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e Abdominal Pain Flashcards

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1
Q

What are the general characteristics for acute abdominal pain?

A
  1. Evaluation of acute abdominal pain requires rapid assessment of likely causes & early initiation of appropriate Tx
  2. DDx should extend beyond intra-abdominal pathology
    A. Epigastric pain : MI, PE, pneumonia
    B. Abd pain : DKA
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2
Q

What are the ddx an abrupt onset abdominal pain?

A
  1. Perforated viscus
  2. SBO
  3. Ureterocalculus
  4. Acute pancreatitis
  5. Ischemic bowel
  6. Ruptured vessel (portal, AAA)
  7. Acute cholecystitis
  8. Ruptured spleen
  9. Acute urinary retention
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3
Q

What are common RUQ ddx?

A
  1. ACute cholecystitis
  2. Duodenal ulcer
  3. Hepatitis
  4. Congestive hepatomegaly
  5. Pyelonephritis
  6. Appendicitis
  7. Right pneumonia
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4
Q

What are common RLQ ddx?

A
  1. Appendicitis
  2. Salpingitis
  3. Tubo-ovarian abscess
  4. Ruptured ectopic pregnancy
  5. Renal/ureteric stone
  6. Incarcerated hernia
  7. Mesenteric adenitis
  8. Meckle’s Diverticulum
  9. Crohn’s dz
  10. Perforated ceacum
  11. Psoas abscess
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5
Q

What are common LLQ ddx?

A
  1. Intestinal obstruction
  2. Acute pancreatitis
  3. Early appendicitis
  4. Mesenteric thrombosis
  5. Aortic aneurysm
  6. Diverticulitis
  7. Sigmoid diverticulitis
  8. Salpingitis
  9. Tubo-ovarian abscess
  10. Rupured ectopic pregnancy
  11. Perforated colon
  12. Crohn’s dz
  13. Ulcerative colitis
  14. renal/ureteral stone
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6
Q

What are common LUQ ddx?

A
  1. Ruptured spleen
  2. Gastric ulcer
  3. Aortic aneurysm
  4. Perforated COlon
  5. Pyelonephritis
  6. Left pneumonia
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7
Q

What are common epigastric pain ddx?

A
  1. Myocardial infarct
  2. Peptic ulcer
  3. Acute Cholecystitis
  4. Perforated Esophagus
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8
Q

What are common ddx with a gradual onset?

A 
1. Peritoneal inflammation or infection
A. Appendicitis
B. Diverticulitis
C. Gastritis
D. PID
E. Chronic pancreatitis
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9
Q

How is a pt with acute abdominal pain assessed for stability?

A 
1. Determine pt stability
A. Ill or toxic appearing ?
B. Responsiveness?
C. GCS
D. ABC’s?
E. Vital signs?
F. Extremity perfusion?
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10
Q

What is included in the abdominal exam in a pt with acute abdominal pain?

A
  1. Inspection
  2. Auscultation
  3. Percussion
    A. Assess organomegaly, ascitis (fluid wave), obstruction, mass
  4. Palpation
    A. Rebound tenderness, board-like rigidity or guarding, pulsatile mass
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11
Q

What additional exams are required for a pt presenting with abdominal pain?

A
  1. DRE (if appropriate)
    A. Guaiac
  2. Genitalia/Pelvic exam (if appropriate)
    A. Do not do a rectal exam on a cardiac pt or a shock pt
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12
Q

What does a positive Iliopsoas sign indicate?

A

Retrocecal appendicitis

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13
Q

What does a positive Rovsing’s sign indicate?

A

Inflammation, peritonitis

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14
Q

What does a positive Obturator sign indicate?

A
  1. inflammation involving the obturator nerve

A. Appy, diverticulitis, PID

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15
Q

What does a positive Murphy’s sign indicate?

A

cholecystitis

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16
Q

What are the ddx for severe abdominal pain?

A
  1. Renal colic
  2. Biliary colic
  3. Acute pancreatitis
  4. Acute gastritis/ulcer
  5. Perforated viscus
  6. Peritonitis
  7. Vascular pathologies
    A. MI, mesenteric ischemia, AAA dissection
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17
Q

What are the common ddx for dull poorly localized pain?

A
  1. Suggests inflammatory process
    A. Appendicitis
    B. Diverticulitis
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18
Q

What are the common ddx for intermittent pain with cramps?

A
  1. Gastroenteritis

2. SBO

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19
Q

What ddx have pain that radiates to the back?

A
  1. Pancreatitis
  2. Peptic ulcer
  3. Gastritis
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20
Q

What ddx have pain that radiates to the shoulder?

A
  1. From ipsilateral diaphragmatic irritation by air, blood or infection in peritoneal cavity
    A. Cholecystitis
    B. Salpingitis/ ovarian pathology
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21
Q

What ddx presents with periumbilical and epigastric pain?

A

Gradually localizes to RLQ -> appendicitis

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22
Q

What ddx presents with Pain radiating to the flank and groin or genitalia?

A
  1. Ureteral colic

2. Testicular torsion

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23
Q

What asst. sxs may be present with acute abdominal pain?

A
  1. Anorexia
  2. N&V
  3. Fever & rigors
  4. Flank pain
  5. Constipation
  6. Diarrhea
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24
Q

What may fever and rigors asst with abdominal pain indicate?

A
  1. Suppurative cholangitis (pyogenic infection/obstruction)
    A. RUQ pain, fever/chills, jaundice (Charcot’s Triad)
    B. Surgical emergency
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25
Q

What may flank pain asst. with abdominal pain indicate?

A
  1. Pyelonephritis

2. Renal colic

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26
Q

What may constipation asst. with abdominal pain indicate?

A

Suggests intestinal obstruction, diverticulitis, appy or ileus

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27
Q

What may diarrhea asst with abdominal pain indicate?

A

Suggests gastroenteritis, colitis, (diverticulitis, appendicitis, SBO)

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28
Q

What dx studies are indicated for abdominal pain?

A
  1. CBC w/ diff
  2. Serum CMP
  3. Serum Lipase and Amylase
  4. UA w/ micro
  5. Urine or serum HCG
  6. EKG
  7. Bedside/stat USN
  8. KUB
  9. CXR
  10. CT
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29
Q

What may the CBC w/ diff show for abdominal pain?

A
  1. Hct ↑ in dehydration
  2. Hct ↓ in anemia or acute bleed
  3. WBC helpful if significantly elevated
    A. “L shift” → bacterial infection
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30
Q

What may the Serum CMP show in abdominal pain?

A 
1. Hepatic Function Tests
A. Suspected hepatitis
B. RUQ pain/tenderness
C. Jaundice/light colored stools
D. Tea colored urine
2. Serum Electrolytes/BUN/Cr
A. Evaluate kidney function 
B. ↑ BUN
-Dehydration
-GI bleed
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31
Q

What may the UA w/ micro show for abdominal pain?

A
  1. UTI’s
  2. Kidney stones
  3. Uncontrolled DM
  4. Dehydration
    a. ↑ SG
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32
Q

What may the urine or serum HCG show for abdominal pain?

A
  1. Obtain in all women of child bearing age unless pregnancy is physically impossible
    A. TAHBSO
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33
Q

Who is at a higher risk for an ectopic pregnancy?

A
  1. Hx PID
  2. IUD
  3. Prior ectopic pregnancy
  4. Failed tubal ligation
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34
Q

What may an EKG show for abdominal pain?

A

Obtain in pt w/ epigastric or upper abd pain & unclear etiology

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35
Q

Why is a bedside/stat USN ordered for abdominal pain?

A

R/O free intra-peritoneal fluid (cul-de-sac), ectopic pregnancy, cholecystitis, hydronephrosis, pancreatitis, AAA, IUP, Ovarian cyst

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36
Q

Why is a KUB ordered for abdominal pain?

A

R/O calculus, SBO, colon obstruction, constipation

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37
Q

Why is a cxr ordered for ab pain?

A

R/O free air, pneumonia

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38
Q

Why is a CT ordered for ab pain?

A

R/O appy, tics, pancreatitis, mass, stones, ischemic bowel

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39
Q

What ab pain pts get surgery?

A
  1. Acute abdomen
    A. Appendicitis, ruptured spleen, GI bleed, bowel perforation, intestinal obstruction, peritonitis, ectopic pregnancy, renal obstruction
    B. Pulsatile abdominal mass
    C. Shock w/ abd pain
  2. If hypotensive or hemodynamically unstable w/abd pain
    A. R/O life threatening pathology
    B. STAT Surgical consult
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40
Q

How is life threatening abd pain managed?

A 
1. Treat shock
A. Oxygen @ rate 2-10 l/min by NC or mask
-Keep SaO2 > 95%
B. 2 large bore IV’s 
-Crystalloid sol’t (NS or LR)
2. Obtain labs:
A. CBC w/ diff 
B. Serum CMP, lipase, lactate, HCG
C. Fingerstick glucose 
D. Type & screen
E. ABG’s
3. Foley catheter to monitor UO
A. Obtain UA (UC if indicated)
4. Rapid IV infusion
5. NG TUbe if indicated
6. IV abx if indicated
7. Pelvic exam
8. DRE
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41
Q

What is the rapid IV infusion for life threatening abd pain?

A
  1. Titrate rate to stabilize BP
  2. Initially 1 liter bolus over 10-20 minutes (adult pts)
  3. Caution in pt w/ Hx of CHF
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42
Q

Persistent shock despite fluid resuscitation in pt w/ acute abd pain requires what?

A

Exploratory laparotomy

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43
Q

When is a nasogastric tube indicated?

A
  1. Intestinal obstruction
  2. Peritonitis
  3. Severe ileus
  4. GI bleed
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44
Q

When are abx indicated for life threatening abd pain?

A
  1. Suspected bacterial peritonitis or perforated viscus :

A. Broad spectrum IV abx after obtaining blood & urine cultures

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45
Q

What may be found on a pelvic exam w/ abd pain?

A

PID, ectopic pregnancy, ovarian cyst, ovarian cancer

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46
Q

What may be found on a DRE w/ abd pain?

A
  1. assess for presence/absence of blood in stool/rectum
    (+) occult blood -> intestinal tumors, IBD, ischemic colitis, bleeding ulcers
  2. Allows exam of prostate
    A. Prostatitis, BPH, prostate nodules
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47
Q

What is the common hx for appendicitis?

A
  1. Classically, initial pain is poorly localized (visceral pain) in periumbilical region
  2. Later pain shifts to RLQ (somatic pain fibers)
  3. Anorexia, N/V, constipation, low grade fever may be present
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48
Q

What are common PE findings for appendicitis?

A
  1. Hypoactive or absent BS
  2. RLQ tenderness over McBurney’s point
    A. Check iliopsoas , obturator, & Rovsing signs
  3. Guarding, splinting
  4. (-) adnexal tenderness on pelvic exam
  5. Right sided tenderness on DRE
  6. No testicle tenderness /hernia
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49
Q

What dx studies are used for appendicitis?

A
  1. CBC
    A. Leukocytosis w/ left shift
  2. UA +/- WBC’s
  3. CT abd & pelvis w/ contrast -> Non-visualized appendix or perforated appendix
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50
Q

What is the treatment for appendicitis?

A
  1. STAT surgery consult, NPO, analgesia, IV fluids, IV antibiotics
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51
Q

What is the common hx for intestinal obstruction?

A
  1. Intermittent poorly localized crampy pain
  2. If pain constant & severe, consider possible perforation or bowel ischemia
  3. Bilious vomiting
52
Q

What is the common pe findings for intestinal obstruction?

A
  1. Ill appearing, does not move
  2. Distended tender abd w/ high pitched bowel sounds
  3. Absent bowel sounds w/ ileus
  4. Tender throughout
  5. Mild-mod guarding
  6. (-) stool guaiac
53
Q

What is the common dx studies for intestinal obstruction?

A
  1. KUB -> dilated loops of bowel w/ air fluid levels

2. CBC, CMP

54
Q

What is the common Rx for intestinal obstruction?

A

NPO, +/- NG suction, IV crystalloids, surgery consult, close observation

55
Q

What is the common hx for bowel perforation?

A
  1. Sudden onset severe agonizing mid-abd or lower abd pain
  2. N/V, fever
  3. Hx of diverticulitis is common
56
Q

What is the common pe findings for bowel perforation?

A
  1. Toxic appearing
  2. Shock may be present
  3. Absent BS
  4. Rigid, tender abdomen
57
Q

What is the common lab findings for bowel perforation?

A
  1. CBC, CMP, Blood & urine Cx (If shock -> ABG’s, serum lipase, serum lactate, type & screen)
  2. Leukocytosis w/ L shift
  3. KUB (or CXR) -> free air under diaphragm
58
Q

What is the common Rx for bowel perforation?

A
  1. NPO, IV crystalloids, oxygen, foley cath, STAT general surgery consult, 2. IV abx after cultures obtained
59
Q

What is the common hx for diverticulitis?

A
  1. Gradual onset lower abd pain
  2. Constipation or diarrhea
  3. +/- nausea
  4. +/- hematochezia
60
Q

What is the common pe findings for diverticulitis?

A
  1. +/- low grade fever
  2. Softly distended
  3. Hypoactive BS
  4. Tenderness LLQ (most common), L mid abd or RLQ w/ guarding
  5. +/- palpable abd mass
  6. +/- (+) stool guaiac
61
Q

What is the common labs for diverticulitis?

A
  1. UA
  2. CBC w/diff, +/- CMP
  3. CT Abd & pelvis w/contrast (IV or oral)
62
Q

What is the common Rx for diverticulitis?

A
  1. NPO, IV crystalloids, IV abx (then oral), observation
  2. Can be treated as OP if no peritoneal signs
  3. F/U colonoscopy may be indicated
63
Q

What is the common hx for gastroenteritis?

A
  1. Severe crampy abd pain that may have come on gradually or abruptly
  2. N/V/Diarrhea
64
Q

What is the common pe findings for gastroenteritis?

A
  1. May be orthostatic if dehydrated

2. Generalized tenderness without guarding

65
Q

What is the common dx studies for gastroenteritis?

A
  1. +/- CBC, BMP
  2. UA
    A. ↑ SG indicates dehydration
66
Q

What is the common Rx for gastroenteritis?

A
  1. Oral hydration (if tolerates po) or IV hydration
  2. +/- Antiemetic
  3. Severely ill should be hospitalized
67
Q

What is the common hx for IBD?

A
  1. Intermittent abd cramping & intermittent bloody diarrhea
  2. Weight loss
  3. +/- fevers
68
Q

What is the common pe findings for IBD?

A

Abd exam variable

69
Q

What is the common dx studies for IBD?

A
  1. CBC, BMP, ESR, CRP
  2. UA
  3. CT Abd to assess for bowel perforation, obstruction, intraperitoneal abscess
70
Q

What is the common Rx for IBD?

A
  1. If hypotensive or shock: Follow Shock Protocol
  2. NPO
  3. NG tube suction if vomiting
  4. Antiemetics
  5. Surgical consult if:
    Significant hemorrhage, perforation, abscess, or toxic megacolon
71
Q

What is hte Rx for an ambulatory IBD pt?

A
  1. Oral abx
  2. Steroids
  3. Sulfasalazine
72
Q

What is the common hx for biliary colic?

A
  1. Abrupt onset of pain in upper abd (esp RUQ) after eating
  2. Usually resolves after several hours
  3. Referred pain to right scapula
73
Q

What is the common pe findings for biliary colic?

A
  1. Afebrile
  2. RUQ tenderness & occasionally, palpable gall bladder
  3. (+) Murphy’s sign
74
Q

What is the common dx studies for biliary colic?

A
  1. Abd USN -> gallstones, dilated GB or cystic duct
  2. OP HIDA scan if (-) USN
  3. +/- CBC, CMP if indicated
75
Q

What is the common Rx for biliary colic?

A

Analgesics, Clear liquids-> fat free diet, elective surgery

76
Q

What is the common hx for acute cholecystitis?

A
  1. RUQ pain
  2. Anorexia
  3. N/V
  4. Fever
77
Q

What is the common pe results for acute cholecystitis?

A
  1. Low grade fever
  2. (+) Murphy’s sign
  3. May have palpable gall bladder
78
Q

What is the common dx studies for for acute cholecystitis?

A
  1. CBC, CMP if indicated
  2. Abd USN
  3. Gallstones, dilated intra & extra hepatic bile ducts, thickened GB wall
79
Q

What is the common Rx for for acute cholecystitis?

A

NPO, NG tube to suction for vomiting, IV crystalloids, parenteral analgesics, surgical consult

80
Q

What is the common hx for ruptured AA?

A
  1. Severe abd pain of sudden onset that often radiates into low back
  2. Syncope usually related to blood loss & lack of cerebral perfusion
  3. Eventually leads to shock
81
Q

What is the common pe findings for ruptured AA?

A
  1. Pulsatile abd mass

2. Unequal LE pulses

82
Q

What are the common dx studies for ruptured AA?

A

STAT bedside abd USN

83
Q

What is the common Rx for ruptured AA?

A
  1. CBC, Type & Cross match
  2. STAT vascular surgery consult
  3. Follow shock protocol
    A. IV access
    B. 2 large bore peripheral caths or central venous catheter
    C. Treat shock w/ IV crystalloids followed by whole blood
    D. Oxygen
    E. Foley cath
84
Q

What is the common hx for ischemic colitis?

A
  1. Abrupt onset of localized or diffuse crampy abd pain & diarrhea
  2. Ischemic areas may progress to gangrene if ischemia is severe
  3. Hematochezia
  4. Elderly
85
Q

What is the common pe findings for ischemic colitis?

A
  1. Hyperactive to hypoactive BS as progresses
  2. Softly distended
  3. Mild to moderate tenderness to palpation over affected area
  4. (+) stool guaiac
86
Q

What is the common dx studies for ischemic colitis?

A
  1. CBC, CMP variable
  2. CT abd w/ IV contrast
    A. Colonoscopy - procedure of choice if CT inconclusive
87
Q

What is the common Rx for ischemic colitis?

A 
1. Supportive-
A. NPO
B. NG tube if ileus
C. IV crystalloids
D. Parenteral analgesia
E. Oxygen
2. Bowel resection if symptoms increase
88
Q

What is the common Hx for mesenteric ischemia?

A
  1. Sudden onset of severe, diffuse abd pain in mid or lower abdomen
  2. Pain is out of proportion to exam & not relieved by narcotics
  3. N/V/D
  4. Hematochezia
89
Q

What is the common pe findings for mesenteric ischemia?

A

No focal findings initially -> then abd distention

90
Q

What is the common dx studies for mesenteric ischemia?

A
  1. CBC: Leukocytosis
  2. CMP
    A. Azotemia
    B. Acidosis
  3. CT angiogram
91
Q

What is the common Rx for mesenteric ischemia?

A

Hospitalization & immediate surgical consult

92
Q

What is the common Hx for renal colic?

A
  1. Sudden onset of severe flank pain, often radiates to groin
  2. Constant dull ache between episodes may be present
  3. N/V, restlessness (pacing floor)
93
Q

What is the common pe findings for renal colic?

A
  1. Severe CVA tenderness

2. Remainder of exam typically unremarkable

94
Q

What is the common dx studies for renal colic?

A
  1. UA -> RBC’s, WBC’s, crystals
  2. KUB may show calculi if radio-opaque
  3. Noncontrast CT abd
95
Q

What is the common Rx for renal colic?

A
  1. Analgesia, tamsulosin (Flomax)
  2. ↑ fluids
  3. Strain urine
  4. F/U w/Urologist
  5. Small stones (5mm) may require urologic intervention
96
Q

What is the common Hx for pyelonephritis?

A
  1. Flank pain, dysuria, frequency, urgency
  2. Fever, rigors
  3. N/V
97
Q

What is the common pe findings for pyelonephritis?

A
  1. CVA tenderness

2. +/- abd tenderness

98
Q

What is the common labs for pyelonephritis?

A
  1. UA
  2. Urine C&S
  3. Blood cultures
  4. CBC, BMP
99
Q

What is the common Rx for pyelonephritis?

A
  1. OP (oral abx & hydration)
    A. If tolerates po & reliable to return
  2. IP (IV abx & IV hydration)
    A. If severely ill, pregnant, very young, very old, immunocompromised, GU tract abnormality
100
Q

What is the common Hx for acute pancreatitis?

A
  1. Acute onset of severe unrelenting epigastric pain radiating thru to back
  2. N/V
  3. Shock (severe cases)
  4. Predisposing conditions:
    A. Alcoholism
    B. Gallstones
101
Q

What is the common pe findings for acute pancreatitis?

A
  1. Hypoactive or absent BS

2. Tender epigastrium w/guarding

102
Q

What is the common labs for acute pancreatitis?

A
  1. WBC
  2. Amylase, Lipase
  3. CMP
  4. If Dx uncertain: CT abd
103
Q

What is the common Rx for acute pancreatitis?

A
  1. IP -> NPO, NG tube if needed, aggressive crystalloid IVF, analgesia
  2. Chronic pancreatitis -> Treat OP if tolerating po & pain controlled w/ oral med
104
Q

What are the risk factors for ectopic pregnancy?

A
  1. Ectopic pregnancy should be considered in all women of child bearing age who presents w/ abd pain
  2. Previous ectopic
  3. Hx STD’s
  4. Smoking
  5. IUD
105
Q

What is the common Hx for ruptured ectopic pregnancy?

A
  1. Classic triad:
    A. Abd pain, amennorhea, vaginal bleeding/spotting
  2. Prior to rupture, pain is vague & poorly localized
  3. After rupture -> severe unilateral abd/pelvic pain
  4. N/V
  5. +/- Shoulder pain
  6. Postural hypotension -> shock
106
Q

What is the common exam findings for ruptured ectopic pregnancy?

A
  1. Unilateral doughy mass in adnexal area

2. Tender cervical motion

107
Q

What is the common dx studies for ruptured ectopic pregnancy?

A

Transvaginal U/S

108
Q

What is the common Rx for ruptured ectopic pregnancy?

A
  1. Treat shock or hypotension w/ IV crystalloids & blood if necessary
  2. Emergent surgical intervention
109
Q

What is the common Hx for acute salpingitis (PID)?

A
  1. Gradual onset of pelvic/lower abd pain
  2. Vaginal discharge/bleeding
  3. +/- N/V
  4. Fever
  5. Sexually active
110
Q

What is the common exam findings for acute salpingitis (PID)?

A
  1. Normal BS
  2. Tender hypogastrium, may localize
  3. Cervical motion tenderness
  4. Adnexal tenderness or fullness (tubo-ovarian abscess)
111
Q

What is the common dx studies for acute salpingitis (PID)?

A
  1. UA: +/- WBC’s, + RBC’s
  2. CBC: Leukocytosis w/L shift
  3. Urine or serum HCG
  4. GC/Chlamydia Cx, general Cx
  5. Pelvic sono -> Thickened fluid filled fallopian tubes, +/- fluid in cul-de-sac
    A. R/O tubo-ovarian abscess
112
Q

What is the common bacteria for acute salpingitis (PID)?

A
  1. N. gonorrhoeae
  2. Chlamydia trachomatis
  3. Mycoplasma
  4. Staphylococcus
  5. Streptococcus
113
Q

What is the common Rx for acute salpingitis (PID)?

A
  1. Empiric antibiotics
    A. OP
    B. Ceftriaxone 250 mg IM/IV x 1 dose AND doxycycline 100 mg PO bid x 14 d
    C. +/- metronidazole (Flagyl) 500 mg PO bid x 14 d
114
Q

When should an acute salpingitis (PID) pt be hospitalized?

A
  1. Uncertain Dx
  2. Pregnancy
  3. Unable to tolerate po
  4. Failed OP treatment
  5. Pt unable to follow-up
115
Q

What is the common hx for ovarian torsion?

A
  1. Sudden unilateral lower abd pain/pelvic pain of mod-severe intensity
  2. Worse w/ position change
  3. Pain may radiate to groin, back, flank
  4. N/V
  5. Hx ovarian cysts
116
Q

What is the common exam findings for ovarian torsion?

A

Exquisite tenderness of affected adnexa

117
Q

What is the common dx studies for ovarian torsion?

A
  1. (-) HCG
  2. D-Dimer (↑ > 70% of cases)
  3. Normal CBC
  4. Normal UA/UC
  5. Pelvic U/S w/ doppler
    A. (-) doppler does not R/O torsion
    B. MRI in highly suspicious case
118
Q

What is the common Rx for ovarian torsion?

A

Admit for observation & laparoscopy to uncoil

119
Q

What may be found on USN in ovarian torsion?

A
  1. Enlarged ovary
  2. Peripherally displaced ovarian follicles
  3. Free pelvic fluid > 80% of cases
  4. Whirlpool sign of twisted vascular pedicle
  5. Underlying ovarian lesion
  6. Uterus may be slightly deviated towards the torted ovary
120
Q

What is the standard therapy for suspected bacterial peritonitis?

A

Cefotaxime 2 gm IV q8h x 5days

121
Q

What abx is used for uncomplicated SBP?

A

Ofloxacin 400 mg PO bid x 8days

122
Q

What is the abx of choice for nosocomial SBP?

A

Extended spectrum abx (carbapenems, Zosyn)

123
Q

What is the abx of choice for a pt recieving fluorquinolones or bactrim SBP prohylaxis?

A

Cefotaxime 2 gm IV q8h x 5days

124
Q

What is the abx of choice for a pt with SBP with a beta lactam hypersensitivity?

A

Ciprofloxacin 400 mg IV q12h

125
Q

What is the abx of choice for a with SBP and advanced renal failure, creatinine >1mg/dl, BUN>30 or total bili >4?

A

IV cefotaxime 2 gm IV q8h x 5 days

IV albumin 1.5 g/kg given on day 1 and 1.0g/kg given on day 3

Gen Med: Emergency Med (13 decks)

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