??

Chronic relapsing-remitting inflammatory condition involving mucosa & submucosa of RECTUM & COLON

This inflammatory condition:

NO small bowel involvement

No full thickness involvement

No skip lesions

No granulomas/fistulas

males, fm hx +, bi-modal 20-35  and 50-65 yrs

This inflammatory condition:

bloody diarrhea with bouts of constipation

lower abdominal pain & cramping

wt. loss

fever

tenesmus

Extraintestinal manifestations

Ulcerative colitis

Think T AAGED (i've aged)

Thomboembolism, Arthritis, Aphthous stomatis, E. nodosum and Episcleritis Uveitis, Derma disorders

OR

Think J BELLS

Joints-etereropathic arthritis

Bone-osteoporosis

Eye-uveitis, iritis

Liver-Cholelithiasis, Cholangitis, Pancreatitis

Lungs-Pulomary embolism

Skin- erythema nodosum

??

 Inflammatory relapsing-remitting inflammatory condition with flare ups that may affect any part of the GI tract

Anywhere in the GI tract

Transmural-full thickness

Skip lesions

Granulomas

Fistulas, Abscesses

??

Non-bloody diarrhea

Abdominal pain/colicky

Wt-loss

Fever

RLQ mass

IV fluids

NG tube

NPO

Antidiarrheal-LOPERAMIDE

Steroids-PREDNISONE

Acute dx-ASA aminosalycilates

Crohn's-surgery

Colorectal polyps:

Definition

Classified

Risk of Ca

Definition:  Tissue growth into bowel, mucosa & submusoa

Classified: Sessile-Flat

Pedunculated-on a Stalk

Risk of Ca: Size larger than 2 cm

Colorectal polyps:

S&S

Dx

Tx

S&S:  Bleeding red/dark

Change in BM habits

Mucus per rectum

Electrolyte loss

Asymptomatic

Dx:  Colonscopy

Tx:  Endoscopic resection

Anal Fissure:

Define

Common site

Cause

Define:  Tear/Fissure in anal epithelium

Common site:  Posterior midline

Cause:  Hard stool passage-constipation

Hyperactive sphincter

Disease process-crohn's disease

Anal Fissure:

S&S

chronic fissure triad

tx

S&S:  Pain in anus

Rectal bleeding

Blood of toilet paper after bm

sentinal tag

tear in anal skin

extremely painful rectal exam

chronic fissure triad: 

 Fissure, Sentinal pile, Hypertrophied anal papilla

tx: think HATSS

High fiber diet, anal hygiene, Topial nifedipine/botox, Sitz baths, Stool softners

Internal & External Hemorrhoids:

Definition

Location

Pain

Definition: 

Internal-prolapse of rectal mucosa, contain nl dilated veins

External-Thrombosis/Blood clots of veins, covered by skin

Location:  Pectinate line Above-Internal  Below-External

Pain:  Only in EXTERNAL

1st stage-NO Prolapse

2nd-Prolapse w/ BM & spontaneous reducible

3rd-Prolapse w/ manual reduction

4th-Prolapse & cannot be reduced

Hemorrhoids:

Sx

Tx

Sx:  rectal mass

rectal bleeding

pruitis

pain-external only

tx:  think HATS

high fiber diet

anal hygiene

topical steroid- 1% hydrocortisol

Sitz bath

??

Bouts of crampy abdominal pain & bloody diarrhea

Colonscopy reveals-Segmental inflammatory changes, most prominent in watershed areas of rectosigmoid junction and splenic flexure

Tx-conservative

if progressive strictures surgery

Volvulus:

Define

Sites & %

Where is the most common cause of bowel obstruction

Define:  Twisting of bowel on itself=Loop=Obstruction

Sites & %:

75% Sigmoid

25% Cecum

Where is the most common cause of bowel obstruction:
Underdeveloped countries

??

CBC nl, Elevated WBC

Electrolytes-Dehydration

Plain Abdominal x-ray-Air filled colon, Coffee Bean or Bent inner tube

Water contrast Enema- Birds Beak

Volvulus

Tx:

Conservative-Reducible proctoscope/sigmoidscope

Nonviable-Colon resection w/anastomosis/ileiostomy

Perforated-Ileostomy

??

Hydrochloric acid & bacteria come in contact with the peritoneal surface

and cause an intense inflammatory response=PAIN

??

Abrupt severe abdominal pain

Boardlike rigidity of abdomen

Common site affected:

Anterior Duodenum

Hx of PUD

??

Diffuse abdominal pain

**Guarding & Rigidity

Absence of bowel sounds

Systemic sepsis can develop quickly

??

Hematochezia

Hematemesis

Melena

Leads to:  Weakness, Anemia, Iron deficiency

Cause: Liver cirrhosis

What type of Cancer Colon/Rectal, Pancreatic, Liver??

wt loss

fatigue/weakness

R-sided mass, iron deficiency anemia, post prandial discomfort, + occult heme stool

L-sided, alternate b/w constipation & diarrhea, increased risk of obstruction, hematochezia

Metastases occur where for:

Colon

Rectum

Colon:  LIVER

Rectum:  LUNGS

What type of Cancer Colon/Rectal, Pancreatic, Liver??

Insidious wt loss, fatigue, anorexia

Painless Jaundice

Epigastric pain w/ relief upon leaning forward

Pruitis

Courvosier's sign

What type of Cancer Colon/Rectal, Pancreatic, Liver??

RUQ / Epigastric pain

Abdominal swelling

Wt loss

Sudden ascites

Friction Rub ____ present

Liver Ca

Hep B & C

Breast malignancies:

H&P findings??

Peau d' orange

Erythema

 Nipple inversion

Change in skin of nipple/areola

Palpable lymph nodes

DCIS:  unilateral breast

LCIS:  bilateral breast

think NAACP

Nulliparity

Age of onset of menses b/f 13 yrs

Age of menopause after 55 yrs

Ca in breast, FM HX

Pregnancy 1st after 30 yrs

??

Asymptomatic lump-breast

nipple discharge

fluctuations in size & disappearance/appearanace of breast mass

Why is this occuring?

Asymptomatic lump-breast

nipple discharge

fluctuations in size & disappearance/appearanace of breast mass

Fibrocystic dz

30-50 yrs, +ETOH,  18-22 yrs

TMN

Tumor

Metastases

Node

What stage is this??

DCIS

LCIS

What stage is this??

<2 cm tumor breast

No Nodes or Metastases

What stage is this??

Tumor < 2 cm with mobile axillary node involvement

OR

2-5 cm tumor with no Node involvement

What stage is this:

Tumor 2-5 cm with mobile axillary node involvement

OR

>5 cm tumor with no node involvement 

What stage is this??

tumor >5 with mobile axillary nodes

OR
any size tumor with FIXED nodes

What stage is this:

Peau d' orange

Chest wall invasion/fixation

Inflammatory Ca

Breast skin ulceration

Breast skin satellite metastases

Any tumor and +ipsilateral internal mammary nodes involved

What stage is this:

Distant metastates

including ipsilateral clavicular nodes

Carpal Tunnel Syndrome:

Nerve??

Associated w/ what conditions

Nerve??:  Median nerve compression in the carpal tunnel

Associated w/ what conditions:

Hypothyroidism

DM

ETOH

Aging

Carpal Tunnel Sydrome:

S&S

H&P

S&S:

Tingling-digits 1,2,3, half of 4

Numbness

awakens at nite & exacerbated by repetitive motion

H&P:

Dry skin on affected fingers

Thenar atrophy-advance compression of nerve

Carpal Tunnel Sydrome:

Dx

Tx

Dx:  Tinel's

Phalen's

2 point discrimination, Monofilament

Tx:

Non op- nite splinting, antiinflammatory, avoid repetitive motion, corticosteroids

Op- Release of transvers carpal ligament

Joint dislocation:

Define

Complaint

H&P

Define:  Complete loss of contact b/w 2 articular surfaces

Complaint:  PAIN over involved jt

H&P:  Jt pain exacerbated by mvmt

Joint dislocation:

Dx

Tx

Dx:  MRI

X-ray

CT

Tx:

Reduction

Immobilizer

Analgesics

muscle relaxants

tranquilizers

Joint dislocation:

What structures are at risk with this condition?

Arteries

Veins

Nerves

Fractures:

Define extremity exam in fx extremity??

1. OBSERVE entire extremity

2. Neurological-sensation, mvmt

3. Vascular-pulses, cap refill

Fractures:

What x-rays should be obtained?

2 Views

&

Above & Below fx

Fractures:

How are they described?

1. Skin status-open or closed

2. Bone-by thirds Proximal, Middle, Distal

3. Pattern of fx

4. Alignment- displacement, angulation, rotation

Fracture-define:

Closed

Open (RISK OF??)

Simple

Closed:  Skin intact

Open:  Fragment of fx exposed to outside environment

risk-INFX

Simple: 1 fx line, 2 bone fragments

Fracture-define:

Comminuted

Transvers

Oblique

Comminuted:  more than 2 fragments, "fragmentation"

Transverse:  Fx line perpendicular to long bone axis

Oblique: Fx line oblique to long bone axis

Fracture-define:

Spiral

Longitudinal

Impacted

Spiral:  Severe oblique fx that rotates along long bone axis

Longitudinal:  fx parallel to long bone axis

Impacted:  fx from compressive force

Spine Fractures:

H&P??

1. Eval & Palpate spine

tenderness

asymmetry

step off spinous process

2. Neuro exam

sensation

motor strenght

reflexes

3. Eval Rectal tone & Perianal sensation

spinal shock

Spine Fractures:

Dx

Tx

Dx: 

 Radiographs, MRI, CT

Tx: 

 Orthotics

Braces

Surgery-decompress & stabalize spine

Pathological Fx:

Define

&

Symptoms

 Fx found in bone of weakened area of dz. process

Occurs by trivial injury or spontaneously

Symptoms-BONE PAIN

Pathological Fx Presentation, what conditions are associated:

Painfull bowing of bones, pseudo fx ??

Bone pain, Hypercalcemia ??

Oteopenia of unknow cause??

Painfull bowing of bones, pseudo fx ??

Rickets, Osteomalacia

Bone pain, Hypercalcemia ??

Hyperparathyroidism, Malignancy

Oteopenia of unknow cause??

Hyperthyroidism, Cushings's syndrome

Pathological Fx Presentation, what conditions are associated:

Back pain, male & female, hypogonadal

Bone pain other ??

Back pain, male & female, hypogonadal ??

Osteoporosis

Bone pain other ??

Primary metastatic tumor

Multiple Myeloma

Paget's Dz

Rotator Cuff Tear:

muscle involved

tests

tx

muscle involved:

SITS muscle

Supraspinatus, Infraspinatus, Teres minor, Subscapularis

tests:

Neer sign of impingement, MRI,  x-ray of humerus

tx:

conservative-PT, surgery

Bicep Tendon Repair:

Cartoon sign

S&S

Cartoon sign: 

Popeye-muscle bulge/visible defect

S&S:

Palpable pain in affected shoulder bicep groove upon forearm supination resistance

Muscle weakness

Loss of motion

Audible snap

Bicep Tendon Repair:

Dx

Tx

Dx:

MRI

Yergason

Tx:

Ortho referral

surgery

Fat Embolism Sydrome:

TRIAD

H&P

TRIAD:

Respiratory distress

AMS

Thrombocytopenia

H&P:

Occurs w/ 3 days of a long bone fx

MS changes

Tachycardia

Dyspnea

Petechiae

Fat Embolism Sydrome:

Lab studies for dx??

Decrease platelet, <15,000

Decrease arterial O2, < 60

Increase Lipase

Increase Fat in urine

CXR-patchy infiltrates

EKG:

tachycardia

Inverted T waves

Depressed ST waves

RBBB

Fat Embolism:

Tx

ORTHO EMERGENCY

Respiratory therapist

+ end expiratory pressure

Corticosteroids

Hip Replacement:

S&S

Etiology

Dx & TX

S&S:

Early sign of hip arthritis-decreased hip internal rotation & painful external rotation

Abductor muscle loss

disability

Etiology:

Degenerative arthritis

RA,  Fx

Dx: x-ray  &  Tx: ortho, replacement, PT

Knee Replacement:

H&P

Dx

H&P:

Intraarticular pain

Patellofemoral pain

Osteochondrial pain

Dx:

MRI

X-ray