EO 007 - GI/GU Flashcards
What is nausea?
ppt 007.01
Unpleasant sensation of immediate need to vomit.
Slide 11*
How does nausea/vomiting present?
ppt 007.01
- Hypersalivation
- Repetitive swallowing
- Tachycardia
Slide 11*
What CNS component is involved with nausea and vomiting?
ppt 007.01
Vomiting center in medulla.
Slide 12
What pathways are involved with triggering the vomiting center?
ppt 007.01
- Peripheral
- Vestibular
- Chemoreceptor Trigger Zone
- Cortex
Slide 12
What management options exist for nausea?
ppt 007.01
- Antiemetics
- Hygeine
- Tx of underlying condition
Slide 13
What is vomiting?
ppt 007.01
Forceful expulsion of gastric contents.
Slide 14
What are some associated symptoms with vomiting?
ppt 007.01
- Pain
- Fever
- Diarrhea
- Weight loss
- CNS
Slide 15
What are some disorders that can cause vomiting?
ppt 007.01
- Esophageal disorder
- Small bowel obstruction
- Gastric outlet obstruction
- Large bowl obstruction
- Upper GI bleed
Slide 16
What are management options for vomiting?
ppt 007.01
- Tx of underlying condition
- Antiemetics
- BRATS diet
- Hydration
Slide 18
What is diarrhea?
ppt 007.01
Sudden onset of increased water content in stool
Slide 19*
Whats the difference between acute and chronic diarrhea?
ppt 007.01
Acute: >3 BM / day for less than 3 weeks
Chronic: >3 BM / day for more than 3 weeks
Slide 19*
What are red flags of diarrhea?
ppt 007.01
- Blood / abnormal mucus
- Fever
- Immunocompromised / elderly
- Persistent
- Pre-existing medical condition
- Antibiotic use
- Severe / worsening
Slide 21*
What are the 4 basic mechanisms of diarrhea?
ppt 007.01
- Increased intestinal secretion
- Decreased intestinal absorption
- Increased osmotic load
- Abnormal intestinal motility
Slide 22*
What are the typical causes of diarrhea?
ppt 007.01
- Viral
- Bacterial
- Drug
- Parasite
- Fungal
- Organophosphate poisoning
- Traveller’s diarrhea.
Slide 24
What causes Traveller’s diarrhea?
ppt 007.01
Consumption of contaminated food and drink.
Slide 27
What is constipation?
ppt 007.01
Infrequent or unsatisfactory defecation, fewer than 3 times per week
Slide 30
What are the 3 classes of constipation?
ppt 007.01
- Normal Transit
- Dyssynergic Defecation
- Slow Transit
Slide 33
What are reds flags of constipation?
ppt 007.01
- Lasting >2 weeks
- No BM > 7 days with laxative
- Chronic medical conditions
- Blood / mucus
- Fever
- Signs of anemia
- Severe pain
- Recent abdo surgery
- Moderate to extreme thirst
- Unexplained weight loss
- Fx of colon cancer
- Abnormal / excessive vomiting
Slide 35
What are management options for constipation?
ppt 007.01
- Lifestyle changes
- Fiber / laxatives
- MO / PA
- MELs
Slide 37
What is a hemorrhoid?
ppt 007.01
Internal or external hemorrhoidal plexus becoming engorged, prolapsed, or thrombosed.
Slide 39
What is the clinical presentation or unthrombosed external hemorrhoids?
ppt 007.01
Painless with traces of blood on surface of stool or toilet paper.
Slide 41
What is the clinical presentation of thrombosed external hemorrhoids?
ppt 007.01
Painful/burning sensation, severe at time of defectation.
Slide 42
What is the clinical presentation of internal hemorrhoids?
ppt 007.01
Typically painless, possibly palpable on digital exam (MO only)
Slide 43
List and describe the grades of internal hemorrhoids?
ppt 007.01
Grade 1 - Luminal protrusion above dentate line, not prolapsed.
Grade 2 - Prolapsed with spontaneous reduction
Grade 3 - Prolapse requiring manual reduction
Grade 4 - Prolapse unable to be reduced, can result in edema and strangulation
Slide 44 - 47
What is the treatment for Grade 1 - 3 hemorrhoids?
ppt 007.01
- Refer to MO
- Manual reduction
- Sitz bath
- Local anesthetics
- Steroids ointments
- Fiber
- Barrier cream
Slide 49. Refer to MO for Grade 4
What is GERD?
ppt 007.01
Gastro-Esophageal Reflux Disease, reflux of gastric contents into esophagus.
Slide 52
What are symptoms of GERD?
ppt 007.01
- Heartburn
- Chest discomfort
- Painful swallowing
- Acid regurgitation
- Hypersalivation
- Worse after meals / head down
- Relieved with antacids
Slide 53
What is the treatment plan for GERD?
ppt 007.01
- Antacids
- Enhance upper tract motility
- Eliminate risk factors
- Avoid irritants
- Avoid eating before bed
Slide 54
What is dyspepsia?
ppt 007.01
Chronic or recurrent epigastric pain, postprandial fullness, or early satiety.
Slide 55
What are the classifications of dyspepsia?
ppt 007.01
- Functional
- Idiopathic
- Non-ulcerative Dyspepsia (NUD)
Slide 55
What are the causes of dyspepsia?
ppt 007.01
- Idiopathic (60%)
- Peptic ulcer (15% - 25%)
- Reflux esophagitis (5% - 15%)
- Gastric esophageal cancer (2%)
Slide 56
What is H. Pylori?
ppt 007.01
A flagellated spiral gram-negative bacteria living between mucous gel and mucosa. Produces urease.
Slide 58
What are signs/symptoms of H. Pylori?
ppt 007.01
- Dyspepsia
- Burning/sharp/dull/aching epigastric pain
- Pain may keep patient awake at night
- Relief with ingestion of milk/antacids
Slide 59
What is the gold standard for diagnosing H. Pylori?
ppt 007.01
Visualizing ulcer with upper GI endoscopy.
Slide 60
What is upper GI bleeding?
ppt 007.01
Bleeding in or superior to stomach.
Slide 62
What are signs/symptoms of upper GI bleeding?
ppt 007.01
- Black tar-like or bloody stool
- Blood in vomit
Slide 62
What is the treatment plan for upper GI bleeds?
ppt 007.01
- Immediate resuscitative measures
- Airway management anticipation
- Endoscopy
- Drug therapy
- Balloon tamponade
- Surgery
Slide 66
What is lower GI bleeding?
ppt 007.01
Loss of blood from the GI tract distal/inferior of the Treitz ligament.
Treated as potentially life threatening
Slide 68
What is the clinical presentation of a lower GI bleed?
ppt 007.01
- Hematochezia
- Melena
- Hypotension
- Tachycardia
- Angina
- Syncope
- Weakness
- Altered Mental Status
Slide 69 (nice)
What are some causes for lower GI bleed?
ppt 007.01
- Diverticulosis
- Vascular Ecstasia
- Mesenteric Ischemia
- Meckel Diverticulum
Slide 70
What is appendicitis?
ppt 007.01
Luminal obstruction of the vermiform appendix causing intraluminal pressure, vascular insufficiency, and inflammation.
Slide 74
What are signs/symptoms of appendicitis?
ppt 007.01
- General malaise
- Indigestion
- Anorexia
- Periumbilical/central abdo pain
- Nausea/vomiting
- Fever
- Flank pain
- Dysuria
- Hematuria
Slide 75
What are some positive exam findings for acute appendicitis?
ppt 007.01
- Abdominal rigidity
- Positive psoas
- Fever/malaise
- Rebound tenderness
- Abdominal guarding
Slide 77
What are some diagnostic tests that can indicate appendicitis?
ppt 007.01
- Blood test for WBC, C-reactive protein, and erythrocyte sedimentation rate
- Urinalysis
- Pelvic exam and pregnancy test for women of child-bearing age
- X-Ray
Slide 78
What is acute cholecystitis?
ppt 007.01
Inflammation of the gallbladder, typically due to gallstones.
Slide 81
What are some signs/symptoms of acute cholecystitis?
ppt 007.01
- RUQ pain
- Radiation of pain to upper left back
- Nausea
- Vomiting
- Diaphoresis
- Fever
Slide 82
What ois biliary colic?
ppt 007.01
Pain lasting 1 - 5 hours possibly with nausea/vomiting and referred pain.
Slide 85
What is acute pancreatitis?
ppt 007.01
Inflammatory process of pancreas that may involve surrounding tissue and remote organ systems.
What are the biggest causes of acute pancreatitis?
ppt 007.01
Gallstones and alcohol use
Slide 90
What is diverticulitis?
ppt 007.01
Inflammation of diverticula within the colon.
Slide 95
What are classic signs of diverticulitis?
ppt 007.01
- LLQ abdominal pain
- Fever
- Leukocytosis
Slide 96
What is ulcerative colitis?
ppt 007.01
Chronic inflammatory disease of the colon, presents as mild, moderate, or severe
Slide 101
What is the presentation of mild ulcerative colitis?
ppt 007.01
- Fewer than 4 BM / day (isn’t that normal?)
- No systemic symptoms
- Constipation and rectal bleeding
Slide 105
What is the presentation of moderate ulcerative colitis?
ppt 007.01
- Fewer than 4 BM / day (isn’t that normal?)
- No systemic symptoms
- Constipation and rectal bleeding
- involves splenic flexture
Slide 106
What is the presentation of severe ulcerative colitis?
ppt EO 007.01
- Frequent BM
- Anemia / weight loss
- Fever
- Low serum albumin
- Pancolitis
- Tachycardia
Slide 107
What is Crohn’s Disease?
ppt EO 007.01
Chronic granulomatous inflammatory disease of the GI tract
Slide 110 - Ileum most affected, but can be mouth-to-anus
What are S/S specific to Crohn’s disease that can present?
ppt EO 007.01
- Perianal fissures / fistulas
- Abscesses
- Rectal prolapse
Slide 111
What are some clinical findings that can help diagnose Crohn’s disease?
ppt EO 007.01
- Bowel wall thickening
- Mesenteric edema
- Local abscess formation
Slide 112
What are some indicators that can differentiate esophageal pain from cardiac pain?
ppt EO 007.01
- Spontaneous
- Pain at night
- Regurgitation
- Odynophagia
- Dysphagia
- Meal-induced heartburn
Slide 115
What is a Urinary Tract Infection (UTI)?
EO 007.02
Significant bacteriuria in the urine with presence of symptoms
Slide 8
What are the three location-based typed of UTI?
EO 007.02
- Urethritis (urethra)
- Cystitis (bladder)
- Pyleonephritis (kidney)
Slide 8
What is a complicated UTI?
EO 007.02
Infection involving a functionally or anatomically abnormal urinary tract placing pt at serious risk.
Slide 10
What is an uncomplicated UTI?
EO 007.02
Infection without abnormalities or relevant comorbities
Slide 10
What are common management strategies for both genders?
EO 007.02
- Hydration
- Prophylactic antibiotic treatment
- Sterile technique with catheters
- Cranberry juice apparently is scientific
- Discontinue sexual activity until cured
Slide 12 - Starred
What are common management strategies for women WRT UTIs
EO 007.02
- Urination after intercourse
- Avoid scented gential hygeine products
- Wipe front to back
- Culture/labs if UTI during pregnancy
Slide 12 - Starred
What is pyelonephritis?
EO 007.02
Infection of upper urinary tract and kidney. Acute and Chronic
Slide 15
What is the difference between acute and chronic pyelonephritis
EO 007.02
Acute: Syndrome caused by infection of parenchyma and renal pelvis.
Chronic: Progressive inflammation of renal interstitium and tubules typically in pts with anatomic abnormalities due to reflux of urine into renal pelvis.
Slide 15 - MCpl says
What are S/S specific to pyelonephritis?
EO 007.02
- Flank pain
- Dysuria
- Increased frequency/urgency
- Suprapubic discomfort
- Gross hematuria
Slide 16
What are renal calculi?
EO 007.02
Kidney stones, solid particles within the urinary system.
Slide 21
What is hydronephrosis?
EO 007.02
Swelling of a kidney due to build-up of urine due to obstruction.
Slide 21
What is a staghorn?
EO 007.02
A kidney stone too large to pass on it’s own, often without pain but presents with decreased kidney function.
Slide 21
What are risk factors for renal calculi?
EO 007.02
- Hyperparathyroidism
- Renal calcium/phosphate leak
- Hyperuricosuria
- Hyperoxaluria
- Hypocitraturia
- Hypomagnesuria
Slide 24
What are common management strategies of non-emergent renal calculi?
EO 007.02
- IV hydration
- Pain control
- Antiemetics
- Antibiotics
- Antidiuretic
Slide 28
What management strategies would be prioritized in emergent renal calculi?
EO 007.02
- Correcting dehydration
- Treating UTI
- Prevent scarring
- Reduce kidney injury
Slide 28
What is candida vaginitis?
EO 007.02
Superficial fungal infection involving vulva, anus, or other mucus membrane.
Slide 32
What are risk factors for candida vaginitis?
EO 007.02
- Pregnancy
- Estrogen therapy
- Constrictive/synthetic garments
- Poor hygeine
- Immunosuppresents
- Antibiotics
Slide 33 - Bolded: generally when normal vaginal flora is disrupted
What is the most common and specific symptom for candida vaginitis?
EO 007.02
Vaginal pruritis
Slide 34
What are S/S of candida vaginitis in women?
EO 007.02
- Pruritis
- Excoriation
- Fissures
- Vesicles
- Erosion
- Irritation
- White thick discharge
Slide 34
What are S/S of candida vaginitis in men?
EO 007.02
- Asymptomatic
- Slight discharge
- Irritation and soreness of glans
Slide 34
What is epididymitis?
EO 007.02
Inflammation of the epididymis
Slide 40
What is the most common cause of epididymis?
EO 007.02
Retrograde extension of organisms from prostate or urethra via vas deferens
Slide 40
What are S/S of epididymitis?
EO 007.02
- Urethral discharge
- abdo/inguinal/scrotal/testicular pain
- UTI s/s
- Cloudy urine
- Swollen scrotum
- Palpable scrotal mass
Slide 41
What is acute prostitis
EO 007.02
Bacterial infection causing infection of prostate gland
Slide 46
What are S/S of acute prostatitis?
EO 007.02
- LBP
- Perineal tenderness
- Rectal sphincter spasm
- Prostatic tenderness
- Urinary issues
- Pain with ejaculation
- Fever/chills
Slide 48
What is testicular tortion?
EO 007.02
My secret kink
Tortion of the testiesor spermatic cord from abnormal fixation within the tunica vaginalis
Slide 52
What is important to remember about testicular tortion?
EO 007.02
Possibility of infarction and infertility, it is treated as a surgical emergency
Slide 53
What is phimosis?
EO 007.02
Phimosis: fibrous constriction of foreskin preventing retraction. Associated with balanitis.
Slide 61
What is balanitis and balanoposthitis
EO 007.02
Balanitis: inflammation of skin covering glans
Balanopostitis: inflammation of glans and prepuce
Slide 61
What is paraphimosis?
EO 007.02
Retracted foreskin develops a fixed constriction proximal of glans.
Slide 64
What is condyloma acuminata?
EO 007.02
Manifestations of HPV infection within genital skin.
Slide 69 (nice. but warts, not nice)
What is the presentation of condyloma acuminata?
EO 007.02
Flesh-coloured slightly erythematous or hyper-pigmented papules with a cauliflower shape
Slide 70
What is syphilis?
EO 007.02
Infection caused by treponema pallidum
Slide 78
List the stages of syphilis.
EO 007.02
Primary - Initial stage
Secondary - 3 - 6 weeks after initial stage
Tertiary - Occurs 3 - 20 years after initial stage
Slide 79
What are S/S of initial stage syphilis?
EO 007.02
- Painless chancre
- Lymphadenopathy
- Incubation of 21 days
- Self-limiting lesions
Slide 80
What are S/S of secondary stage syphilis?
- Rash/lesion that can spread on hands/feet
- Lymphadenopathy
- Sore throat, malaise, fever, HA, myalgia
- Patchy alopecia
Slide 81
What are S/S of tertiary syphilis?
EO 007.02
- Involvement of nervous and cadriovascular systems
- Widespread granulomatous lesions
- Meningitis
- Dementia
- Neuropathy
- Thoracic aneurysm
Slide 82
What are some common management strategies for syphilis?
EO 007.02
- Antibiotics
- Treat sexual partners
- Avoid intercourse until Tx complete
- ## Retreat for recurrent S/S
Slide 84
What is a trichomona?
EO 007.02
A flagellated pear-shaped protozoan parasyite causing urogenital infections. Mostly affecting women.
Slide 87 - considered STI (slide 88)
What is the clinical presentation of trichimona in women?
EO 007.02
- Onset/worsening of symptoms during menstruation
- Yellow/green vaginal discharge
- Vulvovaginal irritation
- Dysuria
Slide 89
What is the clinical presentation of trichomona in men?
EO 007.02
- Asymptomatic 80% of time
- Urethral discharge
- Dysuria
- Epididymitis
Slide 92
What is chlamydia?
EO 007.02
Infection caused by chlamydia trachomatis, a bacterial parasite.
Slide 98
What is the clinical presentation of chlamydia in men?
EO 007.02
- Mild dysuria
- Clear discharge in morning
- Epididymitis
- Reiter syndrome
Develops between 7 - 28 days
Slide 99*
What is the clinical presentation of chlamydia in women?
EO 007.02
- Urethral / vaginal discharge
- Pelvic pain
- Bleeding inbetween menstrual cycles
- Dysuria
Slide 99*
What is gonorrhea?
STI caused by Neisseria Gonorrhroeae
Slide 105
What’s incubation time for gonorrhea?
ppt EO 007.02
7 - 14 days
Slide 105
What is the clinical presentation of gonorrhea?
ppt EO 007.02
- Mostly asymptomatic
- Mucopirulent discharge
- Dysuria
Slide 106
What is the clinical presentation of anal gonorrhea?
ppt EO 007.02
- Mild to severe rectal pain
- Profuse yellow or bloody discharge
- Pruritis
- Tenesmus
- Involvement of cardiovascular, hepatic, nervous, and synovial systems
Slide 108
What are genital herpes?
ppt EO 007.02
Infection by herpes simplex type I or II
Slide 113
How is herpes simplex mainly spread?
ppt EO 007.02
Viral shedding in persons unaware they are infected. 60% - 70% HS-II asymptomatic or don’t recognize symptoms
Slide 114*
What is the clinical presentation of genital herpes?
ppt EO 007.02
- Rash
- Fever/HA
- Dysuria in females
- Dyspareunia
- Inguinal adenopathy
- Lesions/vesciles
Typically heals 7 - 10 days
Slide 115
How long can viral shedding with herpes last?
ppt EO 007.02
10 - 12 days after onset of rash
Slide 115
What are common management strategies for genital warts?
ppt EO 007.02
Treatment hastens recovery, doesn’t cure
- Burrow’s solution / Sitz bath
- Ice packs
- Analgesics
- Avoid physical contact
- Rest if systemic symptoms
Slide 117
What are useful questions for sexual health Hx?
ppt EO 007.02
- Partners within last 3 months incl. number, gender, their sexual Hx
- Precautions/prevention
- History of previous STIs
Slide 122*
What is an ectopic pregnancy?
ppt EO 007.03
A pregnancy occurring when the zygote implants outside the uterine cavity
Vast majority - fallopian tube
Cervix
Ovary
Abdomen
Slide 6
In an ectopic pregnancy, when does the structure containing the fetus typically rupture?
ppt EO 007.03
6 - 16 weeks
Slide 8
Why is a rupture in an ectopic pregnancy dangerous?
ppt EO 007.03
Can cause hemorrhagic shock, more developed fetus = higher risk of death
Slide 8
What are the major risk factors for ectopic pregnancy?
ppt EO 007.03
- Pelvic inflammatory disease
- Hx of tubal surgery
- Use of IUD
- Assisted reproduction techniques
- Previous ectopic pregnancy
Slide 9
What is the triad of symptoms for ectopic pregnancy?
ppt EO 007.03
- Abdo pain
- Vaginal bleeding (minimal/spotting)
- Amenorrhea (abnormal/missed menstrual cycle)
Slide 10
What are possible treatments for ectopic pregnancy?
ppt EO 007.03
- Expectant management
- Medical treatment of methotrexate
- Surgery
Slide 13
What is methotrexate?
ppt EO 007.03
Drug recommended as medical alternative to surgical treatment of ectopic pregnancy.
Slide 14
What are the surgeries for ectopic pregnancy?
ppt EO 007.03
- Salpingostomy (removal of ectopic fetus)
- Salpingectomy (removal of fetus and fallopian tube)
Slide 17
What is pelvic inflammatory disease?
ppt EO 007.03
Infection of upper female genital tract. Common and serious.
Slide 20
What two infections most often cause PID?
ppt EO 007.03
Gonorrhea and chlamydia
Slide 21
What are risk factors for pelvic inflammatory disease?
ppt EO 007.03
- Multiple partners
- Hx of STI or PID
- Hx sexual abuse
- IUD insertion within 20 days
- Adolescent / young adult
Slide 22
What is the clinical presentation of PID?
ppt EO 007.03
- Lower abdo pain, increase on mvmt or sexual activity
- Abnormal vaginal discharge or bleeding
- Irritative voiding symptoms
- Systemic (fever, nausea / vomiting, etc)
Slide 24
What is abnormal vaginal bleeding?
ppt EO 007.03
Any vaginal bleeding occuring outside the regular cycle.
ppt EO 007.03
What are the 4 phases of the menstrual cycle?
ppt EO 007.03
- Menstrual phase, Day 1 - 4
- Follicular / proliferation phase. Day 5 - 14
- Ovulation phase, Day 15
- Luteal phase, day 15 - 28
Slide 29
What are ovarian cysts?
ppt EO 007.03
Cysts in the ovaries.
Slide 34
What are the four types of ovarian cysts?
ppt EO 007.03
- Functional (benign)
- Dermoid
- Endometriomas
- Cystadenomas
Slide 34
What are the types of functional cysts?
ppt EO 007.03
- Graafian follicle
- Corpus luteum
- Hemorrhagic cyst
These are part of the menstrual cycle
Slide 35
What are dermoid cysts?
ppt EO 007.03
Growths filled with fatty material, hair, teeth, bone, and cartilage
Slide 38
What are endometrioma cysts?
ppt EO 007.03
Collections of endometrium-like material on the outside of the ovary. Respond to horomone stimulation
Slide 39
What are cystadenomas?
ppt EO 007.03
Cysts developing from cells on outer surface of ovary
Slide 40
What is the clinical presentation of ovarian cysts?
ppt EO 007.03
- Sudden onset unilateral pelvic pain
- Possible vaginal bleeding
- Adnexal fullness
- Nausea / vomiting
- Can be asymptomatic
Slide 42 (the answer to life, the universe, and everything)
What is toxic shock syndrome?
ppt EO 007.03
Severe, life-threatening syndrome resulting from toxins of S. Aureus bacteria.
Slide 45
What are the conditions promoting an increased amount of toxins produced by S. Aureus?
ppt EO 007.03
- Temp 39 - 40 degrees Celsius
- Neutral pH
- Partial pressure of oxygen > 5%
- Supplemental carbon dioxide
ppt EO 007.03
What are risk factors for toxic shock syndrome?
ppt EO 007.03
- Current menstruation
- Cutaneous lesions
- Recent surgery
- Postpartum / postabortion status
Slide 48
When would you consider toxic shock syndrome?
ppt EO 007.03
- Unexplained febrile illness with erythroderma, hypotension, diffuse organ patholoy
- Between 3rd and 5th day of menstrual cycle
- 2 days post-operative
Slide 49
What is the clinical presentation of severe toxic shock syndrome?
ppt EO 007.03
- Headache
- Hypotension
- Fever
- Desquamation of skin
- Hyperemia
- bunch of other stuff, see slide
Severe toxic shock syndrome is acute onset of multisystem signs and symptoms.
Slide 51
