abdo cases Flashcards
n and v hx
acuity / onset, abdo pain, pre or postprandial or food poisoning, pregnancy, gi or abdo pain, neuro (headache, stiff neck, vertigo, numb or weak), urinary, exacer/alleviate, meds, hx abdo sx
n and v ex
vitals, ent (press on sinuses), fundoscopic ex (due to increased icp), abdo ex. heart, lung, rectal, pelvic ex
n and v ix
preg: urine hCG, pelvic ex, pelvic us
ubc, euc, ca, glucose
ua, HIV Ab
n and v ddx
pregnancy, gastritis, hyperCa2++, DM, UTI, depression
preggers
morning n and v, fatigue, polyuria, LMP over a month ago, breasts full and tender, actives sans contraception
abdo pain hx
socrates/liqraa (timing; associated constitution, gi, heart, lung, renal pelvic)
abdo surgeries, trauma, gallstones, renal stones, atherosclerosis
meds (NSAIDS, steroids), etoh/drugs, needles, violence, stress/anxiety, sexual, preggers
abdo pain ex
tenderness, guarding rebound, Murphy’s (arrest of inspiration when pressing on RUQ), posas /obdurator/Rovsing signs, CVA percussion, bowel sounds, aortic bruits (AAA, carotids). rectal, pelvis (for women)
sudden colicky R flank pain. rads to testicles, n,v,hematuria, cva tenderness
nephrolithiasis, rcc, pyeloneph, GI (appendicitis)
ix: ua, urine culture and sensitivity / cytology, bun/cr, ct abdo, us renal, kub, ivp, bc (blood culture)
dull epigastric pain, rads to back. weight loss, dark urine, clay stools. jaundice, smoker, drinker
pancreatic ca, cholangioca (also jaundice and stool/urine combo). chronic pancreatitis.
acute viral or alcoholic hepatitis. cholecystitis/choledocholithais.
aaa, peptic ulcer
cbc, euc, lipase (more specific for pancreas), amylase, lfts (ast/alt/bilirubin/alp), us or ct abdo
midepigastric rads to back, improves with forward lean. anorexia, n,v, etoh (binge)
acute pancreatitis, cholecystitis/choledocholithiasis
PUD, gastritis
AAA, mesenteric ischemia, alocholic hepatitis, Boorhave’s (no vomiting blood doe)/Mallory Weiss
cbc, euc, bun/cr, lfts, amylaes/lipase, us or ct abdo, upper endoscopy, ecg
40s, obese, female, ruq pain rads to R scapula/back, n,v,fever,after ingesting fatty food. +Murphy’s
acute cholecystitis, choledocolithiasis, hepatitis, ascending cholantigis
PUD, fitx-hugh-curtis, acute subhepatic appendicitis
cbc, lfts, us or ct abdo, bc (blood culture)
40s obese female, ruq pain, fever, JAUNDICE. gallstones a yr ago, HYPOtensive
ascending cholantitis, acute gallstone cholangitis, acute cholecystitis, hepatitis, sclerosing cholangitis, fitz hugh
cbc, lfts, bc, viral hepatitis serology, us abdo, mrcp/ercp
25 m ruq, fever, anorexia, n,v. dark urine, clay stools
acute hepatitis, acute cholecystitis (but urine adn stool), asending cholantitis/choledoco, pancreatitis, acute glomerulonepth
cbc, amylase/lipase, lfts, viral hepatitis serology, ua, us abdo
35 m, burning epigastric pain, postprandial, relieved by food/antacids
PUD, gastritis, gerd
cholecystitis, chrnoic pancreatitis, mesenteric ischemia
rectal, fobt, amylase/lipase/lactate, lft’s, upper endoscopy (H pylori-also test with breath, blood or stool exam), upper gi series
abdo pain key features
pancreas-epigastric, rads to back (alcohol, smoking exacerbates)
gall bladder-RUQ, fat, female, forty, tachycardio/hypotensive
37 m severe epigastric pain, n, v, fever, toxic. PHx relieved by food, antacids, smokes
perforated peptic ulcer
acute pancreatitis, hepatitis, cholecystitis, gallstone cholangitis, mesenteric ischemia
cbc, euc, amylase/lipase/lactate, lfts, bc
rectal, cxr, kub, ct abdo, upper endoscopy
luq abdo pain rads to L scapula, mono previously
splenic rupture, splenic infarct, kidney stone, rib fracture, pneumonia, perforated peptic ulcer
cbc, euc, cxr, ct or us (if hemodynamically unstable) abdo
crampy abdo, v, distended, can’t pass flatus/stool. abdo surgeries
intestinal obstruction (from adhesions, ie sbo), ileus, sb/colon ca, volvulus, gastroenteritis, food poisoning, hernia
rectal ex, cbc, euc, axr, ct abdo pelvis +/- contrast, colonoscopy
elderly, acute onset severe, crampy pain. n,v, big dark stool. phx: chf, af
mesenteric ischemia/infarction, diverticulitis, PUD, gastroenteritis, acute pancreatitis, cholecystitis
rectal, cbc, euc, amylase/lipase/lactate, ecg, axr, ct abdo, mesenteric angio, barium enema
20s F acute severe RLQ pan, n,v.cyst R ovary
ovarian torsion, ruptured ovarian cyst (but would be more acute), ectopic, PID
appendicitis, nephrolithiasis, bowel infarction/perforation
pelvic ex, urine hCG, doppler us pelvis, rectal
ua, cbc, NAAT chlamydia gono, vdrl/rpr
ct abdo, laparoscopy
older M, LLQ abdo pain, fever chills 3 days. alternating diarrhea and constip. low fiber, high fat diet
diverticulitis, crohn’s, UC, gastroenteritis, abcess
recral ex, cbc, euc, cxr, axr, ct abdo, bc
20s RLQ abdo,n,v. periumbilical dull to RLQ sharp. mcBurney’s, Murphey’s, psoas +
acute appendicitis, gastroentero, divertculitis, crohn’s, volvulus/obstruction, perforation
neprolithiasis, acute cholecystitis
30s F perumbilical 6 mo, relieved by defecation, worsens when upset/stress, alternating constip and diarr.
IBS, celiac, chron’s, diverticulosis (but would be older), chronic pancreatisis, parasitic infection (amebiasis, giardiasis), endometriosis
rectal, fobt, pelvic, urine hcg
cbc, euc, stool for o and p, e histolytica antigen
colonoscopy, ct abdo pelvis
20s F, bilat lower abdo pain, started with first day menstrual period. fever, thick green yellow discharge, unprotected sex
PID, endometirosis, dysmenorrhea, vaginitis, cystitis, pyelo, spontaneous abortion
pelvic, urine hcg, cervical cultures
cbc, esr, ua, u culture, pelvis us
bloody stool hx ex
melena/dark vs bright red blood, in the bowl or on the tp, amount, duration, associated ssx (b sx, abdo/rectal pain, tenesmus, difficulty passing/straining, c/d), trauma,
Hx similar. hx colonoscopy, meds (esp anticoagulants), menstrual cycle
hx easy bleeds/atherosclerotic vascular dz, renal, aortic valve, liver dz. aaa repair. etoh. Fhx colon ca
ex: vitals, orthostatic bp, abdo, rectal
elderly, weight loss, bloody stool, c, FHx colon ca
colorectal ca. anal fissure (brighter blood), hemorrhoids, diverticulosis, ischemic bowel dz, angiodysplasia, upper gi bleed, inflam bowel dz
ix: rectal, cbc, lfts, inr/pt, cea, colonoscopy, ct abdo
30s F rectal bleeding, d, lower abdo pain, tenesmus for months
UC (rectal vs skip lesions), chron’s, proctitis, anal fissure, hemorrhoids, diverticulosis, dysentery
rectal, cbc, pt/ptt, colonoscopy, ct abdo/pelvis
older M painless bright red blood per rectum, chronic c, low fiber
diverticulosis, anal fissure, hemorr, angiodysplasia, colorectal ca
rectal, cbc, blood type/cross, pt/ptt, euc, tagged rbc scan
colonoscopy, ct abdo pelv
upper gi bleeds hx ex
amt, duration, context/tiing (after vomiting, etoh, nosebleeds), associated sx (b, n,abdo pain, dyspepsia), meds (anticoag, nsaids, steroids). hx PUD, liver dz, AAA repair, easy bleeding
ex: vitals/orthostatic, *ent, heart,lung,abdo,rectal
40s F coffee ground emesis, dark tarry stools, intermittent epigastric pain relieved by food/antacids
bleeding peptic ulcer, gastritis, gastric ca, esophageal varices
40s F epigastric pain coffee ground vomit, RA treated with NSAIDS, etoh
gastritis, bleeding peptic ulcer, gastric ca, varicess, mallory weiss tear
upper gi bleeds ix
rectal, cbc, blood typing, euc, lfts, inr, upper endoscopy (H pylori tests if ulcer)
constip / diarrhea hx
freq / duration of change, color, oder, volume, mucus, flatulence, flating stools.
associated sx (b, abdo pain, bloating, tenesmus, straining, melena, hematochezia) thyroid dz (palpitations, hot, weight loss)
diet (fiber, fluids), meds (antibiotics/cdiff), sick contacts, travel, camping. HIV rfs, abdo sx (adhesions obstructing), diabetes, pancreatitis, etoh and drug use, FHx colon Sx
constip / diarrhea ex
vitals, thyroid, endo, abdo, rectal, pelvic for females
constip / diarrhea ix
rectal, fobt, cdiff toxin, stool leukocytes and culture,stool o and p, giardia antigen, entamoeba histolytica antigen
cbc, euc, lfts, tsh/t4, utox, viral hep serology, hydrogen/urea breath test, 5-hiaa (carcinoid)
colonoscopy, barium enema, ct abdo pelvis, small bowel series
33 M water diarrhea, diffuse abdo pain, weight loss 3 w. hx apthous ulcers
crohn’s, uc, gastroentero, celiac, hperthyroidism, pseudomembrane colitis, small bowel lymphoma, carcinoid
watery diarr, abdo cramps, bloating, post milk relieved by fasts
lactose intolerance, gastroenero, inflam or irritiable bowel dz, hyperthy
watter diarrhea, cramps, Mexico
traveler’s d (e coli), giardiasis, emebiasis, food poisoning, hep a
40s F, watery diarrhea, abdo cramps, UTI antibiotics recently
pseudomembranous colitis, gastroentero, cryptosporidiosis, food poisoning, inflam bowel dz
watery dia, v, diffuse abdo pain (vs cramps-more infectious etiology), fever, sick contacts
gastroenter (infecious via bacteria, virus, parasites, protozoa), food poisoning
alternating c and d, abdo pain, relieved by defecation.
irritable bowel, inflam, celiac, chronic pancreatitis, lactose intolderance, gi parasite (ascariasis, giardiasis)
c (hard stool), poor diet
low fiber diet, depression, irritibal bowel, hypothyroid, substance abuse
elderly alternating d and c, decreased stool caliber (obstructing lesion on left, look for anemia on right), blood in stool, unintentional weight loss. FHx
colon/colorectal ca, diverticulosis, irritable bowel, inflam bowel, gi parasite
