Module 11 Flashcards
Interstitial Cystitis (IC)
- Chronic painful bladder disorder
- Causes
- Autoimmune? F>M
- Antiproliferative Factor (APF) > blocks normal growth of cells in bladder – found in IC patients
- This increases sensation
- Signs and Symptoms
- S/S of UTI w/o bacteria
- Irritation of bladder wall >
- bleeding and pain
- inflammation > fibrosis
- Hemorrhagic ulcers – Hunner’s ulcers
- Urinary frequency (up to 60x day/night)
- Testing
- Frequency, urgency, dysuria w/o infection
- Tx
- No cure
- Pentosan, Polysulfate Sodium (Elmiron) – 30% of patients improve
- Diet changes - ↓alcohol, caffeine (irritants)
- Females more than guys
- Can measure a marker (antiproliferative factor) in the bloodstream. This prevents from dividing properly
- It is like a UTI on steroids
- You won’t see any signs of bacteria
- The testing will first be clinical
- Tx decrease things that produce less urine
- Can test blood stream for APF which is a blood test EXAM it is a blood test that you can do to test for interstitial cystitis
SIADH Syndrome Of Inappropriate ADH Secretion
- Excessive secretion of ADH
- Causes
- Idiopathic
- Brain injury, infection, trauma, stroke, hemorrhage
- ADH secreting tumor (bronchogenic cancer *most common)
- Signs and Symptoms
- Hyponatremia (does this make sense?)
- Dilutional hyponatremia from water intoxication
- Hyponatremia (does this make sense?)
- Testing
- ↓Serum osmolarity vs.↑Urine osmolarity
- Too much TBW should lead to more urine, right?
- The low serum osmolarity suppresses Renin and Aldosterone, so Na is not reabsorbed. More concentrated urine Results
- CT/MRI – tumor?
- Too much ADH is produced
Diabetes Insipidus
- Lack of ADH
- Causes
- Neurogenic - absence of ADH (Pituitary problem?)
- Nephrogenic - inadequate response of renal tubules to ADH
- Psychogenic - excessive fluid intake that suppresses ADH
- Signs and Symptoms
- Excessive urination and thirst
- Polyuria and polydipsia
- Excretion of large volume dilute urine, dehydration
- Testing
- ↑Serum osmolarity vs. ↓Urine osmolarity
- Plasma ADH levels
Not enough ADH
Will definitely see this and ADH on future exams
Benign Prostatic Hyperplasia (BPH)
- Enlargement of the prostate
- 80% of men will have prostatic enlargement before age 80
- 0% of women
- Causes
- Decreased T/E ratio
- Signs and Symptoms
- Usually > 40
- Hesitant, interrupted, weak stream
- Urgency, frequency
- Nocturia, leaking/dripping
- Testing
- DRE
- PSA –DDx from prostate cancer
- Biopsy
- Tx
- Medications, Surgery, Laser
- Almost all guys have prostate enlargement
- More prostate cells
- T/E= testosterone/estrogen
- Weak stream even though bladder is full
- Nocturia is having to get up all the time and go to the bathroom in the middle of the night
- DRE is digital rectal exam (a finger)
- PSA is Prostate Specific Antigen EXAM can be used to track. The higher usually the more that the prostate cancer is growing.
- Slow growing cancer
T/E Ratio & BPH
Men produce estrogen (Estradiol), but in much lower amounts than women. And a healthy male physiology depends upon a high T-E (testosterone-estrogen) ratio balance. With aging, the T-E ratio drops often dramatically. The enzyme Aromotase, which is especially prevalent in fat cells, converts (T) to (E). And since most men loose muscle and gain fat as they age, Aromotase activity increases thus reducing (T) even as it increases (E). Scientist have stressed the importance of (E) and the (T-E) ratio in promoting prostate problems. The data has shown a direct negative biochemical effect of (E) on the physiology of the prostate, and the consideration of (E) suppression as an efficient pharmacotheraputic strategy in medical treatment.
- Males have a drop in testosterone levels as they age. The enzyme called aromotase increases.
gynecomastia
The development of breast tissue as well as adipose tissue
Urinary Incontinence
- Stress Incontinence
- Incontinence with laughing, coughing, sneezing, lifting
- Decreased pelvic floor muscle strength
- Stress Incontinence
- Urge Incontinence (AKA “reflex incontinence” if it results from overactive nerves controlling the bladder)
- Uninhibited, involuntary contractions of the detrusor muscle
- Involuntary loss of urine (can’t make it to the bathroom in time) occurring for no apparent reason while suddenly feeling the need or urge to urinate - incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running (as when washing dishes or hearing someone else taking a shower).
- Constant dripping
- Neurological disorders > Parkinson’s disease, MS, CNS or peripheral nerve damage
- Overflow Incontinence
- Blockage of the bladder outlet (benign prostatic hyperplasia, prostate cancer, or narrowing of the urethra)
- Bladder is always full so that it frequently leaks urine
- Signs and Symptoms
- S/S of UTI
- Testing
- Clinical
- Pelvic U/S
- R/O UTI
- Incontinence is going when you don’t want to go
- Stress incontinence
- Overflow means the bladder doesn’t empty completely and they can start to leak
- s/s can look like a UTI so rule it out first
Type of incontinence: Stress
Leakage of urine with increased intra-abdominal pressure such as when laughing, coughing or lifting heavy objects
- Etiology: weakened pelvic floor, urethral hypermobility, bladder neck prolaspe
- Clinical Correlates: History of pelvic surgery, multiparity, cystocele or rectocele on exam, atrophic vaginitis on exam
Type of incontinence: Urge
Leakage of urine when an involuntary bladder contraction overcomes outlet resistance
- Etiology: Neurologic disorders, infection, intrinsic bladder lesion, idiopathic
- Clinical correlates: Spinal cord injury, stroke, parkinson’s or MS, urinary tract infections, bladder stone, tumor or foreign body
Type of incontinence: overflow
leakage of urine when the bladder is unable to empty fully. A high post-void urine volume is the diagnostic hallmark
- Etiology: Bladder outlet obstruction, detrussor muscle weakness, autonomic neuropathy, medication side effect (anticholinergics)
- Clinical correlates: Benign prostatic hypertrophy (BPH), Diabetes mellitus
Diarrhea
- Loose, watery stools with increased frequency
- Chronic > 4 weeks
- Causes
- GI disorders
- IBD, UC, Crohn’s Disease, Celiac Disease
- Food Allergies
- Artificial sweeteners - sorbitol
- Viral, Bacterial, Parasites
- Water, food, travel
- Medication
- Antibiotics
- GI disorders
- Signs and Symptoms
- Frequent loose stools
- Abdominal pain and cramping
- Fever, chills, malaise, dehydration
- Bloody stools
- Testing
- Culture
- Ova & Parasite (O&P) test
- CT
- Rectal Exam
- Tx: BRAT
*Lots of causes of diarrhea
- Food allergies are a big one & it’s often difficult to know which one
- Some people still do better when they cut gluten from their diet
- Bacterial is usually longer lasting and can be deadly. Can having bleeding of inside of small intestine or colon
If you give someone antibiotics for another infection can result in diarrhea because they can kill off good bacteria and you can get overgrowth of bad bacteria
- Ova & parasite take a while to come back. They check for eggs?
Constipation
- Infrequent bowel movements
Inflammatory Bowel Diseases
1) Diverticulitis
2) Ulcerative colitis (UC)
3) Crohn’s disease
- IBD don’t confuse this with IBS irritable bowel syndrome
- 3 types
- Diverticulitis, everyone will get it
- Exam is very very very heavy on these so really know them
Diverticulitis
- Caused by diverticulosis – out pouching of GI tract > can become inflamed/infected
- Causes
- Elderly people
- > 50% of Americans > 60 years old have diverticulosis
- Signs and Symptoms
- Abdomen pain, cramping, N/V
- Can lead to perforations
- Bleeding
- Peritonitis
- Scarring can lead to blockage
- Fistula – sticks to other organs
- infection
- Testing
- Routine colonoscopy
- CT, abdominal US
- TX
- High fiber diet – soft stools lower pressure inside intestine
- Antibiotics
- Surgery
- Everyone gets this as you get older
- Diverticulosis is out pouching of the colon
- If the out pouching gets inflammed
- Can cause scarring inside epithelium
- If you have a history of colon cancer you should get a colonoscopy earlier than 50
- If a person has diverticulosis give them a high fiber diet to prevent diverticulitis
Ulcerative Colitis (UC)
- Inflammation of colon that causes ulceration
- More common at rectum and sigmoid colon
- Causes
- Unknown – however infections, genetic, immunologic factors are suggested causes
- 20 - 40 yrs
- FHx (Jewish descent)
- Signs and Symptoms
- Left sided pain more common – Why?
- Diarrhea
- Tenesmus (urge to defecate), Abd. Pain, Melena
- Remission/exacerbation of symptoms
- Risk of colon cancer increases if patient has UC for >10 yrs
- Pseudopolyps due to continued healing of ulcers
- Testing
- CBC
- Colonoscopy
- R/O infectious disorders
- Tx – meds, surgery (Ileal pouch anal anastomosis IPPA)
- Ulceration is not good
- Usually with this you don’t see healthy regions interspersed with unhealthy regions
- Left sided abd pain because that is where the sigmoid colon is
- Could have bloody diarrhea
- Frank blood is very red red blood
- BRBPR Bright Red Blood —– Rectum
- Untreated for 10 years is a risk of colon cancer
- Pseudopholyps are sores
- Usually just the lining
- Shag carpet appearance of the lining of the intestines
Recognize coble stone look vs. shag carpet look. There will be a picture for the exam - From a total colectomy done for clinically severe, intractable chronic ulcerative colitis (CUC). Note the shag carpet of inflammatory pseudopolyps.
