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GIGU & Men’s Health > Accessory Organs > Flashcards

Accessory Organs Flashcards

1
Q

Cholestasis

A

Reduction or blocked flow of bile

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2
Q

Cholestasis: Consequences

A

• Since bile aids in the absorption of nutrients, if blocked, can lead to
malabsorption and nutrition deficiencies particularly fat soluble vitamins: A, D, E, K

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3
Q

Cholestasis: Diagnostic Considerations

A

• Diagnose cholestasis on symptoms, signs and labs
. • But the CAUSE of cholestasis must be identified as well as any CONSEQUENCES.

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4
Q

Cholestasis is seen in:

A

Both liver and gall bladder disease

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5
Q

Cholestasis: Signs/Symptoms

A

• Jaundice
‘• Pruritis
• Stool: pale, foul
• Urine: dark
• May have Sx/Si related to the cause / nutritional issues
• Nausea or vomiting
• Inability to digest certain foods
• RUQ pain
• Fatigue

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6
Q

Cholestasis: Labs

A

– Bilirubin: increased
– ALP: increased
– AST/ ALT: increases

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7
Q

Cholestasis: Treatment

A

• Treatment:
– Treat underlying cause
– If chronic, consider fat soluble vitamin deficiencies: ADEK

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8
Q

Protecting the Liver

A

• Choose a healthy diet.
• Maintain a healthy weight.
• Drink alcohol in moderation, if at all.
• Limit to < one drink a day (women) and < two drinks a day (men)
• Get vaccinated.
• Use medications wisely.
• Avoid contact with blood and body fluids.
• Watch what gets on your skin.
• Take care with aerosol sprays.
• Use ventilation or wear a mask when using toxic chemicals
• Avoid risky behavior: Sharing needles, unprotected sex, safe tattoos or body piercings

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9
Q

Fatty Liver Disease

A

• Excessive accumulation of lipids in hepatocytes

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10
Q

Fatty Liver Disease: Acute

A

– Acute: pregnancy (AFLP)

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11
Q

Fatty Liver Disease: Chronic

A

– Chronic: metabolic (NAFLD), alcohol (ALD)

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12
Q

Fatty Liver Disease: Most Common Type

A

NAFLD

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13
Q

Chronic Fatty Liver Disease: Diagnosing

A

– May feel tired or have mild abdominal discomfort but otherwise have no symptoms.
– May first be discovered incidentally with routine liver function test
– On exam may have hepatomegaly but not tender (1/3)

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14
Q

NAFLD vs. ALD: Associations, Alcohol, Progressions

A

Associations
-NAFLD: Associated with Metabolic issues
-ALD: Associated with Alcohol Liver Disease

Alcohol
-NAFLD: No alcohol use
-ADL: Excessive Alcohol Use

Progressions
-NAFLD: NASH, Cirrhosis
-ALD: Alcoholic hapatitis, cirrhosis

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15
Q

Chronic Fatty Liver: Signs/Symptoms

A

-Mostly Asymptomatic
-IF Symptomatic: Fatigue, malaise, dull RUQ pain
-Exam: Hepatosplenomegaly (33%)

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16
Q

Chronic Fatty Liver: Diagnosing

A

• Common clinical presentation:
“healthy” pt. (few to no sx) with
abnormal liver tests
• Most often diagnosed incidentally
on routine labs
• Confirm with CT (or MRI) and liver
biopsy
• Need to identify the cause:
– Metabolic: labs
– Alcoholic: history/ CAGE

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17
Q

Chronic Fatty Liver: Treatment (Medical)

A

• Address cause/ risk factors:
– Lose weight
– Control cholesterol
– Control DM
– Stop drinking
• Protect liver!

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18
Q

Chronic Fatty Liver: Treatment (Lifestyle)

A

• Healthy diet
• Maintain weight
• Exercise

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19
Q

Hepatitis

A

Swelling and inflammation of the liver characterized by diffuse or patchy necrosis

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20
Q

Hepatitis: Causes

A

Viruses, alcohol, drugs, metabolic

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21
Q

Hepatitis: Complications

A

• Varices, portal hypertension protect against risk factors

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22
Q

Hepatitis: Prognosis

A

– Can be self limited
– Or may lead to damage: cirrhosis, liver failure or cancer

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23
Q

Hepatitis: History

A

• Symptoms may be non specific
• In chronic conditions may have even less symptoms
• Important to review for risk factors related to causes

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24
Q

Hepatitis: Exam

A

• May not see abnormalities until late stages or when it progresses to other diseases
• May see signs of complications

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25
Q

Hepatitis: Diagnostics

A

Labs: viral, liver function, autoimmune
Diagnostics: US, biopsy

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26
Q

What acute hepatitis conditions can progress to chronic?

A

– Hepatitis B, C, D

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27
Q

Acute Hepatitis: Causes

A

• Infection: Viral A,B,C,D,E
-Toxin: Alcohol, Drugs/Herbs
-Immune: Autoimmune Hepatitis, Primary biliary cholangitis, acute episodes primary sclerosing cholangitis
-Metabolic: NASH

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28
Q

Acute Hepatitis: Signs/Symptoms (Early)

A

Early s/s (prodrome phase):
• Anorexia
• Malaise
• Nausea or vomiting
• Fever
• RUQ pain/discomfort
• Aches such as arthralgia

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29
Q

Acute Hepatitis: Signs/Symptoms (Icteric Phase)

A

• S/S of cholestasis
– Dark urine
– Jaundice (peaks 1-2 weeks)
• Diarrhea
• Headache

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30
Q

Acute Hepatitis: Exam (Icteric Phase)

A

• Jaundice
• Hepatomegaly with tenderness (edges remains soft and smooth)
• Splenomegaly (mild sx) (15-50%
• Lymphadenopathy

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31
Q

Acute Hepatitis: Diagnostics

A

• Liver function tests
(AST and ALT elevated out of proportion to alkaline phosphatase, usually with hyperbilirubinemia)
• Viral serologic testing

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32
Q

Chronic Hepatitis: More Common Causes

A

– NAFLD
– Hepatitis B and C
– Alcoholic hepatitis
– Autoimmune hepatitis

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33
Q

Chronic Hepatitis

A

• Chronic inflammation of the liver lasting over 6 months

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34
Q

Chronic Hepatitis: Diagnostic Challenges

A

– Can be insidious
– No history of other conditions such as acute hepatitis, NALFD
– Few to no symptoms (or symptoms are non specific)
– May not detect until advanced stage of cirrhosis

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35
Q

Chronic Hepatitis: First Indications

A

Abnormal liver tests

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36
Q

Chronic Hepatitis: Complications

A

-Thyroid, arthropathy, peripheral neuropathy
-Malabsorption related issues
-Other chronic liver disorders (primary biliary cholangitis)

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37
Q

NASH: Cause

A

Metabolic: Obesity, insulin, resistance, lipid issues

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38
Q

NASH: How to identify cause

A

• Rule in metabolic issues
• 3rd MC cause of liver disease

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39
Q

ALD: Cause, How to identify cause, Progression

A

-Cause: Alcohol
-How to identify cause: Rule in drinking
-Progression: May have progressed from fatty liver, may move to cirrhosis

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40
Q

Chronic Hepatitis: Viral

A

-Cause: Hepatitis Virus B,C,D
-How to identify cause: Viral labs, past history of acute hepatitis
-Progression: Progressed from acute viral condition, about 20% develop into cirrhosis

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41
Q

Chronic Hepatitis: Autoimmune

A

-Cause: Unknown
-Progression: May progress to cirrhosis

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42
Q

Chronic Hepatitis: Symptoms

A

-May be asymptomatic
-Non-specific type symptoms: Malaise, anorexia, fatigue, low-grade fever, non-specific upper abdominal discomfort
*jaunncide can be present but rare
-May have cholestasis: Pruritis, pale stools, steatorrhea

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43
Q

Chronic Hepatitis: Exam

A

– Hepatomegaly-75%
– Splenomegaly

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44
Q

Chronic Hepatitis: Diagnostics

A

-Liver function tests
-Biopsy (to stage)
-Additional testing to identify cause: Viral serology, autoantibodies, etc.

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45
Q

Chronic Hepatitis: Lifestyle (Treatment)

A

-Rest
-Hydrate
-Balanced, nutritious diet
-Protect liver
-Avoid Alcohol

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46
Q

Chronic Hepatitis (Autoimmune): Epidemiology

A

– Female: 70-80% – Ages: 10-20 yo and 45-70 yo
(ages slightly vary in literature)

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47
Q

Chronic Hepatitis (Autoimmune): Cause

A

Unknown

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48
Q

Chronic Hepatitis (Autoimmune): Risk Factors

A

Risk factors:
– Female
– Hereditary
– Certain viral infections
– Associated with other autoimmune diseases*

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49
Q

Chronic Hepatitis (Autoimmune): Complications

A

-Anemia
-Acne
-Amenorrhea
-Hemolytic portal hypertension, esophageal varices

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50
Q

Chronic Hepatitis (Autoimmune): Progression

A

– May lead to cirrhosis, liver failure and cancer

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51
Q

Chronic Hepatitis (Autoimmune): Associated Conditions

A

• Celiac sprue
• Ulcerative colitis
• Primary biliary cholangitis
• Primary sclerosing cholangitis
• Nephritis
• Graves disease
• Type 1 diabetes
• Hashimoto’s disease
• RA

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52
Q

Fibrosis & Cirrhosis

A
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53
Q

Cirrhosis

A

• Progressive state: fibrosis/ scarring in liver becomes extensive
– Affects function (decreases)
– Often end stage of other diseases
– If not diagnosed early, more scar tissue forms
– Advanced stage is life threatening, leading to liver failure and liver cancer

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54
Q

Leading Cause of Death Worldwide

A

Cirrhosis

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55
Q

Cirrhosis: Progression Rate

A

• Progression rate varies from fibrosis to cirrhosis

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56
Q

Cirrhosis: Prognosis

A

• Prognosis:
– Irreversible
– Treatment is supportive

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57
Q

Cirrhosis: Causes (3)

A

-Infections
-Immune
-Cancers
-Other

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58
Q

Cirrhosis: Infections

A

-Viruses
-MC: Hepatitis A,B,C

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59
Q

Cirrhosis: Immune (3)

A

-Autoimmune Hepatitis
-Primary billary cholangitis
-Primary sclerosing cholangitis

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60
Q

Cirrhosis: Cancers

A

-Liver cell/adenoma

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61
Q

Cirrhosis: Other Causes

A

-Chronic alcohol abuse
-NALFD
-Certain medications and herbal compounds

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62
Q

Cirrhosis: Difficulties w/ diagnosing

A

• Sx may not develop for years
• 1/3 never develop symptoms
• Initial symptoms are vague and nonspecific
• Other symptoms related to complications

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63
Q

Cirrhosis: Complications

A

– Portal hypertension, GI bleeds (esophageal, gastric, or rectal varices,pulmonary hypertension), kidney injury
– Hormone imbalance, nutritional deficiencies, anemias, cholestasis, osteoporosis

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64
Q

Cirrhosis: Initial Symptoms

A

• General fatigue
• Malaise
• Anorexia
• Weakness
• Weight loss

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65
Q

Cirrhosis: Later Symptoms/Complications

A

• Anemias
• Jaundice
• Confusion
• Pruritus
• Peripheral neuropathy
• Axillary hair loss
• Dyspnea
• Portal hypertension
• Liver failure
• Ascites
• Acute kidney

66
Q

Cirrhosis: Exam

A

-Liver tender, palpable & firm, blunt edge typically

Other signs related to complications
– Jaundice, petechiae, spider nevi, splenomegaly
– Ascites, caput medusa
– Clubbing, glossitis
– Muscle wasting

67
Q

Cirrhosis: Diagnostics

A

-Liver function tests
-Determine cause: test for viruses, autoimmunity
-Anemia, CBC
-Biopsy: To determine severity, extent and cause

68
Q

Cirrhosis: Lifestyle (Treatment)

A

-Stop drinking
-Supplements: Address nutritional deficiencies

69
Q

Alcoholic Liver Disease: Progression

A

-Fatty Liver Disease: Fat on liver (Over 90%)
-Alcoholic Hepatitis: Inflammation/necrosis (10-35%)
-Alcoholic cirrhosis: Advanced fibrotic state (10-20%)

70
Q

Alcohol Liver Disease: Risk Factors (5)

A

– Quantity/ duration of alcohol (usually over 8 years)
– Gender, genetics, metabolic traits
– Concomitant hepatitis C & iron accumulation
– Obesity
– Women: more likely to suffer liver damage

71
Q

Alcoholic Liver Disease: Fatty Liver (Initial Stage)*

A

• Often reversible
• May / may not progress to other conditions
• Sxmost apparent 30’s/40’s
• Severe problems appear a decade later
• Virtually all heavy drinkers develop

72
Q

Alcoholic Liver Disease: Alcoholic Hepatitis*

A

• Progression from steatosis
• Appx. 35% alcoholic hepatitis
• Cirrhosis may or may not be present
• 30% develop cirrhosis (w/in 6 months)
• Most likely to occur in people who drink heavily for many years
• But not all heavy drinkers develop alcoholic hepatitis
• May occur even in those who drink moderately

73
Q

Alcoholic Liver Disease: Alcoholic cirrhosis*

A

• 10-20% develop cirrhoris cirrhosis
• Advance stage-can cause liver failure
• Alcoholic hepatitis may or may not co-exist

74
Q

Liver Cancer: Forms

A

• Many forms of liver cancer
– Many are metastases from other tumors
(colon, lung, renal, breast, ovarian, prostate)

75
Q

Liver Cancer: Symptoms

A

– Jaundice, abdominal pain, weight loss,
fever, hepatomegaly, back pain

76
Q

Diagnosis of Liver Cancer is found:

A

– Incidentally found through imaging or symptomatically

77
Q

Liver Cancer: Treatment

A

– Surgery, chemotherapy, radiation, etc
– Not all forms are curable

78
Q

Gall Bladder Disease: Risk Factors

A

– “The 5 F’s” (old saying)
• Female
• Family history
• “Fat” (obesity)
• Fertile (pregnancy)
• Forty (40) and over

79
Q

Gall Bladder Disease: Signs/Symptoms

A

• RUQ pain
• Right shoulder or back pain
• Indigestion
• Nausea or vomiting
• Sx of cholestasis:
• Urinary changes: dark
• Clay colored stool

80
Q

Gall Bladder Disease: Exam/Diagnostics

A

• RUQ tenderness
• Jaundice if blocked
(sx of cholestasis)

81
Q

Cholelithiasis

A

• Presence of one or more calculi (gallstones) in gallbladder
– Most asymptomatic

82
Q

Cholelithiasis: Most common occurrence

A

-Incidence increases w/ age
-highest in 5th & 6th decade

83
Q

Cholelithiasis: Predisposing factors

A

The 5 Fs
-Female
-Fertile (pregnancy)
-Fat (obesity)
-Forties (40+)
-Flatuent
-Family History (May have DM, HRT)

84
Q

Cholelithiasis: Symptoms

A

-Post prandial upper abdominal pain: often acute onset
-May radiate to right subscapular area or epigastrum
-Nausea, vomiting, dyspepsia, fatty food intolerance

85
Q

Cholelithiasis: Exam

A

• Mild tenderness w/ palpation but no guarding or rebound

86
Q

Cholelithiasis: Complications

A

• If obstructs gall bladder:can cause cholecystitis (inflammation of the GB)
• If stone moves into duct: choledocholithiasis
• Once in duct, if it causes obstruction of duct: cholangitis
• Once in duct, if it blocks ampulla de Vater: Pancreatitis

87
Q

Choledocholithiasis

A

• Gallstones in the common bile duct

88
Q

Choledocholithiasis: Complications

A

– Can cause obstruction (partial, complete)
– If infected, can become cholangitis
– if it blocks the ampulla of Vater, can cause pancreatitis

89
Q

Cholecystitis

A

• Acute or chronic inflammation of the gallbladder
– Usually from gallstone blocking the cystic duct
– May also be acalculous

90
Q

Cholecystitis: Complications

A

Infections, perforation, peritonitis, pancreatitis

91
Q

Cholecystitis: Treatment

A

Gallbladder is often removed

92
Q

Acute Cholecystitis

A

• Acute inflammation of the gallbladder
– Generally secondary to gallstone obstruction in >95%

93
Q

When is Acute Cholecystitis most common?

A

• Most common: females in 5th & 6th decade

94
Q

Acute Cholecystitis: Most have had prior attacks of

A

Biliary colic

95
Q

Pain with cholecystititis is:

A

More severe & lasts longer

96
Q

Acute Cholecystitis usually subsides & resolves

A

• Subsides in 2-3 days & resolves within 1 week in 85% of
patients

97
Q

Acute Cholecystitis: Signs & Symptoms

A

• Intermittent –progress to constant
– More severe and longer than the biliary colic with gall stones
• RUQ pain
• May radiate to infrascapular
region or back
• Nausea & vomiting (>70%)
• Fever (33%)
• Jaundice (25-50%)
• Ingestion of large, fatty meal
before onset?

98
Q

Acute Cholecystitis: Exam

A

-Murphy’s Inspiration Sign (+)

99
Q

Acute Cholecystitis: Diagnostics

A

-US to diagnose
-Liver function tests, CBC

100
Q

Chronic Cholecystitis

A
101
Q

Chronic Cholecystitis

A

• Long standing gallbladder inflammation
– Always due to gallstones
– Prior episodes of cholecystitis
– Long term can begin to become fibrotic
– Porcelain gallbladder: extensive calcification of fibrosis

102
Q

Chronic Cholecystitis: Symptoms

A

Recurrent biliary colic
– No fever (fever suggests acute state)

103
Q

Chronic Cholecystitis: Treament

A

Laparoscopic cholecystectomy (remove the gall bladder)

104
Q

Cholangitis

A

• Inflammation and/or infection of the hepatic & common bile ducts
– Associated with common bile duct obstruction
– Obstruction causes rapid proliferation of bacteria
– Other causes: biliary tract stenosis, tumor, parasites

105
Q

Cholangitis: Peak Incidence

A

7th decade: unusual < 50 yo

106
Q

Cholangitis: Complications

A

Pancreatitis

107
Q

Cholangitis: Development

A

70-90% of cases:
• Gallstone partially blocks duct
• Bacteria from duodenum ascends into gall bladder •
-Infection with inflammation sets in

10-30% of cases
• Blockage caused by strictures, tumors, etc
• Still allows bacteria to ascend & cause infection

108
Q

Cholangitis: Development

A

70-90% of cases:
• Gallstone partially blocks duct
• Bacteria from duodenum ascends into gall bladder • Infection with inflammation sets in

10-30% of cases
• Blockage caused by strictures, tumors, etc
• Still allows bacteria to ascend & cause infection

109
Q

Cholangitis: Signs & Symptoms

A

• Acute onset
• Charcot’s triad: (mc sx)
– RUQ pain
– Jaundice
– Fever
• Dark colored urine
• May have other symptoms if there are complications

110
Q

Cholangitis: Exam

A

– Murphy’s is not positive

111
Q

Cholangitis: Diagnostics (4)

A

– Labs: WBC ,ALP & bilirubin
– Ultrasound

112
Q

Cholangitis has a ___% mortality rate

A

50%

113
Q

Primary Biliary Cholangitis (PBC)

A

• Autoimmune progressive destruction of intrahepatic (liver) bile ducts

114
Q

PBC leads to: (3)

A

– Leads to cholestasis, cirrhosis, liver failure

115
Q

PBC: Etiology

A

• 95% of patients are female age 35-70
– Genetic predisposition prevalent

• Up to 84% of pts have at least one other autoimmunity:
– Sjogren’s syndrome, RA, Raynaud’s phenomenon, scleroderma, thyroiditis

116
Q

PBC: Development of Sx

A

• Sx may develop at any stage: 50% have no sx, other sx may have for months/ years

117
Q

PBC: Signs & Symptoms

A

• 50% of pts have no sx

• Initial sx tend to be:
– Fatigue & pruritus (50%)
– Dry mouth / eyes

Other possible sx:
• RUQ pain (10%)
• Musculoskeletal
complaints (up to 70% )
• Peripheral neuropathy
– Sx related to other
autoimmune disorders

118
Q

PBC:Exam

A

-Non-Tender hepatomegaly (25%)
-Splenomegaly (15%)
-Jaundice (10%)

119
Q

PBC:Diagnostics (4)

A

• Diagnostics:
– Liver function tests
– AMA (elevated in 95%)
– US, liver biopsy

120
Q

PBC: Treatment

A

• No specific treatment
– Depends on status of pt
• Focus on management of complications
• Avoid alcohol & hepatotoxic drugs
• Osteoporosis, vitamin A, K, E deficiency common

121
Q

Primary Sclerosing Cholangitis

A

• Autoimmune disease: Progressive inflammation and scarring of bile ducts
– Affects both intrahepatic and extrahepatic ducts
– Bile duct blockage causes bile to accumulate in liver, damaging liver and causing fibrosis/cirrhosis

122
Q

Primary Sclerosing Cholangitis: Etiology

A

• 2:1 male to female starting around 20-

-More than 80% have ulcerative colitis

123
Q

Primary Sclerosing Cholangitis: Complications

A

– Malabsorption issues
– Leads to cirrhosis, liver failure & liver cancer

124
Q

Primary Sclerosing Cholangitis: Treatment

A

• Tx: liver transplant
– Supportive care: fat soluble vitamins A,D, E, K

125
Q

Primary Sclerosing Cholangitis: Signs/Symptoms

A

• Fatigue
• Severe jaundice
• Intense pruritis
• Dark urine
• Malabsorption
• Steatorrhea
• Cholangitis (bile duct infection)(Charcot’s triad)
• Hepatomegaly
• Portal hypertension

126
Q

Primary Sclerosing Cholangitis: Diagnostics

A

• Endoscopic (ERCP)

127
Q

Pancreatitis

A

• Inflammation of the pancreas

• Can be acute or chronic
– Acute: can be life threatening
– Chronic: often result of fibrosis

128
Q

Pancreatitis: Causes (2)

A

• Causes:
– Most common condition: gall stones
– Alcohol abuse
– Other

129
Q

Pancreatitis: Pathology

A

• Pathology: conditions cause the release of activated pancreatic enzymes
– Pancreatitis is a secondary effect

130
Q

Acute Pancreatitis

A

• Inflammation of the pancreas
• Sudden onset
• Can be life threatening…EMERGENCY

131
Q

Acute Pancreatitis: Causes (2)

A

• Most common (80%): gallstones and alcohol abuse
• Other acute causes

132
Q

Acute Pancreatitis: Diagnosis

A

– Diagnosis based on clinical presentation and labs
• Specifically amylase and lipase

133
Q

Acute pain that is intense radiating into the back and boring: Only 2 DDxs

A

AAA and Pancreatitis

134
Q

Appencitis is a common ddx for:

A

Meckel’s Diverticulum

135
Q

Acute pancreatitis: Symptoms

A

• Pain
– Sudden onset
– Steady pain, peaking within 10-30 minutes
– Epigastric region
– May radiate to back (50%)
• Fever
• Shock and confusion

136
Q

Acute Pancreatitis: Differential Diagnosis

A

Dissecting anuerysm

137
Q

Acute Pancreatitis: Exam

A

• Tachycardia
• Abdominal guarding
• Distention
• Hypoactive bowel sounds
• Palpable abdominal mass with tenderness

138
Q

Acute Pancreatitis: Diagnostics (4)

A

• Amylase & lipase
– Elevated first day
– Return to normal in 3-7
-WBCs elevated
• CT , endoscopy
• Ultrasound if gallstones suspected

139
Q

Chronic Pancreatitis

A

• Persistent inflammation of pancreas
– Permanent structural damage
– Decline in exocrine & endocrine function

140
Q

Chronic Pancreatitis: Causes

A

• Causes (U.S.):
– Alcohol (<50%)* Change to 50%
– Idiopathic (15-25%)
– Other: autoimmune, hereditary, stenosis

141
Q

Chronic Pancreatitis: Development

A

• Development:
– Initial symptoms: recurrent pain
– Later complications may develop: malabsorption, DM

142
Q

Chronic Pancreatitis: Diagnosing

A

• Diagnosing can be difficult
• Based on clinical suspicion as labs can often be normal
• Imaging can confirm: CT
• May see late pancreatic calcification on x-ray (30%)
• Must exclude pancreatic cancer as source of pain

143
Q

Chronic Pancreatitis: Symptoms

A

• Pain
– Recurrent
– Severe-may last hours or several days
– Epigastric & LUQ pain
– May radiate to back
• Weight loss
• May have other symptoms related to malabsorption or glucose intolerance

144
Q

Chronic Pancreatitis: Diagnostics

A

• Amylase and lipase
– Often normal
– Late stages may be abnormal
• Other labs may be
abnormal due to malabsorption/ DM

145
Q

Chronic Pancreatitis: Treatment (Medical)

A

• Frequent, small volume low fat meals
• Fasting during episodes

146
Q

Chronic Pancreatitis: Treatment (Lifestyle)

A

• Avoid alcohol
• Pancreatic enzymes

147
Q

Pancreatic Cancer is considered a:

A

• “Silent killer”: early stages nonsymptomatic

• 2010: 43,000 diagnosed
– Poor prognosis: 38,000 died
– Fewer than 5% survive after 5 years

148
Q

Appendicitis

A

• Acute inflammation of appendix

149
Q

Appendicitis: Epidemiology

A

– Occurs in 5-10% of population
– Most commonly between 10-30 years old

150
Q

Appendicitis is considered a:

A

• Emergency ..can rupture

151
Q

Appendicitis: Classic Symptoms

A

• Pain
– Initially epigastric or
periumbilical –Localizes to RLQ within 12-18 hrs
– May also have flank pain
• Nausea, vomiting, anorexia
• Low grade fever
• Rosvings, psoas sign, obturator
sign, McBurneys, sign

152
Q

Rosvings Sign

A

Rebound test: palpate LLQ with pain referral to RLQ

153
Q

Psoas Sign

A

Pain with right thigh extension

154
Q

Obturator Sign

A

Pain with internal rotation of flexed right thigh

155
Q

Obturator Sign

A

Pain with internal rotation of flexed right thigh

156
Q

McBurney’s Sign

A

Point of maximal tenderness in RLQ …1/3 in from ASIS

157
Q

Dunphy Sign

A

RLQ pain with coughing (nice to know)

158
Q

Markle Sign

A

Heel drop causes pain

159
Q

Appendicitis: Diagnostics

A

• Primarily diagnosis is clinical and requires immediate referral

160
Q

Appendicits: Treatment

A

• Urgent surgery

GIGU & Men’s Health (7 decks)

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