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_________: regurgitation & excessive secretions.
- *Esophagus fails to unite (abnormal opening).
- *87% occur with fistulas.
______: interconnection between the esophagus & trachea.
- *Abnormal connection.
- *Goes with atresia.
- Upper fistula: coughing, cyanosis, regurgitation, pneumonia.
Which type of atresia/fistula results in abdominal distention & colicky pain?
- Atresia & lower fistula.
- *Most common.
What is the name for an all encompassing fistula?
- H-Type: combo of atresia, atresia + lower fistula & upper fistula.
Where is the MC location for a fistula?
At the tracheal carnia.
Excessive secretions, coughing, cyanosis, aspiration pneumonia & distention of the abdomen are associated with which condition?
3 ways to DX atresia/fistula?
- 1. Nasogastric tube cannot go into stomach.
- 2. Radiopaque catheter on x-ray.
- 3. Radiopaque dye on fluoroscopy (increases risk of chemical pneumonia).
GERD is a common complication of atresia/fistulas. What can be done to relieve this issue?
- Nissen fundoplication.
- *Also used for hiatal hernia.
________: failure of the LES to relax.
MC age for achalasia?
- 20-40 YO.
- *But may occur at any age.
- *DX via barium x-ray.
Name 3 signs & symptoms for achalasia...
- 1. Dysphagia.
- 2. Chest pain/substernal fullness.
- 3. Regurgitation.
- 4. Nocturnal cough.
- 5. Insideous onset over many months or years.
- *May have a vial component of Chaga's DX (T. Cruzi).
A "birds beak" or "rats tail" is seen with which condition?
3 DDX's for achalasia?
- 1. Scleroderma.
- 2. Stenosing carcinoma.
- 3. Stricture, diffused esophageal spasm.
Treatment for achalasia...
- Eat small portions, slowly w/ liquid.
- Chew throughly.
- Drugs to relax smooth mm.
- Pneumatic dilation of the sphincter.
What percentage of achalasia patients undergo malignant degeneration?
- Squamous Cell Carcinoma 5%
- *Other complications: aspiration pnemonia, esophagitis, lower esophageal diverticula.
5 DDX's for Globus Hystericus...
(sensation of lump in the throat D/T anxiety)
- 1. Esophageal webs.
- 2. Diffuse esophageal spasm.
- 3. GERD.
- 4. MM disorders.
- 5. Malignancy.
_____: dilated & tortuous superficial esophageal veins that may rupture, potentially causing death.
- Esophageal Varices.
- *Upper GI bleed.
Esophageal Varicies present which which type of stool?
- Black Tarry stool.
- (ET = Esophageal Tarry).
What is the MCC of esophageal varicies?
Hepatic portal hypertension (D/T cirrhosis).
4 S/S associated with Esophageal Varicies?
- 1. Hematemesis: bright red blood <50%.
- 2. Coffee ground vomit.
- 3. Substernal pain (DDX achalasia, glob. hystericus).
- 4. Black tarry stool (melena).
Which conditions are associated with a positive Guaiac Test (stool sample)?
- Esophageal Varicies & Gastritis.
- *Esophageal varicies: also DX via endoscopy & hepatic venogram.
- *Gastritis: also CBC for prescence of H-Pylori.
Esophageal varicies should be DDXed with which 3 upper GI bleeding conditions?
- 1. Gastritis.
- 2. Esophageal laceration (Mallory Wise Syndrome).
- 3. Peptic ulcers.
What percentage of patients presenting with esophageal varicies die?
- 40-50% die with first major bleed.
- *Survivors have a recurrence w/in first year & 50% die.
What percentage of malignant GI tumors come from the esophagus?
- *Highly malignant D/T asymptomatic presentation.
- *Adenocarcinoma: 50-80%, in the lower 1/3.
- *Adults 50 YO+.
- *Squamous = foreign country.
Which tumor stage spreads to the lymphatics?
- I: In situ, superficial layer of epithelium.
- II: In situ, invading (agressive) submucosa (vessels).
- III: In nodes & deeper structures.
- IV: Mets = affects distal organs.
What is the the survival rate for esophageal cancer?
5 year less than 20% (most die w/in 1st year of diagnosis).
Barrett's esophagus affects the ____ part of the esophagus.
- *Complication of long standing GERD (hiatal hernia).
- *Risk factor for esophageal adenocarcinoma.
- *Squamous cells replaced with pseudo columnar epithelium.
What % of Barrett's Esophagus results is malignant degernation?
50% have adenocarcinoma (=80% mortality rate).
What is an a/k/a for diffused esophageal spasm?
- Corckscrew Esophagus.
- *Uncoordinated contractions of the esophagus.
- *Severe chest pain, dysphagia, regurgitation.
Nitroglycerine, Ca+ Channel Blockers, Botulin Toxin & Endoscopic Balloon Dilation is used to treat...
Corkscrew Esophagus (Diffused Esophageal Spasm).
What is the cause of MI?
- Death of cardiac mm D/T ischemia.
- *S/S last longer than 20 min.
- *Diaphoresis (sweating).
- *Take strong ant-acid... if does not go away = MI.
Which wave is altered on the ECG with a MI?
Q-wave: due to blood flow & pressure changes.
Blood tests are looking for which 2 markers for MI DX?
- 1. Creatinine kinase.
- 2. Troponin.
What is the cause of angina pectoris?
- Atherosclerosis of the coronary arteries.
- *Decreases lumen size, but no damage to heart tissue.
Which wave is altered on the ECG with Angina Pectoris?
- ST-Segment... Also for Prinz-Metal Variant Angina.
- *DX via Stress Test.
- *Also DX via coronary angiogram.
- *Nitroglycerine helps.
A/k/a for Angina Inversa?
- Prinz-Metal Variant Angina (Variant Angina).
- *Chest pain at rest which occurs in cycles.
- *D/T vasoSPASM of coronary arteries.
The Ergonovine IV Provocation Test is associated with...
GERD affects the _______ esophagus.
Name 5 aggravating factors for GERD.
- 1. Alcohol.
- 2. Fatty food.
- 3. Caffeine.
- 4. Nicotine.
- 5. Hiatal hernia.
- *Large meals, recumbency, stress, pregnancy, estrogen.
Dyspepsia & pyrosis are associated with...
- *Dyspepsia: indegestion.
- *Pyrosis: heartburn.
A/k/a for Schatzki's Ring...
- Esophageal Rings.
- "low ESR" = Esophageal/Schatzki's Rings in lower esophagus.
- *Ring of tissue at the squamoclolumnar junction.
- *Usually asymptomatic.
________: possibly congenital thin membrane in the mid to lower esophagus.
- Esophageal webs: seen in Plummer-Vinson Syndrome.
- *Dysphagia, odynophagia, nasopharyngeal reflux, thoracic pain.
- *Webs sometimes disappear when anemia is addressed.
Name 5 causes of gastritis...
- 1. Alcohol.
- 2. Prolonged NSAID use.
- 3. Surgery.
- 4. Trauma.
- 5. Infection.
- *May be asymptomatic... or upper abdominal pain, nausea, vomiting, belching (eructation), bloating & loss of appetite.
What type of anemia may occur as a result of chronic gastritis?
_____: breach in the mucosa of the alimentary tract that extends into the submucosa or deeper.
- Peptic ulcer: bigger than 5cm.
- *Most frequent in the duodenum or stomach, but can be anywhere.
- *H-Pylori involved.
Where is the MC location for peptic ulcers?
- Duodenum or stomach.
What is the biggest risk factor for peptic ulcers?
NSAID's (shuts off mucus D/T blocking COX-1 which produces prostaglandins which make the mucus layer).
Hematemesis, melena & epigastric pain are associated with which condition?
How do you test for H Pylori? (3)
- 1. Urea breath test.
- 2. Antibody blood test.
- 3. Stool antigen test.
How long does it generally take to treat a peptic ulcer?
What is the second MC tumor in the world?
- Malignant gastric tumors.
- *MC in men than women.
- *Can survive w/ treatment if stage I, II.
Name 4 environmental factors for malignant gastric tumors.
- 1. Nitrites.
- 2. Pickled, smoked or salted foods.
- 3. Decreased fat, fruit & veggies.
- 4. Blood type A.
Malignant gastric tumors need to be DDXed from...
_______: 95% of hiatal hernias.
Sliding: LES above diaphragm.
______: fundus above diaphragm.
- Rolling: fundus above diaphragm.
- "Rolling is fun"
______: multiple gastrin producing tumors, usually of the pancreas or duodenum.
- Zollinger Ellison Syndrome = Gastrin ZEG
- *Gastrin = ^HCL = ulcers.
- *Recurring, does not respond to treatment.
- *1/4 undergo malignant degeneration & spread to the parathyroid, pituitary & adrenals.
- *Treated by surgically removing tumors.
_____: laceration of the distal esophagus &/or proximal stomach.
- Mallory-Weiss Syndrome
Diarrhea & sometimes ulcerative/inflammatory changes in the SI & LI is associated with...
- Gastroenteritis: acute diarrhea.
- *12,000 deaths/day in developing countries.
Which gastroenteritis pathogen causes rice water stool & has an incubation period of 1-4 days?
- *Only 100 organisms need to cause SX.
- *Destroys epithelium of SI & LI, rectum & cecum.
- *Dysentary: invades the intestinal mucosa.
- *Fecal oral, contaminated food.
Which gastroenteritis pathogen causes a fever & arthalgia?
- Salmonella: fever, HA, arthalgia, pharyngitis, anorexia.
- *100,000/year in the US with 30 deaths/year.
- *Found in eggs.
- *Food & water bourne.
- *Incubates for 12-72 hours.
Which gastroenteritis pathogen causes your typical food poisoning?
- *Food left at room temperature.
- *Meat, fish, custard, milk, eggs.
- *Severe nausea, vomiting, diarrhea, HA & fever.
- *Quick incubation, 2-8 hours.
- *MRSA: methicillin resistant staph aureus.
Which gastroenteritis pathogen causes drooping of the eyelid?
- *Home canned foods, honey (kids <1yr).
- *Veggies, fish, fruits, beef, milk productions, pork & poultry.
- *Nausea, vomiting, abdominal, cramps, diarrhea, drooping of the eyelid (NO fever).
- *Incubation: 18-36 hours.
Which gastroenteritis pathogen causes watery & sometimes bloody stool?
- Campylobacter. "Bring water for camping!"
- *Comma shaped, flagellated gram-negative.
- *Responsible for 2x the enteric DX of Salmonella.
- *Eggs & chicken.
- *Incubation 1-2 days (up to 6 days).
- *SX last for a week.
- *Guillian-Barre: jejunum & ilium.
Which gastroenteritis pathogen causes Montezuma's Revenge?
- E Coli "Traveler's Diarrhea."
- *Undercooked beef, unpasturized milk, contaminated water.
- *Severe abdominal cramps, watery diarrhea (possibly bloody), low or absent fever.
- *Abrupt onset.
What is the MCC of Viral Gastroenteritis in children?
- Rotavirus: during the winter, age 6-24 months old.
- *May result in death.
- *Destroys enterocytes.
- *10 particles to cause infection.
What is the 2nd MCC of Viral Gastroenteritis in children?
What is the MCC of Viral Gastroenteritis in adults?
- Noro virus.
- *Abdominal pain.
- *Contaminated food or water, person to person.
Kosher's Sign is associated with which condition?
- Appendicitis: mid abdominal pain moves to the lower right quadrant.
- *Dunphy's Sign: LRQ pain w/ cough.
- *Blumberg's Sign: rebound tenderness.
- *Rovsing's Sign: increased RLQ pain w/ deep palpation in the LLQ.
What 2 conditions need to be DDXed for appendicitis?
- 1. Kidney DX.
- 2. Meckle's Diverticulum.
_______: a remnant diverticulum of the vitelline duct or yolk sac.
- Meckel's Diverticulum: usually asymptomatic.
- *2% present w/ appendicitis-like symptoms.
- *For females need to R/O falopain tube/ovary problems.
______: malabsorption syndrome caused by infectious agents found in tropical regions.
- Tropical Sprue: flattening of the microvilli & inflammation of the SI.
- *Malabsorption = fatty shit.
- *Diarrhea, steatorrhea, abdominal discomfort, nutritional deficiencies.
- *DX from deficiency of albumin, folic acid, CA+, B12 & Fe+.
- *Ascities D/T edema/osmopressure.
- *Pernicious anemia.
Which malabsorption disease is cause by Tropheryma Whipplei.
- Whipple's DX: malabsorption, possibly affecting any organ in the body.
- *MC in men.
- *Anemia, skin pigmentation, polyarthralgia/arthritis, weight loss, diarrhea.
- *Steatorrhea & swelling.
What is the treatment for Whipple's DX?
- Long term antibiotics (1-2 years).
- *Can be fatal if not treated.
What lab is elevated with Celiac's Disease?
- Alk Phos.
- *Atrophied villi upon endoscopic exam.
Which condition presents with a cracked mud appearance?
- Celiac's Disease: malabsorption DX D/T gluten sensitivity.
Which GI condition starts at the rectum/sigmoid & goes up?
- Ulcerative colitis: inflammatory bowel DX.
- *MC ages 15-30 YO.
- *Affects mucosa & submucosa.
- *Polyarthritis, AS, uveitis, sacroilitis & hepatic involvement.
- *Bloody diarrhea D/T destruction of the mucosa.
- *Lead pipe sign.
- *Increases risk of colorectal cancer.
What is the treatment for Ulcerative Colitis?
Avoid raw fruits & veggies.
A/k/a for Regional Enteritis?
- Crohn's Disease. "Skipping Chron's"
- *Small intestine.
- *Skip, transmural lesions, string sign.
- *Chronic inflammatory DX affecting distal ileum & colon.
- You learn to skip stones by tying a rock to a string.
Which condition presents in the third decade of life w/ fistulas & noncaseating granulomas?
- Chron's (Regional Enteritis).
- *No specific treatment... generally grows back after surgery... so try to limit flare ups.
Dilation of the colon accompanied by lack of paralysis is associated with which condition?
- Acquired megacolon.
- *80% of the myenteric nerve plexus destroyed for peristalsis to disappear.
- *Associated with T. Cruzi.
What is the treatment for Acquired Megacolon?
Fiber, laxitives, corticosteroids, disimpaction.
Where does Hirschsprung's DX start?
- At the anus & progresses proximally.
- *Congenital aganglionic myenteric plexus.
What are the S/S of Hirschsprung's DX? (2)
- 1. Does not pass meconium in first 48 hours.
- 2. Abdominal distention.
- *Treatment: surgically remove section of colon that is affected.
What quadrant does pain associated with Diverticulitis show up?
- *Geriatric pts.
- *DX via CT scan.
Where do malignant tumors of the bowel generally present?
- *Elevated, ridged, singular (peptic ulcers are depressed & not ridged).
What type of cancer accounts for 1/4 of cancers in the US?
- Colorectal Cancer: left colon & constipation.
- *Polyps usually benign but can undergo malignant degeneration.
What are 3 risk factors for colorectal cancer?
- 1. Low fiber.
- 2. High fat.
- 3. Processed foods.
Malignant bowel tumor S/S for the right colon?
- Palpable tumor, occult bleeding, fatigue & weakness.
- *Left colon = constipation.
4 pre-hepatic icterus causing conditions...
- 1. Hemolytic anemia.
- 2. Obstructed Portal V.
- 3. Malaria.
- 3. Splenomegaly.
- *Unconjugated bilirubin.
Hyperslpeneism presents with ________ bilirubin.
Is pre-prehepatic obstruction associated with conjugated or unconjugated bilirubin?
3 Causes of intrahapatic icterus?
- 1. Gilbert's Syndrome: unconjugated (indirect) bilirubin.
- 2. Hepatitis: smooth & tender liver.
- 3. Cirrhosis
What are 2 lab findings associated with intrahepatic obstruction?
- 1. Dark urine.
- 2. ^ serum Alk Phos, ALT, AST.
Post-hepatic obstruction is due to...
- Obstruction of the biliary tree, MC D/T gall stones.
- *Also pancreatic cancer.
Does post-hepatic icterus present with conjugated or unconjugated bilirubin in the blood?
What are 3 lab findings associated with post-hepatic icterus?
- 1. Dark urine.
- 2. Pale stool.
- 3. ^ serum Alk Phos, ALT & AST.
- *Alk Phos: liver & bone.
- *ALT (SGPT): liver.
- *AST (SGOT): increased metaoblic activitiy (heart, lung, mm, kidney, brain, pancreas).
Which form of hepatic icterus causes pale stool?
- Pale stool = Post hepatic.
Steatohepatitis D/T obesity is known as...
- NASH (Non-Alcoholic Steatohepatitits)
- *Steatohepatitis is reversible with diet changes.
- *Mostly asymptomatic.
- *May undergo cirrhosis or malignant degeneration.
Is ALT or AST grater with NASH?
- Obesity (Fatty) = F.ALT
Which Hepatitis infection presents with clay colored stool & is D/T a picornavirus-like RNA infection?
- Hep A: fever, abdominal pain, nausea, jaundice, dark urine, clay color stool.
- *Acute infection
- *2-6 week incubation
- *Economic status = risk factor
- *MC asymptomatic
- *Secreted in feces near the end of incubation
- *IgM antibodies detected for up to 14 weeks
Which form of hepatitis has a fecal-oral transmission, dark urine & is MCly asymptomatic?
Which hepatitis infection is spread through bodily fluids, is prominent in Asia & may lead to chronic hepatitis?
- Heb B: DNA virus.
- *Incubation 4-26 weeks.
- *Nausea, fever, body aches, vomiting, dark urine & possible progression to jaundice.
- *Infection lasts for a few weeks.
- *Acute: clears up spontaneously.
- *Chronic: treat w/ anti-viral meds, Epivir, Hepsera.
Which hepatitis infection is D/T an enveloped ssRNA infection w/ a 2-26 week incubation period?
- Hep C
- *Major cause of liver DX worldwide.
- *85% will have chronic liver DX.
- *Transmission via transfusions, inoculations & sex.
- *Usually asymptomatic = incidental finding during routine blood tests.
- *May progress to hepatocellular carcinoma.
- *60-70% of cases are asymptomatic for first 6 months.
Which hepatitis has the worst sequelae?
Which hepatitis is spread via blood?
Which disease is a superinfection which leads to cirrhosis?
- Hep D: coinfection with Hep B.
Which hepatitis infection has a high mortality rate with pregnant women?
- Hep E.
- *Fecal-oral transmission.
Is liver cirrhosis reversible, or irreversible?
- *In top 10 leading causes of death.
- *D/T alcoholism, Hep B & C, biliary DX, NASH & hemochromatosis.
Name 5 S/S of cirrhosis.
- 1. Clubbed nails.
- 2. Hypertrophic OA.
- 3. Caput medusa.
- 4. Jaundice.
- 5. Ascities.
- *Esophageal varicies D/T portal HT/.
- *Palmar erythmia.
- *Spider angiomata.
- *Muehrcke's nails: D/T hypoalbuminia.
- *Terry's nails: distal 1/3, D/T hypoalbuminia.
- *Dupuytren's contracture.
3 elevated lab findings associated with cirrhosis? 2 decreased lab findings?
- 1. AST/ALT
- 2. sGGT
- 3. Bilirubin
- 1. Albumin
- 2. Prothrombin clotting factors
What is the MCC of liver cancer?
Metastatic spread from other organs.
What is the name of primary liver cancer?
- Hepatocellular carcinoma (HCC).
- *Friction rubs & bruits heard upon auscultation.
What are the 2 major risk factors for HCC?
HCC presents with elevated _____ lab findings.
- *It is hard to differentiate tumor from cirrhosis = biopsy is best.
______: benign, inherited condition which produces mild hyperbilirubinemia.
- Gilbert's Syndrome.
- *Life long condition.
- *Mis DX as chronic hepatitis.
- *Mild jaundice with stress, exertion or fasting.
- * ^ levels of unconjugated bilirubin.
- *Normal liver FX tests & UA.
- *No treatment.
What are the 2 types of gallstones?
- 1. Cholesterol: large, MC.
- 2. Pigment/bile.
What is the MC presentation for gall stones?
- *Up to 80% stay silent for a lifetime.
Which condition is caused by obstruction of the gallbladder's neck or cystic duct?
- Acute calculus cholecystitis.
- *Post op, severe trauma, severe burns.
- *Chronic calculus cholecystitis: nausea, abdominal pain, belching, diarrhea.
T/F acute cholelithiasis pain radiates to the testicles in males.
- False... it refers to the medial-inferior angle of the scapula.
- *Ureterolithiasis radiates to the testicles.
3 DX signs for cholecystitis?
- 1. Georgievskiy-Myussi's (Phrenic Nerve) Sign: pain when pressing between the edges of the SCM.
- 2. Ortner's Sign: pain when tapping the right costal arch.
- 3. Boas's Sign: pain below right scapula.
Which sign for cholecystitis presents with pain when tapping the right costal arch?
What is the MC treatment for cholecystitis?
The MCC of choledocholithiasis is...
- Gallstones in the common bile duct.
- *Clay colored stool, jaundice.
- *MRCP for DX.
T/F Choledocholithiasis may elevate hepatic enzymes.
- True... ^ Alk Phos, Amylase & Lipase.
- *May present w/ jaundice.
ERCP is used to treat which condition?
- *Also used for alcohol.
What is the MCC of acute pancreatitis?
- Gallstones. DIFFERENT THAN BOARDS!!!!!!!
- *#2: alcoholism.
- *Can be reversible.
Causes of acute pancreatitis...
I GET SMASHED
- Ethanol (alcohol)
- Autoimmune DX
- Scorpion or snake venom
- ERCP: Endoscopic Retrograde CholangioPancreatography.
Severe epigastric pain which may radiate to the back is associated with...
- Acute pancreatitis.
- *Decreased by leaning forward.
- *Nausea, vomiting, diarrhea.
What is Grunwald's Sign?
*Turner's: hemorrhagic discoloration to the flank.
- Ecchymosis (bruising) around the umbilicus D/T acute pancreatitis
- *Cullen's: hemorrhagic discoloration of the umbilicus. I want to have Edward Cullen's baby.
What is Kamenchik's Sign?
Pain with pressure at the xiphoid D/T acute pancreatitis.
What is Mayo-Robson's Sign?
Pain at the 12th costotransverse angle D/T acute pancreatitis.
What is Korte's Sign?
- Pain at the head of pancreas (6-7 cm above umbilicus).
Which 3 blood tests are elevated with pancreatitis?
Amylase, lipase & Alk Phos.
Does pancreatic failure elevate or decrease amylase & lipase?
What is the primary cause of chronic pancreatitis?
- *Also D/T repeated acute attacks or long standing inflammation.
- *NOT reversible.
- *May be silent until pancreatic insufficiency & DM develop.
- *TX: anti-H3 receptor meds.
Which test is used to DX pancreatitis?
Secretin Stimulation Test
Trousseau Sign & Courvoisier Sign are associated with which condition?
- Tumors of the Pancreas.
- *Courvoisier Sign: + in 10% of cases.
What is the 4th leading cause of cancer death?
- Tumors of the pancreas.
- *MC = adenocarcinoma.
- *Tumor develops for a long time before S/S.
- *Treatment palliative, not curative.
- *MC @ the head of the pancreas.
Malignant obstruction of the head of the pancreas leads to...
What type of DM has a juvenile onset & is associated with acute ketoacidosis?
- IDDM Type 1
- *8-15 YO.
- *Destruction of beta cells.
IDDM Type 1 positive fasting GLU test value....
- >125 mg/dL
- *Severe: Plasma GLE test 2 hours after a challenge >500 mg/dL
AGE stands for...
- End products
Nonketotic hyperosmolar comas are associated with which type of DM?
- NID DM T2
- *Ketoacidosis is rare.
- Diagnosis is the same as type 1:
- *Fasting >126 mg/dL
- *OGTT >200 mg/dL
- *High specific gravity
What is the leading cause of blindness & end stage renal DX in the US?
NID DM T2
Which form of diabetes is a/k/a Central Diabetes?
- Diabetes Insipidus: inflammation, tumor or trauma to the hypothalamus & pituitary.
- *Nephrogenic DI: D/T renal tubular unresponsiveness to ADH.
- *Does NOT present w/ polyphagia.
- *Transparent urine (D/T high ADH).
Which type of diabetes is DX via the water deprivation test?
- Central Diabetes Inspidus.
- *Test stops when orthostatic hypotension & postural tachycardia appear, or when 5% or more of initial body weight has been lost.
Which disease of the kidney destroys parenchyma & causes renal failure?
- Autosomal-dominant Polycystic Kidney DX (ADPKD): adults.
- *Affects kidney FX in the 4th-5th decade of life.
- *PDK-1 or 2.
- *Intracranial Berry Aneurysms & mitral valve prolapse.
- *DX: Must see at least 2 cysts in one kidney & 1 cyst on the contralateral kidney.
Which form of polycystic kidney DX results in a sponge-like kidney?
- Autosomal-Recessive Polycystic Kidney DX (ARPKD): sponge kidney.
- *Infants succumb rapidly... renal failure occurs early.
- *Leads to congenital hepatic fibrosis. Infants get sponge baths.
What are 2 S/S of polycystic kidney DX?
- 1. Abdominal discomfort
- 2. Hematuria
- 3. UTI
- 4. Palpable masses in the abdomen
- 5. Polyuria
- 6. HT.
Polycystic kidney disease is inherited & _____.
What age group is affected by acute glomerulonephritis?
- Kids 6-10 YO.
- *Post-infectious DX: A-beta hemolytic strep.
- *Inflammation of the glomeruli w/ abrupt onset of hematuria & mild proteinuria.
- *Nephritic syndrome = hematuria & proteinuria.
Murphy's punch is usually ______ in acute glomerulonephritis.
- Negative: the glomeruli are tiny!
- *Positive w/ acute pyelonephritis.
Name 4 S/S of acute glomerulonephritis.
- 1. Oliguria: low urine output.
- 2. Edema: starts periorbital, then pitting around ankles.
- 3. Dark urine/hematuria.
- 4. HX of strep infection.
- *Sometimes HT.
Acute glomerulonephritis presents with what type of urine?
- Pink urine.
- *The glomerulus filters blood.
Which kidney syndrome results in the urinary secretion of protein, anorexia, malise & frothy urine?
- Nephrotic Syndrome: urinary excretion of proteins >3g/day.
- *Kidney damage.
Nephritic syndrome is the result of further kidney damage... What are the urine findings?
- Nephritic Syndrome: pores large enough for proteins & RBC's to get through = hematuria.
- *IgA Nephropathy: MC nephritic syndrome... peaks at 20 YO.
2 lab findings for acute glomerulonephritis?
(Clue: 1 comes from the HX)
- 1. + ASO Titer
- 2. Azotemia: elevated BUN & serum creatinine.
Elevated BUN & serum creatinine.
What is the treatment for acute glomerulonephritis?
- Generally self-limiting.
- *Maintain Na+ & H2O balance.
What are the lab findings associated with Chronic Glomerulonephritis?
- 1. BUN & Creatinine high, but not as high as acute.
- 2. HEP
______: patchy suppurative bacterial inflammation affecting the kidneys.
- Acute Pyelonephritis: D/T ascending UTI which has reached the pyelum or renal pelvis.
- *Predisposing conditions: UTI, iatrogenic, DM, pregnancy, etc.
What does acute pyelonephritis present with in the urine? (2)
- Bacteria & nitrates.
- *Nitrates inhibit bacterial growth, that's why they are in food.
Acute pyelonephritis presents with pain at....
- The costovertebral angle.
- *Abdominal rigidity, sepsis.
- *MC in females up to 40 YO D/T anatomy; males increase with age D/T prostate hypertrophy.
WBC casts are associated with which condition?
- Acute pyelonephritis.
- *Pyelo = pus... the WBC's are all clotted up together & stuck = forms a cast.
- *Cloudy urine.
What are the 4 lab findings associated with acute pyelonephritis?
- 1. Alkaline pH
- 2. Pyuria.
- 3. Hematuria.
- 4. WBC casts.
- *Casts are only formed in the tubules = renal involvement.
Which kidney disease requires long-term antibiotic treatment?
- Chronic pyelonephritis: chronic tubulointestinal inflammation & renal scarring that involves the calyces & pelvis.
- *Get rid of obstruction & treat infection.
Chronic pyelonephritis is diagnosed by which 3 findings?
(Clue: 1 ortho test, 2 UA findings)
- 1. + Murphy's Punch
- 2. Pyuria
- 3. Bacteriuria
What condition is associated with rapid, steadily increasing azotemia w/ or w/o oliguria (low urine output)?
- Acute renal failure.
- *Generally temporary & benign.
- *Prerenal, renal & postrenal.
In addition to presenting with oliguria & anemia, what are 2 lab findings for acute renal failure?
- 1. Azotemia (BUN nitrogen).
- 2. Urinary sediment.
Acute pyelonephritis presents with an ______ ASO titer.
- *Although pyelonephritis is caused by bacteria, it is D/T E. Coli.
- *Glomerulonephritis has + ASO Titer.
What are 5 causes of prerenal acute renal failure?
- 1. Cardiac failure.
- 2. Hypotension.
- 3. Low blood volume.
- 4. Renal stenosis.
- 5. Renal V thrombosis.
- *Renal: decreased blood flow, decreased GFR, tubular obstruction, tubular damage.
- *Post-renal: prostatic hypertrophy, malignancy, kidney stones.
What is the MCC of chronic renal failure?
- Diabetic nephropathy.
- *Urine breath, nocturia, HT.
What are the 4 stages of chronic renal failure?
- 1. Diminished renal reserve: GFR 50%/normal.
- 2. Renal insufficiency: GFR 20-50%/normal. Azotemia. HT. Poly/nocturia. Decreased urine concentration.
- 3. Renal failure: GFR <20%/normal. Kidneys cannot regular vol & conc = edema, metabolic acidosis, hypocalcemia, uremia (elevated BUN).
- 4. End-stage renal failure: GFR <25%. Terminal stage of uremia.
_____: azotemia associated w/ metabolic &/or endocrine alterations.
- *Uremic gastroenteritis, periphreal neuritis, pericarditis.
Broad waxy casts are associated with...
- Chronic renal failure.
- Surfing stoners need chronic & wax for their broad surf board.
What are the 5 lab findings associated with chronic renal failure?
- 1. Nitrogen retention.
- 2. Acidosis.
- 3. Anemia.
- 4. Elevated urea & creatinine (PLASMA).
- 5. Broad waxy casts.
Diet management for chronic renal failure: ________ caloric intake & ________ proteins to prevent ketosis.
- Diet management for chronic renal failure: increase caloric intake & decrease proteins to prevent ketosis.
- *Monitor Na+ H2O balance.
______: dilation of the renal pelvis, infundibulum & calyces D/T obstruction of the ureters.
- Hydronephrosis: causes muscular atony (decreased tone), fibrosis & loss of peristaltic activity.
- *Gradual loss of renal FX.
- *Damages kidney beyond repair.
T/F Hydronephrosis damges the kidney beyond repair.
Which kidney DX results in colicky flank pain?
- Hydronephrosis: flank mass may be palpable in infancy or childhood.
- *Possible kidney stones D/T stasis.
Where do nephrolithiasis occur?
Anywhere in the urinary tract.
What are the 4 types of nephrolithiasis?
- 1. Ca+ Oxalate: 55% D/T hypercalcemia. Also associated w/ gout.
- 2. Magnesium Ammonium Phosphate: BIGGEST stones = stanghorn calculi... D/T infection of urea-splitting bacteria.
- 3. UA: gout, rapid cell turnover (lukemia).
- 4. Cystine: genetic defects & decreased renal absorption.
- *All stones are seen on x-ray except for pure UA.
Which type of nephrolithiasis results in stanghorn calculi?
Mg+ Ammonium Phosphate.
What is the MC primary renal tumor in childhood?
- Wilm's Tumor: large abdominal mass possibly bilateral.
- *Rarely involves both kidneys (5-10%).
- *May cause HT.
Wilm's Tumor presents with ____ in the UA.
3 congenital abnormalities associated w/ Wilm's Tumor...
- 1. WAGR Syndrome: congenital abnormalities & mental retardation.
- 2. Denys-Drash Syndrome: gonadal dysgenesis.
- 3. Beckwith-Wiedemann Syndrome: enlargement of body organs.
Which syndrome associated with Wilm's Tumors has enlargement of body organs?
- BECKwith-Wiedemann Syndrome: enlarged organs, macroglossia, hemihypertrophy.
- You know David BECKham has a big one...
Which syndrome associated with Wilm's Tumors has anaridia?
WAGR Syndrome: anaridia (no iris), genital disorders & mental retardation.
What are the most significant risk factors for tumors of the kidney? (2)
- Adenocarcinoma: tobacco & obesity.
- *Tumors generally silent.
- *If symptomatic (10%): costovertebral pain, palpable mass & hematuria.
Kidney stones may be silent, but it is also true that _______ may also present with painless hematuria.
Carcinoma of the kidney.
What is the MC type of kidney adenocarcinoma?
- 1. Clear cell: MC. In proximal tubules.
- 2. Papillary: in DCT. Multifocal = invades renal V.
- 3. Chromophobe: haloed nucleus.
- 4. Collecting Duct.
Where are the 2 MC MET locations for kidney adenocarcinoma?
- Lungs & bones.
- *If isolated, cure rate is 90%.
For DX of bacterial cystitis, the culture count has to be > ______ CFU/mL
- >1,000 CFU/mL
- *Cloudy urine.
- *50% resolve w/o antibiotics.
- *Cranberry juice reduces incidence.
95% of bladder tumors are of ______ tissue origin.
- 95% of bladder tumors are of epithelial origin.
- *12,000 deaths/year.
- *Transitional cell MC.
- *Cigarettes, arylamines, schistoma infections, analgesics.
- *Endemic in Egypt, Sudan & Portugal D/T flatworms.
Which type of cancer presents with painless hematuria?
What does BCG stand for?
Bacillus Calmette-Guerin: immuno therapy by way of TB vaccine.
______: failure of one or both testes to descend.
- *2/3 spontaneous descend w/in first 4 months of life.
- *Can be palpated in inguinal canal.
- *Side of undescended testis = inguinal hernial
- *Associated w/ testicular cancer.
- *HCG treatment 2-3x's/wk = possible descent.
A purulent yellow-green urethral discharge is associated with which STD?
- Gonorrheal Urethritis (The Clap).
- *Women more susceptible.
- *Incubation 2-14 days.
- *DDX chlamydia.
Scrotal pain, sometimes referring to the abdomen D/T inflammation is associated with...
- Epidiymitis: usually unilateral.
- * <35 YO = STD (G or C).
- * >35 YO = iatrogenic.
- *Swelling, induration (hardening), erythema & tenderness.
What is Phren's Test & which condition is it associated with?
- Phren's Test: lifting the affected testicle reduces pain = epidymitis.
- *If the pain gets worse = torsion = 911. The penis is close friends (phren's) with the testicles = phren's for testicular torsion.
What % of mumps cases develop orchitis?
- *Children <10 YO (80%/cases).
- *2/3 are unilateral.
- *Diminished fertility if bilateral (2/3).
- *Orchitis occurs 4-7 days after parotid swelling.
- *R/O testicular torsion via Doppler US.
What are the 2 MCC's of ED?
- Atherosclerosis & diabetes (80%).
- *Primary ED is rare.
- *Complications from prostate surgery, drugs, alcohol, psychological, neurological disorders & structural disorders.
- *Bulbocavernosus reflex.
_____: painful, long duration abnormal erection.
What are the 2 types?
- 1. Ischemic/low flow: blood gets in but can't get out.
- 2. Non-ischemic/High flow: MC- too much blood getting in... no pain, no necrosis.
What is the MCC of priapism?
Spinal cord trauma.
What clinical test differentiates between ischemic & non-ischemic priapism?
- Intracavernosal ABG.
- *Treat w/ icepacks over the perineum, walking, drugs, aspiration, etc.
_______: fibrosis of the cavernous sheaths leading to deviated & sometimes painful erections
- Peyronine's DX: MC D/T erection >4 hours.
- *Intromission: penis penetrates vagina.
- *Tumescence: swelling/erectile tissue.
_____: inability to retract foreskin to expose the glans penis.
- Phimosis: normal in children.
- *Treatment not necessary unless balanitis (swelling of the penis head), UTI & dermatological DX present.
______: entrapment of the foreskin in the retracted position.
- Paraphimosis "a tight turtleneck."
- *If conservative treatment does not work, must do circumcision.
Internal hemorrhoids occur above _____, whereas external are below.
- Pectinate line.
- *External are prone to thrombosis & cause the most pain = painful purplish swelling.
- *Internal can become prolapsed & strangulated.
Which type of hemorrhoid causes hematochezia?
- Internal hemorrhoids.
- *Hematochezia: bleeding w/ defecation.
- *External = pain & thrombosis.
What grade of hemorrhoid requires manual reduction?
- Grade 1: no prolapse.
- Grade 2: prolapse w/ defecation, but spontaneous reduces.
- Grade 3: requires manual reduction.
- Grade 4: cannot be manually reduced.
What will blood tests show for condyloma lata?
What anal condition is caused by Treponema Pallidum?
- Anal syphilitic warts (chancres): shows a spike on blood tests.
- *Transmitted by sex during the 1st & 2nd stage.
- *Genital ulcers, skin lesions, meningitis, aortic DX, neurologic syndromes (HA, deafness).
- 1st stage: 3-4 weeks later = chancre.
- 2nd stage: 4-10 weeks later = mucus membrane lesions, fever, anorexia, lymphadenopathy, syphlitic dermatitis & condyloma lata.
- 3rd stage: cardiovascular, neurosyphilis & gummas.
What is the best blood test for anal syphilitic chancres?
Treponemal Test (FTA-ABS).
______: chronic ovoid ulcer in the squamous epithelium of the anus.
- Anal fissure: acute longitudinal tear.
- *Conservative treatment followed by possible surgery.
Perianal fissures are associated with which GI condition?
Regional Enteritis (Chron's Disease).
_______: episodic rectal pain D/T spasm of the levator ani.
- Proctalgia fugax.
- *Usually lasts <20 min.
- *Benign condition.
______: tube-like tract from the anal canal to the perianal skin.
- Anal fistula.
- *Seen w/ Chron's & TB.
Where do perianal abscesses generally occur?
- The anal crypt.
- *Chron's DX, E Coli, Proetus Vulgaris.
- *Painful perianal swelling w/ redness & tenderness.
______: inflammation of the anal & lower rectal mucosa possibly D/T STD or infection.
- Proctitis: rectal bleeding.
- *Associated w/ anal sex.
- *Camylobacter, shingella & salmonella.
- *Gonorrhea, Chlamydia, herpes & syphilis.
______: painless protrusion of the rectum through the anus.
________: nonmalignant adenomatous prostate overgrowth.
- *80%/men >80 YO possibly D/T hormonal changes.
- *Urine flow becomes restricted... also frequent, urgent, nocturnal & dribbling.
How do you DX BPH? (3)
- 1. Palpation = rubbery w/ loss of median furrow.
- 2. PSA to R/O cancer, but it's elevated w/ BPH 30-50% of the time.
- 3. Transrectal US.
What is a positive PSA test for someone under 50 YO?
- PSA >2.5 = BPH.
- *PSA >4 (50 YO+) = BPH.
TURP is associated with which condition?
- Transurethral Restion of the Prostate = BPH.
- *Alpha-adrenergic blockers help w/ voiding.
- *2-25% may become incontinent.
How is prostatitis DX?
- 1. UA for WBC
- 2. US to R/O abscess or inflammation of seminal vesicles.
- 3. Cytoscopy.
How is prostatic cancer graded?
- Gleason score: graded twice, then add two scores together.
- *Median age/DX 72 YO.
- *More die with it than from it.
- *No SX until advanced.
Findings with prostate cancer? (4)
- 1. Stony hard nodules.
- 2. Elevated PSA.
- 3. Transurethral US.
- 4. Biopsy, graded via Gleason Score.
- *Prostatectomy for men <70 YO.
Which side does the pt lay on for the prostate exam?
- Left side.
- *ID the lateral lobes & median sulcus.
- *Should feel rubbery.