Advanced Physical Assessment
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| A pilonidal cyst | fairly common, congenital, midline superficial to the coccyx or the lower sacrum- tuft of hair, pus if infected
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| External hemorrhoids | are dilated hemorrhoidal veins below the pectinate line covered with skin- seldom produce symptoms- unless thrombosis occurs (acute local pain that increases with defecation) tender, swollen, bluish, ovoid mass is visible at the anal margin
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| Internal hemorrhoids | cannot see unless prolapsed- may cause bright-red bleeding, during defecation- if prolapsed, appears as reddish, moist
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| Prolapse of the Rectum | appearing as a doughnut or rosette of red tissue- is relatively small and shows radiating folds
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| Anal fissure | painful- comes with constipation- midline posterior- less commonly anteriorcentinal skintag below it- apply lidocaine beforehand d/t pain
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| Anal fistula | it is an inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus. An abscess is the cause- look for the opening
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| Biliary colic | female, fertile, 40s, fatty- releasing cholecystokinin- pain radiates to the chest after fatty meal- no tenderness? (acute cholecystitis has INFLAMMATION- difference- abdomen is tender +Murphys)
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| 23 y/o male presents with several hours h/o RUQ/ epigastric pain, n/v, Pain radiates to back. No hematemesis, no melena, hematochezia, night of heavy drinking, Denies f/c, No d/c | acute pancreatitis
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| 64 y/o male presents with 3 day h/o pain LLQ, Nonradiating, no change w/meals, better with BM, Some constipation, no melena, hematochezia, No f/c, no n/v. no dysuria, hematuria | diverticulitis LLQ
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| Tenderness, rebound tenderness, rigidity, fever | peritonitis
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| TEST s/s never wake you up at night | irritable bowel no weight loss, no fever, no blood in stool inflammatory WILL WAKE YOU
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| Hiatal Hernia with Esophagitis | Part of the stomach passes through the esophageal hiatus in the diaphragm into the chest cavity-Epigastric pain or heartburn- worsens with lying down-relieved by sitting up or antacids-Water brash, Dysphagia, sudden onset of vomiting, pain
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| Duodenal ulcer | from infection with H. pylori, & ↑gastric acid secretion (e.g. Zollinger-Ellison syndrome or gastrinoma), twice as often in men as in women, during fasting, relieved by food
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| Gastric ulcer | pain is worse with food
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| Stomach cancer | hard to detect early, loss of appetite, feeling full, dysphagia, hepatomegaly, wt loss, mid epigastric tenderness, enlarged supraclavicular lymph node (left side) need endoscopy for persistent epigastric pain/ulcer
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| Crohns disease | characterized by fistulas- any point in the gut- the anus- antibiotic is cipro/flagyl-
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| Ulcerative colitis | Chronic inflammatory disorder of the colon and rectum that produces mucosal friability and areas of ulceration-immunologic and genetic factors have been implicated-predisposes to colon cancer, wt loss, fever
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| Colon cancer | Symptoms depend on cancer location (rectum, sigmoid, proximal, and descending colon), size, and presence of metastases-abdominal pain, blood in the stool, or a recent change in the frequency or character of stools- 2nd most common CA
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| Hepatitis- any | Some are asymptomatic; others report jaundice, anorexia, abdominal pain, clay-colored stools, tea-colored urine, and fatigue- hepatomegaly- abnormal lfts
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| Gallstones/cholelithiasis | mild colicky pain 1st with mild transient jaundice with inflammation, indigestion
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| Cholelithiasis/gallstones | Stone formation in the gallbladder occurs when certain substances reach a high concentration in bile and produce crystals- produces episodes of acute cholecystitis
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| Cholesystitis | pain in the RUQ, may be rebound w/ radiation to the right scapular region; abrupt, severe, lasts for 2-4 hours, fever, jaundice, anorexia, fat intolerance, flatulence, anorexi, full palpable gallbladder in the RUQ, +Murphys
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| 2 most common causes of acute pancreatitis | etoh and gallstones (fatty foods)
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| Acute glomerulonephritits | many causes; most common infx (poststreptococcal) and immune-mediated (IgA nephropathy)- Inflammation of the capillary loops of the renal glomeruli- s/s- nausea, malaise; flank pain, headache secondary to hypertension, tea-colored urine or gross hematuria
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| Hydronephrosis | big kidney- turns into bags of water- Dilatation of the renal pelvis and calyces due to an obstruction of urine flow anywhere from the urethral meatus to the kidneys-kidneys palpable, cva tenderness, abdominal/flank pain, hematuria, fever, n/v
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| Pyelonephritis | Infection of the kidney and renal pelvis, fever, dysuria, flank pain, rigors, polyuria, urinary frequency, urgency, and hematuria, cva tenderness, pyuria and bacteriuria are present and confirm dx
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| Renal calculi vs renal calculi | renal stones are more painful
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| Renal Calculi | Stones formed in pelvis of the kidney-causes obstruction and infections in the urinary tract- made of calcium salts, uric acid, cystine, and struvite- n/v, fever, dysuria, hematuria, flank pain
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| Pruritis Ani | infectious- treat the family- Commonly caused by fungal infection in adults and by parasites (pin worms) in children
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