Abdominal Pain

Question 1

ectopic pregnancy plan

Answer 1

beta hCG, transabdominal/transvaginal ultrasound

Question 2

ectopic pregnancy pt explanation

Answer 2

It sounds like you may have an ectopic pregnancy. This is when a fertilized egg implants and grows outside of the uterus, most often in the fallopian tubes. This can be painful as there isn’t enough space for an embryo to grow here. It can also be dangerous if the fallopian tube ruptures and can cause a lot of bleeding. What we can do is get a blood test (HcG) as well as an ultrasound imaging test to confirm this.

Question 3

appendicitis plan

Answer 3

CT scan to rule out if dx uncertain, CBC (neurophilic leukocytosis), give IV fluids and abx, surgery likely

Question 4

appendicitis pt explanation

Answer 4

It sounds like you have acute appendicitis. Your appendix is a finger shaped pouch that comes out from your colon on the R side. When there is inflammation or infection here, you can get intense pain. It’s important that we treat this right away because if untreated, the appendix can rupture which can spread infection throughout your abdomen. You should go to the emergency room right away - we will make sure you get there safely. When you get there they will likely do a CT scan and some blood tests (CBC) to look for signs of infection. Then they will likely prepare you for surgery to remove your appendix and can walk you through those next steps.

Question 5

cholelithiasis/cholecystitis plan

Answer 5

send to ER, get ultrasound and initial labs (LFTs, amylase, lipase), may need surgery. Note: choledocholithiasis is when blocks common bile duct (may have jaundice, elevated alk phos, amylase or lipase)

Question 6

cholelithiasis/cholecystitis pt explanation

Answer 6

It sounds like you have gallstones. Normally your gallbladder stores and secretes bile which helps break down fatty foods. However, sometimes you can develop stones (like a kidney stone) that can block this secretion and be painful. You should go to the emergency room right away - we will make sure you get there safely. They will first evaluate where exactly the blockage might be with some imaging tests, like an ultrasound. They may also do some blood tests to make sure that what is happening is related to your gallbladder.

Question 7

acute pancreatitis plan

Answer 7

send to ER, will need to be admitted. Will do US, CT. Labs: LFTs, amylase, lipase

Question 8

acute pancreatitis pt explanation

Answer 8

It sounds like you have pancreatitis. Your pancreas is an organ in your abdomen that produces enzymes which help digest your food and help your body process sugar. Pancreatitis is when the pancreas gets inflamed or irritated and it can lead to these enzymes digesting your pancreas itself. You should go to the emergency room right away - we will make sure you get there safely. You will likely need to be admitted to the hospital. They will do some imaging tests, like an ultrasound of your abdomen or a CT scan, and they will do some blood tests to check the function of your pancreas.

Question 9

large bowel obstruction plan

Answer 9

get imaging (CT or xray) to confirm, then likely surgery

Question 10

large bowel obstruction pt explanation

Answer 10

It sounds like you may have a bowel obstruction. This is when something is blocking your intestines from moving food and fecal matter through properly. You will likely need to be admitted to the hospital. You will need to have some imaging, like a CT scan and Xray, and then they may decide to perform surgery to correct this. They will be able to walk you through those next steps as needed at the hospital.

Question 11

small bowel obstruction plan

Answer 11

labs (CBC, chem7 to check electrolytes, blood gas), imaging (CT) to confirm then may need surgery

Question 12

small bowel obstruction pt explanation

Answer 12

It sounds like you may have a bowel obstruction. This is when something is blocking your intestines from moving food and fecal matter through properly. You will likely need to be admitted to the hospital. You will need to have some imaging, like a CT scan and Xray, and then they may decide to perform surgery to correct this. They will be able to walk you through those next steps as needed at the hospital.

Question 13

acute mesenteric ischemia plan

Answer 13

CT angiogram, then revascularization and surgery

Question 14

acute mesenteric ischemia pt explanation

Answer 14

It sounds like you may have mesenteric ischemia. This is where narrowed or blocked arteries restrict the blood flow to your small intestine in your abdomen. When this happens, we get concerned that this decreased blood flow could cause permanent damage. You should go to the emergency room right away - we will make sure you get there safely. They will likely first do an imaging test called a CT angiogram to learn more about what is happening. They may need to perform surgery or another procedure to help restore blood flow to your intestines.

Question 15

ischemic colitis plan

Answer 15

colonoscopy, then supportive therapy

Question 16

ischemic colitis pt explanation

Answer 16

It sounds like you may have ischemic colitis. This is an inflammatory condition in the large intestine or colon where there isn’t enough blood flow, often due to a buildup of plaque in the arteries supplying blood to that area. What we can do is set you up to get a colonoscopy to evaluate this further.

Question 17

abdominal aortic aneurysm plan

Answer 17

screening + elective surgery if necessary

Question 18

abdominal aortic aneurysm pt explanation

Answer 18

It sounds like you may have an abdominal aortic aneurysm. This is when a lower portion of your body’s main artery, the aorta, gets weakened and bulges. What we worry about with AAAs is that this aneurysm could rupture, which can be dangerous. For next steps, we can do an imaging test, an ultrasound, to take some images of your aorta. Then depending on what those results say, we can have a conversation about surgery to repair this to prevent the aneurysm from bursting.

Question 19

nephrolithiasis plan

Answer 19

US and CT to confirm, pain control, stone passage

Question 20

nephrolithiasis pt explanation

Answer 20

It sounds like you have kidney stones. This can happen when the concentration of certain salts are unbalanced in the urine. This causes stones to form which can then block the passage of urine and be very painful. What we can do is help you with pain management and give you some medications like ibuprofen for pain and to help with passing the stone through your urine.

Question 21

IBS plan

Answer 21

need to do some tests to rule out other more serious causes

Question 22

IBS pt explanation

Answer 22

It sounds like you have IBS. This is when you have abdominal pain and altered bowel habits. Sometimes these symptoms can also be caused by anemia, when you have a decrease in your red blood cells, so we can order a blood test to check that too. We can also do another blood test to check for other inflammatory diseases.

Question 23

chronic mesenteric ischemia plan

Answer 23

CT angiogram, revascularization surgery

Question 24

chronic mesenteric ischemia pt explanation

Answer 24

It sounds like you may have chronic mesenteric ischemia. This is when plaque builds up in the major arteries — including the celiac and superior mesenteric arteries — that supply blood to the small intestine or small bowel. For next steps, we can do an imaging test, called a CT angiogram. This will involve injecting contrast dye and then looking at the vessels to see if we can find any blockages. From there we can explore other options to help manage this pain, which may mean a procedure to unblock those arteries.

Question 25

diverticulitis plan

Answer 25

CT initially to confirm, then colonoscopy later. outpt management w/ abx for mild case

Question 26

diverticulitis pt explanation

Answer 26

It sounds like you may have diverticulitis. In the intestines, we can sometimes get these bulging pouches that come out from the intestine. This is called diverticulosis. When these pouches get inflamed or infected, then we call this diverticulitis, and I think may be what is causing your pain. What we can do is get an imaging test, called a CT scan to confirm that we see these pouches. And then we can give some antibiotics to help you.

Question 27

ovarian torsion plan

Answer 27

pelvic ultrasound or CT

Question 28

ovarian torsion pt explanation

Answer 28

It sounds like you have a condition called ovarian torsion. This occurs when an ovary gets twisted around the tissues that support it, which could also include the fallopian tube. Our concern is that in addition to causing pain, this can cut off blood supply to the ovary. The next step will be to get a pelvic ultrasound to confirm the diagnosis of ovarian torsion, and then you will likely need a procedure to untwist the ovary and other structures.

Question 29

hepatitis plan

Answer 29

send to ER. LFTs (AST, ALT, GGT, total and direct bilirubin, albumin), amylase, lipase, hepatitis panel, RUQ US

Question 30

hepatitis pt explanation

Answer 30

It sounds like you may have a condition called hepatitis. This is when there is inflammation or injury to the liver. You should go to the emergency room - we will make sure you get there safely. They will do some blood tests to assess your liver function, and some imaging tests, like an ultrasound of your abdomen.

Question 31

pyelonephritis plan

Answer 31

urinalysis and urine culture, CBC

Question 32

pyelonephritis pt explanation

Answer 32

It sounds like you may have pyelonephritis. Pyelonephritis is an infection of the kidneys that usually starts as an infection in the bladder that can come up the urinary system and into the kidney. What we can do for next steps is to collect a urine sample and a blood sample to help us confirm that there is an infection happening. The urine culture will help us to know what kinds of antibiotics we can give you to help treat this. We will also do an imaging test called a CT scan to take a look at the kidney.