GIGU Case Presentations

Question 1

what are the different categories of UTIs?

Answer 1

asymptomatic bacteriuria, cystitis, prostatitis, pyelonephritis

Question 2

what is asymptomatic bacteriuria?

Answer 2

presence of bacteria without symptoms

Question 3

what is cystitis?

Answer 3

symptomatic bladder infection

Question 4

what is prostatitis?

Answer 4

symptomatic prostate inflammation due to infection

Question 5

what is pyelonephritis?

Answer 5

symptomatic infection of the kidneys

Question 6

why does the classification of uncomplicated vs complicated UTI matter?

Answer 6

it determines the duration of treatment

Question 7

what are the three categories that determine if the UTI is complicated or not?

Answer 7

systemic symptoms, history of abnormal voiding, foreign body

Question 8

what makes pyelonephritis different from cystitis?

Answer 8

pyelonephritis includes fevers, flank pain, CVA tenderness, nausea and vomiting

Question 9

would you order imaging on a mild case of pyelonephritis?

Answer 9

no

Question 10

what imaging would you order for a more severe case of pyelonephritis?

Answer 10

CT scan of the abdomen/pelvis

Question 11

what is Lloyd’s sign/punch?

Answer 11

pain to deep percussion in the area of the costovertebral angle

Question 12

what does a positive Lloyd’s test indicate?

Answer 12

pyelonephritis or ureterolithiasis

Question 13

where are somatic dysfunctions commonly found in patients with pyelonephritis?

Answer 13

from T10-L2

Question 14

what is a common somatic finding in the acute and chronic renal patient?

Answer 14

iliopsoas spasm

Question 15

where are the chapman points for the kidneys?

Answer 15

about 1 inch lateral and 1 inch superior to the umbilicus

Question 16

where are the chapman points for the bladder?

Answer 16

the umbilicus

Question 17

where are the chapman points for the urethra?

Answer 17

superior surface of the pubic bone

Question 18

where are the chapman points for the ureters?

Answer 18

there are none

Question 19

what is the duration of treatment for an uncomplicated case of pyelonephritis?

Answer 19

3-5 days

Question 20

what is the duration of treatment for a complicated case of pyelonephritis?

Answer 20

10-14 days

Question 21

where would you expect to find a chapman point for a SBO?

Answer 21

at the 9th ICS on the right

Question 22

what does an elevated specific gravity result indicate?

Answer 22

really concentrated urine- dehydration

Question 23

what are the three different types of mechanical bowel obstructions?

Answer 23

intrinsic, extrinsic, and intraluminal

Question 24

what could cause an intrinsic mechanical bowel obstruction?

Answer 24

congenital diseases, inflammatory bowel disease, primary intestinal malignancy, volvulus

Question 25

what could cause an extrinsic mechanical bowel obstruction?

Answer 25

adhesion (from surgery), or neoplasm

Question 26

what could cause an intraluminal mechanical bowel obstruction?

Answer 26

feces, bezoars, or foreign bodies

Question 27

what is a functional bowel obstruction?

Answer 27

intestinal dysmotility, no actual mechanical blockage

Question 28

what does a strangulated bowel obstruction indicate?

Answer 28

vascular insufficiency and high risk for intestinal ischemia

Question 29

what are the number 1 cause of bowel obstructions in the US?

Answer 29

adhesions

Question 30

what syndrome is a cause of a functional obstruction?

Answer 30

Olgilvie's syndrome (acute dilation of the colon)

Question 31

what can an elevated lactate indicate?

Answer 31

this occurs when there is anaerobic metabolism going on in the body- tells if there is a specific ischemic event going on

Question 32

what is the gold standard for a patient with a suspected bowel obstruction?

Answer 32

CT scan of abdomen and pelvis

Question 33

where are the GI sympathetics located?

Answer 33

T9-L2

Question 34

if a patient with a suspected SBO is able to tolerate it, where should you look for paraspinal TART findings?

Answer 34

from T9-L2

Question 35

where are the chapman points for the small intestine?

Answer 35

8th-10th intercostal space bilaterally

Question 36

where are the chapman points for the colon?

Answer 36

anterior IT band

Question 37

what would you suspect if a patient presented with short duration of symptoms, n/v/d and they are young?

Answer 37

gastroenteritis

Question 38

what is acute kidney injury (AKI)?

Answer 38

impairment of renal filtration and excretory function over days to weeks that results in retention of nitrogenous and other waste products that are normally cleared by the kidney

Question 39

what are the three different types of AKI?

Answer 39

pre-renal AKI, intrinsic AKI, post-renal AKI

Question 40

what could be a cause of pre-renal AKI?

Answer 40

hypotension

Question 41

what could be a cause of intrinsic-AKI?

Answer 41

glomerulonephritis (conditions leading to inflammation of the glomerulus)

Question 42

what could be a cause of post-renal AKI?

Answer 42

bladder outlet obstruction

Question 43

what findings would you expect to see in a patient with pre-renal AKI?

Answer 43

vomiting, diarrhea, history of NSAID use or blood pressure medication, dry mucous membranes, poor skin turgor

Question 44

when might you test the urine albumin/creatinine ratio?

Answer 44

only if there was protein in the urine

Question 45

what is a BUN: Cr ratio greater than 20:1 suggestive of?

Answer 45

pre-renal AKI

Question 46

what do pre-renal patients need in their treatment plan?

Answer 46

IV fluids and NO NSAIDs

Question 47

what might you suspect if the OSE findings were tight paraspinal musculature on the right at the level of T10-L2, Anterior Chapman's Point noted 1 inch above and 1 inch to the right of the umbilicus?

Answer 47

pyelonephritis

Question 48

what might you suspect if the OSE findings were an anterior Chapmans point at the 9th ICS on the right?

Answer 48

an obstructed bowel

Question 49

what is an example of a functional obstruction?

Answer 49

an ileus

Question 50

what is an ileus and what is it commonly caused by?

Answer 50

it is a dysmotility that prevents intestinal content from moving distally; common occurrence post-operatively

Question 51

where should you evaluate the posterior chapman points for a small bowel obstruction/ileus? aka the posterior chapman points for the small intestine

Answer 51

lateral to the spinous process of T8-T10 bilaterally

Question 52

where are the posterior chapman points for the colon?

Answer 52

transverse process of L2-L4 bilaterally