Abdomen Flashcards
Discuss the presentation and management of peptic ulcer disease
Pathophysiology - ulceration in stomach or duodenum - H-pyloria - NSAID Presentation - dyspepsia - worse after food - possible melena - epigastric tenderness - peritoneal signs Investigations - CBC for anemia - high BUN:Creatinine ration if upper GI bleed - Endoscopy Management - PPI - H-pylori management if present
Discuss the presentation and management for Gallstones
Presentation:
- Biliary Colic: RUQ pain, radiation to right shoulder, worse with food intake
- Cholecystitis: biliary colic, fever/chills
- Choledocholithiasis: biliary colic, jaundice
- Ascending cholangitis: Charcot’s triad (RUQ pain, jaundice, fever) + confusion and hypotension (Reynold’s pentad)
Investigations:
- Leukocytosis in cholecystitis and cholangitis
- Elevated conjugated bilirubin in choledocholithiasis and cholangitis
- Elevated Alk Phosph and GGT in choledocholiathiasis and cholangitis
- Ultrasound
Treatment:
- Biliary colic: cholecystectomy
- Cholecystitis: admit, IV fluid resuscitation, urgent surgical cholecystectomy
- Choledocholithiasis: admit, IV fluid resuscitation, ERCP and cholecystectomy
- Cholangitis, admit, IV fluids resuscitation, antibiotics (ceftriaxone and metronidazole), ERCP and cholecystecomy
Discuss the presentation and management for pancreatitis
Pathophysiology - inflammation of the pancreas - gallstone obstructing Ampulla of Vater or alcohol most common causes Presentation - Nausea/vomiting - Severe sharp epigastric pain that radiates to the back - fevery/hypotension - Cullen's sign (bruising around umbilicus) - Grey Turners (bruising around flanks) Investigations - Elevated WBC, amylase, lipase - elevated ALP, GGT if gallstone - Abdominal CT with constrast Management - NPO - hydration - Gallstone then ERCP
Discuss the presentation and management for mesenteric ischemia
Pathophysiology
- thrombus or vasoconstriction of mesenteric artery causing ischemia and infarct of bowel
- Risks: elderly, cardiac disease
Presentation
- Nausea/vomiting
- acute, persistent, severe abdominal pain
- hematochezia
Investigation
- Elevated WBC, lactate, metabolic acidosis
- Abdominal CT
Management
- Ceftriaxone and Flagyl
- Surgical revascularization or thrombolytic agent via angiography
Discuss the presentation and management for appendicitis
Pathophysiology: - Between 15-30 most common Presentation - visceral dull, aching umbilical pain -> somatic, sharp RLQ pain - fever/chills - nausea/vomiting - anorexia - diarrhea - tenderness at McBurney’s point - + Rovsing’s sign/obturator sign/psoas sign - peritoneal signs Investigations: - ultrasound - CT - b-HCG to r/o pregnancy - u/a to r/o UTI Treatment: - IV fluid resuscitation - antibiotics (ceftriaxone and metronidazole) - appendectomy
Discuss the presentation and management for diverticulitis
Presentation
- pain in LLQ
- decrease BMs
- fever or chills
- urinary urgency
- distended abdomen with possible peritoneal signs
Investigations
- leukocytosis
- CT abdomen with gastrogaffin
Management
- Uncomplicated (no abscess, visualized air, fisutal or stricture) treat as outpatient with ciprofloxacin and flagyl as long as tolerate fluids for 14 days
- complicated are admitted, NPO with cipro and flagyl with possible drainage of abscess
- surgery if do not improve which is Hartmann’s resection
- follow up colonoscopy
Discuss the presentation and management for renal colic
Presentation - constantly uncomfortable - nausea, vomiting - flank pain that is severe and radiate to grown - hematuria Investigation - urinalysis and culture - KUB x-ray - CT scan without contrast Management - high likelihood stone will pass if <=5mm - treat with PO fluids, ketorolac, alpha-blockers (flomax)
Discuss the presentation and management for cystitis
Presentation - Increased frequency, urgency, dysuria - pylenonephritis are systemically unwell - CVA tenderness in the elderly Investigations - Urinanalysis for leukocytes, nitrites - Urine culture Management - Septra tab BID for 3 days - Nitrofurantoin 100mg BID for 5-7 days - Unstable or pylenonephritis IV Gentamycin + Ampicillin
Discuss the presentation and management for ectopic pregnancy
Pathophysiology - implantation of embryo outside of uterine cavity Presentation - lower abdominal pain - vaginal bleeding - hypotension/tachycardia if hemorrhage - peritoneal signs Investigations - CBC - bHCG - transvaginal u/s Management - asymptomatic and stable then methotrexate - unstable then referral to gynecology
Discuss the presentation and management for rupture ovarian cyst
Pathophysiology
- rupture of cyst which bleed into abdomen
- PCOS
Presentation
- unilateral lower abdominal pain
- light vaginal bleeding
Investigation
- bHCG negative
- pelvic ultrasound show adnexal mass and fluid
- pelvic CT visualize ovarian mass and clot
Management
- uncomplicated then oral analgesia and follow up
- complicated hospitalization and OBGYN for surgery
Discuss the presentation and management of ovarian torsion
Pathophysiology - rotation of the ovary on its ligament impeding blood flow resulting in ischemia and necrosis Presentation - Nausea/vomiting - acute onset of mild to severe pelvic pain that is sharp, colicky cramp - adnexal mass Management - CBC - bHCG negative - pelvic ultrasound: ovarian mass, edema of ovary, abnormal location of ovaries, decreased blood flow Management - emergent surgery
