General Diagnosis 5 Flashcards
direct/conjugated bilirubin
water soluble
increases with duct obstruction (gallstones), hepatic disease, pancreatic cancer
what might increased bilirubin in the blood lead to?
bilirubin in urine (urobilinogen(=)
indirect/unconjugated bilirubin
not water soluble
increases with hemolytic disease, drugs, spleen disorders
indirect/unconjugated bilirubin can be seen in what anemia?
hemolytic anemia
increase in reticulocyte count (coomb’s test)
gallbladder pain referral
to right shoulder or tip of right scapula (viscerosomatic)
cholecystitis
most commonly seen in overweight females
MC cause is cholelithiasis
s/s of cholecystitis
right upper quadrant pain
nausea
vomiting
precipitated by eating a large fatty meal
murphy’s sign
inspiratory arrest sign
breath in, push up on liver
they will stop breathing because it hurts
refer to gastroenterologist
porcelain gallbladder
calcification that can become malignant due to chronic inflammation
pancreatitis
epigastric pain going straight through the T10-12 area like a knife
chronic pancreatitis
seen with alcoholism
acute pancreatitis
911 emergency
grey turner sign
pancreatitis
bleeding into flank
cullen’s sign
periumbilial eccymosis caused by intraperitoneal hemorrhage or seen with a ruptured ectopic pregnancy
pancreatitis
lab tests for pancreatitis
increased amylase and lipase
pancreatic cancer
usually at head of pancreas
presents with dark urine, clay colored stools and jaundice
what position is usually most comfortable for pancreatic cancer?
flexed/fetal position
s/s of diabetes mellitus
polydypsia
polyphagia
polyuria
labs for diabetes mellitus
glucose tolerance test
fasting plasma glucose
HgA1C
insulin dependant type 1
juvenile
under 30
usually thin
non-insulin dependant type 2
adult over 40 usually obese hyperinsulinemia insulin resistance
diabetes insipidus
condition of posterior pituitary gland in which there is insufficient ADH
may have polydipsia, polyuria
NOT polyphagia
hiatal hernia
protrusion of the stomach above the diaphragm
presents with palpable tenderness in LUQ, reflux esophagitis, dyspepsia (indigestion)
made worse after eating a large meal or when lying down
reflux esophagitis
upward reflux of acid contents of the stomach into the esophagus
caused by sliding hiatal hernia
worse when lying down, after eating a big meal, valsalva, bearing down
barrett’s esophagus
destruction of esophagus due to reflux esophagitis
precursor to esophageal cancer)
tests for reflux esophagitis
xray or upper GI series
peptic ulcers
includes gastric and duodenal ulcers
caused by H. pylori
burning pinpoint epigastric pain
coffee ground emesis
gastric ulcer
has no consistent pain pattern
duodenal ulcer
most common type of peptic ulcer
pain occurs 2 hours after eating
black/tarry stool
what test do you do if you suspect duodenal ulcer?
guiac test: occult blood in stool
pyloric stenosis
projectile vomiting in the newborn
gastric carcinoma
most common on the lesser curvature
virchow’s node
virchow’s node
left supraclavicular lymph node involvement
mono of caused by? s/s
HHV-4
seen in young adults
fever, headache, fatigue, lymphadenopathy in cervical region, splenomegaly
labs for mono
atypical lymphocytes in blood (downey cells)
monospot
heterophile agglutination
paul bunnell
osteopetrosis
bone marrow becomes sclerotic, thus RBCs are not made properly
liver and spleen become enlarged
referral of pain for small intestine
periumbilical
regional ileitis
AKA chron’s disease
nonspecific inflammatory disorder that affects distal ileum and colon
s/s of regional ileitis
RLQ pain
chronic diarrhea
cobblestone appearance on sigmoidoscopy
leads to malabsorption of B12
what else can cause regional ileitis
non-tropical sprue/celiac sprue (gluten allergy) can cause chron’s
ulcerative colitis
most common at the colon and rectum
presents with bloody diarrhea
diagnosed with sigmoidoscopy
irritable bowel syndrome
AKA spastic colon
variable degrees of diarrhea in response to stress
more common in females
abdominal pain and gas relieved by bowel movements
appendicitis
dull periumbilical or epigastric pain that radiates to lower right quadrant (mcburney’s point)
s/s of appendicitis
fever nausea vomiting anorexia increased WBC
tests for appendicitis
rebound tenderness rovsing's sign psoas sign obturator sign CT scan
diverticulitis
consequence of inadequate fiber in diet
chronic constipation which causes small outpouchings within colon that become infected
LLQ pain
meckel’s
outpouching of ileum
zenker’s
outpouching of esophagus
cushing’s disease
inceased production of adrenal cortex hormone (hyperadrenalism, hypercortisolism)
s/s of cushing’s disease
moon face buffalo hump pendulous abdomen with purple striae hirsutism weakness HTN increased cortisol decreased bone density more prominent in spine
addison’s disease
decreased aldosterone
hypoadrenalism
hypocortisolism
s/s of addison’s disease
increased ACTH causes melanin deposition thin person decreased blood pressure weakness fatigue lethargy nausea vomiting hair loss
pheochromocytoma
tumor of adrenal medulla
increased catecholamine production (epinephrine, norepinephrine)
may be similar to hyperthyroidism but this produces extreme HTN
nephrolithiasis
made of cacium
flank pain (writhing)
may radiate/travel to groin
murphy’s test
kidney punch
labs for nephrolithiasis
increased BUN
increased uric acid
creatinine clearance
KUB study
hydronephrosis can cause
staghorn calculi
acute glomerulonephritis
nephritic syndrome
caused by group A hemolytic strep (ASO titer)
RBC casts in urine with small amount of protein
nephrotic syndrome
HTN
edema
massive proteinuria
in pregnant women is called pre-exlampsia
pyelonephritis
starts as an LUTI
ecoli
WBC/fatty casts in urine
pylycystic kidney disease
inherited disorder characterized by many bilateral renal cysts that increase renal size but reduce functioning renal tissue
