PC2otherEx1

Urinary Tract Infections (UTIs)

• UTIs in men happen due to bacteria entering the urinary tract, leading to infection in the urethra, bladder, or kidneys.
• UTIs are less common in men than in women but can be more complicated.
• Blockage from an enlarged prostate or kidney stones can cause UTIs.
• Catheter use increases the risk of UTIs.
• Unprotected sex can cause sexually transmitted infections, so it is important to rule out gonorrhea and chlamydia, especially in sexually active adolescents and young adult males.
• Chronic conditions such as diabetes and urinary retention increase the risk of UTIs.

Diverticulitis

• Diverticulitis is the inflammation or infection of diverticula (small pouches) in the intestinal wall, typically in the colon.
• Diagnosis relies on patient history (LLQ pain, fever, bowel changes), physical exam (LLQ tenderness), and imaging like a CT scan.
• A CT scan is the gold standard for confirming diverticulitis.
• Diverticulitis can lead to life-threatening complications such as sepsis, small-bowel obstruction, hemorrhage, perforation, ileus, and abscess.
• Patient history may show previous episodes of diverticulitis or known diverticulosis.
• Recent changes in bowel habits (constipation or diarrhea) can indicate diverticulitis
• Diet that is low in fiber or history of low physical activity may contribute to diverticulitis.
• Left lower quadrant (LLQ) pain is the most common symptom, and it can be constant and severe.
• Other symptoms include fever, nausea, vomiting, bloating, tenderness, abdominal distension, and changes in bowel movements (constipation or diarrhea).
• Physical examination reveals LLQ tenderness upon palpation, fever or elevated heart rate (indicating systemic infection), and signs of peritonitis in severe cases.
• Lab tests for diverticulitis include a CBC, with an elevated WBC count suggesting infection, and elevated CRP (C-reactive protein).
• A CT scan of the abdomen and pelvis with contrast is the gold standard for confirming diverticulitis, and it detects inflammation, abscesses, or perforation.
• Uncomplicated cases are managed with oral antibiotics, a clear liquid diet, and follow-up.
• Complicated cases (e.g., abscess, perforation) require hospitalization, IV antibiotics, and possibly surgical intervention.
• Prevention includes a high-fiber diet, regular physical activity, and proper hydration.

Cholecystitis

• Is the inflammation of the gallbladder, often caused by gallstones blocking the cystic duct.
• Symptoms include right upper quadrant (RUQ) pain that is steady and severe, potentially radiates to the right shoulder or back, and worsens after eating fatty foods.
• Other symptoms include fever, nausea, and vomiting.
• Positive Murphy's sign indicates cholecystitis, identified by pain upon palpation of the RUQ during deep inspiration.
• A classic presentation is severe RUQ pain that occurs within 1 hour after eating a fatty meal, with frequent nausea and vomiting, with pain that may radiate to the epigastric or right shoulder areas
• Laboratory tests show elevated WBC count (indicating infection/inflammation) and elevated liver enzymes (AST, ALT) and bilirubin.
• Ultrasound is the first-line imaging method to reveal gallstones, a thickened gallbladder wall, or pericholecystic fluid.
• A HIDA scan is used if the diagnosis is unclear after the ultrasound.
• Treatment includes cholecystectomy (surgical removal of the gallbladder), typically performed laparoscopically, or an open procedure for severe cases.

Urinalysis Interpretation

• Normal urine color ranges from light/pale to dark/deep amber.
• Dark yellow urine may indicate dehydration or exercise.
• Green or blue urine may indicate a pseudomonal UTI or other conditions.
• Orange urine may indicate bile pigments, carrots, or other conditions.
• Pink or red urine may indicate hematuria, menstrual contamination, or other conditions.
• Normal urine pH is 4.5-8. A pH below 5 may suggest increased risk of kidney stones, while a pH above 7 may suggest a bacterial UTI.
• Normal urine specific gravity is 1.005-1.025.
• Normal urine glucose is ≤130 mg/d, the presence of sugar may indicate diabetes or liver or pancreas disease.
• Normal urine contains no ketones, the presence may indicate diabetes or illness.
• Normal urine has negative nitrites, the presence may indicate a bacterial infection.
• Urobilirubin is normally present in small amounts (0.5-1 mg/dL)
• Normal urine has ≤3 RBCs, the presence of blood indicate kidney damage, infection, or other conditions.
• Protein is normally ≤150 mg/d
• Normal urine contains ≤2 RBCs/hpf
• Normal urine has ≤2-5 WBCs/hpf
• Normal urine contains ≤15-20 squamous epithelial cells/hpf
• Normal urine contains 0-5 hyaline casts/lpf
• Crystals are occasionally present in normal urine
• Normal urine contains no bacteria or yeast.
• The presence of leukocyte esterase in urine may indicate inflammation or infection.
• The presence of bilirubin in urine may indicate liver damage or disease

Pancreatitis

• Is an inflammation of the pancreas, which can be acute or chronic.
• Acute pancreatitis refers to sudden inflammation that can be mild or life-threatening.
• Chronic pancreatitis is long-term inflammation leading to permanent damage.
• Gallstones are the most common and alcohol abuse (2nd most common) causes.
• Hypertriglyceridemia or hypercalcemia can cause pancreatitis
• Certain medications, infections, trauma, or post-ERCP can cause pancreatitis.
• Symptoms include severe epigastric pain, often radiating to the back and worsening after eating (especially fatty meals), nausea, vomiting, fever, and tachycardia.
• Abdominal tenderness and guarding indicate pancreatitis
• Elevated serum amylase and lipase (lipase is more specific) indicate pancreatitis from laboratory tests. Elevated WBC count and liver enzymes may also be present with pancreatitis.
• CT scan confirms the diagnosis and assesses severity, US evaluates gallstones or biliary obstruction, and MRCP provides detailed biliary imaging.
• NPO (nothing by mouth) is required to rest the pancreas, hospitalization for IV fluids and electrolyte management may be required.
• Treat pain with analgesics and antibiotics only if infection or necrosis is suspected.
• ERCP is used for gallstone-related pancreatitis to remove obstruction.

Nephrolithiasis

• Renal calculi (kidney stones) are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin.
• Kidney stones occur in 1 of 11 people with men affected 2 to 1 over women.
• Development of kidney stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate.
• Low urinary citrate levels or excessive urinary acidity can cause kidney stones.
• Kidney stones may cause excruciating pain, with most patients presenting to the emergency department in agony.
• Recurrent renal calculi can damage the tubular epithelial cells, leading to functional loss of the renal parenchyma.
• The four major types of renal calculi include calcium, uric acid, struvite, and cystine stones.
• Calcium stones are due to hyperparathyroidism, renal calcium leak, absorptive or idiopathic hypercalciuria, hyperoxaluria, hypomagnesemia, and hypocitraturia.
• Uric acid stones are associated with a pH of less than 5.5, a high intake of purine-rich foods (fish, legumes, meat), or cancer; may also be associated with gout.
• Struvite stones are caused caused by Gram-negative, urease-producing organisms that break down urea into ammonia.
• Common organisms include Pseudomonas, Proteus, and Klebsiella, but E. coli does not produce urease and is not associated with struvite stones.
• Cystine stones are visually opaque and amber in color are due to an intrinsic metabolic defect causing the failure of the renal tubules to reabsorb cystine, lysine, ornithine, and arginine.
• Uric acid and cystine are the most likely stone types that develop recurrences out of all types of stones.
• Many drugs are known to cause renal stones, including atazanavir, guaifenesin, indinavir, silicate overuse, sulfonamide, and triamterene.
• Ultrasound may be useful for assessing obstruction and resultant hydronephrosis, especially in pregnancy when x-ray studies are discouraged.
• Ultrasound can also identify uric acid and other non-calcific renal stones if large enough (greater than 4mm), but can miss stones less than 5mm and cannot identify ureteral ones easily.
• A non-contrast abdominal and pelvic computed tomography (CT) scan is the "gold standard" for diagnosing urolithiasis and provides information regarding obstruction.
• Renal calculi can cause ureteropelvic junction or ureteral obstruction and pain that may require opioids.
• IV nonsteroidal anti-inflammatory drugs (NSAIDs) can effectively control the pain while avoiding the side effects of narcotics.
• Patients with renal colic often experience nausea and vomiting, IV hydration and antiemetics may be acutely required.
• Smaller stones (<5 mm) have a greater chance (90%) of passing on their own with medical expulsion therapy (usually tamsulosin, alfuzosin, nifedipine, silodosin, or mirabegron).

Gastric Ulcer

• Gastric ulcer is an open sore in the lining of the stomach. It's also known as a stomach ulcer.
• Helicobacter pylori bacteria is the main causative agent and the most common. This bacteria damages the stomach lining's protective mucus.
• Long-term use of NSAIDs can damage the stomach lining.
• Symptoms include a burning or gnawing pain in the center of the abdomen, pain that feels like an acid burn, indigestion, acid reflux, heartburn, nausea & vomiting, bloating/belching/gas pain, vomiting blood, dark blood in stools that can be black or tarry, also feeling dizzy and fainting.
• Complications include internal bleeding & a blocked stomach.
• Treatment includes antibiotics and acid-suppressing medications

Urolithiasis

• urolithiasis is a condition that occurs when kidney stones exit the renal pelvis and move into the remainder of the urinary collecting system, which includes the ureters, bladder, and urethra
• Approximately 86% of stones will pass spontaneously within 30-40 days. Overall, the size of the stone contributes to how long the stone will take to pass and its probability of happening.
• Stones less than or equal to 2mm take about 8 days, and about 87% of stones will pass spontaneously.
• 3mm will take about 12 days, and about 76% of stones will pass spontaneously.
• Stones that are between 4-6mm will take about 22 days, and about 60% of stones will pass spontaneously.
• 7mm stones have a 48% chance of passing spontaneously.
• Stones that are 8-9mm have about a 25 % chance of passing spontaneously.
• Oral and IV anti-inflammatory medications are indicated as first-line treatments, and opioids are reserved for refractory pain.
• IV lidocaine has been studied as an effective pain control option. Nausea and vomiting should be treated with IV antiemetic medications such as ondansetron, metoclopramide, promethazine.
• Medical expulsive therapy, or MET, includes alpha-blockers, such as doxazosin and tamsulosin, which facilitates passage of larger (5-10 mm) stones. However, they don't help in passage with small stones.
• IV crystalloid fluids are indicated to patients who appear dehydrated with persistent vomiting.

Gastroesophageal Reflux Disease (GERD)

• GERD is when stomach acid flows back into the esophagus because the lower esophageal sphincter doesn't work properly.
• Symptoms: Heartburn/burning sensation, regurgitation of sour or bitter liquid, chest pain, difficulty swallowing, sore throat, coughing, increased salivation, shortness of breath.
• Causes: A weak or relaxed esophageal sphincter, eating certain foods, smoking.
• Treatment: Lifestyle changes such as eating smaller meals, maintaining a healthy weight, avoiding certain foods.
• Medication: Over-the-counter or prescription medications such as antacids, H2 blockers, or proton pump inhibitors (PPIs).
• Complications: Long-term acid reflux can damage the esophagus, pharynx, or respiratory tract.

Acute Kidney Injury (AKI)

• AKI, previously known as acute renal failure, denotes a sudden and potentially reversible decline in kidney function, based on increased creatinine or decreased urine volume.
• Distinguishing between prerenal, intrarenal, and postrenal etiologies is key for effective treatment.
• AKI is diagnosed by:
  • Increase in serum creatinine by 0. 3 mg/dL or more within 48 hours.
  • Increase in serum creatinine to 1. 5 times or more from baseline in past 7 days.
  • Urine volume of less than 0. 5 mL/kg/h for at least 6 hours.
• Best determined with a fluid challenge to see prerenal cases with a monitor on urine output and renal function.
• Treatment:
  • Correct volume overload to avoid pulmonary and cardiac complications (may use IV furosemide).
  • Often, patients need dialysis to correct electrolyte disturbances.
  • Avoid nephrotoxic drugs.
  • Monitor and adjust medications, dietary potassium, and phosphorus.
  • Treat hyperkalemia if EKG changes are present with Dietary restriction, insulin, and glucose potassium-binding resins and calcium gluconate.
• Differential diagnoses include renal calculi, kidney disease, hypovolemia, GI bleeding, decreased cardiac output, UTIs, urinary obstruction, and some dietary supplements that cause issues with kidneys.
• Most prerenal AKI resolves completely if treated early, but persistent insults can lead to ATN (acute tubular necrosis) with possible incomplete recovery.
• Therefore necessary to monitor.
• Mortality occurs from 40 to 50% in the hospital.

AKI Complications

• several complications may be associated with increasing mortality. The most common complications include metabolic derangements such as:
  • Hyperkalemia can lead to arrhythmias and, if severe, is considered a medical emergency.
  • Metabolic acidosis may necessitate systemic administration of bicarbonate or citrate buffers.
  • Hyperphosphatemia can usually be prevented by decreasing dietary ingestion or using phosphate binders.
  • Pulmonary edema can occur and require use of diuretics or renal replacement therapy.
• Organ-Related Includes:
  • Cardiovascular such as heart failure and also arrhythmias can occur and cardiac arrest can arise.
  • Gastrointestinal: Nausea, vomiting, GI bleeding, and anorexia can occur, may also cause pancreatitis.
  • Neurologic: CNS-related signs of uremia include lethargy, somnolence, disturbed sleep-wake cycle, and cognitive impairment

AKI Deterrence and Patient Education

• Several factors should be advised to preserve renal function, such as avoiding nephrotoxic agents and dehydration. NSAIDs are also known to cause interstitial nephritis

Hemorrhoids

• External hemorrhoids are supplied by somatic nerves, thus producing pain while internal hemorrhoids are innervated by visceral nerve fibers so do not cause pain
• Approximately 40% of cases are asymptomatic
• Most common presentation is painless rectal bleeding during defecation with or without prolapsing anal tissue Causes include:
  • Constipation and prolonged straining
  • Dietary factors including low fiber diet, spicy foods and alcohol intake
• Internal hemorrhoids are further graded based on their appearance and degree of prolapse (Goligher's classification)
  • First degree hemorrhoids (grade I): the anal cushions bleed but do not prolapse
  • Second degree hemorrhoids (grade II): the anal cushions prolapse through the anus on straining but reduce spontaneously
  • Third degree hemorrhoids (grade III): the anal cushions prolapse through the anus on straining or exertion and require manual replacement into the anal canal
  • Fourth degree hemorrhoids (grade IV): the prolapse stays out at all times and is irreducible

Hemorrhoid Treatments

• Eat high-fiber foods to soften the stool and increases its bulk (eat slowly to avoid gas).
• Topical treatments such as applying a hemorrhoid cream or suppository containing hydrocortisone can be bought over the counter to help. Use witch hazel or another numbing agent as well.
• Take pain relievers such as Tylenol, Aspirin, Motrin, Advil to help relieve discomfort.
• For external hemorrhoid thrombectomy, health care provider can get rid of hemorrhoid.
• Minimally Invasive Procedures can be performed such as with the use of rubber band ligation.
  • A rubber band is placed around hemorrhoid to cut off blood flow for the hemorrhoid to fall off within a week. This can be uncomfortable. Alternatively, schlerotherapy with a chemical solutino can be injected to to shrink it.

Pyelonephritis

• Bacterial infection causing inflammation of the kidneys
• Typically occurs in immunocompromised patients
• Main symptoms of infection plus flank pain
• Treatment consists of antipyretics, analgesics, and antibiotics. Norovirus: Resistant to disinfectants, needs more intense hand washing

Constipation

• Functional- lifestyle
• Idiopathic- abnormal function but nothing wrong anatomically
• Treatment: Fiber and water intake increases

Prostatitis

• Acute infection ascending into the urinary tract

• 35- E.coli proteus

• <35- Gonorrhea, chlamydia
• HPI sudden onset of fever, chills, suprapubic pain radiating to rectum/ back.
• Dysuria, frequency, urgency, nocturia, cloudy urine.
• Tender, boggy, warm prostate= DRE.
• Treat G+C <35 rocephine/doxycycline
• Treat gram- >35 cipro or levaquin/ tendon rupture

Hernia

• Inguinal: Most common, tissue or part of small intestine extends through weakened area in the groin or scrotum. 25% of MALES
• Femoral: Outer groin and is most common in women, especially pregnant/obese.
• Umbilical: Part of the intestine of abdominal tissue protrudes through or near navel, present at birth.
• Epigastric: Bulge of fat tissue pushes through belly wall, typically small and occur in the middle of the belly area.
• Hiatal: Upper portion of stomach moves to chest through a small opening.

Epididymitis

• Coiled tubular organ at posterior aspect of the testis, storage area for immature sperm.
• Usually, bacteria ascend uretha to reach epidydimis, causing infection. <35 Gonorrhea, chlamydia.

35 gram- E.coli Hallmark- Positive Prehn's sign. Relief of scrotal elevation. Treat pain with NSAIDs

Bowel Obstruction

• Most common presentation is: Abdominal pain, Distension, Nausea and Vomiting Surgical emergency due to mechanical blockage of the bowel. Small-bowel is intra-abdominal adhesions.

Testicular Torsion

• Presents with sudden onset of severe testicular pain, red testicle, and N/V.
• Exam cremestaric reflex is absent.
• Requires immediate surgical intervention

Hematocele

• Collection of blood/fluid within scrotum. Common after vasectomy.

Hydrocele

• Collection of serous peritoneal fluid within scrotum 10% of testicula malignancies present with hydrocele Observe vs. Surgery Referral

Varicocele

• Collection of abnormally large dilated veins in scrotum

Pinworm

Enterobius Vercularis diagnose with a cellophane tape test