Int Dx Ii Final Cram Sheet (ndvc)

Int Dx II Final Cram sheet (NDVC) • Small bowel Dz o Celiac sprue (gluten (gliadin) intolerance)(non-tropical sprue). In Young, F>M  Fe, folate, B12 def, weight loss, bloating, diarrhea, etc. o IBS - More mucus in stools, 20-40yo, o Crohn’s dz o Pancreatic insufficiency

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Whipple’s Dz – Tropheryma whipelli (gram+), multisystem, intestinal lipodystrophy, bac. Changes form, no culture.  Irregular folds in small bowel and thickening of wall. Malabsorption, arthritis, pericarditis, osteomalacia o Lactose Intolerance – 1 in 6, insufficient lactase – bloating, diarrhea, flatulence, abd pn, etc. Dx:Hydrogen breath test  Asians>blacks>whites  Conditional lactose intolerance after an illness o Meckel’s diverticulum –appendix at end of ileum, often misDx as appendicitis, remnant of vitelline duct, congenital  M/c congenital anomaly of SI o Mesenteric ischemia – most pnful condition in medicine, high mortality, superior mesenteric artery or venous system.  50% embolic, KUB may be normal, look for in diabetics, Pts with systemic dz, alcoholics Genitourinary Diseases o Up to 75% of kidney can be destroyed without symptoms of loss of function. Numerous congenital anomalies (horseshoe/undescending kidney, etc.), benign polycystic dz is m/c dz of kidney. • Urinary Tract Infections o M/c bacterial infection: In F from bacteria from enteric system. (URT m/c viral dz) o Lower UTI: Urethritis (chlamydia) or cystitis (E.coli (also Proteus)), infections can move retrograde.  Hematuria, polyuria, dysuria, urgency, o Upper UTI: pyelonephritis  Fever, CVA pn, radiating pn to groin, chills, malaise, vomiting, diarrhea o 10-100 K bact/ml – contaminated, >100K/ml – Sx usually are present. o Diabetics more prone to UTI’s since sugar in urine acts as a food source. o Pregnancy more prone from obstruction to ureters. o Retrograde and intravenous pyelograms (IVP) – upper and lower obstructions.  Retrograde now surplanted by US. • STD’s o NGU – non-gonococcal urethritis, m/c STD, most commonly from Chlamydia, often asymptomatic in F,  Meatal edema, whitish meatal discharge, dysuria o Gonorrhea – Neisseria gonorrhea – urethra m/c site for infection  Urethritis, cervicitis, opthalmia, Bartholin’s absceses  Itching, discharge, urethritis; females are 4X as likely for infection as men from single intercourse o Herpes Simplex – HSV II affects 20% of adults, blisters. No cure, only Sx relief. o Genital warts – condylomata accuminata – by HPV – 1/3 of all STD’s. Will reoccur. Kidney Dz • Urolithiasis

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Calculus in urinary tract – Ca2+ most common, stones 3-4 mm can become visible on PFXR and can lodge in ureter. M>F 4:1, Stag horn calculus can be seen in urinary pelvis. Hydronephrosis from obstruction can be seen by IVP. Colicky CVA, N/V, referred pn to groin, FCNS

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Tx: Low Ca diet,

fluid intake, uteroscopic removal or shockwave lithotripsy

Glomerulonephritis (acute nephritic synd)(GN) o Autoimmune inflammation of glomerulus, 50% of Pts <13 yo o M/c cause of renal failure (25%) o M/c post group A beta strep infection Proteinuria o Small amounts can be normal. Must Dx on 3X. Possible “transient idiopathic proteinuria” o IDDM, nephrotic syndrome, amyloid, NSAID use Nephritic syndrome o 2ndary to glomerulonephritis: HTN, edema, hematuria, proteinuria; can lead to renal failure Nephrotic syndrome o From membranous GN; edema, protein loss, HTN, pleural effusion, hypoalbuminemia, hyperlipidemia, Acute renal failure o N/V, oligo/anuria, uremic neuropathy, elevated BUN & creatinine, electrolyte imbalance, o Pre-renal failure (m/c) (from inadequate renal perfusion) o Intra-renal/intrinsic renal failure – renal dz (GN, NSAID damage, acute tubular necrosis, microvasculopathy) o Post-renal failure – from obstruction: stones, BPH, abd mass, mets Chronic renal failure o From DM (37%), HTN, GN, polycystic dz, drug toxicity, etc. o Pallor, edema, HTN, depression, fatigue, N/V, pruritis. These Pts require dialysis. Elevated BUN & creatinine, proteinuria, RBC casts, Renal Cysts o Fluid filled cavities, show up in 50% of autopsies, simple cysts are 70% of all renal masses o Polycystic renal dz – m/c hereditary dz in US, 50% have renal failure by 60yo., UTI’s, also lvr/pancreas cysts Renal cell carcinoma (“hypernephroma”)

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Malignant. 1:10K, M>F (2X). Familial risk. Smoking, Tylenol use. Hematuria, CVA pn, abd mass, HTN, Wt loss o Stage I and II good Px, Stage III and IV poor (<20%) Prostate Dz • Prostatitis o M >50yo, • BPH - 80% by 80yo, 10-30% have occult CA, nocturia, hesitancy, etc., Px good. • Prostate carcinoma o Has past lung CA as the leading CA in men. M/c in black men, generally asymptomatic, mass on DRE, pn referred to bones, outflow obstruction. Elevated PSA, acid phos, biopsy Things less pleasant • Testicular torsion o M/c 1-18, 1 in 4000, leads to testicular infarct/ischemia, hemiscrotal pn, swelling, N/V, afebrile • Epididymitis o Septic/traumatic inflammtion of epididymis; tender, edema, discharge, dysuria, fever; usually self limited. • Hydrocoele o Fluid in testicular space. Congenital w/ inguinal hernia, 2ndary to infection, tumor, trauma. o Scrotal enlargement/pn • Orchitis o Associated w/ mumps, infection of testicle, testicular pn/swelling, bilateral, inguinal lymphadenopathy; can lead to sterility. • Testicular CA (seminoma, teratoma, choriocarcinoma) o M/c in young M, scrotal mass that doesn’t transilluminate, not painful (less than normal testes), pn from mets more common. Px 70-80% at early stages. • Bladder CA o Transitional cell (m/c), also squamous cell and adenocarcinoma. Occupational exposure, smoking. Painless hematuria, frequency/urgency, mets cause pn in distant organs Liver (75% damaged before failure) (low pressure system) • Hepatitis A o HAV (RNA virus) – fecal/oral route – 1/3 of all hepatides. Rarely becomes fulmanent hep, inc time 15-45 days. Hepatomegaly, malaise, jaundice, bilirubinuria. About 6 wks (acute only), no carrier status. • Hep B o HBV (DNA virus) – uncommon chronic, usually acute. Blood transmission.  Chronic rare – hep CA, liver decompensation. o Elevated ALT, AST, alk phos, hyperbilirubinemia. HBV hyperimmunoglobulin. • Hep C o HCV (DNA virus) – blood transmission. M/c non-alcoholic cause of lvr dz. Gradual (15-150 days incub), milder onset than A or B, persistent infection common (chronic/carrier) chronic hepatitis • Alcoholic Hepatitis o M/c form of hepatitis, m/c cause of cirrhosis, Hepatomegaly, ascites, splenomegaly (more common than w/ viral) • Cirrhosis o M/c from viral or alcoholic causes (also Tylenol, CHF, amyloidosis) o Early signs: weakness, disturbed sleep, cramps, weight loss. o Late signs: anorexia, weight loss, N/V, jaundice, hepato/splenomegaly, ascites, ammenorrhea/impotence, CNS damage, skin lesions. • Primary biliary cirrhosis o Autoimmune destruction of intrahepatic ducts, 95% in F, anti-mitochondrial Ab are pathognonomic, fatigue, pruritis, hepato/splenomegaly later. Can be symptomatic or asymptomatic, but can be fatal 7-16 yrs from Dx. • Hepatic Tumors o Benign: Hemangioma (m/c, vascular, asymptomatic), adenoma (asymptomatic, in steroid abusers) o Malignant:  Hepatocellular CA • In lvr dz, cirrhosis, HBV/HCV, 1/3 asymptomatic. Ascites, jaundice, hepatomegaly, elevated AFP (90%), PX 20-30% after resection.  Cholangiocarcinoma • Intrahepatic bile duct malignancy. More common in Asia. Lvr mass. Associated with Fluke infestation. Slow progression to Mets.  Mets (M/c, most commonly from colon CA) Gall Bladder Dz • Cholelithiasis (stones) (F’s: Female, fat, forty, flatulence, fair skin, (fertile)) o 75% of stones are cholesterol. Pn refers to right shoulder. • Cholecystitis (inflammation) o M/c associated with stones. RUQ pn, radiating to R shoulder, Murphy’s sign, fever, jaundice, Px good. • Cholangitis - Inflammation of bile ducts o Charcot’s triad: fever/chills, RUQ pn, jaundice; bilirubinuria, Px good; • Primary Sclerosing Cholangitis – inflammation leading to stricture. o M/c in M 20-40, associated with UC. Progressive jaundice, indigestion, malaise, anorexia. Poor Px. • Gall bladder cancer

o Adenocarcinoma m/c, usually found during surgery for stones, weight loss, palpable GB, RUQ pn, poor Px Pancreatic Dz • Acute pancreatitis

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2ndary to biliary dz, severe abd/back pn, fetal position, mild jaundice, shock, N/v; lipase/amylase , 5-10% mortality associated w/ shock. Tx Pn, NPO, tx complications. Chronic Pancreatitis – recurring pancreatitis. o Wt loss, foul smelling stools, Abd tenderness, epigastric/back pn, M>F 5:1, KUB may have calcifications. 50% die in 10 yrs (malignancy) Pancreatic cancer

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2nd m/c tumor of GI, m/c in head of pancreas, jaundice, abd pn, wt loss, biliary obst s/sx, early mets (poor Px), M>F 2:1