Mosby 17 Flashcards
Elderly Diseases: Urinary incontinence - stress
Symptoms
Associated disease
Postovoid residual
Small volume incontinence with sneezing, laughing, coughing, etc.
Can have ass’d pelvic organ prolapse
Normal postvoid residual
Elderly Diseases: Urinary incontinence - urge
Description
Associatied
Postvoid
Uncontrolled urge to void
“I get the sudden urge to pee so quickly I can’t make it to the bathroom”
Can be related to CNS disorder
Normal postvoid residual
Elderly Diseases: Urinary incontinence - Overflow
Symptoms
Associated symptoms
Postvoid
Small volume incontinence 2/2 uring leaking around an obstructionBPH: pressure builds in bladder until it is slowly squeezed through the narrowed urethra
Sx: dribbling, nocturia, incomplete emptying
Neurogenic bladder: Bladder can’t contract well, so pressure builds in the bladder until it starts to leak out
High postvoid residual
Elderly Diseases: Urinary incontinence - Functional
Symptoms
Postvoid volume
In pt with a disability that prevents them from getting to the bathroom in time or prevents them from knowing they need to pee (E.g. severe dementia)
They would be able to make it to the bathroom if they didn’t have the disability
Normal postvoid residual
Elderly Diseases: Fecal incontinence
Three causes
Three major causes
Fecal impaction- “overflow incontinence”; diarrhea moves around the hard stool
Underlying disease
Neurogenic disorders
Stroke, dementia, degeneration of nerves to the area leading to loss of sphincter tone
PE: Can see decreased sphincter tone on DRE
Peds Diseases: Intussusception
What is it?
Population and ass
Presentation
Physical
Diagnosis
Prolapse of one part in intestine into another leading to obstruction
Common cause of obstruction in kids
Most commonly 2/2 lymph node hyperplasia or Meckel diverticulum
In adults, most commonly 2/2 cancer
Classic sx: Colicky abdominal pain (kid doubled over in pain) with “red currant jelly” stools
PE: sausage shaped mass in R or LUQ
Dx AND Tx: air contrast enema
Peds Diseases: Pyloric Stenosis
Symptoms
Association
Physical exam
Hypertrophy of pylorus
Sx: projectile vomiting in a few week old infant with failure to thrive
Ass’d with erythromycin use and more common in first born males
PE: Olive shaped RUQ mass
Peds Diseases: Meconium Ileus
What is it
Symptoms
Diagnosis
Other possible diagnosis
Distal intestinal obstruction due to thick inspissated meconium “clogging” up the system
Failure to pass meconium within first 24 hours
Most commonly in cystic fibrosis
Sx: obstructive sx (vomiting, abdominal distention)
Major differential diagnosis includes Hirschprungs disease
Peds Diseases: Biliary Atresia
What is it
Symptoms
Diagnosis
Treatment
Congenital obstruction or absence of bile ducts leading to bile flow obstruction
Can occur postnatally (thought to be infectious) or embryonic
Sx of cholestasis (jaundice, clay colored stools, dark urine) in first few weeks of life
Dx: US
Tx: Most often requires liver transplant (esp. if internal ducts are affected)
Peds Diseases: Meckel Diverticulum
What is it
Rule of 2
Cause
Symptoms
What can cause
Outpouching of ileum
Rule of 2’s: 2 in. long, withing 2 feet from terminal ileum, presents by 2 years of age, in 2% of population
2/2 incomplete obliteration of the vitelline duct
Sx: painless rectal bleeding
Can cause intussusception
Peds Diseases: Necrotizing enterocolitis
Decscription
Symptoms
X-Ray
Intestinal necrosis occurring in premature infants
Sx: failure to thrive, vomiting, bloody stools, peritoneal signs, very sick premie
AXR: pneumatosis intestinalis (air in bowel wall)
Peds Diseases: Neuroblastoma
What is it
Symptoms
Comparison to wilms tumor
Malignancy of peripheral sympathetic nervous system
Most commonly in adrenal medulla
Sx: most commonly asymptomatic abdominal mass, but can cause different mass-related local symptoms based on location
Crosses midline (vs. Wilms tumor)
Peds Diseases: Wilms Tumor
What is it
Population
Syndrome
Symptoms
Most common intraabdominal tumor in kids
In 2-3 year olds
Mostly sporadic, but can be familial
WAGR syndrome: Wilms tumor, aniridia, GU abnormalities, mental retardation
Sx: Painless abdominal mass (typically doesn’t cross midline), may have hematuria
Peds Diseases: Hirschprung Disease
What is it
Presnetation in older kids
Sign
Lack of parasympathetic ganglion cells in distal colonColon can’t relax in this area
Failure to pass meconium in first 24 hours
Accumulation of stool proximal to defect
Can present in older kids as severe constipation
“Blast” sign: digital rectal exam causes explosive release of stool
Peds Diseases: Hemolytic Uremic Syndrome
Triad
Populatuion
Symptoms
Triad of hemolytic anemia, thrombocytopenia, uremia
One of the most common cause of acute renal failure in kids less than 4
Most common cause in E. coli O157:H7 (in bad hamburger meat classically)
Sx: typically have a preceding URI or gastroenteritis; dehydration, edema, petechiae, hepatosplenomegaly, oliguria
Adult: Acute Diarrhea
Most common cause
Associated factors
Symptoms
Most commonly viral
Most common bacterial gastroenteritites: Salmonella, campylobacter
Common associations:
Traveler: Enterotoxigenic E. Coli
Camping: Giardia, entamoeba
HIV: Cryptosporidium
Undercooked beef with bloody urine: E. coli O157:H7
Cruise: Norwalk virus
Bloody diarrhea: invasive organisms like campylobacter, shigella, salmonella
Adult: GERD
What is it
Symptoms
Associated symptoms
Other diagnosis
Reflux of gastric contents into esophagus
Sx: burning post-prandial chest pain, worse with laying down
Ass’d cough, sour taste in throat, hoarseness
On differential diagnosis of chest pain (including killers like MI, PE, etc.)
Adult: Irritable Bowel Syndrome
Criteria
Absent symptoms
Correlation Symptoms
Rome CriteriaRecurrent abdominal pain or discomfort for at least 3 days/month for 3 months with 2 of following:
Relief with defecation
Change in stool frequency
Change in stool form (diarrhea/constipation)
None of the alarm symptoms of inflammatory bowel syndrome
No bloody diarrhea or weight loss
Can be correlated with stress
Adult: Hiatal Hernia with Esophagitis
What is it
Similar to
Symptoms
Treatment
Part of the stomach passes though the esophageal hiatus leading to loss of the “functional” LES
Similar symptoms to GERD
Can incarcerate like any hernia: Sx: sudden vomiting, pain, complete dysphagia
Tx is surgical
Adult: Duodenal Ulcer
Cause
Symptoms
Almost always 2/2 H. pylori
Can cause GI bleed (hematemesis, melena, hematochezia, anemic sx) or perforate (presents like an acute abdomen)
Anterior more likely to perf, posterior more likely to hemorrhage
Adult: Crohn’s Disease and Ulcerative Colitis
comparison
This will be high yield for years to come (know the differences between these two)
Some high yield differences
Crons
- Entire GI tract involved (mouth to anus)- perianal skin tags, mouth ulcers, etc.
- Fistula likely
- Extraintestinal symptoms common
- Diarrhea less frequently bloody
UC
- Only colon affected
- Fistula not likely
- Extraintestinal symptoms common
- Diarrhea more frequently bloody
Adult: Stomach Cancer
Symptoms
Vague sx: wt loss, early satiety, dysphagia, epigastric pain
Adult: Diverticular disease
symptoms
diverticulosis vs. diverticulitis
Outpouching of colon (most commonly sigmoid)
Diverticulosis- Presence of diverticula in the colon
Most common symptom- GI bleed (hematochezia, melena)
Diverticulitis- Inflammation of a diverticulum
Most common symptoms- LLQ pain, anorexia, N/V, diarrhea/constipation
Common in older population
Adult: Colon Cancer
Main symptoms
Symptoms
Any adult with anemia has colon cancer until proven otherwise!
Sx: Depends on location- Bleeding sx more likely if proximal, obstructive sx or change in stool caliber more likely with distal lesions
Look at risk factors on P. 492 and Screening on P. 525
