GI/GU Flashcards
Alimentary Tract
30 feet long
Includes the mouth and ends at the rectum.
Includes the pharynx, esophagus, stomach, small and large intestine.
Accessory organs
Gall bladder Liver Appendix Pancreas Biliary Duct System
If questioning liver or splenic enlargement auscultate for?
Friction rub (sandpaper)
Ballottement
Lightly tapping fingers in a line accross the abdomen or up and down the abdomen
Splenic Percussion
Just posterior to the mid axillary line in the area of the 10th rib. Shouldn’t be felt unless 3x the normal size.
Rebound tenderness
If pain increases after your release your hand, + rebound tenderness
What could a tender liver on palpation mean?
Inflammation
Hepatitis
Cholecystitis
What could an inflamed spleen mean?
Viral illness
DO NOT palpate if suspected splenic injury
When should you be able to palpate the kidneys?
Postpartum women and pediatrics.
Where are the kidneys palpated?
4 cm above the right iliac crest.
5 cm above the left iliac crest.
When should you do a rectal exam?
Any patient with abdominal pain.
What diet decreases the risk of colon cancer?
Low fiber and high fat
Risk factors for colon cancer
Inflammatory bowel disease Adenomatous polyps/adenomas Personal history or certain types of cancer (uterine, ovarian) Race- high incidence in black women Physical inactivity and obesity Smoking Diets high in processed meat
Increased age Men>Women First-degree relative African American Excessive ETOH
Preventing colon cancer
NSAIDs and ASA
Fruits and vegetables, diets low in red meat
Surveillance
Weight loss
Screening tests for colon cancer
FOBT Colonoscopy Sigmoidoscopy Double contrast barium enema CT Colonography
When should colonoscopies be done?
Age 50 and up unless you have a first degree relative , then check 10 years before that
Age 50-75 FOBT annually, sigmoidoscopy every 5 years, with FOBT every 3 years, screening colo every 10 years.
Age 76-85 No routine screening
What causes sudden severe abdominal pain?
Acute perforation, inflammation, torsion of abdominal organ, ruptured fallopian tube, perforated gastric ulcer, peritonitis or acute pancreatitis
Nausea without vomitting
Hepatocellular disease, pregnancy, metastatic disease
Causes of dry skin
Chronic renal or hepatic diseases Lymphoma Hodgkin's disease Malignancies DRY SKIN
Shifting dullness
Ascites test
Percuss the border of tympany and dullness with the patient supine, then have them roll onto their side. Percuss and mark the borders again.
Normal- the borders remain consistent.
Ascites- dullness shifts to the dependent side, tympany at the top.
Fluid wave
Ascites test
If easily palpable means there is ascites.
Press hand edges down the midline and tap on one side with fingertips while feeling the opposite side.
Rovsing’s sign
Pain in the RLQ during left sided pressure.
+ for pain indicates appendicitis
Psoas sign
Ask patient to raise their thigh against your hand while pressing on the knee. This contracts psoas muscle. If this increases their pain it indicates an inflamed appendix.
Obturator sign
Flex patients right thigh at the hip. With the knee bent rotate the leg internally. This stretches the internal obturator muscle. If + for pain in the right hypogastric area this is indicates inflamed appendix.
Murphy’s sign
When patient has RUQ pain/tenderness. Hook the left thumb of the right hand under the costal margin. As patient to take a deep breathe. Note the degree of tenderness. A sharp increase in tenderness with inspiratory effort is a + sign for acute cholecystitis.
McBurney’s sign
2 inches from the anterior superior spinous process of the ilium on a line drawn from that process to the umbilicus. Press down on this point, if having pain indicates appendicitis.
Diagnostic tests for abdominal pain
Labs- cbc, urinalysis, pregnancy test, amylase/lipase,
ECG
Radiologic studies- plain films, ultrasound, CT
General treatment principles for abdominal pain
Volume repletion
Pain relief
Antibiotics
Surgical consult, serial evaluation, discharge
Functions of the Genitourinary System
Reproduction process
Removing and filtering waste products
Maintaining volume states and fluid composition
Assisting in the regulation of acid-base balance
Regulating BP
Producing erythropoietin and vitamin D
How often should men do a self-screening?
Once a month in the shower
HPV vaccine
Age 11-21 for males. Can prevent genital warts, anal cancer, and penile cancer. Reduce HPV transmission to female sex partners and lower risk of oropharyngeal cancers.
Instructions for Safe Sexual Practices
Using a new condom with each sex act
Apply before any contact occurs
Add only water-based lubricants
Immediately withdraw if condom breaks and hold the condom while withdrawing
When should men seek clinical attention for genital concerns?
Painless lump, swelling, enlargement in either tsticle, pain or discomfort in a testicle, feeling of heaviness or a sudden fluid collection in the scrotum or a dull machine in the lower abdomen or groin.
Diagnostic Testing for Genitourinary Disorders
Blood Test Urinalysis- culture and sensitivity 24 hour urine collection for protein and creatinine Spot urine specimen for sodium and urine osmolality Renal ultrasound IV pyelography Fractional excretion of NA+ level GFR PSA prostate-antigen test
Newborn urine
Should occur during the first 24 hours after birth
Usually colorless and odorless
Persistant diaper rash can be a sign of a UTI
Determine if there was use of sex hormones or birth control pills during pregnancy
GU considerations for the peds patient
UTIs do not occur until 2-6 years old unless abnormal structure of the kidneys
Sign of UTI- toilet trained child having accidents
Increase incidence in adolescents can indicate sexual activity
Peyronie disease
Palpable, non tender hard plaques found just beneath the skin usually along the dorsum of the penis. Crooked, painful erections.
Hydrocele
Non tender fluid filled mass within the tunica vaginalis. Trasilluminates and the examining fingers can palpate above the mass within the scrotum.
Hypospadias
Congenital displacement of the urethral meatus to the inferior surface of the penis.
Scrotal edema
Pitting edema may make the scrotal skin taut as seen in CHF or renal disease.
Scrotal hernia
Indirect inguinal hernia that comes through the external inguinal ring so the examining fingers cannot get above within the scrotum
Cryptochordism
Testis atrophied outside the scrotum in the inguinal canal, abdomen, or near the pubic
Small Testes
Kleinfelter syndrome-Testes <2cm
Cirrhosis, myotonic dystrophy, use of estrogens and hypopituitarism
Acute orchitis
inflamed, painful, tender, and swollen testes
Spermatocele and cyst of the epididymis
A painless moveable cystic mass above the testis. Both illuminate
Varicocele of the spermatic cord
Gravity mediated varicose veins of the spermatic cord, usually found on the left.
Acute epididymitis
Inflamed epididymis, swollen, tender. Can be caused by neisseria gonorrhea, chlamydia, e. coli, Pseudomonas, trauma, an autoimmune disease.
Torsion of the spermatic cord
twisting of the testicle. The cremasteric reflex is almost always absent on the affected side. Surgical emergency, obstructed circulation.
