Approach To GIGU Cases Flashcards
CASE 1: 45yo F with F, N, right Flank pain over 12 hrs. Pain with urination
Dull and constant pain on right flank not radiating and 6/10, pressure on flank makes it worse
+ Lloyds Punch , RUQ tenderness, Chapman point ANT 1in sup and lat to umbilicus
Possible DDx
Nephrolithiasis , Pyelonephritis*
Kidney stones
UTI
If creatinine and BUN are elevated what does that make you think
AKD, something wrong with kidney
Blood and nitrate and Leuk Esterase in the urine
+ Lloyds punch, F,N (CASE 1)
+ Leuk Esterase and nitrate = UTI
Blood (WBC and RBC) = infection
4 types of UTIs
- Asymptomatic Bacteriuria
- Cystitis (bladder)
- Prostatitis (prostate)
- Pyelonephritis (kidneys)
What makes a UTI and complicated UTI
- Systemic Sx : F, Flank Pain , CVA tenderness, Rigors (shaking)
- History of ABD voiding of urine: BPH, stricture
- Foreign Bodies : catheter, stone, stent
Cystitis Vs Pyelonephritis
Pyelonephritis has
- F,
- FLANK PAIN,
- CVA tenderness,
- N+V
What do I do if I treat a UTI with ABs and it doesn’t improve
Think this could be an abscess and that can only be treated by being drained + CT scan
Uncomplicated UTI Ab length
3-5 days
Complicated UTI AB length
10-14 days
CASE 2: 60yo intermittent dull ache pain 2/10 to sharp 8/10 on ABD, started 12hrs ago
Eating makes it worse, 2 emesis(V) episodes, N, no blood in stool of vomit
Distended ABD with BMI of 24 (not normal), occasional high pitched sounds on auscultation, tenderness to palpating + guarding
+ ANT Chapman point on 9th right ICS
UA : spec Grav —> poor PO intake
Urine Microscopy : Hyaline casts= dehydrated
SI obstruction * PUD Gastritis GERD, Achalasia Cholecystitis, Hepatitis Food Poisoning
Small Bowel Obstruction 4 causes
- Intrinsic : Congenital Disease, IBD, primary instestinal malignancy
- Extrinsic : Adhesion (from past surgery), neoplasm *most common
- Intraluminal : Feces, Bezoars, Foreign bodies
- NOT MECHANICAL (functional day mobility)
SBO : partial, high-grade, complete
SBO : Simple, Strangulated
Partial is the least serious and complete is the most serious
Strangulated : vascular insufficiency and HIGH risk for SI ischemia (can be with hernia)
Diffuse abdominal pain with a lot of V after eating
Start thinking SBO
* ADHESION is most common here in US
Ileus
Dysmobility that prevents SI contents from moving distally
* common after Surgery, can cause delayed discharge from hospital, can be resolved on own
Oligilvie’s Syndrome (on boards they like this)
A type of Ileus, acute dilation of the colon
Elevated lactate can mean
Ischemia in body
Colon CP
RIGTH anterior IT band (cecum is proximal IT band, hepatic flexure of colon is distal IT band)
Splenic FLEXURE and Sigmoid Colon CP
Splenic FLEXURE Distal Left IT band
S.C. Is proximal left IT band
how to treat SBO
Noting by mouth
Suck air or fluid out by tube
Surgery if patient can handle it
CASE 3 : 20yo male with ABD pain and N, V, D for 24hr, dull crampy, 7/10 before D and 2/10 after D, cant eat, very dark urine
No fever, or Dysuria
dry mouth, Hyperactive bowels on auscultation x4, mild tenderness
Tenting of skin (dehydrated)
Hyaline Casts, high BUN and creatinine*
ANT CP right 10th ICS
IBD Gastroenteritis Hepatitis AKI* secondary to Gastroenteritis Cholecystitis
Case 3 has what type of AKI
Pre-renal AKI Injury upstream of kidneys Dehydrated Tachycardia, poor skin turgur HypOtention N, V, D
What do you do if there is protein in urine
Albumin/creatinine ratio
How to Tx: Pre-renal AKI
IV fluids
STOP NSAIDS
* hemodialysis only if BUN is >90
