Other Systems 2 Flashcards by Lauren Wolfe

MSK changes with pregnancy

25-35 lb weight gain

Postural changes: forward head, kyphosis, inc lordosis, ant pelvic tilt, COM moves sup/ant, ligament laxity

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Cardiovascular changes with pregnancy

Low BP 1st/2nd trimester, increases in 3rd trimester

Inc blood volume and CO

RHR inc 10-20 BPM (use RPE)

Supine lying can cause compression of IVC (4 mo in) causing dec CO and supine hypotensive syndrome (no supine after 1st tri)

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Benefits of left sidelying during pregnancy

dec IVC compression
maximizes CO
dec GERD as internal organs are relaxed
improves maternal/fetal circulation

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thermoregulatory changes in pregnancy

inc metabolic rate and heat production

lower fasting blood glucose

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Preeclampsia

pregnancy induced HTN, 20 weeks

sxs:
Inc protein in urine, hyperreflexia, edema, headache, sudden weight gain

BP >140/90. second abnormal BP reading 4 hours after first confirms diagnosis

EMERGENT

Can lead to eclampsia but not always

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Eclampsia

Occurs post birth
Preeclampsia not a pre-requisite, can occur in isolation

sxs:
seizures, headache, visual disturbances

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pregnancy exercise contraindications

uncontrolled
- heart disease
- restrictive lung disease
- maternal type 1 DM

incompetent cervix
vaginal bleeding (2nd/3rd tri)
placenta previa after 26 weeks
preclampsia or preg HTN
rupture of membranes
premature labor
severe anemia

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Diastasis recti treatment

<2 cm - bracing not needed
>2 cm - bracing + head lifts > PPT
>4 cm - bracing + breathing techniques
>6 cm - bracing only

performed in hook lying

all abdominal contractions performed with exhalation to minimize intra-abdominal pressure

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LUQ referred pain

diaphragm (hiatal hernia), body/tail of pancreas, spleen, kidney (left)

“Don’t Be Stupid Kid”

and esophagus (GERD)

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RUQ referred pain

gallbladder (cholecystitis), liver, head of pancreas, peptic ulcers

“Good Luck Harry Potter”

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RLQ referred pain

appendix (appendicitis), crohn’s disease

“AC”

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LLQ referred pain

diverticulitis, ulcerative colitis, IBS

“DUI”

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Pain referral mid-back/scapula

esophagus, gallbladder, stomach, pancreas

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Pain referral shoulder (left and right)

left shoulder: heart, diaphragm, spleen, tail of pancreas

right shoulder: gallbladder, liver, head of pancreas

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Pain referral pelvis/low back/sacrum

colon, appendix, pelvic viscera

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Pancoast tumor pain referral

Upper lung tumor

Pain referred in C8-T2 nerve distribution
Mimics TOS
Pain top of ipsilateral shoulder

ddx: SOB, coughing, cancer red flags

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GERD main s/s

Heartburn: usually occurs 30-60 minutes after eating and at night while lying down supine.

sxs:
dysphagia
sour taste
hoarseness of voice
atypical pain head/neck

complications:
aspiration, pneumonia, asthma
esophagitis

weak or poor closing lower esophageal sphincter

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GERD tx

maintain upright position
meals 3-4 hours before sleep
sleep on left to prevent nocturnal reflex
exercise 2-3 hours after eating
avoid spicy, chocolate, fatty, peppermint food
drugs
- antacid
- H2 receptor blockers
- proton pump inhibitors

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Hiatal hernia

Caused by diaphragm weakness
Stomach entrapment
Requires surgical intervention
Post-op: 6-8 weeks no stretching of incision or intense exercise

Pain referred to L shoulder

May present like GERD (ddx)

Referral pattern for femoral hernia

Lateral pelvic wall pain
Groin pain

Referral pattern for inguinal hernia

Groin pain

Referral pattern for umbilical hernia

Pain around umbilical ring in mid to low abdomen

Cholecystitis

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

sxs:
Pain referred to R scapula (RUQ)
Nausea, vomiting, fever
Pain increases with FATTY foods

Special test: Murphy’s sign

Murphy’s sign

Gallbladder inflammation, cholecystitis

Palpate near right subcostal margin as patient takes a deep breath; if pain and tenderness is elicited during inspiration, the test is positive

Gastric (stomach) ulcers

Caused by chronic NSAIDS, stress, anxiety, H. pylori Sxs: Pain inc with food due to acid secretion Pain after eating Pain referred to R shoulder (RUQ) Burning, cramping in epigastric area Coffee ground emesis Melena tarry stools Relieved w/ antacid and medical tx of bacteria

Duodenal ulcers

In duodenum Caused mainly by h. pylori sxs: Pain inc with absence of food (early mornings, b/t meals) Burning, cramping in epigastric area Refers to R shoulder (RUQ) Coffee ground emesis Melena (dark) tarry stools**** Relief w/ tx of infection

Ulcerative colitis

Inflammatory bowel disease (IBD) Large intestines and rectum CONTINUOUS lesions sxs: rectal pain bleeding bloody diarrhea w/ mucus/pus fecal urgency weight loss LBP LLQ pain

Crohn's disease

Inflammatory bowel disease (IBD) Occurs anywhere in GI tract SKIP lesions (non-continuous) sxs: Relief w/ passing gas abdominal pain weight loss joint arthritis RLQ pain

Irritable bowel syndrome (IBS)

Spastic, nervous, irritable colon Cause: emotional stress, anxiety, high fat, lactose Sxs: Relief w/ defecation Sharp cramps in morning or after eating n/v, bloating, foul breath, diarrhea No sxs during sleep Ribbon like stools LLQ pain tx: stress reduction, dietary modification, exercise, dec fat, inc fiber

Appendicitis

Inflammation of vermiform appendix Progression can lead to swollen/gangrenous appendix Perforated can lead to peritonitis sxs: Waves of pain progressing to steady Anorexia, n/v, inc temp, leukocytosis, fever RLQ pain Tender at mcburney's point Rovsing's sign for pain migration Blumberg's sign for rebound tenderness EMERGENT - immediate medial attention required

McBurney's point

Palpate 1/2 b/t umbilicus and ASIS Pain suggestive of acute appendicitis

Rovsing's sign

Palpation in LLQ elicits pain in RLQ Suggestive of acute appendicitis

Blumberg's sign

Rebound tenderness Deep palpation of the abdomen over the suspected inflamed appendix, followed by a sudden release of pressure Pain when pressure is released from the abdomen Indicates peritoneal inflammation, such as from appendicitis

Psoas sign

Resisted R hip flexion or R passive hip extension Pain suggestive of acute appendicitis

Obturator sign

Resisted R ER or passive R IR Pain on R suggestive of acute appendicitis

Hop sign

Individual jumps up/down If pain or grimace may suggest acute appendicitis

Markle's sign

Raise onto toes then drop quickly down to heels If pain or grimace may suggest acute appendicitis

Hiatal hernia main s/s

Same as GERD LUQ

Peptic ulcer main s/s

Coffee ground emesis Melena tarry stools Gastric ulcer - pain inc w/ presence food duodenal ulcer - pain inc w/o food RUQ epigastric pain

Cholecystitis main s/s

Pain inc after eating fatty foods Positive murphy's sign RUQ (mainly R scapula)

Crohn's disease main s/s

Pain decreased by passing gas Reactive arthritis RLQ Umbilicus and lower back

Ulcerative colitis main s/s

Bloody diarrhea with mucus/pus LLQ Lower back and rectal pain

Irritable bowel syndrome main s/s

Abdominal cramping Ribbon like stools Pains decreased by passing stools and at rest LLQ

Appendicitis main s/s

Mcburneys point tenderness Fever Inc WBC and all test for appendicitis RLQ

Liver disease main s/s

Light (clay) colored stools Dark colored urine Palmar erythema Easy bruising Asterixis (flapping tremor of hand) RUQ