CLIPP 22 Flashcards
pattern of insidious onset of abd pain
inflammation of the visceral peritoneum alone or a well-contained process (like an abscess).
crampy or colicky abd pain
obstruction in a peristaltic organ (like bowel or ureter).
is diarrhea common in appys
no - typically no BM in last several hr
pain –> shoulder
cholecystits
RUQ pain in PID
perihepatitis–Fitz-Hugh-Curtis syndrome–an occasional complication (5% of cases) of PID caused by N. gonorrhoeae or C. trachomatis (this pain is of sudden onset and may refer to the right shoulder).
-infalmm of pericolic gutter, hepatic capsule and diaphragm
group most at risk for PID (age wise)
the highest rates of PID are in sexually active girls 15-19 years of age), PID must be considered in a young woman with acute abdominal pain, even if there is no history of sexual activity.
mesenteric adentisi
nflammation of the mesenteric lymph nodes, has many causes and often presents like appendicitis. The typical presentation is of RLQ pain with fever, vomiting, and diarrhea.
what respi infection can -> abd pain
pneumonia if in lower lobes
important cause of male abd pain
testicular torsion
male urologic emergency
testicular torsion!
cremasteric reflex
stroke thigh, causes that side of the testicle and scotum to rise
testicular torsion sx
sually occurs in early adolescence and presents with acute onset of severe hemi-scrotal pain, nausea, and vomiting.
Physical examination reveals an enlarged tender testis, scrotal edema, and absence of the cremasteric muscle reflex.
dx of testc torsion
made mainly on clinical suspicion - can use US for help but clinical sups is key and don’t delay tx if you have high suspiecion
common lab tests in appy
cbc, crp
cosider rectal exam if
abd complaint or if neuro sx
key PEx findings in PID
purulent cervix, adnexal/cerv motion tendernss
absence of CVA tenderness argues against
uTI, tho this is not specific
PEx in early ectopics
can be totally normal
US is critical test in
PID complicated cases - i.e. tubo ovarian abscess
barium studies used in eval of
chronic abd pain, intussceuption
4 complications of PID
infertiltiy, sepsis, tubo ovarian abscess, intra abd abscess
things that can make you be tx inpatient for PID
Pregnancy (A)
Previous noncompliance/homeless (B)
High fever (C)
Intractable vomiting (C), and/or
Inability to exclude a surgical emergency (D).
Patients with HIV (E) who have mild or moderate PID may be managed as an outpatient.
do states require reporting of STI
yes
what is expedited partner therapy
when pt given enough meds to tx their partner for the STI too - recommended by CDC
what gyn thing causes hemodyn instability
ruptured ectopic (bc of hemorrhage, which can spill into peritoneum and causes peritoneal signs and radiation to R shoulder)
pt w/ pain;ess bleeding 6-8 weeks post LMP
ectopic
