, rebound Murphy arrest – inspiratory arrest w/ palpation ↓BS Low Fever/WBC |
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Acalculous Cholecystitis Def/Pres
|
(acute cholecystitis w/out stone obstruction…inflammation regardless)
(pt often w/ severe underlying illness) RUQ pain +/- Rsubscapula N/V, anorexia RUQ TTP, rebound Murphy arrest – inspiratory arrest w/ palpation ↓BS Low Fever/WBC |
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Choledocholithiasis Def/Pres
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(gallstone in CBD)
RUQ/epigastric pain Jaundice |
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Cholangitis Def/Pres
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(infxn of biliary tract 2/2 obstruction bile stasis bacteria)
(obstruction often 2/2 choledocholithiasis) Charcot Triad/Raynaud Pentad… RUQ pain Jaundice Fever Septic shock AMS Pt is acutely ill |
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Gallbladder carcinoma Def/Pres
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(self explanatory, often in elderly and associated w/ stones)
(Sx similar to post-hepatic bile obstruction) Jaundice Biliary colic Weight loss/anorexia RUQ mass Palpable gallbladder – advanced |
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Primary Sclerosing Cholangitis Def/Pres
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(bile duct (both types) wall thickening narrow lumens cirrhosis/portal HTN/liver failure)
(dz is chronic, idiopathic, progressive and often a~w/ CUC) Jaundice Pruritis Fatigue Malaise Weight loss |
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Primary Biliary Cirrhosis Def/Pres
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(destruction of intrahepatic bile ducts portal inflammation, scarring)
(chronic, progressive, AUTOIMMUNE dz often in middle-aged women) Fatigue Pruritis – early RUQ discomfort Xanthoma/xanthelasmata Osteoporosis Portal HTN Jaundice – late |
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Cholangiocarcinoma Def/Pres
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(tumor of bile duct)
(often in prox 1/3 of CBD = Klatskin tumor, often >70yo, often a~w/ PSC/CUC) Obstructive jaundice = dark urine, clay stools, pruritis Weight loss |
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Choledochal cyst Def/Pres
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(cystic dilatation of biliary tree, more common in women)
Epigastric pain Jaundice Fever RUQ mass Can cholangiocarcinoma |
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Bile Duct Stricture Def/Pres
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(self-explanatory/narrowing often 2/2 iatrogenic injury)
Obstructive jaundice – dark urine, clay stools, pruritis Can SBC, abscess, ascending cholangitis |
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Biliary dyskinesia Def/Pres
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(motor dysfxn of sphincter of Oddi)
Recurrent Biliary colic (w/out evidence of stones) |
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Acute Appendicitis Def/Pres
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(lumen obstruction stasis bacteria inflammation)
(can compromised blood supply necrosis, can perforation) (obstruction often 2/2 hyperplasia of lymphoid or fecalith) Abd pain – epigastrium RLQ Anorexia N/V RLQ TTP (McBurney point) R/G, ↓BS Low fever Rovsing sign – LLQ palpation RLQ pain Psoas sign – R thigh extension in LLDecubitus RLQ pain Obturator sign – R thigh flexed and internally rotated RLQ pain |
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Carcinoid tumor/syndrome Def/Pres
|
(Neuroendocrine tumor often in SI excess serotonin secretion)
Flushing Diarrhea Wheezing Sweating Abd pain Heart valve dysfxn Can mets |
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Acute pancreatitis Def/Pres
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(premature digestive enzyme release autodigestion inflammation of pancreas)
(often 2/2 alcohol or gallstone blocking ampulla of vater) Epigastric pain Rback, steady, dull, severe N/V anorexia Low fever Abd distension |
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Chronic Pancreatitis Def/Pres
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(fibrosis/replacement 2/2 chronic inflammation often 2/2 alcoholism)
Severe abd pain – can be aggravated by EtOH N/V Weight loss Steatorrhea DM |
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Pancreatic Cancer Def/Pres
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(self-explanatory, most often in head of pancreas, often in blacks, smokers)
Abd pain – vague Jaundice – if in head of pancreas Weight loss Migratory thrombophlebitis Couvosier sign (palpable GB) – if head of pancreas |
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Esophageal Cancer Def/Pres
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(SCC – blacks, prox 2/3, smoking/EtOH)
(Adenocarcinoma – distal 1/3, GERD/Barretts) Dysphagia (solid > liquid) Weight loss Anorexia Hematemesis |
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Achalasia Def/Pres
|
(failure of LES relaxation w/ abnl/↓ peristalsis often 2/2 idiopathic, adenocarcionoma, Chagas)
Dysphagia (liquid = solid) Pts learn mvmts to force food/liquid down Regurgitation Weight loss Aspiration CP |
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Diffuse Esophageal Spasm Def/Pres
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(spontaneous constriction at several segments of esophagus)
Non-cardiac CP R jaw/arms/back (like angina) Dysphagia NO REGURGITATION |
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Sliding Hiatal Hernia Def/Pres
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(GE jxn and stomach in thorax/above diaphragm through esophageal hiatus)
ASx Heart burn/CP/dyphagia GERD, esophagitis |
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Paraesophageal hiatal hernia Def/Pres
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(stomach in thorax/above diaphragm but GE jxn is not, can strangulation)
ASx Hearburn/CP/dysphagia Obstruction/hemorrhage/strangulation |
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Mallory Weiss Def/Pres
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(mucosal tear at GE jxn 2/2 forceful vomiting/retching often in alcoholics)
Hematemesis vomiting/retching no pain? |
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Plummer-Vinson Def/Pres
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(upper esophageal web + IDA, koilonychias, atrophic oral mucosa)
Dysphagia Spoon fingernails 10% SCCA oral cavity |
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Schatzki Ring Def/Pres
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(lower esophageal web AND sliding hiatal hernia often 2/2 SA ingestion of alkali/acid)
ASx Mod dysphagia GERD Sx Can stricture, esophageal CA |
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Zenker Diverticulum Def/Pres
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(outpouching of prox 1/3 2/2 crycopharyngeal failure ↑lumen pressure)
Often > 50yo Dysphagia Regurgitation Halitosis Weight loss Chronic cough |
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Esophageal Perforation Def/Pres
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(self explanatory, often 2/2 surgery, vomiting/Boerhaave)
Severe CP Tachy/HoTN Dyspnea Fever Mediastinal crunch |
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PUD Def/Pres
|
(?destruction of gastric epithelium often 2/2 NSAIDs, H. pylori, ZE syndrome)
Epigastric pain Can GI bleed Duodenal – pain relieved by eating…opposite for gastric |
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Acute Gastritis Def/Pres
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(inflammation of gastric mucosa often 2/2 NSAIDs, H. Pylori, stress (burns, sepsis))
Epigastric pain |
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Chronic Gastritis Def/Pres
|
(chronic inflammation of gastric mucosa 2/2 H.pylori OR autoimmune…diff path)
Epigastric pain +/- N/V/anorexia Can PUD, carcinoma, MALToma Pernicious anemia if autoimmune/atrophic |
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Gastric Cancer Def/Pres
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(4 different morphologies, often a~w/ atrophic gastritis, h.pylori, smoked fish/nitrates)
Abd pain Weight loss Early satiety N/V Melena |
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Gastric Lymphoma Def/Pres
|
(MALToma? 2/2 atrophic gastritis/H.pylori??)
Abd pain Weight loss Early satiety N/V Melena Can have complications: bleeding, obstruction, perforation |
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SBO Def/Pres
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(can be partial/complete, closed/2-point or open often 2/2 surgical adhesion, hernia)
Crampy abd pain N/V No stool No flatus Abd distension |
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Paralytic ileus Def/Pres
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(↓/absent peristalsis/motility NOT2/2 obstruction often 2/2 drugs, surgery)
???SBO Sx… Crampy abd pain N/V No stool No flatus Abd distension |
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Celiac Sprue Def/Pres
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(malabsorption 2/2 anti-gliadin Ab flattened villi of small bowel)
Weight loss Abd distension Bloating Diarrhea |
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Chrons Dz Def/Pres
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(IBD: transmural, skip lesions, often terminal ileum, noncaseating granuloma, fat creeping)
Nonbloody diarrhea Malabsorption Abd pain N/V Fever/malaise Extraintestinal – eye, skin, arthritis, osteoporosis B12 deficiency Cholelithiasis/nephrolithiasis Can fistula, stricture Many flares |
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Ulcerative Colitis Def/Pres
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(IBD: mucosa/submucoas, continuous from rectum, crypt abscess)
Bloody Diarrhea Abd pain Tenesmus Can colon cancer Can PSC, cholangiocarcinoma Can toxic megacolon Extraintestinal – ankylosing spondylitis, uveitis |
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Graves Dz Def/Pres
|
(Thyroid stimulating IgG TSH-R hyperthyroid)
Hyperthyroidism Proptosis Symmetrically enlarged thyroid +/- thyroid bruit |
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Plummers Dz Def/Pres
|
(multinodular toxic goiter = ↑fxn areas ↑T4/T3 secretion w/ poor fxning other areas)
Hyperthyroidism Bumpy, irregular thyroid |
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Hyperthyroidism Def/Pres
|
(often 2/2 Graves or Plummers/MNT goiter)
Nervousness Tremor Heat intolerance/sweating Weight loss w/ good appetite Diarrhea Palpitations Muscle weakness Enlarged thyroid Proptosis – Graves only Arrhythmias Pretibial myxedema Brisk DTR |
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Thyroid Storm Def/Pres
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(acute exacerbation of thyrotoxicosis often 2/2 precipitating stressor…infxn, DKA, preggers)
Fever Tachycardia Psychosis N/V/D |
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Hypothyroidism Def/Pres
|
(often 2/2 Hashimotos thyroiditis or thyroid Tx, but can be 2/2 pituitary/HT)
Fatigue/weakness Heavy menstrual periods Slight weight gain w/ low appetite Cold intolerance Constipation Depression Dry skin Coarse hair Myxedema (nonpitting edema) Slow relaxation of DTR Bradycardia |
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Subactue viral thyroiditis Def/Pres
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(viral induced thyroid inflammation)
Prodrome – fever, flu Transient hyperthyroidism euthyroid hypothyroid Painful thyroid |
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Subactue lymphocytic thyroiditis Def/Pres
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Hyperthyroidism hypothyroid
Painless |
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Hashimoto thyroiditis Def/Pres
|
(autoimmune thyroid d/o more common in women. Anti-thyroid Ab)
Goiter Hypothyroidism |
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Fibrous/Reidel Thyroiditis Def/Pres
|
(fibrous tissue replaces thyroid)
Firm thyroid +/- hypothyroid |
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Hyperprolactinemia Def/Pres
|
(often 2/2 prolactinoma, meds, Da inhibition from other pit adenoma/mass, ↓thyroid)
Men – hypogonadism/impotence, gynecomastia Women – amenorrhea, galactorrhea VF defect, HA |
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Acromegaly Def/Pres
|
(excess GH secretion often 2/2 pituitary adenoma)
(after epiphyseal closure…”gigantism” if before epiphyseal closure) Soft tissue growth Skeleton growth Coarse facial feature Large hands/feet Organomegaly Hypertrophic cardiomyopathy – causes death DM/Glucose intolerance HA, bitemporal hemianopsia, HTN |
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Craniopharyngioma Def/Pres
|
(tumor arising from rathke pouch remnant mass effect/pit compression)
VF defect HA Papilledema Hyperprolactinemia, DI, panhypopit |
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Hypopituitarism Def/Pres
|
(↓some/all pit hormones often 2/2 HT or pit tumor but also 2/2 sheehans)
(Sx depend on ↓hormone) ↓GH – growth failure, ↓muscle mass ↓prolactin – no lactation ↓ACTH – adrenal insufficiency ↓TSH – hypothyroidism (2ndary) ↓LSH/FH – amenorrhea, impotence ↓ADH – DI ↓MSH – decreased pigmentation |
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Diabetes Insipidus Def/Pres
|
(defect in ADH fxn either central/secretion or nephrogenic/receptor recognition)
Polyuria Thirst/polydipsia |
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SIADH Def/Pres
|
(excess ADH from pituitary or exogenous source often 2/2 other d/o)
(natriuresis continues to occur) Acute hyponatremia – brain swelling seizures, coma Anorexia N/V NO EDEMA |
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Hypoparathyroidism Def/Pres
|
(↓PTH often 2/2 neck surgery ↓Ca)
Arrhythmia Rickets/osteomalaciea Hypocalcemia Sx – tingling, tetany Prolonged QT |
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Pseudohypoparathyroidism Def/Pres
|
(end-organ resistance to PTH)
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Primary Hyperparathyroidism Def/Pres
|
(↑PTH often adenoma or hyperplasia ↑Ca)
Stones Bones – osteitis fibrosa cystica (brown tumor) Groans – pain, pancreatitis, gout, PUD Moans – depression, anxiety Short QT |
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Cushing Syndrome Pres/Def
|
(excessive cortisol 2/2 pituitary adenoma, exogenous steroids, ectopic ACTH)
Buffalo hump Abd striae Acne HTN DM Hypogonadism Masculinization in females Proximal muscle wasting Osteoporosis Depression/Mania Impaired immunity |
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Pheochromocytoma Pres/Def
|
(tumor that secretes NE/Epi often arise in Adrenal medulla)
HTN Episodes of severe HTN Severe HA Severe sweating Palpitations Anxiety ↑glc HLD ↓K |
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Primary Hyperaldosteronism Pres/Def
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(excess aldo produced by adrenal glands (adenoma, hyperplasia) ↑Na/↓K/↓H)
HTN Headache Fatigue/weakness Polydipsia NO PERIPHERAL EDEMA |
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Adrenal Insufficiency Pres/Def
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(decreased adrenal hormones (cortisol, aldosterone) 2/2 autoimmune, steroids)
GI – N/V, pain, anorexia/weight loss Mental Hypoglycemia Orthostatic HoTN Hyperpigmentation ↓Na – HoTN, shock ↑K |
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Congenital Adrenal Hyperplasia Pres/Def
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(AR dz of enzyme defect ↓cortisol/aldo ↑androgens (shunt in pathway))
(↑ACTH hyperplasia) Females w/ ambiguous external genitalia but nl ovaries/uterus Salt wasting form – emesis, dehydration, HoTN/shock (2-4 wks of life) ↓Na ↑K Hypoglycemia |
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Hypoglycemia Pres/Def
|
(low blood glc, most important for brain b/c only uses glc)
Elevated Epi – Pheo type Sx Neuroglycopenic Sx – irritability, weakness, HA, confusion, coma |
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Insulinoma Pres/Def
|
(insulin producing tumor of pancreatic b-cells, seen w/ MEN I, can ↓glc)
ASx Epi Sx Neuroglycopenic Sx |
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ZE syndrome Pres/Def
|
(pancreatic tumor that secretes gastrin)
PUD – abnl degree Abd pain Diarrhea Weight loss |
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Glucagonoma Pres/Def
|
(pancreatic tumor that secretes glucagon)
Necrotizing migratory erythema Glossitis Stomatitis DM Hyperlgycemia |
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Somatostatinoma Pres/Def
|
Gallstones
DM Steatorrhea |
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VIPoma Pres/Def
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Watery diarrhea
Achlorhydria ↑glc ↑Ca |
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Pre-renal ARF Pres/Def
|
(rapid decline in renal fxn (Cr ↑ > 0.5) 2/2 ↓renal perfusion)
(↓GFR w/ intact parenchyma Na/water conservation, []ed urine) (continuing ischemia ATN) Dry MM HoTN Tachy Decreased turgor Oliguria/anuria |
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Intrinsic ARF Pres/Def
|
(rapid decline in renal fxn (Cr ↑ > 0.5) 2/2 tissue damage)
(impaired filtration and tubular reabsorption/secretion Na loss) Features depend on cause Edema |
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Postrenal ARF Pres/Def
|
(rapid decline in renal fxn (Cr ↑ > 0.5) 2/2 obstruction ↑pressure ↓GFR)
(if untreated can ATN) Often 2/2 BPH |
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Chronic Renal Failure Pres/Def
|
(irreversible ↓GFR over months-yrs often 2/2 DM or HTN)
HTN – RAAS Na conservation CHF Pericarditis GI Sx CNS/Seizures Anemia - ↓EPO Bleeding – plt dysfxn ↑K, Mg, Phos, ↓VitD |
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Nephrotic Syndrome Pres/Def
|
(abnl glom permeability)
Urine Prot > 3.5g/d Hypoalbumin HLD Fatty casts Edema Hypercoagulable state Increased infxn |
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Nephritis syndrome Pres/Def
|
(inflammation of glom)
Hematuria Mild proteinuria ARF – azotemia, oliguria HTN Edema |
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Minimal Change Dz Pres/Def
|
Nephrotic syndrome
Often in Children |
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Focal Segmental Glomerulosclerosis Pres/Def
|
Nephrotic syndrome
Hematuria HTN Aw/ HIV |
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Membranous GN Pres/Def
|
Nephrotic syndrome
|
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IgA nephropathy/Berger Pres/Def
|
ASx recurrent hematuria/proteinuria
Nl renal fxn Sx often 2/2 virus, exercise |
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Hereditary Nephritis/Alport Pres/Def
|
XL or AD genetics
Hematuria Pyuria Proteinuria High-frequency hearing loss Progressive renal failure |
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Membranoproliferative GN Pres/Def
|
Often 2/2 HCV
Aw/ cryoglobulinemia |
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Poststreptococcal GN Pres/Def
|
10-14 d after URI strep (b-hemolytic)
Children Nephritic syndrome |
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Goodpasture Syndrome Pres/Def
|
(proliferative/crescentic GN, pulm hemorrhage 2/2 anti-GBM Ab)
Fever Myalgia Rapid renal failure Hemoptysis Cough Dyspnea Lung before kidney Sx/Dz |
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Acute Interstitial Nephritis Pres/Def
|
(inflammation of interstitium often 2/2 allregy to PCN/NSAID or infxn)
Renal ARF Rash Fever Eosinophilia +/- pyuria, hematuria |
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Chronic Interstitial Nephritis Pres/Def
|
(slow progressive interstitial inflammation scarring)
No S/Sx hypersensitivity |
|
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Renal Papillary Necrosis Pres/Def
|
+/- ureteral obstruction
|
|
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Renal Tubular Acidosis I Pres/Def
|
(defect in H+ secretion from distal tubule no HCO3 generation)
Decreased ECF volume Hypokalemia (other loss of ions) Stones Non-anion gap metabolic acidosis |
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Renal Tubular Acidosis II Pres/Def
|
(defect in HCO3 reabsorption in prox tubule HCO3 in urine)
Hypokalemia Non-anion gap Metabolic acidosis No stones |
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Renal Tubular Acidosis IV Pres/Def
|
(defect in aldo production or fxn/receptivity Na lost, K+/H+ retained)
Hyperkalemia Non-anion gap metabolic acidosis Rarely stones |
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Hartnup Syndrome Pres/Def
|
(AR genetic d/o of defective AA transporter ↓AA reabsorption (trp, NAD))
Pellagra Sx: Dermatitis Diarrhea Ataxia Psychiatric disturbance |
|
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Fanconi Syndrome Pres/Def
|
(prox tubule dysfxn: glucose, AA, Na, K, phos, uric acid, bicarb)
Glucosuria Phosphaturia Rickets/osteomalacia Proteinuria Polyuria Dehydration Type II RTA Hypercalciuria Hypokalemia |
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Adult Polycystic Kidney Dz Pres/Def
|
(AD Dz ESRD in 50% pts)
Hematuria Abd pain HTN Palpable kidney Complications – berry aneurysm, MVP, other organ cysts |
|
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Medullary sponge kidney Pres/Def
|
(cystic dilation of collecting ducts)
Hematuria UTIs Nephrolithiasis Aw/ ↑PTH dz |
|
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Simple Renal Cysts Pres/Def
|
ASx
Discovered incidentally on US |
|
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Renal A. stenosis Pres/Def
|
(↓Blood flow RAAS activation severe HTN)
(2/2 either atherosclerosis = old/male/smoker or fibromuscular dysplasia = young/female) Sudden onset severe HTN (no FHx) Decreased renal fxn Abd bruit |
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Renal V. thrombosis Pres/Def
|
Renal failure
Flank pain HTN Hematuria Proteinuria |
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Hypertensive Nephrosclerosis Pres/Def
|
(systemic HTN ↑hydrostatic Pressure sclerosis)
Can be benign/gradual Can be malignant rapid decrease in fxn -↑↑↑BP Sx -proteinuria, hematuria -RBC and WBC casts |
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|
Sickle cell nephropathy Pres/Def
|
(RBCs sickle in microvasculature esp in papilla infarction/necrosis)
Nephrotic syndrome Risk of dehydration/sickle crises |
|
|
Nephrolithiasis Pres/Def
|
(stones within urinary tract)
Renal colic = sudden pain severe, cant stay still, flank R groin N/V Hematuria UTI |
|
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Urinary Tract Obstruction Pres/Def
|
(urinary Sx if below uretovesicular jxn…otherwise colic often 2/2 BPH/Prostate Ca)
Oliguria UTIs Hematuria/proteinuria Renal failure – usually only if bilateral |
|
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Prostate Cancer Pres/Def
|
Late obstructive Sx
Bone pain from mets Weight loss |
|
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Renal cell Carcinoma Pres/Def
|
Hematuria
Abd/flank pain Abd/flank mass Weight loss Fever Paraneoplastic syndromes (uncommon. PTH, renin, cortisol, FSH/LH) |
|
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Bladder Cancer Pres/Def
|
Often aw/ cigarette smoking
Painless hematuria Dysuria Frequency |
|
|
Testicular Cancer Pres/Def
|
Men 20-35
Painless mass on testicle Gynecomastia |
|
|
Penile Cancer Pres/Def
|
70+yo
Aw/ HPV 18, non-circumcised Exophytic mass on penis |
|
|
Testicular Torsion Pres/Def
|
(twisting of spermatic cord venous/arterial occlusion ischemia/infarction)
Adolescent Severe testicular pain Elevated testicle |
|
|
Epididymitis Pres/Def
|
(infxn of epididymas often 2/2 E. coli, Gonorrhea/Chlamydia)
Swollen testicle Dysuria F/C |
|
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Hypovolemia Pres/Def
|
(i.e. ↓plasma/ECF, can have 3rd spacing, GI loss, etc.)
CNS Δs – AMS, sleepiness Orthostatic HoTN ↓CVP ↓skin turgor Pale Oliguria Weakness Ileus ARF (prerenal) |
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Hypervolemia Pres/Def
|
(i.e. ↑plasma/ECF, 2/2 iatrogenic/IV, fluid retaining Dz)
Weight gain Edema/ascites JVD ↑CVP Rales ↓Hct ↓Alb |
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|
Hyponatremia Pres/Def
|
(water > Na in serum, <135mmol/L, Sx at <120)
(water will shift hypertonic cells ↑ICP in brain) CNS Sx – HA, delirium, irritability, ↑DTR ↑ICP/seizure/coma N/V Ileus Watery diarrhea HTN Oliguria? |
|
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Hypernatremia Pres/Def
|
(Na > 145 in plasma 2/2 loss of water or Na gained)
(water will shift from hypotonic cells ↓ICP?) CNS Sx – AMS, restlessness, focal deficit, confusion, seizure Dry MM |
|
|
Hypocalcemia Pres/Def
|
(Ca < 8.5 2/2 low or more binding to albumin during alkalosis)
(often 2/2 ↓PTH, ↑calcitonin, ↓Vit D) ASx Rickets/osteomalacia Tetany - ↑DTR, chvostek sign Basal ganglia calcification Arrhythmia Prolonged QT |
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Hypercalcemia Pres/Def
|
(Ca > 10.5 often 2/2 ↑PTH, bone breakdown, Vit D)
Stones Bones – bone aches, osteitis fibrosa cystic Moans – muscle pain, pancreatitis (enzyme activation), gout Groans – depression, fatague, anxiety HTN Weight loss ↓QT |
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Hypokalemia Pres/Def
|
(K < 3.5 often 2/2 GI loss, renal loss, poor intake)
(acid out of cells, insulin into cells) Arrhythmia – T-flat/invert, U-wave Muscular weakness ↓DTR Ileus |
|
|
Hyperkalemia Pres/Def
|
(K > 5.0 often 2/2 renal failure, ↓aldo, iatrogenic, or cell shift)
Arrhythmia – peaked T, prolonged PR, wide QRS, VFib Muscle weakness ↓DTR Respiratory failure N/V/D |
|
|
Hypomagnesemia Pres/Def
|
(Mg < 1.8 often 2/2 GI/malabsorption, alcoholism, renal)
Muscular/CNS irritability ↓Ca (↓PTH) ↓K Arrhythmia like hypokalemia – low T, U wave ?difficult to correct ↓Ca or ↓K? |
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Hypermagnesemia Pres/Def
|
(Mg > 2.5 often 2/2 renal failure, rhabdo)
Muscle/CNS depression Arrhythmia like hyperkalemia – peaked T, long PR, wide QRS |
|
|
Hypophosphatemia Pres/Def
|
(phos < 3.0 often 2/2 alcohol, ↓VitD, ↑PTH)
ASx if mild CNS Weakness Cytopenic dyfxns Cardiomyopathy Rhabdo |
|
|
Hyperphosphatemia Pres/Def
|
(phos > 4.5 often 2/2 renal failure, intake, rhabdo/lysis)
Metastatic calcifications Bind Ca ↓Ca CNS Δs (tetany) |
