Other Systems 2 FF (GI, pregnancy)

common physiological changes during pregnancy

1. weight gain 25-35 lbs

2. MSK posture more kyphotic and lordotic

3. BP LOW in 1st and 2nd trimester, HIGH in 3rd

4. resting HR increases by 10-20

why and when do you avoid supine lying when pregant

No supine after 1st trimester because it can compress inferior vena cava which decreases cardiac output

- should lay on left side

preeclampsia

- acute hypertension after the 20th week of gestation (>140/90 and then a second one after 4 hours confirms it)

- increase protein in urine, hyperreflexia, edema, headache and sudden weight gain

what is different about eclampsia

occurs after birth and involves seizures

some contraindications to exercise while pregnant

early dilation of cervix, vaginal bleeding during 2nd/3rd trimester, uncontrolled maternal diabetes, premature labor, placenta previa

treatment for diastasis recti depending on separation diameter

> 2 cm: abdominal bracing and head lift

> 4 cm: abdominal bracing and breathing

GERD presentation

- heartburn 30 min after eating and at night lying down

- dysphagia

- hoarseness of voice

- atypical chest pain

treatment for GERD

- maintain upright positions and avoid supine

- eat meals 3-4 hours before sleep

- exercise 2-3 hours after or before eating

- avoid spicy, chocolate, fatty food, peppermint

what refers pain to mid-back/scapula

PEGS

pancreas, esophagus, gallbladder, stomach

what refers pain to L shoulder

heart, diaphragm, spleen and tail of pancreas

what refers pain to R shoulder

gall bladder, liver and head of pancreas

what refers pain to pelvis/low back/sacrum

colon, appendix, pelvic viscera

pancoast tumor

upper lung tumor

- refers in C8-T2 and mimics TOS

- pain at top of shoulder and ipsilateral shoulder

Kehr's sign

pain to L shoulder when supine and legs are raised which increases abdominal pressure

- may indicate ruptures spleen

RUQ pain

good luck harry potter kid

- gall bladder

- liver

- head of pancreas

- peptic ulcer

- R kidney

LUQ pain

don't be silly kid harry

- diaphragm

- body/tail of pancreas

- spleen

- L kidney

- heart

RLQ pain

appendix, Crohn's disease

LLQ pain

diverticulitis, ulcerative colitis, IBS

cholecystitis presentation

blockage or impact of gallstones in the cystic duct

- pain in RUQ or radiating to R scap

- nausea, vomit, low fever

- pain increases with ingestion of fatty food

(+) Murphy Sign

Murphy's Sign

palpate near R subcostal margin as patient takes deep breath

- pain w/ inspiration = positive (cholecystitis)

where does a hiatal hernia refer to?

shoulder pain (L)

- symptoms similar to GERD

where does a femoral hernia refer to?

lateral pelvic wall and groin pain

where does an inguinal hernia refer to?

groin pain

where does an umbilical hernia refer to?

umbilical ring in mid to lower abdomen

gastric ulcers vs duodenal ulcers

gastric: lesions in stomach due to NSAIDs, stress, anxiety or H pylori

- pain increases w/ PRESENCE of food

duodenal: lesions in duodenum due to H pylori

- pain increases w/ ABSENCE of food

peptic ulcer emesis and stool presentation

coffee ground emesis and melena tarry stools

irritable bowel syndrome presentation

- spastic, nervous or irritable colon that is painful in the morning or after eating

- symptoms disappear after defecation and sleeping

- ribbon like stools

- pain in LLQ

differential diagnosis of GI bleeding

peptic ulcer: coffee ground emesis

ulcerative colitis: bloody diarrhea

duodenal ulcer: melena

liver/pancreas/colon: white, clay gray stool

bleed in GI tract: red blood in stool

appendicitis presentation

- pain in RLQ starts in waves and progresses to steady

- anorexia, nausea, vomiting, fever, leukocytosis

- McBurney's, Rovsing's, Blumber's sign

McBurney's point

press and painful

Rovsing's test

palpation to LLQ

pinch and inch test

on RLQ = appendicitis

on LLQ = diverticulitis

Blumberg's sign

rebound tenderness