PC2Exam1Part2

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Urinary Tract Infection Overview

• UTIs in men are caused by bacteria entering the urinary tract, infecting the urethra, bladder, or kidneys
• UTIs are less common in men but can be more complicated than in women

Urinary Tract Infection Causes

• Blockage from an enlarged prostate or kidney stones may cause a UTI
• Catheter use can increase the risk of infection
• Unprotected sex can increase the risk of sexually transmitted infections; rule out gonorrhea and chlamydia in sexually active adolescent and young adult males
• Chronic conditions such as diabetes and urinary retention can predispose to UTIs

Diverticulitis Definition

• Diverticulitis involves inflammation or infection of diverticula, which are small pouches in the intestinal wall, typically in the colon

Diverticulitis Diagnosis

• Relies on patient history, physical exam, and imaging
• Patient history that includes LLQ pain, fever, and bowel changes
• Physical exam that reveals LLQ tenderness
• A CT scan is the gold standard for confirming diverticulitis

Diverticulitis Complications

• Sepsis
• Small-bowel obstruction
• Hemorrhage
• Perforation
• Ileus
• Abscess formation

Diverticulitis Patient History

• Patient history will include prior episodes of diverticulitis or diverticulosis
• Recent changed in bowel habits such as constipation or diarrhea may be present
• Individuals may have a diet low in fiber or a history of low physical activity

Diverticulitis Symptoms

• LLQ abdominal pain (most common), which can be constant and severe
• Fever, nausea, or vomiting may be present
• Bloating, tenderness, or abdominal distension is possible
• Changes in bowel movements can occur (constipation or diarrhea)

Diverticulitis Physical Examination

• LLQ tenderness noted upon palpation
• Fever or elevated heart rate may indicate systemic infection
• Look for signs of peritonitis (rigid abdomen, rebound tenderness) in severe cases

Diverticulitis Diagnostics

• Lab tests to look for elevated CBC count which suggests infection
• CRP (C-reactive protein) may be elevated

Diverticulitis Imaging

• CT scan of the abdomen and pelvis with contrast, which is the gold standard for confirming diverticulitis
• CT scan detects inflammation, abscesses, or perforation

Diverticulitis Management: Uncomplicated Cases

• Oral antibiotics, clear liquid diet, and follow-up

Diverticulitis Management: Complicated Cases

• Hospitalization, IV antibiotics, and possible surgical intervention

Diverticulitis Prevention

• High-fiber diet, regular physical activity, and proper hydration can prevent diverticulosis

Cholecystitis Definition

• Cholecystitis involves inflammation of the gallbladder, often due to gallstones blocking the cystic duct

Cholecystitis Symptoms

• RUQ pain that is steady and severe; it may radiate to the right shoulder or back and worsens after eating fatty foods
• Fever, nausea, and vomiting may be present
• Positive Murphy's sign involves pain upon palpation of the RUQ during deep inspiration
• A classic presentation involves the patient complaining of severe right upper quadrant pain that occurs within 1 hour or more after eating a fatty meal; pain may radiate to epigastric or right shoulder areas and can involve frequent nausea and vomiting

Cholecystitis Diagnosis and Treatment

• Lab tests reveal elevated WBC count (indicating infection/inflammation) and elevated liver enzymes (AST, ALT) and bilirubin in some cases

Cholecystitis Imaging

• Ultrasound is the first-line imaging choice; it shows gallstones, thickened gallbladder wall, or pericholecystic fluid
• A HIDA scan is used if diagnosis is unclear after ultrasound

Cholecystitis Treatment

• Cholecystectomy (surgical removal of the gallbladder)
• Laparoscopic approach (most common) possible
• Open procedure for severe cases

Urinalysis Interpretation: Normal Values

• Color: yellow (light/pale to dark/deep amber)
• Clarity/turbidity: clear or cloudy
• pH: 4.5-8
• Specific gravity: 1.005-1.025
• Glucose: ≤130 mg/d
• Ketones: none
• Nitrites: negative
• Leukocyte esterase: negative
• Bilirubin: negative
• Urobilirubin: small amount (0.5-1 mg/dL)
• Blood: ≤3 RBCs
• Protein: ≤150 mg/d
• RBCs: ≤2 RBCs/hpf
• WBCs: ≤2-5 WBCs/hpf
• Squamous epithelial cells: ≤15-20 squamous epithelial cells/hpf
• Casts: 0-5 hyaline casts/lpf
• Crystals: occasionally
• Bacteria: none
• Yeast: none

Urinalysis: Abnormal Colors

• Yellow: normal color, ranging from light to deep amber
• Dark yellow may indicate dehydration or exercise
• Green or blue may indicate a Pseudomonal UTI or other conditions
• Orange may indicate bile pigments, carrots, or other conditions
• Pink or red may indicate hematuria, menstrual contamination, or other conditions

Urine Composition Abnormalities

• pH below 5 may indicate an increased risk of kidney stones, while a pH above 7 may indicate a bacterial UTI
• Small increases in protein aren't cause for concern, but larger amounts may is indicative of kidney problems
• Sugar in urine may indicate diabetes or liver/pancreas disease
• Presence of ketones may indicate diabetes or illness
• Presence of bilirubin may indicate liver damage or disease
• Blood in urine may indicate kidney damage, infection, or other conditions
• Nitrites may indicate a bacterial infection
• Leukocyte esterase in urine may signify inflammation or infection

Pancreatitis Definition

• Inflammation of the pancreas, which can be acute or chronic

Pancreatitis: Acute vs Chronic

• Acute pancreatitis involves sudden inflammation that can be mild or life-threatening
• Chronic involves long-term inflammation leading to permanent damage

Pancreatitis Causes

• Gallstones (most common cause)
• Alcohol abuse (second most common)
• Hypertriglyceridemia or hypercalcemia
• Certain medications, infections, trauma, or post-ERCP (Endoscopic Retrograde Cholangiopancreatography)

Pancreatitis Symptoms

• Severe epigastric pain that often radiates to the back and worsens after eating, especially fatty meals
• Nausea and vomiting
• Fever and tachycardia
• Abdominal tenderness and guarding

Pancreatitis Diagnosis

• Elevated serum amylase and lipase (lipase is more specific)
• Elevated WBC count, liver enzymes (if associated with gallstones)

Pancreatitis Imaging

• CT scan to confirm the diagnosis and assess the severity
• Ultrasound should be done to evaluate gallstones or biliary obstruction
• MRCP (Magnetic Resonance Cholangiopancreatography) is done for detailed biliary imaging

Pancreatitis Treatment

• NPO (nothing by mouth) to rest the pancreas along with IV fluids and electrolyte management for hydration
• Analgesics for pain control
• Antibiotics only if infection or necrosis is suspected
• ERCP for gallstone-related pancreatitis to remove obstruction

Nephrolithiasis Definition

• Renal calculi are a common cause of hematuria and of pain in the abdomen, flank, or groin

Nephrolithiasis Prevalence

• Occurs in 1 of every 11 people in the United States, with men affected 2 to 1 compared to women Development is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate

Nephrolithiasis Other Causes

• Low urinary citrate levels (an inhibitor of stone formation) or excessive urinary acidity
• Renal calculi presents with excruciating pain, and most patients present to the emergency department in agony
• A single event does not cause kidney failure, but recurrent renal calculi can damage the tubular epithelial cells, leading to functional loss of the renal parenchyma

Renal Calculi Types

• Calcium stones: due to hyperparathyroidism, renal calcium leak, absorptive or idiopathic hypercalciuria, hyperoxaluria, hypomagnesemia, and hypocitraturia
• Uric acid stones: associated with a pH of less than 5.5, a high intake of purine-rich foods (fish, legumes, meat), or cancer
• Struvite stones: caused by Gram-negative, urease-producing organisms that break down urea into ammonia
• Common organisms are Pseudomonas, Proteus, and Klebsiella; E. coli does not produce urease and is not associated with struvite stones
• Cystine stones: due to an intrinsic metabolic defect causing the failure of the renal tubules to reabsorb cystine, lysine, ornithine, and arginine; visually opaque and amber
  • Uric acid and cystine are likely stone types that develop recurrences

Nephrolithiasis Causes

• Many drugs are known to cause renal stones, including atazanavir, guaifenesin, indinavir, silicate overuse, sulfonamide, and triamterene

Nephrolithiasis Ultrasound Use

• It is useful for assessing obstruction and resultant hydronephrosis, especially in pregnancy, where x-ray studies are discouraged
• Ultrasound can also identify uric acid and other non-calcific renal stones if they are large enough (usually greater than 4 mm), but it can also miss the presence of stones less than 5 mm and cannot easily identify ureteral stones

Nephrolithiasis Diagnosis

• A non-contrast abdominal and pelvic computed tomography scan is considered the "gold standard" as it is the most sensitive and reliable test to diagnose urolithiasis, as well as provide obstruction information

Nephrolithiasis Treatment

• Renal calculi can be extremely painful when they cause a ureteropelvic junction or ureteral obstruction or they become infected
• Control pain with opioids, or intravenous (IV) nonsteroidal anti-inflammatory drugs
• IV antiemetics and hydration is required
• Patients with renal colic will often experience nausea and vomiting

Nephrolithiasis Management

• Many stones is watched conservatively, with intervention planned as an outpatient., with smaller stones (<5 mm) having a greater chance (90%) of passing naturally
• Medical expulsion therapy (usually tmasulosin, alfuzosin, nifedipine, alfuzosin, silodosin, or mirabegron)

Gastric ulcer Definition

• Gastric ulcer is an open sore in the lining of the stomach (stomach ulcer)

Gastric ulcer Causes

• Helicobacter pylori bacteria is the most common, which damages the stomach lining's protective mucus
• Nonsteroidal anti-inflammatory drugs (NSAIDs) that can damage the stomach lining

Gastric ulcers Symptoms

• Burning or gnawing pain in the center of the abdomen
• Pain that feels like an acid burn or indigestion
• Acid reflux and heartburn along with nausea and vomiting
• Bloating, belching, and gas pain
• Vomiting blood, which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Dizziness or fainting may be present

Gastric ulcers Complications

• Internal bleeding, which can be slow and long-term, or rapid and severe
• A blocked stomach outlet, which can cause repeated vomiting

Gastric ulcers Treatment

• Treatment antibiotics and acid-suppressing medications

Urolithiasis definition

• Renal stones are formed within the kidneys (nephrolithiasis)
• Urolithiasis is a condition where these stones exit the renal pelvis and move into the remainder of the urinary collecting system which includes the ureters, bladder, and urethra

Urolithiasis Treatment

• Treatment is based upon the patient's acute presentation, including both conservative medical therapies and surgical interventions
• Pain control is key; use oral and IV anti-inflammatory medications (NSAIDs) as first-line, and opioids can be reserved for refractory pain
• IV lidocaine has also been studied as an pain control
• Nausea and vomiting should be treated with IV antiemetics medications such as ondansetron, metoclopramide, and promethazine

Urolithiasis Expulsive therapy

• Medical expulsive therapy, or MET, includes alpha-blockers, such as doxazosin and tamsulosin, which is a useful adjunct to facilitate passage of larger (5-10 mm) stones but has not been found beneficial in smaller stone passage
• IV crystalloid fluids can be given to patients who appear dehydrated who have persistent vomiting/facilitate stone passage due to volume Approximately 86% of stones will pass spontaneously within 30-40 days, where stone size is often related to time taken for stone passage

Stones and passage rates

• Less than or equal to 2 mm stones take ~8 days for mean passage and passage rate of 87%
• 3 mm stones take ~12 days for mean passage and passage rate of 76%
• Between 4-6 mm stones take ~22 days for mean passage and passage rate of 60%
• 7 mm stone has a passage rate of ~48%
• 8-9 mm stone has a passage rate of ~25%

Gastroesophageal Reflux Disease (GERD)

• A digestive disorder that happens when stomach acid flows back into the esophagus due to the lower esophageal sphincter contracting improperly

GERD symptoms

• Heartburn (burning in the chest or throat)
• Regurgitation of sour or bitter liquid
• Non-burning chest pain
• Difficulty swallowing or sore throat
• Coughing or increase salivation
• Shortness of breath

GERD causes

• A weak or relaxed lower esophageal sphincter
• Eating certain foods, such as citrus fruits, fatty or spicy foods, chocolate, caffeine, alcohol, carbonated drinks, and peppermint
• Smoking

GERD treatment

• Lifestyle changes, such as eating smaller meals more frequently, maintaining a healthy weight, and avoiding certain foods
• Over-the-counter or prescription medications, such as antacids, H2 blockers, or proton pump inhibitors (PPIs)

GERD complications

• Long-term acid reflux can damage the esophagus, pharynx, or respiratory tract

Acute Kidney Injury Definition

• Denotes a sudden and often reversible reduction in kidney function, as measured by increased creatinine or decreased urine volume
• Acute renal failure (ARF)
• Can differentiate between prerenal, intrarenal, and postrenal etiologies and overlap/interrelate
• Distinguishing the causes is fundamental to effectively and efficiently treating AKI, which improves patient outcomes

How blood work helps diagnose AKI

• BUN and creatinine are normal right after a renal insult
• AKI is indicated by a decline in urine output and it can lead to the accumulation of water, sodium, and other metabolic products
• Prevalent especially among hospitalized patients up to 7% of hospital admissions and 30% of ICU admissions (KDIGO)
• Diagnosis by the presence of one of the following:
• Increase in serum creatinine by 0.3 mg/dL or more (26.5 µmol/L or more) within 48 hours
• Increase in serum creatinine to 1.5 times or more than the baseline of the prior 7 days
• Urine volume less than 0.5 mL/kg/h for at least 6 hours
• Many cases overlap between prerenal and ATN types of AKI

AKI Diagnosis with Fluid Challenge

• Determine if AKI is prerenal or not is a fluid challenge (closely monitoring urine output and renal function)
  • If not contraindicated all acute renal dysfunction patient should receive a fluid challenge
• If renal function improves with fluid, this indicates prerenal AKI
• Acute tubular necrosis may take weeks to months for complete recovery; and diuretics may be required during the oliguric phase of ATN if significant volume overload develops
• Avoid further kidney insults, such nephrotoxic drug
• Many medications must be renally adjusted once a patient develops AKI
• Monitor dietary ingestion of potassium and phosphorus

Hyperkalemia

• Manage expeditiously with the following approaches:
• Dietary restriction
• Insulin, IV dextrose, and beta-agonists
• Potassium-binding resins
• Calcium gluconate to stabilize the cardiac membrane if EKG changes are present
• Dialysis for nonresponsive hyperkalemia
• Correct volume overload early to avoid pulmonary and cardiac complications with diuretics such as IV furosemide

AKI differential diagnoses

• Renal calculi, acute or chronic kidney disease, hypovolemia, gastrointestinal bleeding, decreased cardiac output, urinary tract infection, and urinary obstruction Rarely, ingesting excessive protein or dietary supplements can cause elevated creatinine levels unrelated to kidney disease

AKI Prognosis

• Most prerenal AKI cases recover completely with correction of the underlying insult if treated early
  • Persistence of the underlying insult may lead to ATN, so damage may lack completely reversible, and repeated AKI leads to cumulative worsening of renal function
• Patients with AKI are closely monitored to normalize renal function (In-hospital mortality rate for AKI is 40% to 50%, and the mortality for ICU patients is more than 50%)

AKI Prognostic Factors:

• Older age, duration of illness, fluid balance, diuretic use, oliguria, hypotension, inotropic support, multiorgan involvement, sepsis, number of transfusions
• Over the long term, at least 12% to 15% of patients with AKI require permanent dialysis with increased mortality in APACHE III scores, advanced age, and persistent creatinine elevation
• AKI mortality can be caused by hyperkalemia, volume overload, metabolic acidosis, and hyponatremia

Complications of AKI

• Hyperkalemia: Can lead to arrhythmias and is a medical emergency
• Metabolic acidosis: necessitate systemic administration of bicarbonate or citrate buffers
• Hyperphosphatemia: prevented by decreasing dietary ingestion or using phosphate binders
• Pulmonary edema: pulmonary edema from volume overload and peripheral edema from an inability to excrete body water (common in the oliguric phase of ATN and may necessitate the use of diuretics or renal replacement therapy
• Cardiovascular: Heart failure secondary to fluid overload secondary to oliguric AKI with Arrhythmias 2/2 acidosis and electrolyte abnormalities, cardiac arrest 2/2 metabolic derangements, and myocardial infarction and pericarditis is also rare complications
• Gastrointestinal (GI): Nausea, vomiting, GI bleeding, and anorexia can be associated with AKI
• Amylase may be elevated with AKI, which means you measure serum lipase to diagnose pancreatitis if clinical suspicion is present
• Neurologic: CNS-related signs of uremia include lethargy, somnolence, disturbed sleep-wake cycle, and cognitive impairment

AKI Deterrence and Patient Education

• Key points for for those at risk or have developed AKI
  • Avoid nephrotoxic agents, and dehydration
• NSAIDs causes interstitial nephritis, which can cause development/worsening of AKI
• ACE inhibitors and angiotensin receptor blockers known to affect renal autoregulation
• Healthcare workers inform of condition, causes, and potential complications
• Nephrologist is recommended for AKI with dietary salt, fluid restriction, and reduced potassium
• Protein should be consumed, since AKI induces a catabolic state

Healthcare recommendations:

• Ensure the patient is not on nephrotoxic medications/ compliance with blood pressure medications
• Primary care providers updated about hospitalized patients, and if in the event ongoing serum chemistry abnormalities are present post-discharge, an interprofessional approach can lower the morbidity of AKI

Hemorrhoids Definition

• Swollen and inflamed veins in the anus and rectum that can cause pain, itching, and bleeding

External Hemorrhoid Info

• Supplied by somatic nerves (causing pain) while internal hemorrhoids are innervated by visceral nerve fibers so does not cause pain
• Cases asymptomatic at 40% (Int J Colorectal Dis 2012;27:215)
• Presentation is painless rectal bleeding during defecation with or without prolapsing anal tissue (Ann Afr Med 2019;18:12)
• can caused Perineal irritation or anal itching, feeling of incomplete evacuation or rectal fullness

Additional Info on Hemorrhoids

• Anal pain in cases of thrombosed or strangulated hemorrhoids or associated anal fissure and perianal abscess
• Evaluate for other causes if Positive fecal occult blood/anemia found
• Internal hemorrhoids are further graded based on their appearance and degree of prolapse (Goligher's classification)

Hemorrhoids Causes:

• Constipation and prolonged straining
• Pregnancy
• Dietary factors including low fiber diet, spicy foods and alcohol intake
• Other risk factors: advancing age, diarrhea, pelvic tumors, prolonged sitting and patients on anticoagulation and antiplatelet therapy

Hemorrhoids treatment:

• Eat fiber for stool softening and bulking
• Topical treatments containing hydrocortisone, witch hazel, or a numbing medicine for a week
• Take sitz baths for 10 to 15 minutes two or three times a day
• Relieve discomfort with acetaminophen (Tylenol), aspirin or ibuprofen (Advil, Motrin IB, others)

Hemorrhoid medicine

• Might only produce mild discomfort using creams, ointments, suppositories or pads that you can buy without a prescription (witch hazel, or hydrocortisone and lidocaine)
• If a painful blood clot has formed inside, consider external hemorrhoid thrombectomy done with anesthetics inside 72 hours
• Might recommend minimally invasive procedures with no numbing such as the following:

Minimally Invasive Hemmorhoid Treatment

• Rubber band ligation: cuts off blood flow/wither hemorrhoid
• Sclerotherapy: chemical solution shrinks hemorrhoid tissue with less pain
• Coagulation: laser or infrared hardens and shrivel bleeding internal hemorrhoids

More intensive Hemmorhoid Treatment

• Hemorrhoid removal (hemorrhoidectomy): surgeon uses anesthetic with sedative

Pyelonephritis Definition

• Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys which is generally a complication of an ascending urinary tract infection that spreads from the bladder to the kidneys

Who Is High Risk For Pyelonephritis

• Pediatric patients, renal transplant patients, and pregnant patients

Symptoms associated with Pyelonephritis

• Symptoms usually include fever, flank pain, nausea, vomiting, burning with urination, increased urinary frequency, and urgency

Pyelonephritis medical Tx

• Mainstays of treatment for acute pyelonephritis: antibiotics, analgesics, and antipyretics; nonsteroidal anti-inflammatory drugs (NSAIDs) for both pain and fever

Pyelonephritis Diagnostics

• Urinalysis will often display pyuria
• Most cases of acute pyelonephritis will be caused by E. coli, so patients can be treated with oral cephalosporins or sulfamethoxazole-trimethoprim for 14 days or a fluoroquinolone for a week

Constipation Information

• Consists of infrequent/difficult bowel movements typically three times or less per week
• Functional constipation often affects children/adults where there is infrequent/difficult bowel movements without structural/organic cause
• Contributing factors include pain, fever, dehydration, dietary concerns, psychology, toilet issues, medicines, and genetics

Constipation Types

• Chronic idiopathic constellation
• Irregularity in defecation and difficulty in passing stool and also lacks a underlying clear cause
• <5% in cases with persistent discomfort, the subtype has a chronic often long lasting nature with infrequent bowel movements

Constipation Managment

• Lifestyle modifications + dietary alteration, in cases with medication to alleviate symptoms and achieve quality of life

Secondary constipation

• Related to medical disorders, dietary issues, structural problems, and medications

Constipation Dx and Tx

• Approach to treatment focuses on fixing the root cause, making dietary changes/modifications, managin underlying problems, medication adjustments
• Diet with extra fiber and hydration; schedule toilet time +activity, Biofeedback + therapy
• Medicine (stool softeners)

Prostatitis

• Acute infection of prostate which ascends into the urinary tract
• <35 years: gonorrhea & chlamydia

• 35 years: Enterobacteriaceae (E.coli, Proteus)

  • HPI: Sudden onset of high fever, chills
• Sudden pain: suprapubic pain/perineal pain/pain radiating to rectum or back, ejaculatory pain. UTI symptoms (dysuria, frequency, nocturia, cloudy urine).
• DRE: Gentle prostate exam only if done to avoid a vigorous prostate exam (lead to bacteremia). Prostate will be extremely tender, boggy, and possibly warm. + UA, no PSA

Diagnostics for Prostitis

• CBC (leukocytosis with shift to left, presence of band cells)
• UA (large WBCs, hematuria) Urine C&S, repeat 4-6 weeks after treatment initiated.
• No PSA for at least 4 weeks.

Prostitis Tx

Treat for gornorrea + clamydia if suspect, if suspect another use, Ciprofloxacin or Levaquin (educate about risk of tendon rupture) for 4-6 weeks

Hernia Information

• Inguinal hernia is the most common type of hernia with Occurs in the groin area with affects around 25% of men or people assigned male at birth Femoral: is located on the outer portion of the groin, and most common in women aspecially pregnant + obease

Umbilical hernia

Occurs when part of the intestine or abdominal tissue protrudes through or near the navel with an Onset as baby or short after Occurs when an organ or tissue protrudes through an incision or scar from previous abdominal surgery + is common in eldery or overweight

Epigastric hernia

Occurs when a bulge of fat tissue pushes through a weak part of the belly wall with a Location on between breast bone and belly button

Epigastric hernia Tx

A medical emergency that is due ti surgical blockage of the bowel due to pathological adherion

Hiatal hernia

• Occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, affecting 20% of people in the U.S. and 50% over the age of 50
• Epididymis is the coiled tubular organ located at the posterior aspect of the testis that is the storage area for immature sperm.

Epididymitis

• Infection caused by bacteria ascend up to urethra
• <35 years gonorrhea, chlamydia
• ->35 years gram- E. coli
• Most common cause of acute scrotal pain in prepubertal boys. Acute onset of red, swollen, painful scrotum with Labs Testing for gonorrhea and chlamydia + r/u testicular torsion

Epididymitis Signs

• Multiple sex partners, STI hx, prolonged sitting, anal intercourse, UTI
• unilateral testicular tenderness, scrotum swollen and erythematous with induration of the posterior epididymis
• Positive Prehn's sign (relief of pain with scrotal elevation) and Cremasteric reflex present (stroking inner part of thigh causes muscle to retract and pull up testicle)

Epididymitis Tx

< 35 for gonorrhea + chlamydia, if + partner might be treated

35 years treat with Levaquin (educate on risk of tendon injury while on med)

• Treat pain with NSAIDS = tylennole/ Codeine
• -Scrotal elevation, ice packs, bed rest for a few days, stool softeners, no sex
• ED precautions if signs of sepsis (intractable pain, fever, abscess)

Bowel Obstruction

Small bowel obstruction = Surgical emergency due to mechanical blockage of the bowel Patient Presentation with history: abdominal surgeries, inflammatory bowel disease/cancer, hernia abdominal pain, distention, nausea/vomiting, and even loose bowel

Bowel Obstruction Examination

Bowel sounds may go from pitched to none over time.

• Physical finds of pertonitis

Bowel Obstruction diagnosis

Gold stand= CT scan for surgery Surgery + fluid replacement

• large is emergies becuase fo seposis/ instablitt and may need intervention from tumors hernias

Testiclular troision

Causes; spermatic card cut off the blood with Examiantion includes testing the reflex

Testicular torsion

Accounts for approximately 50% of acute scrotal pain in boyz age 7-14
It is more common than testicualr troion so must asses 
Blue dot means; tenner , small discloration 

Cremastic reflex=absneet Nuseasa and vomiting

Hydrocele : serous fluid in testicles

• Px =Swollen
• Diag= sonogram

Rectal bleeding

• Cause infections, hemmrhages

rectacle

• Collection of abnormailty dilated scotum.

Pinworm infections

• Most common hellmenth infections that can be diagnosed with testing the area for microscoppic worm cells where treatment is oral
• Testis cancer; Solid, firm, mass

Sexually Transmitted Infections

• The most common and curable STIs are trichomonas, chlamydia, gonorrhoea and syphilis.
• Viral STIs including HIV, genital herpes simplex virus (HSV), viral hepatitis B, human papillomavirus (HPV) and human T-lymphotropic virus type 1 (HTLV-1) lack or have limited treatment options.
• Vaccines are available for hepatitis B to prevent infection that can lead to liver cancer and for HPV to prevent cervical cancer..
• HIV, HSV and HTLV-1 are lifelong infections: for HIV and HSV there are treatments that can suppress the virus, but currently there are no cures for any of these viral STIs.
• Condoms used correctly and consistently are effective methods to protect against STIs and HIV..

LFTS

Normal Ranges: Alanine transaminase (ALT): 7–56 units per liter (U/L) Aspartate aminotransferase (AST): 5–40 IU/L Alkaline phosphatase (ALP): 40–129 U/L Albumin: g/dL 3.5–5.0 Total protein: g/dL 6.3-7.9 Bilirubin: mg/dL 0.1–1.2 Gamma-glutamyltransferase (GGT): 8–61 U/L Prothrombin time (PT) 9.4–12.5 second

LFTS Elevated

• elevated: liver damage
• PT can indicate decreased clotting factors, vitamin K deficiency, or warfarin treatment

CBC

Normal Ranges: Red blood cell count Male: 4.35 to 5.65 trillion cells/liter Female: 3.92 to 5.13 trillion cells/liter Hemoglobin Male: 13.2 to 16.6 grams/deciliter Female: 11.6 to 15 grams/deciliter Hematocrit Male: 38.3% to 48.6% Female: 35.5% to 44.9% White blood cell count 3.4 billion to 9.6 billion cells/liter Platelet count Male: 135 billion to 317 billion/liter Female: 157 billion to 371 billion/liter

• CBC can diagnose and monitor many conditions, such as anemia, infections, and bone marrow disorders. A CBC can measure number and types of cells

CBC Info

• RBC: The number of RBCs in your blood with a low RBC count correlating with anemia, and a high count with heart and lung conditions.
• WBC: The number of WBCs in your blood with a High WBC count showing infection reaction, and low count with autoimmune disorder or bone Marrow disorder

Acute Gastroenteritis

• Caused by virsues and is generally limited Fluid replacement with possible drugs for vomitting

Abdominal Pain Assessment Techniques

• Rovsing's sign
• Psoas sign
• Obturator sign
• DRE
• Murphy's sign
• McBurney's sign
• Auscultation
• Palpation

Key Signs and Signifacne

 McBurney's Point: Indicates acute appendicitis.
Cullen's Sign: Associated with pancreatitis and ruptured ectopic pregnancy due to intraperitoneal bleeding.
Murphy's Sign: Suggests acute cholecystitis.
Obturator Sign: Can indicate acute appendicitis, especially when the appendix is located in the pelvis. psoas: appenditic
Psoas Sign: Suggests acute appendicitis, particularly if the appendix is retrocecal. 

Rovsing's Sign: Indicates appendicitis, and can also be a sign of peritoniits Reo: peritonist

Dirrareh Definition and Info

Categories of Duration= duration and type Acute diarrhea is withing weeks, cronhinc= longer

ectopic pegnacy

Life thereing pregancy that is outsid of teh uteris

Appencidius

inflaiatnion of the appendx, 0 with symopms

Appencidius symotm

Start navval shitfs to right quaded= move ment makes wrose rosing sing Infections= high white cells

Appenciddi diag

Ultrtason is okay CT scan is better

Cypto Info

Uncented seticles

Phomyies and Paramphomies

Cant push foresing backward Backwards