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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
MSK S&S of lover disease
posterior thoracic pain R shoulder/subscapular pain intercostal pain mm wasting cachexia
26
what is hepatic encephalopathy
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
what is portal vein HTN
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
fluid abnormalities that are common with liver disease
ascites edema
29
what is ascites
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
skin changes seen with liver disease
jaundice easy bruising palmar erythema
31
blood changes seen with liver disease
abnormal clotting
32
GI changes seen with liver disease
malnourishment anorexia hypoalbuminemia N/V/D C. Diff
33
what is jaundice
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
what is cirrhosis
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
what is chronic hepatitis
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
clinical presentation of chronic hepatitis
fatigue loss of appetite joint/mm pain RUQ pain
37
what is acute liver failure
acute onset = < 6 months failure occurs within 8 weeks of 1st symptom rapid progression of symptoms of liver failure 80-90% mortality rate
38
What is a MELD score
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
what is the only option for irreversible liver failure
liver transplant can be partial living donor same anti rejection meds as other transplants
40
PT implications of liver failure
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
describe acute pancreatitis
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
describe chronic pancreatitis
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
what is cholecystitis
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
what is cholelithiasis
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
what is Gastro esophageal reflux disease (GERD)
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
describe gastroesophageal cancer
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
what is a nasogastric tube
in nose to stomach if pt is intubated, same tube is used through mouth, called orogastric tube (OGT)
48
what is a nasoduodenal/nasojejunal tube
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
what is a gastrostomy or jejunostomy tube
through the abdominal skin to the stomach or jejunum percutaneous gastrostomy tube (PEG) placed without making external incision
50
what is a gastrojejunostomy tube (GJT)
through abdominal skin to the stomach AND jejunum one lumen used for removal of fluid one used to provide fluid/nutrition
51
what is a bowel obstruction
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
PT implications for bowel obstruction
post op precautions mobility is motility (prevention is better than treatment)
53
describe bowel ischemia
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
describe appendicitis
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
describe diverticulitis
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
what is chrons disease
chronic inflammation of any part of GI tract in any of the mucosal layers abdominal pain, diarrhea
57
what is ulcerative colitis
chronic inflammation of the colon and rectum bloody stool/diarrhea

Year 3: Clinical Medicine and Pathophysiology (8 decks)

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