Abdominal Pain Flashcards
List 7 red flags in abdominal pain
- Severe pain
- Melena
- Wt. loss
- Abnormal labs
- Age >55
- Vomiting
- Dysphagia
- Mass
- Concerning family history
- Previous history of malignancy or vascular concerns
- Bilious Vomiting
List 7 red flag physical exam findings
- Pallor
- Sweating
- Hypotension
- Tachycardia
- Fever
- Rebound tenderness
- Decreased output
What medications should you ask about in abdominal pain (7)
NSAIDS, ASA, TCA, Iron, EtOH, abx Steroids Nicotine Valproate Phenytoin
DDX for diffuse abdominal pain (7)
Peritonitis Mesenteric ischemia Pan-colitis Constipation Early appendicitis DKA Hypercalcemia Somatization Pregnancy
DDX for epigastric pain (10)
Gastritis PUD Duodenal ulcer AAA Aortic dissection MI Pericarditis Mallory weis tear Pancreatitis NSAIDS/ASA Biliary colic
RUQ pain (10)
Cholecystitis Hepatitis Biliary collic Nephrolithiasis Pyelonephritis RLL pneumonia R Pleural effusion Costochronditis Herpes Appendicitis if pregnant Trauma
LUQ pain (10)
Pancreatitis PUD Gastritis NSAIDS Splenic infact Spenic rupture Nephrolitiasis Pyelonephritis LLL Pneumonia L sided pleural effusion Herpes Trauma Costocondritis
LLQ pain (10)
Diverticulitis Constipation Ovairan torsion Ovarian cyst Ovarian Abscess Proctitis Volvulis Ectopic Endometriosis Cystitis Epididymitis Testicular torsion Nephrolithiasis
RLQ pain (10)
Testicular torsion Epiddymitis Ovarian torsion Ovarian cyst PID Ectopic Appendicitis Colitis Hernia Cystitis Nephrolitiasis
Pelvic pain (10)
PID Cystitis Endometriosis Fibroids Ectopic Mittleschmerz Constipation Diverticulitis Colitis Appendicitis
DDX if abdo pain with fever (5)
Infection Malignancy IBD Pancreatitis Infarction
Dx if abdo pain and jaundice (2)
Pancreatitis
Hepatitis
Concerning physical exam finding for bleeding in the abdomen
Turners (flank bruising) and Cullens (periumbilical bruising)
List 4 causes of abdominal pain not caused by anything in the abdomen (systemic causes)
DKA Drugs Anemia Depression Could also list resp and cardiac causes like pneumonia, MI, aortic dissection etc.
DDX for abdominal pain in children
Life threatening -Intussusception -Appendicitis -Obstruction -Testicular torsion Common -Gastro -Constipation Missed: -Abuse -Ulcer -Mumps -Pneumonia -UTI -Diabetes
Treatment for H. Phylori
- PPI like Pariet
- Bismuth
- Nitroimidazole like metronidazole
- Tetracycline
FOR 14 DAYS
What are some risks of long term PPIs
B12 deficiency (iron? Mg?) Dementia C Diff** only one with real evidence Fractures Pneumonia
Risks for H. Pylori
Low SES Immigrants Living in crowded conditions No reliable hot water Parents infected
Red flag symptoms for Dyspepsia
Vomiting Wt. loss Melena Age >50 Dysphagia Anemia
When to do an endoscopy for dyspepsia
Age >60 Red flags -Wt loss -Dysphagia -Vomiting -Anemia -Melena Failure of reasonable trial of treatment
Risks for Barrett’s
Old Fat White Male Smoker
List 3 investigations you would consider for dyspepsia
H. Pylori serology
Hemoglobin
Endoscopy
Non pharm management of dyspepsia (7)
Weight loss Stop smoking Stop drinking Stop NSAIDS Aboid triggers Eat smaller meals Elevate head of bed Don't eat <3 hours before lying flat
First line dtreatment for Dyspepsia
Antacids or H2 receptor antagonists if mild
PPI (Pariet) if moderate
Can increase dose to BID
Second line treatments for Dyspepsia
TCA like amitryptaline
Prokinetic like domperidone
When do we treat urethral stones
> 5 mm
When do we treat urethral stones with medical expulsive therapy
5-10 MM and distal
How to we check for Urethral stones
US KUB or CT KUB
How do you do forced IV hydration for urethral stones
We don’t anymore, no longer recommended by Can Urol Association
Risks for gallstones
Female Forty Fertile Obese OCP
Medications that increase Risks for pancreatitis
Septra Flagyl HCTZ ACE i Progesterone Atorvastatin Estrogen Steroids
Risks for pancreatitis
Gallstones EtOH Trauma Steroids Mumps Malignancy Autoimmune Scorpions High TG ERCP Drugs
