Abdomen, Genital, & Prostate SG PDF

Abdominal: Know Rome IV Criteria for IBS o Recurrent abdominal pain, at least 1 day per week in the last 3 months, associated with 2 or more of the following: § Related to defecation § Associated with a change i...

Abdominal: Know Rome IV Criteria for IBS o Recurrent abdominal pain, at least 1 day per week in the last 3 months, associated with 2 or more of the following: § Related to defecation § Associated with a change in stool frequency § Associated with a change in stool form (appearance) Colorectal Cancer Screening Guidelines o Recommended colonoscopy screening for those at high risk or those of average risk alsodo started at ages 45-50. ironpanel § Some commonly experienced symptoms include change in bowel habits, inlabs change in stool consistency (pencil thin stools), blood in stool, and abdominal discomfort. o Those with increased risk (family hx, other syndromes), may start earlier. o Colonoscopy every 10 years o Fecal Immunochemical Testing for occult blood for patients who are unable to do colonoscopy, recommend annually. o Cologuard (Stool DNA testing) mm every 1-3 years mm for older patients or those with o CT colonography every 5 years is considered colonoscopy risk. mmmm o IF ANY ABOVE TESTS ARE POSITIVE à colonoscopy Abdominal sounds o Hyperactive: loud, gurgling rushed sounds. Increased peristalsis, common with diarrhea. o Hypoactive: soft, low, widely separated sounds such as one or two occurring in 2 peritonitis minutes. Common in constipation. Also, fasting. o Absent bowel sounds: No bowel sounds present in one position after 2 minutes of auscultation. obstruction o Bruits: Due to atherosclerotic plaque build-up in artery that results in narrowing of lumen and turbulent blood flow through this area. May be present with AAA and renal artery stenosis. Conditions that cause jaundice ysiowonsetipaestooisingooloredurine itching o Liver disease, biliary obstruction, pancreatitis, or pancreatic cancer. extraintestinaisx o Viral hepatitis (A,B,C) tendernessfullness presentsw inRua arthritis.in Causes of upper and lower GI bleeding o Hematochezia: bright red blood – colon cancer, diverticular disease, UC, y synnogies hemorrhoids (lower GI bleed) painlessmassdullonpercussion § Beet root can cause. o Melena: black, tart, “coffee ground” – gastric or duodenal ulcer or esophageal bleed (upper GI bleed) § Also, iron supp, Pepto-Bismol, and Maalox. *small bowel obstruction will hear high pitched sounds close to obstruction and absent bowel sounds further away *Large bowel obstruction will present with absent bowel sounds and inability to pass gas  Anatomy for each abdominal region Right Hypochondriac Epigastric Left Hypochondriac -Right lobe & body of liver -Stomach (lesser curvature) -Stomach (Body) -Gall bladder -Duodenum -Stomach (Fundus) -Right kidney -Mid. Lobe of liver -Splenic Flexure (Colon) -Transverse/ascending -Pancreas -Spleen colon -Pancreas (tail) -Left Kidney Right Lumbar Umbilical Left Lumbar -Hepatic flexure of the -Transverse colon -Transverse colon colon -Small intestine -Descending colon -Ascending colon -Pancreas -Left kidney -Right kidney Right Iliac Hypogastric Left Iliac -Descending Colon -Sigmoid colon -Descending Colon -Sigmoid Colon -Rectum -Sigmoid Colon -Left ovary **Appendix -Left Ovary **Uterus **Bladder **R/L Ovary (**if enlarged, may show pain) rderobservation auscultation percussion palpation o Normal abdominal exam findings and what they indicate StandonRIGHTside ofit itpthaspainexamin § Abdomen appears flat, symmetrical, and of normal size. No varicosities or scars noted. thatlast § Positive bowel sounds in all 4 quadrants. No bruits in abdominal aorta or renal & iliac arteries B/L. usebellilistenfor whooshsound No obstruction, or bruits. § Abdomen tympanic on percussion aube'sspace No masses, tumors § Liver is 8-12 cm midclavicular line and 4-6 cm mid-sternal line. i anterioraxillary line ayyy No hepatomegaly 18 evoussbtwnamothrib § Traube’s Space tympanic to percussion abnormal finding gleaerge positive cancer antaxillaryline Spleen is in normal place, and not enlarged. colorectal astpalpablespace § Abdomen soft and non-tender to palpation, no organomegaly or masses noted. gassessforgididing § Negative McBurney’s and Rovsing’s Signs (Appendicitis) Infinity 4abnormal § No hepatomegaly, (-) Murphey’s Sign (gallbladder), No splenomegaly reboundtendernesgradiatastia § Abdominal aorta is 2-4cm? in width (AAA) Murphy's onoleoystitisuscholelithrasisis § Negative Fluid Wave Test (ascites) butnasdiscomfo soirrnosis.o HFperitonitisportalatincancer pox'sif breat § Negative CVA tenderness (pyelonephritis) i nephrolithiasis no o Which GI conditions are emergency referrals § Abdominal Aortic Aneurysm (AAA) § Appendicitis painoccursBEFOREvomiting fever obturatorpsoas iliopsoassignsrigidity § Cholecystitis/Cholangitis smallintestinebiopsy goldstandard forceliac'sDisease  § Diverticulitis (if severe) § Intestinal Obstruction § Large Bowel Obstruction § Pancreatitis boringepigastricpainradiatingtobackbetter leaningforward reboundtenderness wi § Peritonitis Patient will curl up or keep their hips flexed to relieve abdominal wall distention; abdomen is rigid wi guarding and does not move with respiration! o Diverticulosis vs. Diverticulitis § Diverticulosis Outpouching of sacs in the colon. leaf can Can have intermittent LLQ (sometimes RLQ), constipation, rectal bleeding. to § Diverticulitis Inflammation of INFECTION of the sacs/out pouches. LLQ pain, fever, chills, nausea, vomiting, constipation, diarrhea. Do NOT perform colonoscopy during!! à ER if severe. o Labs for IBD acute § Inflammatory Bowel Disease is a structural disorder, which can be dx by labs/imaging. sfor ingrativeolitis useRomeNforgeneralPxbionohardevidence § CRP, ESR, and lactoferrin ohms tests can help identify inflammation. vialabs § Autoantibodies? It is autoimmune. o Differentials for RUQ, RLQ and LUQ pain RUQ LUQ Acute cholecystitis/cholelithiasis Spleen! Hepatitis Pain/enlargement (EBV) Pleuritic pain Rupture Lung/cardiac causes AA Pancreatitis Mono, cancers Perforated duodenal ulcer Subphrenic abscess Subphrenic abscess Perforated gastric ulcer Pyelonephritis Pyelonephritis Colitis Colitis Hepatic carcinoma Colon Cancer RLQ se waiters anemiamalabsorption evite LLQ intermittentbouts diarrhea Biz of ggCrohn’s Disease y Appendicitis cabsmacrocytic anemia (inflammation TesrAs of ICV) sIinte ftp.qq Diverticulitis Peritonitis (spreading) Perforated duodenal ulcer Colon Cancer (obstruction) Ovarian cyst/torsion Ulcerative Colitis irondeficiencyanemiaTEsr Ectopic pregnancy Ovarian cyst/torsion pAnca Ectopic pregnancy o Conditions caused by H Pylori § Gastritis hxofNsaiduseorhighstress leadto can this sdoupperendoscopy § PUD: peptic ulcer disease § H. pylori urea breath test (+) Gastric ulcer stomach orduodenalulcersmallintestine epigastricpainthatisgnawing dullburning relievedbyfoods nxof Nsa lbuseastress  Urogenital/Prostate Genital lesion differentials & Painful vs. Painless genital lesions Condition Appearance Pain? LAO? Herpes HSV Multiple, ulcers, Yes Yes 2 vesicles. Initial: more severeimultiplenicers Recurrent: single mm Condylomata lata Multiple, moist, flat, Yes Yes (in secondary syphilis) round. Chancre Single, well- No Mild or minimal (in primary syphilis) demarcated ulcer with a clean base and indurated border. Chancroid Nonindurated, Yes Yes serpiginous border and friable base; bleeds definitive covered with a necrotic, purulent A ducreyi onculture exudate. Condylomata acuminata Multiple, verrucous No No (genital warts) HPV 6&11 Molluscum contagiosum 0.04-0.2 in (1-5mm) Yes Rarely umbilicate papules, often in clusters; caseous material may be expressed from center.  Treatment for genital lesions o Genital Herpes (HSV) § Outbreak management w/ anti-virals (acyclovir, valacyclovir/famciclovir) § Dietary changes (low arginine, high lysine) § L-lysine Supplements (anti-viral nutrients) o Syphilis (primary) § IM penicillin G benzathine, 2.4 million units in a single dose. o Chancroid (painful ulcer) § IM ceftriaxone (Rocephin), 250mg in single dose § Oral azithromycin (Zithromax), 1g single dose § Ciprofloxacin (Cipro), 500mg BID x 3 days § Erythromycin, 500 mg TID x 7 days o Genital Warts/HPV (Condylomata acuminata) § Podofilox 0.5% § Imiquimod 3.75-5% § Sinecatechins 15% (green tea, can be compounded for topical use!) § Cryotherapy, surgical removal, TCA, BCA acids o Molluscum contagiosum § Incise and drain lesions § Topical 50% ACV with 50% diluted H2O – apply with Q tip to lesions § Avoid sexual contact – highly contagious o Chlamydia § Antibiotics: Doxycycline 100mg BD x 7 days, OR Azithromycin 1g single dose, OR Levofloxacin 500mg QD x 7 days DRE findings for prostate cancer, BPH and prostatitis o Prostate Cancer § Hard, irregular nodule; asymmetry § Common in posterior lobe o Benign Prostatic Hypertrophy § Symmetrically enlarged § Soft and protrudes into rectal lumen o Prostatitis § Boggy, fluctuant, or tender prostate. “Bouncy, swollen, tender”. Treatment for gonorrhea and chlamydia o Chlamydia urethral discharge § Antibiotics: Doxycycline 100mg BD x 7 days, OR Azithromycin 1g single dose, OR Levofloxacin 500mg QD x 7 days untreated chlamydia cancauseepididymitis  o Gonorrhea painful yellow discharge redness tenderness testicle § Single IM injection of ceftriaxone 500 mg in o Co-infection: tx with both IM and Oral antibiotics doxycycline DDX for scrotal masses -know which cause pain, transilluminate, common ages, severity Diagnosis Common Age Transillumination Scrotal Erythema Pain Epididymitis Any No Yes Severe, increasing Torsion of 15 No No None Prostate Cancer Screening Guidelines o Average risk patients: initiate screening 45-50 yo o High risk patients: age 40-45 or § African Americans § Family hx of dx