Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Decision Making II-Fall 21' > Eval Abd pain in Primary care-jaynstein-FINAL > Flashcards

Eval Abd pain in Primary care-jaynstein-FINAL Flashcards

1
Q

What % of all PCP visits are for a GI complaint?

A

-b/w 7-10%

Constipation:	8.1    per 1,000 pts
Diarrhea:		6.7
Abdominal pain:	6.1
Gastric pain: 	5.0	
Nausea:		2.9
Regurgitation:	2.0

1 case per month of acute abd pain - sudden, severeabdominal pain of unclear etiology that is less than 24 hours in duration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what % of GI complaints in primary care are referred to GI?

A

75% of these abdominal complaints are not referred to GI
25% are referred to GI
23.5% stay in primary care
1-2% referred to secondary care
**Almost 50% of GI referrals eventually get diagnosed with IBS

-Keep in mind that acute surgical complaints get sent out to ER/Surg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Abdominal Pain in PC :

-top 5 diagnoses

A
  • *- appendicitis-28%
  • Cholecystitis- 10%
  • Small bowel obstruction- 4%
  • Gynecological-4%
  • **No clinical dx-34%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The goal for treating abd pain:

A

Determine who needs a work-up for their abd pain (and how extensive that work up should be!)

Options:
1. Symptomatic care / watch and wait

  1. Lab and diagnostic work up –outpatient or emergent?
  2. Referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PC Provider’s role in Abd Pain:
Upwards of ____% of abdominal complaints can be managed in primary care

–>Must work your way through the differentials and determine which patients are appropriate for “watch and wait” vs who you think has an underlying organic cause that needs to be treated

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Common PC abd pain diagnoses:

list top 4

A

Diarrhea
Constipation
Gastroenteritis
Food related (Celiac disease, Lactose intolerance)

  • All of these can be dx with no to minimal work-up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

acute abdominal pain ddx

A 
Appendicitis
Cholecystitis
Pancreatitis
Diverticulitis
Perforation 
Obstruction
Acute ischemia
**AAA
Ectopic
PID
Nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

chronic (>6 months) abdominal pain ddx

A 
PUD
Esophagitis
IBD – CD and UC
Chronic pancreatitis
Diabetes – gastroparesis
IBS
Abdominal wall 
Functional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RUQ ddx

A
  • acute cholecystitis and biliary colic
  • acute hepatitis
  • appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RLQ ddx

A
  • apendicitis***
  • incarc or strangulated hernia
  • endometriosis
  • diverticulitis
  • PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

LUQ ddx

A
  • acute pancreatitis
  • gastric ulcer
  • gastritis
  • splenic enlargement/rupture/ifection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LLQ

A
  • diverticulitis**
  • endometriosis
  • hernia
  • PID
  • Mittelschmerz
  • PID
  • regional enteritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pt’s who are unstable, toxic, in extreme pain, or present with a potentially surgical complaint need _______

A

to be sent to ER**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pt’s who are stable and non-toxic should be worked up _______

A

in the office, A systematic approach by abdominal quadrant is the best step

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RUQ pain: work-up
-hx should focus on differentiating b/w _____

-IF UTI suspected–> dx labs?

A
  • pulmonary, urinary, and hepatobiliary pain
  • If a pulmonary cause is suspected – imaging, labs?
  • If UTI or nephrolithiasis is suspected- **urinalysis is starting point
  • Patients with colic, fever, steatorrhea, or a positive Murphy’s sign–> should receive ultrasonography**
  • Unsure? Ultrasonography test of choice for evaluation of RUQ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cholecystitis:

epidemiology–> how many ppl are dx with gallstones/yr?

A

-20 million, more than 300,000 lab chole’s/yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cholecystitis: diagnostic keys
-NEED to differentiate b/w ______ and _______

RUQ Abdominal tenderness: test sensitivity? test specificity?

A

**cholelithiasis vs acute cholecystitis

RUQ Abdominal tenderness:
Test Sensitivity 77%
Test Specificity 54%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cholecystitis:
Murphy’s sign is present in ___% (LR =5.0)
Test Sensitivity ? & Test Specificity?

A

-65%
Test Sensitivity 92%
Test Specificity 48%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cholecystitis: diagnostic keys
-Pain persists beyond ____ hours and often reoccurs

-Feveris present in only ___% of cases of acute

A

5-6

35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cholecystitis work-up:
labs?
imaging?

A
  • CBC, CMP (lipase)
  • US all pts with suspicion of gallstones who have abnl labs

High suspicion with nl labs or before labs?

Watch and wait?

Get US?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cholecystitis:

tx of Pts with normal labs?

A

watch and wait

–Up to 50% of pts with gallstones will not require a cholecystectomy

22
Q

Cholecystitis:

tx of Pts with abnormal labs?

A
  • *ER or gen surg
  • -Cholecystectomy within 72 hours ideal
  • -Pain control
23
Q

Epigastric pain: ddx?

A

LARGE ddx: PUD, GERD, esophagitis, gastric/esophageal cancer, biliary disease, gastritis, pancreatitis, medication SE, Cardiopulmonary – ACS, AAA

Unsure or no clear diagnosis? –>Start by focusing on causes of dyspepsia

24
Q

dyspepsia:

- associated sx?

A

epigastric pain, discomfort, burning, nausea, and vomiting

25
Q

causes of dyspepsia ?

A

Acid-related disorders such as (GERD) and peptic ulcer disease (PUD)

  • Gastric inflammatory conditions such as helicobacter pylori gastritis or nonsteroidal anti-inflammatory drug (NSAID) related erosions
  • Upper abdominal cancer (e.g., gastric, esophageal, pancreatic tumors)
26
Q

dyspepsia:

GERD and PUD are the cause in ____% of cases

A

40%

If heartburn and regurgitation are the dominant symptoms, GERD is the likely diagnosis

27
Q

Dyspepsia:

important hx?

A

PUD - H/O ulcers? Stress? Caffeine intake? Melena? Worse/better with food? OTC meds alleviating? Smoker?

GERD – Burning? Belching? Chronic cough? Food related? Worse when lying down? OTC meds alleviating?

Biliary disease – Jaundice? Dark urine? Worse after eating?

Pancreatitis – Stabbing pain radiates to back? ETOH? H/O similar? Severe, abrupt pain?

Cancer – Weight loss? F/C/night sweats? Dysphagia? Age > 50? Prolonged vomiting? Smoker?

Medication induced? Include supplements/herbals

28
Q

With the exception of epigastric tenderness, PE is usually unremarkable in patients with uncomplicated ______

29
Q

PE clues for PUD:

30
Q

PE clues for GERD:

A

An association between dental erosions and GERD has been found

31
Q

PE clues for biliary disease:

A

Jaundice or a positive Murphy’s sign suggests gallbladder disease

32
Q

PE clues for Pancreatitis

A

Difficult to control pain

33
Q

PE clues for CA

A

Weight loss, a positive fecal occult blood test, a palpable mass, signal nodes (Virchow’s nodes) and acanthosis nigricans are signs of possible malignancy

34
Q

Pt’s with alarming symptoms need an endoscopy/GI referral : list ex indications

A

age > 50, dysphagia, weight loss/f/c/night sweats, GI bleeding, prolonged vomiting

35
Q

Dyspepsia:
If no alarming symptoms, work-up and treatment options:
Endoscopy–> advantages?

A

Advantages: Gold standard test to exclude gastroduodenal ulcers, reflux esophagitis and upper gastrointestinal cancers.Beneficial because up to 40 percent of patients have an organic cause of dyspepsia. Provides adequate patient reassurance. Test of choice for targeting therapy. Endoscopic complications are rare.

Disadvantages: Expensive.Invasive.Not cost-effective or practical in young patients without alarming symptoms.

36
Q

Dyspepsia:
If no alarming symptoms, work-up and treatment options:
–>Empiric treatment with acid suppression: advantages and disadvantages?

A

Advantages: Least expensive strategy.Rapid relief of symptoms.High response rate.May reduce the number of endoscopies.

Disadvantages: High rate of symptom recurrence.May promote inappropriate long-term medication use.May delay diagnostic testing.May mask the symptoms of malignancy.

37
Q

Dyspepsia: work-up and tx options

-Test for Helicobacter pyloriand treat if test is positive: advantages? disadvantages?

A

Advantages: EBM recommends this approach

Disadvantages: May increase levels of abx resistance. Relies on accurateH. pyloritesting.May result in over tx because of false-positive results or under-treatment because of false-negative results.

  • Fecal specificity (98%) and sensitivity (94%)
  • Breath– ***gold standard; specificity 95-100% and sensitivity is 88-95%
  • Blood >90% sensitivity but specificity has a large range 77-95% - antibody testing
38
Q

-In general, once patients arepositiveserologically for H. pylori, theywill remain positivefor _____

A

the rest of their lives

39
Q

Dyspepsia: work-up and tx options

-Empiric eradication ofH. pylori–> advantages and disadvantages?

A

Advantages: Avoids cost ofH. pyloritesting and endoscopy

Disadvantages: Most evidence does not favor this approach. —May increase levels of antibiotic resistance and antibiotic related complications. Patient inconvenience because of complicated drug regimens.

40
Q

Dyspepsia: work-up and tx options

-Test for Helicobacter pyloriand perform endoscopy if test is positive: advantages and disadvantages?

A

Advantages: Endoscopy will detect gastroduodenal ulcers, reflux esophagitis and upper gastrointestinal cancers. Minimizes antibiotic resistance.

Disadvantages: Not cost-effective compared with testing for H. pylori followed by treatment if the test is positive. Invasive, complications.

41
Q

Dyspepsia meds= empiric antisecretory therapy

-how long of a trial is needed?

A

2-4 week trial

42
Q

List 2 classes of medications that are used for tx of dyspepsia (empiric antisecretory therapy)

A
  • H2 blockers

- PPI

43
Q

H2 blockers tend to be helpful in ___% of pts, cheaper, and with less interactions than PPI

44
Q

list ex’s of H2 blockers

A

Ranitidine (Zantac)
Cimetidine (Tagamet)
Famotidine (Pepcid)

45
Q

PPI should be used IF ______

-list ex’s of PPIs

A

**H2 blocker not working or confirmed H. Pylori – check for interactions!

  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
46
Q

PEARLS

A
  • Consider appendicitis in all Pts who have abdominal pain and an appendix, especially in Pts with the presumed diagnosis of gastroenteritis, PID, or UTI.
  • Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative.
  • An elderly Pt with abdominal pain has a high likelihood of surgical disease.
  • Obtain an ECG in elderly Pts and those with cardiac risk factors presenting with abdominal pain.
47
Q

If the definitive treatment for your #1 diagnosis is surgery –> send the Pt to _______

48
Q

If pt’s pain is not controlled, VS are unstable, or pt cannot tolerate PO’s–> ______ (next step?)

A

send to ER**

49
Q

Abdominal Pain in the Elderly- PEARLS (what are some common reasons elderly Pts have abd pain?)

A
  • Diminished sensation of pain in the elderly
  • Comorbid diseases
  • Polypharmacy
  • Combinations of above result in many more vague, nonspecific presentations
50
Q

Pts who present with abdominal pain, who are older than ____yo, are twice as likely to require surgery

51
Q

Diagnoses more common or often missed in older patients with abd pain include: ______

A

**diverticulitis, sepsis from UTI, occult urinary tract infection, perforated viscus, AAA, and ischemic bowel disease (mesenteric ischemia).

Clinical Decision Making II-Fall 21' (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions