Presentations/ GI weeks Flashcards
Kidney stones (urolithiasis)-
solid piece of material passes into the urinary tract
If stone does get blocked in the ureter then there could be
Blood in the urine
Vomiting
Painful urination
Form due to a high concentration of a certain minerals
Calcium
Uric acid- Gout
Struvite
Cystine
Genetics and Environmental factors for kidney stones
High urine calcium levels Obesity Calcium supplements Dehydration Gout Hyperthyroidism
When is a radiograph not needed to kidney stone diagonsis?
H/o renal stones
Under 50 years old
Unconcerning S/S
When do men usually have their first stone?
between 30-40
When do women usually have their first stone?
between 35-55
Percentage of kidney stone patients who are male?
65-80%
Treatment of small stone
small less than 5mm
typically pass within four weeks of initial symptoms and need no management
Treatment of larger stone:
greater then 5mm
will pass about half the time without further management
Hallmark findings of kidney stone patients:
sudden, sharp, severe pain originating deep in the lumbar area and radiates around the side and down toward the testicle in the male Nausea and vomiting Palpable flank mass Hematuria Fever and chills Urge to urinate frequently Abdominal muscle spasms
Which dermatomes are usually sensitive in kidney stone patients?
T10-L1
Pyelonephritis
inflammation of the renal parenchyma
Chronic Glomerulonephritis
inflammation of the glomeruli of both kidneys
Common types of infection:
pyelonephritis
chronic glomerulonephritis
Less common types of infection:
Renal papillary necrosis
Renal tuberculosis
People at risk for kidney infection:
Age over 60
Hx of diabetes or HTN
Hx of kidney disease, heart attack, or stroke
Hx of kidney stones or UTI
African, Hispanic, Pacific Island, or Native American descent
Exposure to chemicals (e.g. paint, glue, degreasing solvents, cleaning solvents), drugs, or environmental conditions
Low birth weight
Pharmacologically immunocompromised (e.g.. renal transplantation, AIDS)
Stress Incontinence
Those who engage in anal sex
Structural or congenital abnormalities that obstruct urinary flow (e.g. prostatic hypertrophy or malignancy)
Patient’s who have or have had an indwelling urinary catheter or have experienced urinary tract obstruction
Hallmark finding in kidney infection patients:
Unilateral costovertebral tenderness Ipsilateral shoulder pain Flank pain (in rare cases this can be bilateral) Haematuria, polyuria, pyuria, or bacteriuria Offensive smelling urine Dysuria, nocturia and urgency Tachycardia and tachypnoea Fever and chills Systemic ill health, rigor and chills Anorexia and nausea
Endometriosis:
An estrogen-dependent disorder defined by the presence of endometrial tissue (lining of the
uterus) outside of the normal uterus area
Regurgitation Theory:
Most common theory explaining this disorder is which is also called, retrograde menses, which means the blood goes up into the body, rather than down and out
through the vagina
Metaplastic Theory:
Endometrial tissue arises from endometrial differentiation of coelomic epithelium. During development of the embryo there is no differentiation between reproductive
cell types
Vascular/lymphatic Dissemination Theory:
endometrial cells somehow work their way into the
vascular/lymphatic system
4 Most common areas for endometriosis
to occur:
Surface of the ovaries
Endometrioma: in the ovaries
Peritoneum over the uterus
Fallopian tubes
Incidence of endometriosis may be higher in:
women who have infertility issues (15-70%)
women younger than 20 with chronic pelvic pain (44-73%)
women during reproductive age
Risk factors for endometriosis:
starting period early
regular periods with shorter cycles (less than 27 days)
longer duration of period (greater than 7 days)
heavier flow
increased menstrual pain
first degree relative with condition
it is a risk factor for ovarian and breast cancer
Endometriosis signs and symptoms:
Chronic pelvic pain
Dysmenorrhea- painful menstruation
Dyspareunia- difficult or painful intercourse
Low back pain
Dyschezia- excessive straining with stools
Menorrhagia- abnormally heavy bleeding at menstruation
Metrorhagia- abnormal bleeding from the uterus
Cylical bowel and bladder symptoms
Infertility
Differential diagnosis for endometriosis:
pelvic inflammatory disease
ovarian cysts
recurrent UTI
irritable bowel disease
PT for endometriosis:
Postural Exercises Breathing Exercises Soft Tissue Mobilization and Massage Stretching Pelvic Floor Musculature Strengthening
Carcinoma
tissue of origin is epithelial
ADENOCARCINOMA
MALIGNANCY IN GLANDULAR TISSUE
Tumors of the large intestine / colon are described as:
polyps that protrude into the lumen of the gut
Can be sessile (raised mucosal nodules) or pedunculated (attached by a stalk)
Histopathologic appearance: hyperplastic or adenomatous
Neoplastic potential: benign or malignant
Risk factors for colon cancer:
genetic
environmental exposure to toxins
lifestyle: obesity, diabetes 2, excess alcohol use
african american men
Hallmark findings in colon cancer:
Changes in bowel habits Constipation Uncomfortable bowel movements Changes in stool: narrower (pencil thin) Feeling of incomplete emptying Abdominal discomfort Bleeding Constant fatigue Unexplained weight loss Iron deficiency/anemia
Early stages of colon cancer:
Rectal bleeding, hemorrhoids
Pain in abdominals, pelvic, back, or sacrum
Pain in back that radiates down legs
Changes in bowel patterns
Advanced stages of colon cancer:
Constipation progresses to obstipation Diarrhea accompanied by a lot of mucous Nausea, vomiting Abdominal distention Weight loss Fatigue, dyspnea, fever
Differential diagnosis for colon cancer:
Crohns disease
UC
rectal bleeding
