Immune and GI systems Flashcards
What is the primary central gland of the immune system?
thymus
produces lymphocytes (primary immune cells)
(true/false) The thymus is not fully developed until puberty.
FALSE - thymus is fully developed at birth and then reaches maximal size at puberty
Decreases in size and is slowly replaced by adipose tissue as a person ages.
What is the function of the spleen?
- Filters antigens from the blood
- produces leukocytes, monocytes, lymphocytes, and plasma cells in response to infection
- Produces RBC and WBC while in embryo
Only produces lymphocytes after birth unless severe anemia exists
definition
Classification of diagnoses characterized by immune system responses directed against the body’s normal tissues; self-destructive processes impair the body functioning
autoimmune diseases
What is HIV?
A virus that weakens the immune system and destroys cells that fight disease and infection
- CD4+ helper cells, resulting in CD4+ T lymphocytopenia (major immune system defect)
What are the stages of HIV?
Stage 1: flu-like illness within 2-4 wks after exposure/infection
stage 2 (clinical latency): asymptomatic HIV infection or chronic HIV infection that can last a decade or longer
Stage 3 (AIDS): most severe phase; mass destruction of cells resulting in the immune system not being able to fight off disease or illness
How is HIV spread?
Body fluids
Rare: during pregnancy, birth, or breastfeeding
(true/false) HIV can be transmitted through saliva, tears or sweat.
FALSE (unless blood is present)
(true/false) AIDS can be contracted through respiratory inhalation, skin contact, or human waste
FALSE
What is the regular range of CD4?
500-1200 cells/mm
What is used to diagnose AIDS?
- CD4 cell count < 200 cells/mm or if they develop opportunistic illnesses - have a high viral load and are very infectious
- presence of acute symptoms secondary to immune system deficiency (AIDS-Related Complex (ARC))
What is AIDS-related complex (ARC)?
presence of acute symptoms secondary to immune system deficiency
What are the s/s of HIV?
- flu-like symptoms that resolve within a few weeks
(true/false) Getting tested is the only way to diagnose HIV.
true
What are the s/s of AIDS?
- presence of opportunistic infections
- malignancies
- neural conditions
- deconditioning
- anxiety and depression
What opportunistic infections that are considered as AIDS-defining conditions?
- PNA
- candidiasis
- cytomegalovirus
- toxoplasmosis
What is the most common malignancy caused by AIDS?
Kaposki’s sarcoma and non-hodgkins lymphoma
What neuro conditions can be seen with AIDS?
- AIDS dementia complex
- focal encephalitis
- meningitis
- herpes zoster
(true/false) Some patients with AIDS may exhibit a brief, early, nonspecific viral HIV infection and then remain asymptomatic for years.
True
(true/false) antibiotics cure HIV infections
FALSE (no cure for HIV)
Those with HIV will progress to having ____ if not treated.
AIDS
What medication does not cure HIV but does keep those with HIV healthy for many years if taken consistently and correctly?
Antiretroviral therapies (ARTs)
Antiviral drugs reduce the amount of virus (viral load) in the system
What does a retrovirus do?
Replicates in reverse fashion (RNA code is transcribed into DNA)
What are common side affects of ARTs?
- N/V
- diarrhea
- HA
- dizziness
- fatigue
- pain
- rash
(True/false) a person experiencing an acute episode of HIV can participate in exercise testing.
FALSE - no exercise testing during acute infections
Avoid intense exercise with symptomatic individuals due to possible immune suppression occurring
What does staphylococcus aureus commonly begin as?
localized infection through skin portal
Bacterial invasion and spread is through the bloodstream or lymphatic system to almost any body location
What do staphylococcus aureus infections produce on the skin?
Pus formation and abscess
Diagnosis
- swollen, painful red bumps that can quickly progress to an abscess with pus/drainage inside
- area around abscess is warm to the touch
- fever
- possibility to produce life-threatening infections in the body
MRSA
(true/false) MRSA can be treated and reappear in the same individual
true
(true/false) Vancomycin-resistant staphylococcus aureus (VRSA) can be a life-threatening infection
true
- fever
- chills
- swollen lymph nodes
- HA
- muscle and joint aching
- fatigue
- bulls-eye rash
Within 3-30 days of tick bite
Lyme disease
What are the symptoms of lyme disease if left untreated?
Days to months after tick bite
- severe HA and neck stiffness
- arthritis, joint pain and swelling
- palpitations and/or irregular heartbeat (lyme endocarditis)
- inflammation of brain and spinal cord
- nerve pain
- shooting pain
- N/T in hands and feet
- palsy
- issues with short-term memory
What is it called when symptoms of lyme disease linger for months or years after treatment of an acute infection?
10% of cases
Post-lyme disease syndrome (PLDS)
What is the cause of PLDS?
unknown- individuals are asymptomatic in the absence of clinically detectable infection
What are symptoms of PLDS?
- MSK pain
- fatigue
- impaired cognition
- difficulty sleeping
- unexplained numbness
(true/false) An extended course of antibiotics has been proven beneficial for treatment of PLDS.
false
treatment is symptomatic-based (analgesics, antidepressants, and psychotherapy) and most patients recover with time
Diagnosis
- rash with the site of bite being black or crusted
- caused by a tick
- fever and chills
- muscle aches
- confusion
- N/V
- neuro changes
Rocky mountain spotted fever
What are possible complications of rocky mountain spotted fever?
- encephalitis
- inflammation of heart and lungs
- heart failure
- kidney failure
- serious infection in fingers in toes (possible amputation)
- death (if untreated)
Complications of rocky mountain spotted fever can be avoided if treatment is started within ___ days of developing symptoms
5 days
(true/false) MRSA can be contracted via indirect and direct contact to infected person
true
Plasma makes up ___% of of total blood volume
55%
91% water, 7% protein, 2-3% other small molecules
RBCs make up ___% of the total blood volume
45%
What is the function of erythropoietin?
hormone that regulates RBC production
How long do most RBCs last?
120 days
(true/false) RBC count varies with age, activity, and environmental conditions
true
Leukocytes make up __% of total blood volume
1%
Where are leukocytes produced?
bone marrow
Along with RBCs
definition
The normal function and generation of blood cells in bone marrow
hematopoiesis
What regulates production, differentiation, and function of blood cells?
Cytokines and growth factors acting on blood-forming cells
What is ESR?
Rate of RBCs to clot
What is indicated when ESR is elevated?
presence of inflammation
What are the normal values of ESR?
Male: <15 mm/hr
Female: <20 mm/hr
What is hemostasis?
Termination of blood flow by mechanical or chemical processes
- vasospasm
- platelet aggregation
- thrombin and fibrin synthesis
What does blood clotting require?
- platelets (produced in bone marrow)
- Von Willebbrand’s factor (produced by endothelium of BVs)
- clotting factors from the liver using vitamin K
What is fibrinolysis?
clot dissolution that prevents excess clot formation
Atherosclerosis, DM, elevated blood lipids, and cholestrol have a (decreased/increased) platelet function.
increased platelet function
(true/false) A person with a hypocoagulopathy disorder has no limitations for exercise.
FALSE: strenuous exercise contraindicated due to risk of increased hemorrhage
Diagnosis
Condition of inadequate blood flow to the body tissues that is associated with hypotension, inadequate cardiac output, and changes in peripheral blood flow resistance
shock
What causes hypovolemic shock?
Hemorrhage, vomiting, or diarrhea
What s/s is progressive shock associated with?
- restlessness and anxiety
- weakness
- lethargy
- pallor with cool and moist skin
- decreased body temperature
diagnosis
- fatigue and weakness with minimal exertion
- DOE
- pallor or yellow skin of the face, hands, nails, or lips
- tachycardia
- bleeding gums, mucus membranes, or skin w/o trauma
- possible hypoxic damage to the liver and kidney
- possible heart failure
anemia
(true/false) patients with anemia have a normal exercise tolerance.
FALSE- decreased tolerance
Use RPE scale and closely monitor vital signs
diagnosis
Group of inherited, autosomal recessive RBC disorders; Hgb and the size and shape of RBCs are abnormal
sickle cell disease
Types: HbSS, HbSC, HbS, beta thalassemia, HgSD, HbSE, HbSO
diagnosis
Hgb is released from the abnormal RBCs into the plasma resulting in decreased oxygen delivery into the tissues
- results from bone marrow aplasia, hemolysis, folate deficiency, splenic involvement
Chronic hemolyic anemia (sickle cell anemia)
- pain caused by clots in joints, organs, and/or bone
- acute abdominal pain from visceral hypoxia
- swelling in the hands and feet
- persistent HA
- dizziness
- convulsions
- coma
- nystagmus
- chest pain
- dyspnea
- coughing
- tachypnea
sickle cell crisis
definition
rapid drop in hemoglobin levels
anemic crisis
definition
characterized by severe anemia associated with acute viral, bacterial, or fungal infection. Results in an increased risk of infection
aplastic crisis
What is the MOA of hydrooxyurea?
stimulates Hgb production
(heat/cold) therapy is contraindicated with sickle cell anemia.
Cold therapy is contraindicated due to vasoconstriction and sickling
What intensity of exercise is most appropriate for a person with sickle cell disease?
low to moderate level exercise
High intensity exercise leads to dehydration and may increase the risk of sickle cell crisis
What is hemophilia?
bleeding disorders inherited as a sex-linked recessive disorder
Who is commonly diagnosed with hemophilia?
affects males
females are carriers
What is the most common clotting factor deficiency?
Clotting factor VIII deficiency (hemophilia A)
What is another name for hemophilia B?
Christmas disease/clotting factor ix deficiency
What determines the level of severity and rate of spontaneous bleeding in a person with hemophilia?
percentage of clotting factor in the blood
Where is hemiarthrosis most common?
synovial joints
bleeding in the joint
What is observed at a joint with hemiarthrosis?
- swelling
- pain
- decreased ROM
- warmth
long-term results:
- chronic synovitis and arthropathy leading to bone and cartilage destruction
What are possible complications of hemophilia?
- scoliosis
- equinus gait
- lack of knee EXT torque
- decreased aerobic capacity
- ADL deficiency
- LLD
- muscle weakness
- contractures (FLX and PF)
What are clinical s/s of acute bleeding episodes?
- decreased ROM
- stiffness
- pain
- swelling
- tenderness
- heat
- tingling
What PT interventions should be used during the acute stage of hemophilia?
- RICE (rest, ice, compression, elevation)
- prevent deformities
Why is passive stretching rarely used in those with hemophilia?
Increased risk of myositis ossificans
What are the early warning signs of cancer?
- unusual bleeding or discharge
- lumps
- sore throat that does not go away
- B/B disturbance
- hoarseness/persistent cough
- ingestion or dysphagia
- change in size of a wart or mole
- unexplained weight loss
What do leukemia and myeloma affect?
blood (unrestrained growth of WBCs) and blood-forming organs (bone marrow)
How does a metastasis spread in the body?
lymphatic system or bloodstream
What factors are considered when staging cancer?
Primary tumor (T)
Regional lymph node involvement (N)
Metastasis (M)
What are the stages of cancer?
0: carcinoma in situ
1: localized tumor <2 cm; no lymph node involvement
2: locally advanced tumor that is 2-5 cm with or without lymph node involvement
3: Advanced local tumor that has spread to the lymph nodes
4: metastasized tumor
What are the cancer grades?
1 (Low grade): cells resemble normal cells and are gradually growing
2 (intermediate): cells look abnormal and are faster growing (moderate differentiation)
3 (high grade): cells are abnormal with aggressive growth and spreading (poorly differentiated)
4 (high grade): cancer cells are abnormal (undifferentiated)
Cancer can be considered cured if what happens?
If the patient does not have a reoccurrence within 5 years after treatment
What are local and systemic effects of radiation therapy?
- pain
- fatigue
- radiation sickness
- immunosuppression
- fibrosis
- burns
- delayed wound healing
- edema
- hair loss
- radiation encephalopathy
- rapid motor weakness (occurs years after therapy)
What are the local and systemic effects of chemotherapy?
- fatigue
- GI disturbance
- bone marrow suppression
- rash
- neuropathy
- phlebitis
- hair loss
What are the local and systemic effects of immunotherapy?
- fatigue
- weight loss
- flu-like symptoms
- N/V
- anorexia
- fluid retention
What are the local and systemic effects of hormone therapy?
- GI symptoms
- HTN
- steroid-induced diabetes
- myopathy
- weight gain
- hot flashes and sweating
- altered mental status
- impotence
When examining tumors, pain distal to the tumor may suggest what?
metastasis
What are the side effects of cancer treatments?
- intense fatigue
- atrophy and weakness
- ROM deficit
- WBC suppression (leukopenia)
- platelet suppression and increased bleeding (thrombocytopenia)
- anemia
What treatments are appropriate to perform with patients who have significant bony matastases, osteoporosis, or low platelet count?
- AROM
- ADLs
What are contraindications with exercise in patients those who have cancer?
- severe reaction to radiation therapy
- acute infection or fever
- severe N/T/D within 24-36 hours after treatment
- extreme fatigue, muscular weakness, or bone pain
- chest pain, altered HR, elevated BP
- swelling in the ankles
- severe dyspnea, pain with deep breathing, coughing/wheezing
- dizziness
- disorientation
- confusion
- blurred vision
- ataxia
Those receiving chemotherapy should NOT exercise for how long?
At least 24 hours after treatment
Cancer patients with low platelets of < _______/mm may experience spontaneous bleeding
<10,000
Exercise is contraindicated in patients with platelet counts < _____.
< 20,000
Use caution with counts between 20,000-50,000
(true/false) thermal agents are contraindicated for those with cancer.
true
(true/false) hydrotherapy is appropriate for a patient with cancer
false
Do not use (cold/heat) therapy in those who have delayed wound healing
cold therapy
diagnosis
Individual has a long-term pattern of manipulating, exploiting, or violating the rights of others
often criminal
antisocial personality disorder
diagnosis
individual has varying moods, impulsive actions, and problems with relationships; may experience intense episodes of anger, depression, and anxiety that can last hours to days
borderline personality disorder
diagnosis
individual has an inflated sense of their own importance, troubled relationships, a deep need for excessive admiration, and a lack of empathy for others
narcissistic personality disorders
diagnosis
Individual has feelings of extreme social inhibition and sensitivity to negative criticism and rejection
avoidant personality disorder
(true/false) onset of PTSD symptoms can be delayed
true
definition
A type of schizophrenic disorder characterized by mutism or stupor; unresponsiveness; catatonic posturing (unable to move or talk for periods of time; fixed position)
catatonia
diagnosis
Patient experiences neurological symptoms without evidence of specific neurological disease or other medical condition
- significant loss of function and emotional distress
functional neurologic symptom disorder
conversion disorder/functional neurologic syndrome
What are the stages of death and dying?
- denial
- anger
- bargaining
- depression
- acceptance and preparation for death
What are the stages of grief?
- shock/disbelief
- increased awareness and anguish
- mourning
- resolution of loss
- idealization of lost person or function
What does the upper GI tract consist of?
- mouth
- esophagus
- stomach
ingestion and intial digestion of food
What does the middle GI tract consist of?
small intestine (duodenum, jejunum, and ileum)
digestion and absorption of nutrients
What does the lower GI tract consist of?
Large intestine (cecum, colon, rectum)
absorption of water and electrolytes, storage, and elimination of waste
What are the major GI hormones?
- cholecystokinin
- gastrin
- secretin
What is achalasia?
lower esophageal sphincter fails to relax leading to food being trapped in the esophagus
What does nausea stimulate?
Medullary vomiting center
What is obstipation?
intractable constipation with resulting fecal impaction or inability to pass gas and retention of hard, dry stools in the rectum and colon.
can cause partial or complete bowel obstruction
Where can constipation pain refer to?
- abdomen
- anterior hip, groin, or thigh
Visceral pain from the esophagus can refer to the ______.
midback
Midthoracic spine pain (nerve root pain) can appear as _______ pain.
esophageal pain
What organs can have visceral pain referral to the shoulder?
- liver
- diaphragm
- pericardium
What organs can have visceral pain referral to the midback and scapular regions?
- gallbladder
- stomach
- pancreas
- small intestine
What organs can have visceral pain referral to the pelvis, low back, and/or sacrum?
- colon
- appendix
- pelvic viscera
What is hepatitis?
Inflammation of the liver
can be caused by bacteria or a virus
How is hepatitis A transmitted?
fecal-oral route
(true/false) all forms of hepatitis can be acute or chronic.
False-
Hepatitis A is only acute
How is hepatitis B transmitted?
- blood
- body fluids
- body tissues
through blood transfusion, oral or sexual contact, contaminated needles
How is hepatitis C transmitted?
- blood
- body fluids
- body tissues
Through blood transfusion, oral or sexual contact, contaminated needles
How is hepatitis D transmitted?
Dependent upon having hepatitis B
- prognosis is poor and those often have liver failure
What are the s/s of the preicteric phase of hepatitis?
Initial stage
- fever
- anorexia
- N/V
- diarrhea
- fatigue
- malaise
- HA
- abdominal tenderness
- myalgia
- arthralgia
What are the s/s of the jaundice (icteric) phase of hepatitis in addition to the s/s of the preicteric phase?
- fever
- jaundice
- enlarged liver with tenderness
- amber-colored or dark urine
What can chronic hepatitis B and hepatitis C lead to?
chronic liver infection
necrosis, cirrhosis, liver failure
viral hepatitis
diagnosis
Irreversible chronic injury of the hepatic parenchyma as a result of chronic hepatitis
cirrhosis
diagnosis
- jaundice
- peripheral edema
- dupuytren’s contracture
- palmar erythema
- angiomas
- hepatomegaly
- splenomegaly
- ascites
cirrhosis
What is a late complication of cirrhosis?
Hepatic encephalopathy
What is asterixis?
myoclonus of the hand with the wrist in EXT
“liver flap”
What is asterixis a sign of?
liver cirrhosis
Why? liver is unable to convert ammonia to urea
____ can be used to increase bowel movement and excrete ammonia in the stool
lactulose
What is cholelithiasis?
gallstones
What is the treatment for gallstones?
often asymptomatic- no treatment needed
What can happen if a gallstone blocks the common bile duct?
biliary colic
obstruction of biliary tract
Where does pain refer to when a gallstone is present?
RUQ and right scapula
can worsen after a fatty meal
what is cholecystitis?
partial or complete obstruction of the common bile duct resulting in inflammation of the gallbladder
Where does pain from cholecystitis refer to?
Severe pain in the RUQ and radiating to the right scapula
Describe the Murphy’s sign.
Palpate near right subcostal margin while the patient takes a deep breath
(+) pain elicited
A positive murphy’s sign is indicative of what?
cholecystitis
What pain pattern is formed with acute pancreatitis?
Bandlike pain that can radiate to the back
What position can aggravate pain caused by acute appendicitis?
supine
Diagnosis
- bandlike pain radiating to the back
- pain aggravated in supine position
- hypotension
- tachycardia
- N/V
acute pancreatitis
What interventions are used to treat acute pancreatitis?
- IV fluid
- pain medication
- NPO order
- surgery
What pain pattern is caused by chronic pancreatitis?
epigastic and LUQ pain
What are the s/s of chronic pancreatitis?
- anorexia
- N/V
- constipation
- flatulence
- greasy stools (steatorrhea)
When do symptoms of pancreatic cancer arise? What are they?
Once the cancer is more advanced
- abdominal pain radiating to the back
- unexplained weight loss
- jaundice
- dark urine
- light-colored stool
- fatigue
What causes GERD?
Failure of the lower esophageal sphincter to regulate flow of food from the esophagus into the stomach with an increased gastric pressure
diaphragm and esophageal muscles also contrinute to anti-reflux function
Over time, a pH <___ damages the esophagus and causes reflux esophagitis
< 4
Heartburn caused by GERD commonly occurs when?
- 30-60 minutes after eating
- at night when laying down (nocturnal reflux)
What can esophageal pain present as?
head, neck, or chest pain
What is esophageal pain commonly mistaken as?
heart attack
What is Barret’s esophagus?
damage to lower portion of esophagus
What should you avoid during activity when a patient has barret’s esophagus/GERD?
- supine/declined position
- jogging
- jumping
- any exercise that exacerbates symptoms
What medications are used for treatment of GERD?
- acid-suppressing proton pump inhibitor (PPI) (prilosec)
- H2 blockers (famotidine/pepcid)
- cimetidine (tagamet)
- antacids
A rolling hiatal hernia is a protrusion of the stomach through the ______ .
diaphragm
definition
displacement of both the stomach and gastroesophageal junction into the thorax
sliding hiatal hernia
Those who have a hiatal hernia can have symptoms of ____.
GERD
What are s/s of esophageal cancer?
- dysphagia
- unexplained weight loss
- chest pain
- worsening indigestion
- coughing/hoarseness
What is gastritis?
inflammation of the stomach mucosa
What causes acute gastritis?
- severe burns
- aspirin/NSAIDS
- corticosteroids
- food allergies
- viral/bacterial infections
What are the s/s of acute gastritis?
- N/V
- anorexia
- pain
What needs to be monitored in patients who are long-term users of NSAIDS?
- stomach pain
- bleeding
- n/v
What medications are used for treatment of gastritis?
Symptom-based
- acid-suppressing PPIs
- H2 blockers
- antacids
What is peptic ulcer disease?
Ulcerative lesions that occur in the upper GI tract in areas exposed to acid-peptin secretions
Can affect 1 or more layers of the duodenum or stomach
diagnosis s/s
- epigastric pain described as gnawing, burning, or cramping
- pain aggravated by change in position and absence of food within the stomach
- relieved with use of antacids or food
peptic ulcer disease
Where is pain caused by peptic ulcer disease found?
presents as radiating back pain that can radiate to the right shoulder
peptic ulcers are found on the posterior wall of the stomach
definition
A complex of disorders characterized by problems with intestinal absorption of nutrients
malabsorption syndrome
s/s
- anorexia
- weight loss
- abdominal bloating
- pain/cramps
- indigestion
- steatorrhea (fatty feces)
- chronic/excessive diarrhea
malabsorption syndrome
Malabsorption syndromes can cause iron-deficiency anemia with easy bruising and bleeding due to lack of _______.
vitamin K
Malabsorption syndromes can cause muscle weakness and fatigue due to lack of what?
- protein
- folic acid
- vitamin B
Malabsorption syndromes cause bone loss, pain, and increased risk of fractures due to lack of what?
- vitamin D
- calcium
- phosphate
Malabsorption syndrome can cause neuropathy due to lack of what?
includes tetany, parasthesia, and N/T
- magnesium
- calcium
- vitamin B
- vitamin D
- potassium
What are the types of inflammatory bowel disease (IBD)?
- crohn’s disease
- ulcerative colitis
What are the symptoms of ulcerative colitis and crohn’s disease?
Inflammatory bowel diseases
- abdominal pain
- frequent diarrhea/fecal urgency
- weight loss
- stunted growth in pediatric patients
(true/false) Ulcerative colitis and crohn’s disease are characterized by remission and exacerbation of bowel inflammation.
true
Where is pain from UC and CD found?
Lower back
What are the complications of UC and CD?
- intestinal obstruction
- corticosteroid toxicity (low bone density, increased Fx risk)
- nutritional deficiencies
- Chronic IBD can cause anxiety and depression
What are the differences between UC and CD?
CD:
- granulomas inflammation that can occur anywhere in the GI tract
- Skip lesions are present (areas of adjacent normal tissue)
UC:
- ulcerative and exudative inflammation of the large intestine and rectum
- Bloody diarrhea, mucus, and pus
- no skip lesions are present
What is diverticulosis? What are the symptoms?
pouchlike herniations of the colon (especially the sigmoid colon)
- minimal but can include rectal bleeding
What can diverticulosis progress to?
diverticulitis
What is diverticulitis? What are the symptoms?
inflammation of one or more diverticula (pouchlike herniations) of the colon’s mucosal layer – fecal matter penetrates the diverticula and causes inflammation and an abscess
- pain and cramping in LLQ
- N/V
- slight fever
- elevated WBCs
What is noted as appendicitis progresses?
becomes swollen, gangrenous, and possibly perforated
What happens if the appendix is perforated?
Life-threatening and can lead to the development of peritonitis
Where is pain located if caused by appendicitis?
- abrupt onset
- localized in the epigastric or periumbilical areas
- intensity progresses over time
What 6 signs are used for additional testing for appendicitis?
- Blumberg’s sign (rebound tenderness)
- McBurney’s point (point tenderness)
- Rozsing’s sign
- psoas sign
- obturator sign
- markle’s sign
Immediate medical attention is needed if any are positive
Describe blumberg’s sign
Rebound tenderness in response to depression of the abdominal at a site distal to the painful area
Describe McBurney’s point.
Point tenderness 1/3 of the distance from the ASIS and umbilicus
Describe Rovsing’s sign
Pain in the RLQ with pressure administered to the LLQ
Describe the psoas sign.
Pain elicited in the RLQ when the patient is passively put into right hip EXT
Describe the obturator sign.
RLQ pain with right hip ER and FLX (90 degrees) in addition to knee FLX (90 degrees)
What is a (+) psoas sign indicative of?
inflammation of peritoneum over the psoas muscle
What is a (+) obturator sign indicative of?
inflammation of the obturator nerve sheath
What is Markle’s sign?
Elicited RLQ pain when a patient drops from toes –> heel with an abrupt landing
An elevation of WBC count > _______ are indicative of appendix perforation and surgery is indicated
> 20,000
What is peritonitis?
Inflammation of the peritoneum (serous membrane in the abdominal cavity wall)
What causes peritonitis?
bacterial invasion and infection of the peritoneum
Diagnosis s/s
- abdominal distention
- severe abdominal pain
- rigidity from reflex guarding
- rebound tenderness
- decreased or absent bowel sounds
- N/V
- tachycardia
- fever
- elevated WBCs
- electrolyte imbalance
- hypotension
peritonitis
What can peritonitis lead to?
- toxemia and shock
- circulatory failure
- respiratory distress
diagnosis
Internal and/or external varicosities in the lower rectum or anus caused by congestion of the veins in the hemorrhoidal plexus
hemorrhoids
s/s
local pain, irritation, and rectal itching
pain is increased with defecation, constipation, and prolonged sitting
hemorrhoids
(true/false) Pregnancy increases the risk of hemorrhoids
true