---GI---GU---Endo--- Flashcards by edward barquist

Infrequent Stool, excessive straining, sense of incomplete evacuation need for digital manipulation
FEWER THAN 3 STOOLS IN A WEEK

Constipation

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Dull/aching/throbbing pain before defecation and lessens after but persists between bowel movements,
straining, sneezing, coughing makes it worse
Pain and tenderness interfere with WALKING OR SITTING
Perianal Palpable mass

Anorectal Abscess

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Midline gluteal crest with one or multiple sinus openings
recurrent infection at base of spine,
Swelling, TTP, pain persistent discharge

Pilonidal disease

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Located below dentate line
caused by straining, constipation, prolonged sitting, pregnancy, obesity and low fiber diets, visible mass perianal inspection
can have acute onset sever pain, blueish perianal nodule.

External hemorrhoids

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Sense of fullness anus, mucoid discharge on cloths, painless bright red bleeding prolapse and mucoid discharge
caused by straining, constipation prolonged sitting, obesity, pregnancy and low fiber diets
4 stages

Internal hemorrhoids

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Involving rectum/left colon BLOODY diarrhea and fecal urgency, LLQ cramps relieved by defecation no significant tenderness
MOSTLY NON SMOKERS

Ulcerative Colitis

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begins late teens/twenties
abnormal stool passage, bloating/distension, dyspepsia, heart burn, chest pain, HA, fatigue, myalgia, urologic dysfunction, gynecologic symptoms
Intermediate lower ABD pain ONSET associated with defecation frequency and sometimes relieved by defecation
Possible Tender Lower ABD pain

irritable Bowel syndrome

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Chest pain
30-60min after a meal
Pt complain of regurgitation, dysphagia
associated with ingestion of spicy/acidic/salty/ ETOH

GERD

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Smokers and long TERM NSAID usage
Men>women
epigastric pain localized not severe DULL/ ACHING HUNGERLIKE
Relief of pain with goods or antacids

Peptic Ulcer

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Mild-moderate aching ABD with LLQ pain
Constipation/loose stool
N/V/Fever/ LLQ tenderness/Possible palpable mass, stool occult blood is common

Diverticulitis

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Vague/colicky periumbilical/epigastric pain
Pain shifts to RLQ after 12 hrs
Steady achy with walking or coughing pain
decreased bowels sounds, rectal tenderness, N/anorexia, constipation low grade Fever
POS- Psoas/obturator/McBurney’s point/rebound tenderness/rovsings

Appendicitis

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Mild/sudden appearance, steady localized epigastric , Fever/N/V
RUQ ABD tenderness
(POS murphys sign)
leukocytosis after 24-48hrs
Possible palpable mass(gallbladder)

Cholecystitis

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Acute- sudden
Upper ABD tenderness possible palpable mass
N/V/Fever, tachycardia
hypotension, pallor, cool and clammy
severe weakness/sweating/anxiety
Epigastric ABD pain, STEADY/BORING MADE WORSE BY WALKING/LAYING SUPINE better by SITTING/LEANING FWD

Pancreatitis

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ETOH/NSAID abuse, Epigastric pain N/V, hematemesis, stress

Diagnosed with Endoscopy

Gastritis

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history of retching/vomiting/straining

Hematemesis w/w/o melena

Mallory wise

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Excruciating retrosternal pain due to intrathoracic esophageal perforation
spontaneous perforation from severe straining of esophagus

Boerrhave

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Melena-black stool
hematemisis-bright red blood vomit
SBP<100 mmhg
Postural hypotension/tachycardia

Upper GI

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Brown stool mixed or streaked with red blood Or marron stool, or bright red blood on defecation/diarrhea

Lower GI

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Fever, Possible hypotension, Patient in fetal position worsens with any 
movement, visible peristalsis
ABSENCE of BM in all 4 quadrants
Absence or dullness to percussion
BOARDLIKE ABDOMENT
SHAKE PELVIS REBOUND TENDERNESS

Secondary peritonitis

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tachycardia/mild fever
increase in intra ABD pressure reduced muscle tone and other connective
tissue abnormalities force
contents through a widened
internal ring
Palpation- pt coughs/bears down TAPPING sensation at tip of finger

indirect inguinal hernia

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Male cough/bear down bulge anteriorly
Tachycardia, mild fever
males swelling may extend into the scrotum
acquired defects that do not involve passage through inguinal canal

direct inguinal hernia

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confusion, agitation, unresponsive
lethargy, combativeness, seizures
focal neuro deficits
Whipples triad
1.confusion,anxiety,sweating
2.glucose 70mg/dl
3.clinical signs resolve with glucose elevation

Hypoglycemia

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polyuria, polydipsia
unexplained wt. loss, blurred vision, poor wound healing
candidiasis vaginitis, UTI
Glucose 100-126

diabetes 1

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40 Y/O > +, obese
polyuria, polydipsia unexplained wt. loss
hypertension, dyslipidemia, retinal blindness, glaucoma/cataracts
LOWER EXTREMITITY ULCERATIONS SECONDARY TO TINEA PEDIS

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diabetes 2

Polyuria, polydipsia, fatigue N/V, stupor, dehydration, hypotension, tachycardia, mild hypothermia, ABD tenderness RAPID DEEP BREATHING- FRUITY BREATH

Diabetic Ketoacidosis

fatigue, lethargy, weakness, hoarseness, dry skin, brady cardia, constipation, depression, wt. gain menorrhagia, cold intolerance Thin brittle nails, thin hair, pallor, turgor of mucosa late signs: slow speech, peripheral edema, dyspnea, absent sweating. puffiness of face and eyelids, thick tongue, hard pitting edema

Hypothyroidism

Sweating, wt. loss, fever, anxiety, nervousness, disorientation, hyperflexia, palpitation, sinus tachycardia, PAC/AFIB, Enlarged and tender thyroid heat intolerance, tremor, stare, menstrual irregularity

Hyperthyroidism

Diffuse adipose tissue nontender localized to sub areolar region, Asymmetrical, nipple retraction, nipple bleeding or discharge, unusual firmness

Gynecomastia

Due to physical straining, trauma, sexual activity fever, flank pain, scrotal swelling, prostate TTP, Prehn Sign- elevation of scrotum above pubic symphysis Pain in scrotum radiates along spermatic cord or flank

UTI-Epididymitis

Sudden Onset During high humidity or summer months Sedentary life -hypertension, cardiovascular disease, high protein and salt intake LOCALIZED FLANK PAIN CANT FIND A COMFORTABLE POSITION, ipsilateral groin pain may radiate to abdomen

Urinary stone

Painless enlargement of testis-3-6 months, sensation of heaviness Acute testicular pain because of intra testicular hemorrhage

Testicular mass

Spontaneous or with Trauma Men<40 Acute/severe scrotal pain following trauma/physical activity, N/V Negative cremasteric reflex BELLS CLAPPER- high riding testis oriented transversely

Testicular Torsion

May cause Urinary retention fibrous constriction of foreskin preventing retraction (stuck forward)

Phimosis

Possible urinary retention penis distal to foreskin becomes swollen and painful even gangrenous Retracted foreskin develops fixed constriction proximal to the glans (stuck backwards)

Paraphimosis

Perianal/sacral/suprapubic pain, high fever irritative voiding symptoms-urgency/frequency/dysuria prostate swelling lead to urinary retention WARM AND TENDER PROSTATE

Acute prostatitis

Low back and perianal pain suprapubic discomfort irritating voiding -frequency/urgency/dysuria PROSTATE MAY BE NORMAL/BOGGY/INDURATED

Chronic bacterial prostatitis

Fever, flank pain, shaking, chills, N/V/D, tachycardia, costovertebral angle tenderness Irritative voiding-urgency/frequency/dysuria

Pyelonephritis (kidney infection)

Pain worsens during premenstrual cycle/multiple and bilateral Ages 30-50 symptomatic/A Breast pain/TTP found on accident Absence of enlarged or tender lymph nodes

Fibrocystic

Females20 or older\y | Round, Ovoid, rubbery, discrete, relatively mobile, nontender Mass 1-5 cm in in the breast

Fibroadenoma

Rare lesion in breast Trauma caused ecchymosis mass often accompanied with skin or nipple retraction commonly seen after fat injections to augment breasts

Fat necrosis

Painless lump usually found by female patient SINGLE NONTENDER ILL DEFINED MARGINES nipple discharge, pain, erosion, retraction, enlargement or itching of nipples Positive FMHX

Female breast carcinoma

Increase for patient with prostate cancer Painless lump usually found by male patient hard ill defined nontender mass beneath nipple or areola current/history of gynecomastia

Male breast carcinoma

History- LMP, recent sex-use of lubricants, contraceptives, tampons, douches Possible antibiotic use, occlusive cloths WHITE CURD DISCHARGE NOT SMELLY

Vulvovaginal candidiasis

Recent medication or antibiotics | increase in malodorous discharge with out obvious vulvitit/vaginitis NOT SEXUALLY TRANSMITTED

Bacterial vaginosis

STI women pruritic, malodorous frothy, yellow-green discharge with vaginal swelling STRAWBERRY CERVIX red macular lesions

Trichomonas Vaginalis

dysmenorrhea, chronic pelvic poain, dyspareunia, abnormal bleeding, maybe asymptomatic chronic pain and infertility CERVICAL MOTION TENDERNESS TENDER NODULES IN CUL-DE-SAC OR RECTOVAGINAL SEPTUM Adnexal mass or tenderness

Endometriosis

Most common young women Multiple sex partners Fever, chills, purulent cervical discharge, lower back pain, lower ABD pain, menstrual disturbances, post coital bleeding changes to urinary frequency

Pelvic inflammatory disease

Mild nonspecific GI symptoms or pelvic pressure/bloating, | possible palpable mass

Ovarian Mass

Associated with Hirsutism (dark course hair women's lip) obesity, cardiovascular disease CHRONIC ANOVAULATION menstrual disorders-amenorrhea/menorrhagia infertility skin disorders insulin resistance hyperandrogenism

Polycystic ovarian syndrome

Sudden lower quadrant pain Stabbing no radiation backache, Adnexal tenderness 2-3 months abnormal menstruation possible infertility VAGINAL BLEEDING WIHT POS HCG, ABD PAIN UNTIL PROVEN OTHERWISE

Ectopic Pregnancy

Engorged breast or sore or fissured nipples Cellulitis is unilateral fevers, chills usually 3 months after delivery

Mastitis

Sudden onset or severe Unilateral ABD pain/Tenderness with guarding adnexal tenderness on BIMANUAL EXAM 70% on right side N/V

Ovarian Torsion

Amenorrhea, N/V, Breast tenderness, tingling, urinary frequency/urgency, Wt. gain, softening of cervix at 7 wks. QUICKENING PRECEPTION OF 1ST MOVEMENT AT 18 WKS

Intrauterine Pregnancy

Painful swelling on either side of introitus, fluctuant swelling 1-4 cm in diameter later to either labiumminus dyspareunia

Bartholin gland Abscess

emotion/mood predominates along with physical symptoms clear functional impairment of work relationships ``` Bloating/breast pain, ankle swelling sense of increased wt skin disorders, irritability/aggressiveness depression/ability to concentrate libido, lethargy ```

Premenstrual dysphoric disorder | "PMDD"

Recurrent cluster of troublesome physical/emotional symptoms develop during 5 days before onset of menses ``` Bloating/breast pain, ankle swelling sense of increased wt. skin disorders, irritability/aggressiveness depression/ability to concentrate libido, lethargy ```

Premenstrual syndrome | "PMS"

lactation not associated w/child birth Possible pituitary tumors, Cushing syndrome, hypoglycemia Drugs: phenothiazines, tricyclics, antidepressants, and estrogens

Galactorrhea

surface manifestation of underlying ductal carcinoma red scaling, crusty patch forms on the nipples, areola and surround skin. Lesions appear eczematous and usually unilateral

Pagets disease

---GI---GU---Endo--- Flashcards

(58 cards)