Renal disease/GI disease Flashcards
Pyelonephritis
An infectious, inflammatory disease involving the kidney parenchyma and renal pelvis
Acute Pyelonephritis
typically related to a bacterial infection
Chronic Pyelonephritis
a tubulointerstitial disorder marked by progressive, gross, and irregular scarring and deformation of the calices and overlying parenchyma
Chronic pyelonephritis may be responsible for up to 25% of the population with
end stage renal disease
Clinical manifestations of pyelonephritis
Onset of symptoms and signs with acute disease is usually abrupt
May include fever, chills, malaise, headache, and back pain
May complain of tenderness over the costovertebral angle
Often also present are symptoms of bladder irritation – dysuria, urinary frequency, and urgency
Renal Cell Carcinoma
most common adult renal neoplasm accounting for 80-90% of renal tumors
kidney cancer usually silent during early stages
Classic triad associated with renal cancer:
hematuria, abdominal or flank pain, and a palpable abdominal mass
Most common finding of renal cell carcinoma:
Hematuria (urine in blood)
Other physical findings of renal cell carcinoma:
flank pain, weight loss, anemia, abdominal mass, and fever
Important questions during hx?
Questions related to hematuria, unexplained weight loss, fatigue, fever, and malaise
What is the most common metastatic cancer to sterum?
renal cell carcinoma
Renal Cystic Disease
a cavity filled with fluid or renal tubular elements making up a semisolid material
May also be a segment of a dilated nephron
single or multiple, unilateral or bilateral
What can a renal cyst lead to?
degeneration of renal tissue and obstruction of tubular flow
What are the 4 types of renal cystic disease?
polycystic kidney disease
medullary sponge kidney
acquired cystic disease
single or mutiple cysts
Polycystic kidney disease
one of the most common hereditary disorders in the US
What is the most common form of renal cystic disease?
simple renal cysts
usually less than 1 cm in diameter and do not produce symptoms or compromise renal function
Where are simple or solitary cysts found?
incidentally on routine urographic examination or lumbar spine imaging
What is abdominal flank pain associated with?
bleeding into the cyst or growth of the cyst
What usually accounts for gross hematuria?
rupture of a cyst
What can renal cysts cause?
hypertension, UTIs, developing cerebral or aortic aneurysms and mitral valve problems
What are the four categories of urinary incontinence?
total incontinence
stress incontinence
urge incontinence
overflow incontinence
Total incontinence
includes people who lose urine at all times regardless of body position
Stress incontinence
the loss of urine during activities that increased intra-abdominal pressure such as coughing, lifting, or laughing
Urge incontinence
uncontrolled loss of urine, which is preceded by an unexpected, strong urge to void
Overflow incontinence
the uncontrolled loss of urine when intravesicular pressure exceeds outlet resistance
Risk factors for urinary incontinence
Pelvic floor weakness History of myelomeningocele History of benign prostatic hyperplasia Fecal impaction Medication use, including diuretics, tranquilizers, and decongestants Pelvic surgery Bladder irritation
Upper GI tract
Mouth, esophagus, stomach, duodenum
Aids in the ingestion and digestion of food
Lower GI traction
Small and large intestines
What does the small intestine do?
accomplishes digestion and absorption of nutrients
What does the large intestine do?
absorbs water and electrolytes, storing waste products of digestion until elimination
GI Signs and Symptoms
Nausea and vomiting Diarrhea Anorexia Constipation Dysphagia Achalasia Heartburn Abdominal pain Gastrointestinal bleeding Hematemesis Melena Hematochezia Fecal Incontinence
When does nausea occur?
when nerve endings in the stomach and other parts of the body are irritated
precedes vomiting
The involuntary autonomic nervous system:
vomiting mechanism
Complications of vomiting:
Fluid and electrolyte imbalances Pulmonary aspiration of vomitus Gastroesophageal mucosal tear (Mallory-Weiss syndrome) Malnutrition Rupture of the esophagus
What does diarrhea result in:
poor absorption of waters and nutritive elements and electrolytes, fluid volume deficit and acidosis
What are systematic effects of prolonged diarrhea?
dehydration, electrolyte imbalance, and weight loss
Causes of diarrhea:
malabsorption (pancreatitis, Crohn’s), neuromuscular (IBS, Caffeine), mechanical (fecal impaction, postsurgical effect), infectious/inflammatory (viral, bacterial, parasitic), or nonspecific causes (Crohn’s, UC, diet, food allergy, antibiotics, lactose intolerance, food poisoning)
Constipation
condition in which fecal matter is too hard to pass easily or in which bowel movements are so infrequent that discomfort and other symptoms interfere with daily activities.
When can constipation occur?
a result of other factors such as diet, dehydration, side effects of medication, acute or chronic diseases of the digestive system, inactivity or prolonged bed rest, emotional stress, personality, and lack of exercise
Dysphagia
May be caused by neurologic conditions, local trauma and muscle damage, or mechanical obstruction
Intrinsic obstruction:
originating in the wall of the esophageal lumen - tumors, strictures, diverticular herniations
Extrinsic obstruction:
outside the esophageal lumen – tumors or swelling that prevents the passage of food
Achalasia
Failure to relax the smooth muscle fibers of the GI tract.
What does achalasia occur as a result of?
failure of the lower esophageal sphincter to relax normally with swallowing
What do people suffering from achalasia feel?
feeling of fullness in the sternal region and progressive dysphagia
Possible cause of achalasia?
loss of absence of ganglion cells in the myenteric plexus (nerve plexus in the muscular layers of the esophagus, stomach, and intestines) of the esophagus appears to be part of the cause
Other names for heartburn:
dyspepsia, pyrosis, or indigestion
What can bring on heartburn?
hiatal hernia, ingestion of certain foods, drugs such as alcohol and aspirin, and movements such as lifting, stooping, or bending over after a large meal may bring on heartburn
What does the vagus nerve do to the stomach?
controls the secretory and motility functions of the stomach – this causes the stomach to churn, increases the flow of gastric juices, and causes contraction and spasm of the pylorus. If stomach contents displace into esophagus, heartburn occurs
Mechanical pain
occurs by stretching the wall of a hollow organ or the capsule of a solid organ
Inflammatory pain
occurs via the release of mediators such as prostaglandins, histamines, and serotonin or bradykinin stimulating sensory nerve endings
Ischemic pain
occurs as tissue metabolites are release in the area of diminished blood flow
Referred pain
usually well localized and may be associated with hyperalgesia and muscle guarding. Pain from the spine can be referred to the abdomen – usually shows hyperesthesia over the spinal dermatome and is worse with coughing, sneezing, or straining
coffee-ground emesis
blood that has been in contact with hydrochloric acid
hematemesis
vomiting of bright-red blood
melena
black, tarry stools
hematochezia
bleeding from the rectum, or maroon-colored stools
Types of GI Bleeding:
coffee-ground emesis, melena, hematemesis, hemotochezia
Major causes of GI bleeding in therapy population:
erosive gastritis
Causes of erosive gastritis:
Severely ill people with major trauma or systemic illness, burns, or head injury
Peptic ulcers
NSAIDs such as aspirin or ibuprofen
Chronic alcohol abuse
Complications of GI bleeding:
fatigue, postural hypotension, tachycardia, weakness, or shortness of breath on exertion
Slow, chronic blood loss may result in iron deficiency anemia
Fecal incontinence
Inability to control bowel movements
Psychological factors of fecal incontinence:
anxiety, confusion, disorientation, and depression
Physiologic factors of fecal incontinence:
neurologic sensory and motor impairment (stroke and spinal cord injury), anal distortion secondary to childbirth, altered levels of consciousness, and severe diarrhea
Constitutional symptoms
Nausea Vomiting Diarrhea Malaise Fatigue Fever Night sweats Pallor Diaphoresis Dizziness
Possible cause of difficulty swallowing:
Forward head posture or anterior disk protrusion
What can an acute ulcer present as?
thoracolumbar junction pain
Kehr’s sign
Pain in the left shoulder caused by free air or blood in the abdominal cavity
When can Kehr’s sign occur?
perforation of viscus (stomach ulcer, diverticular disease), following laparoscopy, or rupture of spleen
What can also elicit Kehr’s sign?
Any precipitating trauma or injury, such as a sharp blow during an athletic event, a fall, assault, or automobile accident
Hiatal hernia
Occurs when the cardiac (lower esophageal) sphincter becomes enlarged, allowing the stomach to pass through the diaphragm into the thoracic cavity
Congential hiatal hernia:
resulting from a failure of formation or fusion of the multiple developmental components of the diaphragm
Acquired hiatal hernia:
result of penetrating wounds, particular stab wounds of GSW; blunt trauma as occurs in MVAs, and less commonly as a result of surgical trauma, empyema, and subphrenic abscess
What should be avoided with hiatal hernia?
flat supine position and exercises requiring valsalva maneuver
Esophagitis
an inflammation of the esophagus
What can esophagitis be a result of?
reflux (backward flow) of gastric juices, infections, chemical irritants, involvement by systemic diseases or physical agents such as radiation
Most common type of refluc?
Reflux esophagitis
Primary symptoms of GERD?
Heartburn, reflux, dysphagia, and painful swallowing
Described as a burning sensation that moves up and down and may radiate to the back, neck, or jaw
PT considerations for GERD:
Any treatment requiring supine position should be scheduled before meals and avoided just after eating
Gastritis
Inflammation of the lining of the stomach
Peptic Ulcer Disease
break in the protective mucosal lining exposing submucosal areas to gastric secretions
What does peptic refer to?
pepsin, an enzyme that is the principal digestive component of gastric juice
Gastric
affecting the lining of the stomach
Duodenal
occurs in the duodenum
2-3x more common that gastric ulcers
Classic symptom of peptic ulcer disease:
pain described as burning, gnawing, cramping, or aching near the xiphoid, coming in waves that last several minutes
Perforation of the posterior duodenal wall causes
steady midline pain in the thoracic spine from T6-T10 with radiation into the right upper quadrant
Back pain relieved by antacids is an indication
GI involvement and must be reported to the physician
Mechanical Obstructive Disease (Hernia)
An acquired or congenital abnormal protrusion of part of an organ or tissue through the structure normally containing it
Most common types of hernia:
inguinal (75% of all hernias), femoral, umbilical, and incisional or ventral
