Clinical Applications Flashcards
Patient presents with back or flank pain, fever, limp, and inguinal mass. Physical examination shows exacerbation of pain with thigh extension.
Psoas abscess
Patient presents with pain in the RUQ. Patient is diagnosed with an infection, which has caused chronic inflammation of the muscularis externa, which led to hyperplasia and herniation of epithelial cells through this layer. What will be seen on a histological slide of the muscularis externa?
Rokitansky-Aschoff sinuses (deep diverticula of mucosa that may extend through muscularis externa)
Patient presents with an imperforated anus. You educate the patient on the embryological reason for this disorder. You also provide detail on the ways this disorder can be categorized. What do you tell the patient?
An imperforated anus is due to persistent anal membrane. It can be a low, intermediate, or high distinction relative to the levator ani and pelvic bone landmarks.
Duodenal stenosis and duodenal atresia are commonly associated with _____. What is the difference between the 2?
They are commonly associated w/ history of Trisomy 21. Duodenal stenosis is partial occlusion due to ineffective recanalization. Duodenal atresia is complete occlusion.
Patient is a newborn with herniation of SI/LI through the abdominal wall with no peritoneal covering. What is this patient’s diagnosis?
Patient has gastroschiscis.
Patient is a newborn who presents with herniation of SI/LI through the umbilicus. Peritoneal covering remains intact. Parents performed genetic testing of this patient and are aware that she/he has a condition of trisomy. Explain: (1) diagnosis, (2) conditions of trisomy, (3) etiologies.
Patient has omphalocele. Increased risk w/ trisomy 13 and 18. Etiologies: (1) herniated bowel does not fully retract, (2) lateral body folding and fusion is abnormal - wall weakness - herniation, (3) CT of skin and hypoxia muscularture of body wall does not form normally - wall weakness.
Patient is a 2-day old newborn who was brought to the hospital by parents for skin yellowing, white, clay-colored stool, and dark colored urine. What is this patient’s diagnosis? What do you tell the parents regarding mechanism of disease and treatment?
Patient has biliary atresia (2 forms - fetal and perinatal), which is the obliteration of extrahepatic and/or intrahepatic ducts. The ducts are replaced by fibrotic tissue due to acute or chronic inflammation. Treatment - liver transplant; otherwise avg survival time = 12-19 months.
Patient presents to the ED and is diagnosed with pancreatitis for the 4th time in 7 years. What is this patient’s likely diagnosis?
Pancreas division (prone to pancreatitis)
Patient is a 1-month-old who was brought to the ED by his mother for evaluation of vomiting. Mother describes the vomiting as bilious. You ask about patient’s birth history and mother notes that patient was born full term but had a low birth weight. What is this patient’s likely diagnosis?
Annular pancreas
Name the 3 pancreas anomalies.
Accessory pancreatic duct, pancreas division, and annular pancreas
Patient is a 2-month-old infant who was brought to the ED by his mother for evaluation of projectile non-bilious vomiting after feeding, associated with fewer and smaller stools and mild weight loss. What is this patient’s likely diagnosis?
Hypertrophic pyloric stenosis: narrowing of pyloric lumen obstructing food passage
Patient is a 2-month-old infant who was brought to the ED by his mother for evaluation of projectile non-bilious vomiting after feeding, associated with fewer and smaller stools and mild weight loss. You explain to the mother the diagnosis and how it occurs. She asks what causes narrowed opening between stomach and duodenum. What do you tell her?
(1) Muscularis externa hypertrophied to form palpable mass (“olive”) at right costal margin; (2) Spincter unable to relax due to faulty migration of NCC therefore ganglion cells of ENS not well populated
Patient is an elderly male with history of HTN and cardiac disease who reports sudden onset of severe back pain. VS: 90/60 mmHg. Physical exam shows patient is pale, shocked, and tender in the epigastrium. When patient’s abdomen is palpated, there is an “impulse” in the epigastrium. What is the patient’s diagnosis?
Leaking aortic aneurysm
Patient is a 23-year-old female who reports severe pain in the hypogastrium radiating to the sacral region. Patient denies any fevers and is not febrile in the ED. LMP: patient notes that she missed her last period. Physical exam shows tenderness in the supraoptic region. Digital rectal examination and pelvic examination shows tenderness in the rectouterine pouch. What is the diagnosis?
Ruptured ectopic pregnancy
Patient is an 80-year-old male who reports constipation, inability to pass gas, and abdominal swelling for the past 3 days. Patient reports diffuse abdominal pain, which comes in waves. ROS: (+) weight loss. Physical examination shows (+) palpable mass to the LLQ with (+) increased bowel sounds.
Obstructing cancer of descending colon
Patient reports student onset of severe colicky pain from his left “loin” to his “groin”, associated with back pain rated 9/10. Patient additionally reports hematuria, but no dysuria or frequency. Otherwise: (-) fever. Physical examination shows patient is in moderate distress, writhing in pain, and pacing around the room. Abdomen: soft, normal bowel sounds, (-) tenderness, (-) rebound, (-) guarding, (+) left CVA tenderness. What is they patient’s likely diagnosis?
Passage of kidney stone
Patient reports diffuse abdominal pain, which he believes to be “midgut” pain, associated with vomiting, constipation, and inability to pass gas. Patient has a history of abdominal surgeries: appendectomy and hysterectomy. Physical examination shows patient is dry with distended abdomen and increased bowel sounds. However, there is no abdominal tenderness. What is the patient’s likely diagnosis?
Adhesive SBO
Patient is a 25-year-old female who reports abdominal pain for the past 2 days, described as RUQ pain, associated with nausea and vomiting. Patient is a medical student and believes that her pain is “foregut visceral.” Patient also reports recent fever of 101.4 and is febrile in the ED. Additionally, patient reports right shoulder pain, but denies any trauma or injury to that shoulder. Physical exam shows tenderness in the RUQ and positive Murphy sign. What is the patient’s likely diagnosis?
Acute cholecystitis
Patient reports mild abdominal pain for the past 3 weeks, described as constant and worse with eating. Due to the pain, patient states he has been avoiding meals. Today, patient reports that the pain suddenly became severe and has spread throughout his abdomen. Patient complains of all the “typical signs of peritonitis” you have learned about, including abdominal pain/bloating, fever, nausea/vomiting, diarrhea, decreased urine output, increased thirst, decreased bowel movements, and fatigue. What might this patient have?
Perforated gastric ulcer
What is “colicky pain”?
Intermittent cramp like pain caused by obstruction of hollow muscular viscera (GI tract and urinary tract)
What is a common symptom in patients with retroperitoneal pain?
Back pain
What is referred pain?
Pain perceived at a location other than the site of the painful stimulus/origin … caused by network of interconnecting sensory nerves
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. What is at the top of your differential list for this patient?
Hirschprung’s Disease
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. You tell the patient’s mother that the baby likely has Hirschprung’s Disease, but you want to run diagnostic tests to confirm. What do you do?
Rectal biopsy and barium enema
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. Diagnostic tests confirmed Hirschprung’s disease. How would you treat this?
Surgical resection of colon segment lacking the ganglia
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. Diagnostics confirmed that patient has Hirschprung’s disease. Mother wants to know what this is/what causes this disease.
Hirschprung’s Disease is congenital aganglionic megacolon due to absence of migration of NCC. Causes increased wall thickness (hypertrophy) in intestines proximal to aganglionic segment. VIP levels are low therefore colon cannot relax therefore no peristalsis occurs. Abnormal colonic dilation or distinction.
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. Diagnostics confirmed that patient has Hirschprung’s disease. Mother wants to have another baby in the future and is concerned about the genetic mechanism of Hirschprung’s. What do you tell her?
Hirschprung’s = mutation of RET gene (required for migration and differentiation of NCC)
Patient is a 2-day-old newborn who was brought to the ED for constipation, poor feeding, and abdominal distinction which has been increasing in size. Mother notes that patient has not had a bowel movement (“meconium”) since birth. Diagnostics confirmed that patient has Hirschprung’s disease. You also tell mom that the patient has the short-segment disease form. (1) What does this mean? (2) What are the other types?
Short-segment = rectosigmoid region; Long-segment = extends past rectosigmoid, Total colonic aganglionosis = entire colon
