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
