Name the regions:
What organs will you find in the RUQ?
What organs comprise the upper GU tract?
What organs comprise the lower GU tract?
pelvicalcyceal system: urine collection which includes the ureters, bladder, and urethra
Describe the appearance of hematemesis.
coffee ground emesis
What is the medical term for "pain with swallowing"?
What are the symptoms for GI disorders?
Early satiety when eating / loss of appetite
Change in bowel function (diarrhea/constipation)
What region does urinary and renal disorders present on the patient?
What are the symptoms of urinary and renal disorders?
Dysuria, urgency, or frequency
Hesitancy, decreased stream (males)
Polyuria or nocturia
Kidney or flank pain
What should you discuss with your kidney disease patient? (4)
History of kidney dysfunction
History of dialysis – last treatment, location and any problems with AV fistula
Daily urine production
Character of pain: ask patient to describe in own words
Location: have patient report location of the pain
Onset: timing of the pain (acute vs. chronic)
Radiation: Does the pain radiate?
Intensity or Severity of pain (1-10 scale)
Duration: how long has this pain been going on/lasts?
Exacerbating or alleviating factors: what worsens or improves pain?
What are some other GI symptoms?
anorexia (loss of appetite)
Name 3 GU functional adjuncts:
(depicted in clockwise order)
What is the medical term for "difficulty swallowing (solids, liquids, or both) Intermittent or persistent"?
If patient is unable to pass gas and is distended with N/V , what may be our diagnosis?
How do you quantify an acute vs. chronic symptom?
acute is up to 2 weeks
chronic is beyond 2 weeks
The inability to excrete ingested water because of the hypovolemic stimulus to the release of antidiuretic hormone is what?
What results if free water losses are not replaced?
What can occur is there if a GI loss of potassium in the stool?
What can occur with the GI loss of bicarbonate in the stool?
What are the symptoms of GI bleeding? (2)
Melena: black tarry stools (signifies upper GI bleed)
Hematochezia: bright red blood (signifies lower GI bleed)
Odynophagia is painful swallowing and usually is infectious in nature. True or false?
Typical infections include: herpes, candida, or CMV infections in an immunocompromised patient (malignancy or AIDS)
What is characterized by the yellowish discoloration of skin and sclerae from > levels of bilirubin?
What is polyuria?
increase in 24 hour urine volume
What is severe pain that originates at the costovertebral angle and radiates to lower quadrants of the abdomen, upper thigh, or genitals?
What causes urinary incontinence? (9)
Pregnancy and childbirth
Changes with aging, Hysterectomy
Painful bladder syndrome (interstitial cystitis)
Bladder cancer or bladder stones
Where do you listen for bruits during an abdominal exam?
Listen over aorta, renal, iliac, and femoral arteries
What is boborygmi?
What is the normal rate of clicks & gurgles sounds when listening to the bowels?
5 - 34 /minute
Bruits confined to systole are abnormal. True or false?
They are normal.
How do you assess for peritoneal inflammation? (3)
Ask patient to cough
Map tenderness with 1 finger
Assess for rebound tenderness (press fingers down slowly then release quickly)
What do you note when performing abdominal exam during light and deep palpation of the 4 quadrants?
guarding (muscles contract as pressure is applied)
How do you assess for costovertebral angle tenderness (CVA tenderness)? (3)
On pt's back:
Place ball of one hand in the costovertebral angle and strike it with the ulnar surface of your other fist
Use enough force to cause a perceptible but painless jar or thud in a normal person.
Pain is suggestive of pyelonephritis (kidney infection)
What are the risk factors for a AAA?
> 65 years of age
family history of AAA
What is ascites?
Ascites is fluid within the abdomen usually as result of end stage liver disease (cirrhosis) or malignancy.
In a patient with ascites, during an abdominal exam where will you hear tympany/dullness?
Ascites fluid typically sinks with gravity, whereas gas filled loops of bowel float to the top, percussion gives a dull note in dependent areas of the abdomen.
What are mechanical causes of bowel obstructions? (3)
On PE, very high pitched bowel sounds indicate what?
What is formed in the liver and therefore is a measure of hepatic function?
What is the normal range for albumin?
3.5 - 5.5 g/dL
What is AST and ALT?
Both found in multiple tissues of the body (ie: liver, kidney, heart, skeletal muscle), but ALT predominantly in the liver.
What are normal values for AST / ALT?
7 - 40 U/L for both
What enzyme is found in the liver, biliary tract epithelium, and bone?
What is the normal value for alkaline phosphatase?
25-85 IU / L
What labs are used to detect and monitor pancreatic disease?
What lab can indicate a dysfunction of metabolism?
What lab test assesses the extrinsic pathway of clot formation?
What are normal values for this test?
PT (Coumadin therapy)
10 - 15 seconds
What test assesses the intrinsic pathway of clot formation?
what are the normal values?
PTT (Heparin therapy)
PTT measures what blood factor that may be altered due to hepatocellular disease?
What test detects presence of this organism in patients with gastric or duodenal ulceration or inflammation?
- measures the amount of urea nitrogen in the blood
- is directly related to metabolic function of the liver and excretory function of the kidneys?
What are normal values for BUN?
- rises later than BUN suggesting a more chronic disease process
- depends on muscle mass which fluctuates very little
If creatinine value doubles, what does this suggest?
50% reduction in GFR
What are normal creatinine values?
0.5 - 1.5 mg/dL
What lab test measures GFR?
At what levels of K do you need to be concerned about cardiac dysrhythmias?
K < 2.5 mEq/L
K > 5.9 mEq/L
What nuclear medicine is injested in an upper GI series test?
What anesthetic drugs do you use for upper endoscopies?
What procedure is perfomed to treat conditions of the bile ducts and main pancreatic duct, including biliary stones, strictures, certain malignancies, and other disorders?
Endoscopic retrograde cholangiopancreatography (ERCP)
What anesthetic drug do you use for colonoscopies?
What can CT scans assess for within the GI? (4)
When may be a cystoscopy be recommended?
Urinary tract infections
Incontinence or overactive bladder
Abnormal cells found in urine sample
Need for a bladder catheter
Painful urination, chronic pelvic pain, or interstitial cystitis
Urinary blockage from prostate enlargement, stricture, or narrowing
Stone in the urinary tract
Unusual growth, polyp, tumor, or cancer