---GI---GU---Endo--- Flashcards
Infrequent Stool, excessive straining, sense of incomplete evacuation need for digital manipulation
FEWER THAN 3 STOOLS IN A WEEK
Constipation
Dull/aching/throbbing pain before defecation and lessens after but persists between bowel movements,
straining, sneezing, coughing makes it worse
Pain and tenderness interfere with WALKING OR SITTING
Perianal Palpable mass
Anorectal Abscess
Midline gluteal crest with one or multiple sinus openings
recurrent infection at base of spine,
Swelling, TTP, pain persistent discharge
Pilonidal disease
Located below dentate line
caused by straining, constipation, prolonged sitting, pregnancy, obesity and low fiber diets, visible mass perianal inspection
can have acute onset sever pain, blueish perianal nodule.
External hemorrhoids
Sense of fullness anus, mucoid discharge on cloths, painless bright red bleeding prolapse and mucoid discharge
caused by straining, constipation prolonged sitting, obesity, pregnancy and low fiber diets
4 stages
Internal hemorrhoids
Involving rectum/left colon BLOODY diarrhea and fecal urgency, LLQ cramps relieved by defecation no significant tenderness
MOSTLY NON SMOKERS
Ulcerative Colitis
begins late teens/twenties
abnormal stool passage, bloating/distension, dyspepsia, heart burn, chest pain, HA, fatigue, myalgia, urologic dysfunction, gynecologic symptoms
Intermediate lower ABD pain ONSET associated with defecation frequency and sometimes relieved by defecation
Possible Tender Lower ABD pain
irritable Bowel syndrome
Chest pain
30-60min after a meal
Pt complain of regurgitation, dysphagia
associated with ingestion of spicy/acidic/salty/ ETOH
GERD
Smokers and long TERM NSAID usage
Men>women
epigastric pain localized not severe DULL/ ACHING HUNGERLIKE
Relief of pain with goods or antacids
Peptic Ulcer
Mild-moderate aching ABD with LLQ pain
Constipation/loose stool
N/V/Fever/ LLQ tenderness/Possible palpable mass, stool occult blood is common
Diverticulitis
Vague/colicky periumbilical/epigastric pain
Pain shifts to RLQ after 12 hrs
Steady achy with walking or coughing pain
decreased bowels sounds, rectal tenderness, N/anorexia, constipation low grade Fever
POS- Psoas/obturator/McBurney’s point/rebound tenderness/rovsings
Appendicitis
Mild/sudden appearance, steady localized epigastric , Fever/N/V RUQ ABD tenderness (POS murphys sign) leukocytosis after 24-48hrs Possible palpable mass(gallbladder)
Cholecystitis
Acute- sudden
Upper ABD tenderness possible palpable mass
N/V/Fever, tachycardia
hypotension, pallor, cool and clammy
severe weakness/sweating/anxiety
Epigastric ABD pain, STEADY/BORING MADE WORSE BY WALKING/LAYING SUPINE better by SITTING/LEANING FWD
Pancreatitis
ETOH/NSAID abuse, Epigastric pain N/V, hematemesis, stress
Diagnosed with Endoscopy
Gastritis
history of retching/vomiting/straining
Hematemesis w/w/o melena
Mallory wise
Excruciating retrosternal pain due to intrathoracic esophageal perforation
spontaneous perforation from severe straining of esophagus
Boerrhave
Melena-black stool
hematemisis-bright red blood vomit
SBP<100 mmhg
Postural hypotension/tachycardia
Upper GI
Brown stool mixed or streaked with red blood Or marron stool, or bright red blood on defecation/diarrhea
Lower GI
Fever, Possible hypotension, Patient in fetal position worsens with any movement, visible peristalsis ABSENCE of BM in all 4 quadrants Absence or dullness to percussion BOARDLIKE ABDOMENT SHAKE PELVIS REBOUND TENDERNESS
Secondary peritonitis
tachycardia/mild fever
increase in intra ABD pressure reduced muscle tone and other connective
tissue abnormalities force
contents through a widened
internal ring
Palpation- pt coughs/bears down TAPPING sensation at tip of finger
indirect inguinal hernia
Male cough/bear down bulge anteriorly
Tachycardia, mild fever
males swelling may extend into the scrotum
acquired defects that do not involve passage through inguinal canal
direct inguinal hernia
confusion, agitation, unresponsive lethargy, combativeness, seizures focal neuro deficits Whipples triad 1.confusion,anxiety,sweating 2.glucose 70mg/dl 3.clinical signs resolve with glucose elevation
Hypoglycemia
polyuria, polydipsia
unexplained wt. loss, blurred vision, poor wound healing
candidiasis vaginitis, UTI
Glucose 100-126
diabetes 1
40 Y/O > +, obese
polyuria, polydipsia unexplained wt. loss
hypertension, dyslipidemia, retinal blindness, glaucoma/cataracts
LOWER EXTREMITITY ULCERATIONS SECONDARY TO TINEA PEDIS
diabetes 2
Polyuria, polydipsia, fatigue
N/V, stupor, dehydration, hypotension, tachycardia, mild hypothermia, ABD tenderness
RAPID DEEP BREATHING- FRUITY BREATH
Diabetic Ketoacidosis
fatigue, lethargy, weakness, hoarseness, dry skin, brady cardia, constipation, depression, wt. gain menorrhagia, cold intolerance
Thin brittle nails, thin hair, pallor, turgor of mucosa
late signs: slow speech, peripheral edema, dyspnea, absent sweating. puffiness of face and eyelids, thick tongue, hard pitting edema
Hypothyroidism
Sweating, wt. loss, fever, anxiety, nervousness, disorientation, hyperflexia, palpitation, sinus tachycardia, PAC/AFIB, Enlarged and tender thyroid heat intolerance, tremor, stare, menstrual irregularity
Hyperthyroidism
Diffuse adipose tissue nontender localized to sub areolar region, Asymmetrical, nipple retraction, nipple bleeding or discharge, unusual firmness
Gynecomastia
Due to physical straining, trauma, sexual activity
fever, flank pain, scrotal swelling, prostate TTP,
Prehn Sign- elevation of scrotum above pubic symphysis
Pain in scrotum radiates along spermatic cord or flank
UTI-Epididymitis
Sudden Onset
During high humidity or summer months
Sedentary life -hypertension, cardiovascular disease, high protein
and salt intake
LOCALIZED FLANK PAIN CANT FIND A COMFORTABLE POSITION, ipsilateral groin pain may radiate to abdomen
Urinary stone
Painless enlargement of testis-3-6 months,
sensation of heaviness
Acute testicular pain because of intra testicular hemorrhage
Testicular mass
Spontaneous or with Trauma
Men<40
Acute/severe scrotal pain following trauma/physical activity, N/V
Negative cremasteric reflex
BELLS CLAPPER- high riding testis oriented transversely
Testicular Torsion
May cause Urinary retention fibrous constriction of foreskin preventing retraction (stuck forward)
Phimosis
Possible urinary retention
penis distal to foreskin becomes swollen and painful even gangrenous
Retracted foreskin develops fixed constriction proximal to the glans
(stuck backwards)
Paraphimosis
Perianal/sacral/suprapubic pain, high fever
irritative voiding symptoms-urgency/frequency/dysuria
prostate swelling lead to urinary retention
WARM AND TENDER PROSTATE
Acute prostatitis
Low back and perianal pain
suprapubic discomfort
irritating voiding -frequency/urgency/dysuria
PROSTATE MAY BE NORMAL/BOGGY/INDURATED
Chronic bacterial prostatitis
Fever, flank pain, shaking, chills, N/V/D, tachycardia, costovertebral angle tenderness
Irritative voiding-urgency/frequency/dysuria
Pyelonephritis (kidney infection)
Pain worsens during premenstrual cycle/multiple and bilateral
Ages 30-50
symptomatic/A
Breast pain/TTP found on accident
Absence of enlarged or tender lymph nodes
Fibrocystic
Females20 or older\y
Round, Ovoid, rubbery, discrete, relatively mobile, nontender Mass 1-5 cm in in the breast
Fibroadenoma
Rare lesion in breast
Trauma caused
ecchymosis
mass often accompanied with skin or nipple retraction
commonly seen after fat injections to augment breasts
Fat necrosis
Painless lump usually found by female patient
SINGLE NONTENDER ILL DEFINED MARGINES
nipple discharge, pain, erosion, retraction, enlargement or itching of nipples
Positive FMHX
Female breast carcinoma
Increase for patient with prostate cancer
Painless lump usually found by male patient
hard ill defined nontender mass beneath nipple or areola
current/history of gynecomastia
Male breast carcinoma
History- LMP, recent sex-use of lubricants, contraceptives, tampons, douches
Possible antibiotic use, occlusive cloths
WHITE CURD DISCHARGE NOT SMELLY
Vulvovaginal candidiasis
Recent medication or antibiotics
increase in malodorous discharge with out obvious vulvitit/vaginitis NOT SEXUALLY TRANSMITTED
Bacterial vaginosis
STI
women pruritic, malodorous frothy, yellow-green discharge with vaginal swelling
STRAWBERRY CERVIX red macular lesions
Trichomonas Vaginalis
dysmenorrhea, chronic pelvic poain, dyspareunia, abnormal bleeding, maybe asymptomatic
chronic pain and infertility
CERVICAL MOTION TENDERNESS
TENDER NODULES IN CUL-DE-SAC OR RECTOVAGINAL SEPTUM
Adnexal mass or tenderness
Endometriosis
Most common young women
Multiple sex partners
Fever, chills, purulent cervical discharge,
lower back pain, lower ABD pain, menstrual disturbances, post coital bleeding
changes to urinary frequency
Pelvic inflammatory disease
Mild nonspecific GI symptoms or pelvic pressure/bloating,
possible palpable mass
Ovarian Mass
Associated with Hirsutism (dark course hair women’s lip) obesity, cardiovascular disease
CHRONIC ANOVAULATION
menstrual disorders-amenorrhea/menorrhagia
infertility
skin disorders
insulin resistance
hyperandrogenism
Polycystic ovarian syndrome
Sudden lower quadrant pain
Stabbing no radiation
backache, Adnexal tenderness
2-3 months abnormal menstruation possible infertility
VAGINAL BLEEDING WIHT POS HCG, ABD PAIN UNTIL PROVEN OTHERWISE
Ectopic Pregnancy
Engorged breast or sore or fissured nipples
Cellulitis is unilateral
fevers, chills
usually 3 months after delivery
Mastitis
Sudden onset or severe Unilateral ABD pain/Tenderness with guarding
adnexal tenderness on BIMANUAL EXAM
70% on right side
N/V
Ovarian Torsion
Amenorrhea, N/V, Breast tenderness, tingling, urinary frequency/urgency,
Wt. gain, softening of cervix at 7 wks.
QUICKENING PRECEPTION OF 1ST MOVEMENT AT 18 WKS
Intrauterine Pregnancy
Painful swelling on either side of introitus,
fluctuant swelling 1-4 cm in diameter
later to either labiumminus
dyspareunia
Bartholin gland Abscess
emotion/mood predominates along with physical symptoms clear functional impairment of work relationships
Bloating/breast pain, ankle swelling sense of increased wt skin disorders, irritability/aggressiveness depression/ability to concentrate libido, lethargy
Premenstrual dysphoric disorder
“PMDD”
Recurrent cluster of troublesome physical/emotional symptoms develop during 5 days before onset of menses
Bloating/breast pain, ankle swelling sense of increased wt. skin disorders, irritability/aggressiveness depression/ability to concentrate libido, lethargy
Premenstrual syndrome
“PMS”
lactation not associated w/child birth
Possible
pituitary tumors, Cushing syndrome, hypoglycemia
Drugs: phenothiazines, tricyclics, antidepressants, and estrogens
Galactorrhea
surface manifestation of underlying ductal carcinoma
red scaling, crusty patch forms on the nipples, areola and surround skin. Lesions appear eczematous and usually unilateral
Pagets disease
