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Year 3: Clinical Medicine and Pathophysiology > Lecture 6: Renal, hepatic, GI, and GU > Flashcards

Lecture 6: Renal, hepatic, GI, and GU Flashcards

1
Q

what is Murphys sign

A

for RUQ pain

palpate R subcostal region with deep inhale

pt has pain and stops deep inhale = +

+ = indicative of gallbladder problem

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2
Q

what is tympany

A

medical percussion over area filled with air

can be abnormal if air is somewhere it shouldn’t be

abdominal tightness/distention can accompany

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3
Q

what is blumbergs sign

A

rebound tenderness when slow pressure is removed

indicates peritonitis (inflammation in periosteum), appendicitis, colitis, bowel obstruction/perforation

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4
Q

what is McBurney’s point

A

specific area of RLQ used to assess acute appendicitis via blumbergs test

between umbilicus and ASIS

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5
Q

what is chronic kidney disease

A

progressive kidney dysfunction

> 70% of CKD by DM and HTN

nephron destruction = decreased surface area for filtration; decreased globular filtration rate (GFR)

elevated BUN and Cr

chronic diueretic use overworks nephrons, causing eventual death and increased GFR

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6
Q

clinical presentation of CKD

A

joint calcification, osteoporosis, sarcopenia, osteopenia

N&V; increased risk of GI bleed

electrolyte abnormalities

HF, HTN, pulmonary edema, dyspnea

lethargy, AMS< seizures, insomnia

decreased DTRs, general wekness, neuropathy

anemia

increased risk kidney infection

slowed metabolism of any renally cleared meds

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7
Q

what happens with acute renal failure or acute kidney injury

A

acute inflammation of kidneys caused by sudden event (hypovolemia, hypotension, sepsis, med reactions)

sudden loss of blood to kidneys

renal labs rapidly become abnormal

hyperkalemia and hypernatremia both very dangerous side effects

can be reversed depending on degree (emergent hemodialysis)

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8
Q

3 methods of renal dialysis

A
  1. hemodialysis (HD) = 3x/week
  2. peritoneal dialysis (PD) = nightly
  3. continuous renal replacement therapy (CRRT) = constant
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9
Q

CKD requires what type of dialysis

A

stage 4-5 requires dialysis

can be HD or PD

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10
Q

AKI requires what type of dialysis

A

emergent HD or CRRT

used for electrolytes abnormalities that cannot be pharmacologically managed

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11
Q

PT implications for dialysis

A

hypotension and dehydration post dialysis

delayed fluid shifting and blood redistribution

electrolyte lab values

no BP measurements on limb with fistula

energy conservation strategies

mobility during dialysis is usually discouraged, despite supportive literature

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12
Q

UTI risk increases with what factors

A

age
immobility
incontinence
poor hygiene
indwelling Cath
gender
sexual activity
neurgogenic bowel/bladder

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13
Q

clinical presentation of UTI

A

infection signs (AMS, fever, WBCs, etc)

changes in urination: pain, increased frequency, abnormal start/stop

could/discolored urine

nocturia

can progress to sepsis if untreated

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14
Q

what is pyelonephritis

A

UTI that progresses up ureter and causes kidney infection

requires IV antibiotics

S&S
- infection S&S
- abdominal/mid back pain
- urination changes
- cloudy/discolored urine
- hematuria
- can progress to sepsis quick

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15
Q

what is hydronephrosis

A

swelling of kidney caused by inability of urine to drain

blockage in ureters prevents urine to flow to the bladder

can be unilateral or B

untreated = can lead to AKI and toxin build ip

blockage must be removed to relieve pressure on kidney or fluid removed from kidney via other methods

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16
Q

clinical presentation of hydronephrosis

A

abdominal or mid back pain

decreased urine output

pain with urination

increased chance of UTI or pyelonephritis

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17
Q

what is nephrolithiasis

A

kidney stones; build ip of minerals and salt in kidneys or ureter

if stone cannot be passed/shrunk = impaired normal flow of urine which can cause other more serious issues

clinical presentation
- mid/low back pain
- hematuria
- UTI like S&S

can be medical emergency

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18
Q

kidney stone treatment

A

IV hydration

shockwave lithotripsy

ureteroscopy/cystoscopy

retail stent placement

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19
Q

what is a renal cell carcinoma: risk factors and clinical presentation

A

most common renal cancer; in epithelial cells lining the renal tubules

risk factors:
- smoking
- ETOH use
- HTN
- DM
- medications/environmental exposure

clinical presentation:
- hematuria
- flank pain
- obstructed urine flow
- malignant to bones, lungs, and liver

treatment = sx removal

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20
Q

what is a nephrostomy tube

A

placed in renal pelvis to drain urine and maintain normostatic pressures in the kidneys

used if normal urine flow out of the kidneys is obstructed in some way

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21
Q

who needs a kidney transplant and what are the stats and post sx requirements

A

needed once pt is in dialysis dependent CKD

~93000 people waiting for transplant

can be from deceased donor or living

pt takes anti-rejection meds

post op precautions for 6 weeks post sx

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22
Q

describe blood flow to and from the lover

A

blood comes from hepatic artery and portal vein

portal vein drains GI tract, gallbladder, pancreas, and spleen; provides liver with 75% of blood supply

blood drained form liver by hepatic veins directly into the IVC

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23
Q

jobs of the liver

A

synthesis of blood clotting factors, bile, digestive chemical enzymes

metabolism of ETOH, drugs, toxins, carbs, proteins, fatty acids, cholesterol, and ammonia

regulation of glycogen; used for body energy and carb storage

decomposition of RBCs

filleting of large volumes of blood and plasma

24
Q

neurological S&S of liver disease

A

AMS, confusion, hallucination, hepatic encephalopathy

asterixis (bilateral if hepatic in nature)

tremors, numbness/tingling

insomnia

25
Q

MSK S&S of lover disease

A

posterior thoracic pain

R shoulder/subscapular pain

intercostal pain

mm wasting

cachexia

26
Q

what is hepatic encephalopathy

A

neuropsychiatric S&S present with liver disease

hyperammonemia
- liver doesn’t metabolize ammonia
- stays in blood and crosses blood brain barrier

treated with lactulose = increases bowel activity and flushes out ammonia that builds up

27
Q

what is portal vein HTN

A

sign of liver disease

75% of liver blood flow comes from portal vein, which drains from GI tract

high pressure in portal venous system from increased pressure in the liver from fibrosis or nodules

blood backs up towards esophagus and stomach resulting from gastroesophogeal varices which are at risk of rupture causing UGIB

treated with CV meds to reduce risk of clots and lower HR/BP

28
Q

fluid abnormalities that are common with liver disease

A

ascites

edema

29
Q

what is ascites

A

symptom of advanced liver disease

fluid accumulation in peritoneal (abdominal) cavity

results from chronic failure of liver to manage fluid

requires paracentesis to remove fluid

30
Q

skin changes seen with liver disease

A

jaundice

easy bruising

palmar erythema

31
Q

blood changes seen with liver disease

A

abnormal clotting

32
Q

GI changes seen with liver disease

A

malnourishment

anorexia

hypoalbuminemia

N/V/D

C. Diff

33
Q

what is jaundice

A

symptom, not a disease itself

yellowing of skin and mucous membranes from build up of bilirubin

accompanied by elevated liver enzymes

urine and stool also have increased yellowing

treatment of underlying cause
- liver failure
- blocked bile duct

34
Q

what is cirrhosis

A

chronic liver failure

liver inflammation causes fibrosis then necrosis

decreased metabolism of all substances

ETOH and hep C most common causes

~50% have 10 year mortality post dx

presentation:
- light colored stool with dark urine
- jaundice/ascites
- increased risk of bleeding
- hypoglycemia
- weight loss

35
Q

what is chronic hepatitis

A

chronic liver inflammation caused by autoimmune response, virus, or medication side effects

chronic active hep B = liver inflammation due to HBV, also 200x more likely to develop liver cancer

chronic active hep C = liver inflammation due to HCV most common cause of liver cancer and cirrhosis in US

36
Q

clinical presentation of chronic hepatitis

A

fatigue
loss of appetite
joint/mm pain
RUQ pain

37
Q

what is acute liver failure

A

acute onset = < 6 months

failure occurs within 8 weeks of 1st symptom

rapid progression of symptoms of liver failure

80-90% mortality rate

38
Q

What is a MELD score

A

assesses severity of chronic liver disease

predicts mortality

helps with prioritization of liver transplant recipients

formula = 3.78 x [serum bilirubin (mg/dL)] + 11.2 x [INR] + 9.57 x [serum creatine (mg/dL)] + 6.43

scoring
- 40 or more = 71.3% mortality rate
- 30-39 = 52.6%
- 20-29 = 19.6%
- 10-19 = 6.0%
- <9 = 1.9%

39
Q

what is the only option for irreversible liver failure

A

liver transplant

can be partial living donor

same anti rejection meds as other transplants

40
Q

PT implications of liver failure

A

high risk of bleeding

risk of communicable hepatic viruses

standard or enteric precautions

joint and mm pain may not respond same way as usual therapeutic intervention

impact of ascites on ROM, flexibility, movement strategies

awareness of systemic edema and skin integrity issues

energy conservation and activity pacing strategies

matched work and rest periods to Lowe the demand on liver and any impacted vasculature

41
Q

describe acute pancreatitis

A

acute inflammation of pancreas

causes = ETOH abuse, gallstones, infection, meds, autoimmune dysfunction

trypsinogen converts trypsin at a faster rate than can be reabsorbed; causes cellular and vascular damage the acute inflammatory response

clinical presentation:
- RUQ pain
- abdominal pain
- N&V
- can progress to septic pancreatitis

pts sometimes need IV ABX, sx, drain replacement

42
Q

describe chronic pancreatitis

A

chronic/irreversible inflammation of pancreas

causes = long term ETOH abuse, severe acute pancreatitis, autoimmune dysfunction, duct obstruction

presentation:
- abdominal pain
- weight loss
- poor appetite
- N&V
- back pain
- poor glycemic control (induced DM)

pt may need procedure to clear duct obstruction
- endoscopic retrograde cholangiopancreatography (ERCP) uses endoscopy, X-ray, and contrast to view biliary/pancreatic ducts
- intervention can be performed at the same time if needed

43
Q

what is cholecystitis

A

inflammation of gallbladder caused by gall stones blocking normal function of bile duct

presentation:
- RUQ pain, R neck pain, R shoulder/subscap pain
- leukocytes, elevated liver enzymes, elevated bilirubin

44
Q

what is cholelithiasis

A

formation of gallstones made up of excess cholesterol and bilirubin salts that block normal function of the bile ducts

presentation:
- RUQ tenderness/fullness
- reflux
- epigastric pain
- R shoulder/subscap pain

45
Q

what is Gastro esophageal reflux disease (GERD)

A

gastric reflux back flows into esophagus caused by impairments in lower esophageal sphincter

presentation:
- epigastric/esopogeal pain
- indigestion
- N&V
- can mask as MI

pts should remain upright after eating for >30 min; may have to avoid full supine entirely

pharm management:
- antacids to neutralize acid already present (i.e. tums, pesto, mylanta)
- proton pump inhibitors to reduce production of stomach acid (i.e. Prilosec, Nexium, pantoprazole)

46
Q

describe gastroesophageal cancer

A

includes gastric tumors, distal esophageal tumors, proximal esophageal tumors

most types are aggressive and advanced by the time they are symptomatic

risk factors = ETOH use, smoking, obesity, heavily processed diet, radiation exposure

presentation:
- dysphagia
- anorexia
- GERD
- unexplained hoarseness/cough

treatment = sx removal then chemo/radiation
- gastrectomy or partial gastrectomy
- esophagogastrectomy

47
Q

what is a nasogastric tube

A

in nose to stomach

if pt is intubated, same tube is used through mouth, called orogastric tube (OGT)

48
Q

what is a nasoduodenal/nasojejunal tube

A

through nose into duodenum or jejunum

dobnoff tube is smaller, more flexible option that can be sent to the stomach, duodenum, or jejunum depending on pt need

49
Q

what is a gastrostomy or jejunostomy tube

A

through the abdominal skin to the stomach or jejunum

percutaneous gastrostomy tube (PEG) placed without making external incision

50
Q

what is a gastrojejunostomy tube (GJT)

A

through abdominal skin to the stomach AND jejunum

one lumen used for removal of fluid one used to provide fluid/nutrition

51
Q

what is a bowel obstruction

A

mechanical obstruction of bowels due to adhesions, hernia, volvulus, inflammation, foreign body, tumor burden, or ileus

presentation:
- abdominal pain/distension, constipation, N&V, + tympany

almost always requires sx correction

52
Q

PT implications for bowel obstruction

A

post op precautions

mobility is motility (prevention is better than treatment)

53
Q

describe bowel ischemia

A

decreased vascular supply to intestines causes by prolonged bowel obstruction, blood clot, PVD, hypovolemia, hemorrhagic shock

lack of blood flow = tissue death

medical/surgical emergency

post op, pt may have “open” abdomen to decrease edema and abdominal compartment syndrome
- fascial layers need to be surgically closed prior to mobility
- subcutaneous and skin layers may need to remain open but dressed

54
Q

describe appendicitis

A

inflammation of appendix that can result in necrosis and perforation

common in kids

very dangerous for adults

presentation:
- unruptured = RLQ pain at mcburneys point, low back/HS pain, N&V, fever
- ruptured = severe RLQ pain at mcburneys, fever, N&V, sepsis, peritonitis (life threatening)

requires surgical removal and antibiotics

55
Q

describe diverticulitis

A

inflammation of diverticula (pouch like bulges that protrude from the intestinal wall)

caused by diet, obesity, tobacco use, opioids, NSAIDs

inflammation can lead to infection and bleeding

presentation
- LLQ pain
- N&V
- leukocytosis
- LGIB

56
Q

what is chrons disease

A

chronic inflammation of any part of GI tract in any of the mucosal layers

abdominal pain, diarrhea

57
Q

what is ulcerative colitis

A

chronic inflammation of the colon and rectum

bloody stool/diarrhea

Year 3: Clinical Medicine and Pathophysiology (8 decks)

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