Other Systems 2 Flashcards
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
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)
Benefits of left sidelying during pregnancy
dec IVC compression
maximizes CO
dec GERD as internal organs are relaxed
improves maternal/fetal circulation
thermoregulatory changes in pregnancy
inc metabolic rate and heat production
lower fasting blood glucose
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
Eclampsia
Occurs post birth
Preeclampsia not a pre-requisite, can occur in isolation
sxs:
seizures, headache, visual disturbances
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
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
LUQ referred pain
diaphragm (hiatal hernia), body/tail of pancreas, spleen, kidney (left)
“Don’t Be Stupid Kid”
and esophagus (GERD)
RUQ referred pain
gallbladder (cholecystitis), liver, head of pancreas, peptic ulcers
“Good Luck Harry Potter”
RLQ referred pain
appendix (appendicitis), crohn’s disease
“AC”
LLQ referred pain
diverticulitis, ulcerative colitis, IBS
“DUI”
Pain referral mid-back/scapula
esophagus, gallbladder, stomach, pancreas
Pain referral shoulder (left and right)
left shoulder: heart, diaphragm, spleen, tail of pancreas
right shoulder: gallbladder, liver, head of pancreas
Pain referral pelvis/low back/sacrum
colon, appendix, pelvic viscera
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
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
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
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
