Cholecystitis and Pancreatitis Quiz

Urinary Tract Infection (UTI)

• UTIs occur when bacteria enter the urinary tract, causing infection in the urethra, bladder, or kidneys.
• Less common in men than in women but can be more complicated.
• Causes of UTIs include blockage (enlarged prostate, kidney stones), catheter use, and unprotected sex. Rule out sexually transmitted infections (STIs), especially gonorrhea and chlamydia, particularly in adolescents and young adults.
• Chronic conditions such as diabetes and urinary retention can also increase UTI risk.

Diverticulitis

• Inflammation or infection of diverticula (small pouches) in the intestinal wall, typically in the colon.
• Diagnosis relies on patient history (e.g., LLQ pain, fever, bowel changes), physical exam (LLQ tenderness), and imaging, specifically a CT scan (gold standard).
• Diverticulitis can be life-threatening. Potential complications include sepsis, small bowel obstruction, hemorrhage, perforation, ileus, and abscess.
• Patient history should factor in previous episodes of diverticulitis or diverticulosis, changes in bowel habits (constipation or diarrhea), and a diet low in fiber or history of low physical activity.
• Symptoms typically include left lower quadrant (LLQ) pain (most common), which can be constant and severe, fever, nausea, or vomiting, possible bloating, tenderness, or abdominal distension, and changes in bowel movements (constipation or diarrhea).
• Physical examination may reveal LLQ tenderness upon palpation, fever, or increased heart rate, or signs of peritonitis (rigid abdomen, rebound tenderness) in severe cases.

Cholecystitis

• Inflammation of the gallbladder, often due to gallstones blocking the cystic duct.
• Symptoms often include right upper quadrant (RUQ) pain, which may radiate to the right shoulder or back, worsening after eating fatty foods, fever, nausea, and vomiting.
• A classic symptom is pain originating 1 hour or more after eating a fatty meal.
• Diagnosis includes patient history, physical examination, and laboratory tests (elevated WBC count indicative of infection/inflammation and elevated liver enzymes such as AST, ALT, and bilirubin).
• Imaging, typically starting with an ultrasound, can help identify gallstones, a thickened gallbladder wall, or pericholecystic fluid. If the diagnosis is unclear, a HIDA scan may be used.
• Treatment often involves a cholecystectomy (surgical removal of the gallbladder) via laparoscopic surgery (most common) or open procedures for severe cases.

Urinalysis Interpretation

• Normal urinalysis values vary based on clarity/turbidity, color, pH, glucose, specific gravity, ketones, nitrites, leukocyte esterase, bilirubin, urobilirubin, blood, protein, RBCs, WBCs, squamous epithelial cells, casts, crystals, bacteria, and yeast.
• Specific values for each component are provided in the text.
• Variations in color, such as yellow, dark yellow, green, blue, orange, pink, or red, can suggest conditions like dehydration, exercise, pseudomonal UTI, bile pigments, carrots, or other conditions, hematuria, or menstrual contamination.
• Variations in pH or other components can indicate kidney stones, bacterial UTIs, kidney problems, diabetes, or liver disease.

Nephrolithiasis

• Kidney stones, also called renal calculi, are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin.
• Stone formation is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate.
• Excessive urinary acidity or low urinary citrate levels may also contribute.
• The four major types of renal calculi are calcium stones, uric acid stones, struvite stones, and cystine stones.

Pancreatitis

• Inflammation of the pancreas, which can be acute (sudden) or chronic (long-term).
• Causes include gallstones, alcohol abuse, hypertriglyceridemia, hypercalcemia, medications, infections, trauma, or post-ERCP (Endoscopic Retrograde Cholangiopancreatography).
• Symptoms include severe epigastric pain, often radiating to the back, worsening after eating, especially fatty foods; nausea, and vomiting; fever, and tachycardia (rapid heart rate); abdominal tenderness or guarding.
• Diagnosis often involves laboratory tests, such as elevated serum amylase and lipase, and imaging, such as CT scans.

Acute Kidney Injury (AKI)

• A sudden and often reversible decline in Kidney function, measured by glomerular filtration rate (GFR).
• Risk factors include prerenal, intrarenal, and postrenal.
• AKI is a prevalent condition, especially in hospitalized and ICU patients.
• Diagnosis involves serum creatinine in 48 hours and urine production volume.
• Complications include hyperkalemia, metabolic acidosis, hyperphosphatemia; treatment focuses on addressing the underlying cause and managing these complications.

Urolithiasis

• Kidney stones.
• Treatment includes both conservative medical and surgical interventions, often prioritizing pain relief.
• Factors to consider include stone size, likelihood of passing, and patient presentation.

Hernia

• A protrusion of an organ or tissue through a weakened area in the body.
• Types include inguinal, femoral, umbilical, incisional, epigastric, and hiatal.
• Risk factors and symptoms for each type of hernia are presented.

Epididymitis

• Inflammation of the epididymis, a coiled tube on the back of the testicle; cause of scrotal pain.
• Diagnosis includes patient history, physical exam (such as tenderness in the scrotum), and sometimes lab tests.
• Treatment often includes antibiotics, and pain management.
• Risk factors often include sexually transmitted infections.

Bowel Obstruction

• Blockage of the bowel.
• Can have a variety of causes including adhesions, bowel tumors, and volvulus.
• Symptoms generally include abdominal pain and distention.

Testicular Torsion

• Twisting of the spermatic cord, causing reduced blood flow to the testicle.
• Symptoms often include intense scrotal pain, swelling, and sometimes nausea and vomiting.
• Urgent treatment is necessary.

Constipation

• Inability to pass stools.
• Factors contributing to constipation include dehydration, dietary factors, psychological issues, medications, and family history.
• Treatment options vary but often include addressing the root causes first.

Phimosis and Paraphimosis

• Phimosis is the inability to retract the foreskin over the glans penis; paraphimosis is when the foreskin cannot be returned to its normal position
• Diagnoses include the presentation of swelling, pain, and discoloration of the foreskin.
• Treatments can vary, from topical steroids to circumcision or surgical intervention.

Balanitis

• Inflammation of the glans penis (the head of the penis).
• Causes include infections, irritants, and medical conditions.
• Symptoms often include redness, swelling, pain, itching, discharge.
• Diagnosis and treatment protocols are based on the type and cause.

Priapism

• A persistent, painful erection lasting longer than 4 hours without sexual stimulation
• Causes may include medications, underlying medical conditions, and trauma.
• Treatments vary depending on whether the cause is ischemic (low-flow) and non-ischemic (high-flow).

Sexually Transmitted Infections (STIs)

• Infections, often transmitted through sexual contact
• Common STIs include trichomonas, chlamydia, gonorrhea, and syphilis, in addition to others
• Diagnosis & treatment protocols exist for each infection.

Ectopic Pregnancy

• Pregnancy outside the uterine cavity.
• Risk factors & symptoms for this are presented.
• Diagnosis should be considered in sexually active females of childbearing age; initial complaints may vary.
• Treatment & management of complications are discussed

Appendicitis

• Inflammation of the appendix, a small pouch attached to the large intestine
• Symptoms include pain in the RLQ (right lower quadrant), possibly associated pain, tenderness, and rebound tenderness
• Diagnosis and treatment protocols are discussed.

Gastroenteritis

• Inflammation of the stomach and intestines.
• Typically caused by viral or bacterial pathogens; can involve the oral cavity, stomach, or upper intestine.
• Symptoms include vomiting, diarrhea, cramping, nausea