GIGU Case Presentations Flashcards
what are the different categories of UTIs?
asymptomatic bacteriuria, cystitis, prostatitis, pyelonephritis
what is asymptomatic bacteriuria?
presence of bacteria without symptoms
what is cystitis?
symptomatic bladder infection
what is prostatitis?
symptomatic prostate inflammation due to infection
what is pyelonephritis?
symptomatic infection of the kidneys
why does the classification of uncomplicated vs complicated UTI matter?
it determines the duration of treatment
what are the three categories that determine if the UTI is complicated or not?
systemic symptoms, history of abnormal voiding, foreign body
what makes pyelonephritis different from cystitis?
pyelonephritis includes fevers, flank pain, CVA tenderness, nausea and vomiting
would you order imaging on a mild case of pyelonephritis?
no
what imaging would you order for a more severe case of pyelonephritis?
CT scan of the abdomen/pelvis
what is Lloyd’s sign/punch?
pain to deep percussion in the area of the costovertebral angle
what does a positive Lloyd’s test indicate?
pyelonephritis or ureterolithiasis
where are somatic dysfunctions commonly found in patients with pyelonephritis?
from T10-L2
what is a common somatic finding in the acute and chronic renal patient?
iliopsoas spasm
where are the chapman points for the kidneys?
about 1 inch lateral and 1 inch superior to the umbilicus
where are the chapman points for the bladder?
the umbilicus
where are the chapman points for the urethra?
superior surface of the pubic bone
where are the chapman points for the ureters?
there are none
what is the duration of treatment for an uncomplicated case of pyelonephritis?
3-5 days
what is the duration of treatment for a complicated case of pyelonephritis?
10-14 days
where would you expect to find a chapman point for a SBO?
at the 9th ICS on the right
what does an elevated specific gravity result indicate?
really concentrated urine- dehydration
what are the three different types of mechanical bowel obstructions?
intrinsic, extrinsic, and intraluminal
what could cause an intrinsic mechanical bowel obstruction?
congenital diseases, inflammatory bowel disease, primary intestinal malignancy, volvulus
what could cause an extrinsic mechanical bowel obstruction?
adhesion (from surgery), or neoplasm
what could cause an intraluminal mechanical bowel obstruction?
feces, bezoars, or foreign bodies
what is a functional bowel obstruction?
intestinal dysmotility, no actual mechanical blockage
what does a strangulated bowel obstruction indicate?
vascular insufficiency and high risk for intestinal ischemia
what are the number 1 cause of bowel obstructions in the US?
adhesions
what syndrome is a cause of a functional obstruction?
Olgilvie’s syndrome (acute dilation of the colon)
what can an elevated lactate indicate?
this occurs when there is anaerobic metabolism going on in the body- tells if there is a specific ischemic event going on
what is the gold standard for a patient with a suspected bowel obstruction?
CT scan of abdomen and pelvis
where are the GI sympathetics located?
T9-L2
if a patient with a suspected SBO is able to tolerate it, where should you look for paraspinal TART findings?
from T9-L2
where are the chapman points for the small intestine?
8th-10th intercostal space bilaterally
where are the chapman points for the colon?
anterior IT band
what would you suspect if a patient presented with short duration of symptoms, n/v/d and they are young?
gastroenteritis
what is acute kidney injury (AKI)?
impairment of renal filtration and excretory function over days to weeks that results in retention of nitrogenous and other waste products that are normally cleared by the kidney
what are the three different types of AKI?
pre-renal AKI, intrinsic AKI, post-renal AKI
what could be a cause of pre-renal AKI?
hypotension
what could be a cause of intrinsic-AKI?
glomerulonephritis (conditions leading to inflammation of the glomerulus)
what could be a cause of post-renal AKI?
bladder outlet obstruction
what findings would you expect to see in a patient with pre-renal AKI?
vomiting, diarrhea, history of NSAID use or blood pressure medication, dry mucous membranes, poor skin turgor
when might you test the urine albumin/creatinine ratio?
only if there was protein in the urine
what is a BUN: Cr ratio greater than 20:1 suggestive of?
pre-renal AKI
what do pre-renal patients need in their treatment plan?
IV fluids and NO NSAIDs
what might you suspect if the OSE findings were tight paraspinal musculature on the right at the level of T10-L2, Anterior Chapman’s Point noted 1 inch above and 1 inch to the right of the umbilicus?
pyelonephritis
what might you suspect if the OSE findings were an anterior Chapmans point at the 9th ICS on the right?
an obstructed bowel
what is an example of a functional obstruction?
an ileus
what is an ileus and what is it commonly caused by?
it is a dysmotility that prevents intestinal content from moving distally; common occurrence post-operatively
where should you evaluate the posterior chapman points for a small bowel obstruction/ileus? aka the posterior chapman points for the small intestine
lateral to the spinous process of T8-T10 bilaterally
where are the posterior chapman points for the colon?
transverse process of L2-L4 bilaterally
