Eval of abd pain in PC Flashcards
What is the TOC for eval of RUQ pain?
u/s
+ murphy’s sign is in what disease?
cholecystitis
A patient with cholecystits has +u/s and nl labs. What is the tx?
watch and wait
A patient with cholecystits has +u/s and abnl labs. What is the tx?
ER or gen surg for chole
You should keep _______ on the ddx for epigastric pain
cardiopulmonary
melena is a PE clue for what disease?
PUD
These are alarming sxs and need what?
Alarming sxs: age >50, dysphagia, weight loss/f/c/night sweats, gi bleeding, prolonged vomiting
endoscopy/GI referral
What is the GS test for h.pylori?
breath test
It is important to know what with H.pylori antibody testing?
Once patients are positive, they will remain positive for the rest of their lives
How long should you do a trial of empiric therapy with H2 blockers or PPIs?
2-4 wks
What is the TOC for a perf?
Xray (shows air under the diaphragm)
What is the mc cause of PUD?
H.pylori
What is the tx for PUD from H. pylori infection?
QUAD THERAPY: bismuth, tetracycline, flagyl, prilosec
A patient with PUD should avoid ______
NSAIDS
What is the TOC for pancreatitis?
CT abd pelvis with contrast
What is the TOC for pancreatitis if you suspect stone disease?
u/s
What is the tx for pancreatitis?
outpatient tx, fluids, clear liquid diet, pain control
_______ should be considered in all patients with RLQ pain
appendicitis
TOC for appendicitis?
CT or U/S in women
_________ should be considered and highest on your differential in patients with LLQ pain
diverticulitis
In patients that have never had sxs of diverticulitis before, what is the TOC?
CT with con
Treatment for diverticulitis?
clear liquid and high fiber diet, flagyl and cipro
A patient with bowel alterations and sensation of incomplete emptying most likely has what condition?
IBS
Treatment for IBS?
diet, stress reduction, symptom directed
Unilateral flank pain and hematuria are classic findings in what disease?
nephrolithiasis
What is the gold standard imaging for a first time or uncertain dx of nephrolithiasis?
CT without contrast
Can do u/s if concern for hydronephrosis
A stone < _____ mm will usually pass on its own
5
Tx for nephrolithiasis if it cannot pass on its own?
tordol IM, alpha blocker x 14 days
If you have a high suspicion for SBO, what toc is it?
CT abd/pelvis with contrast
MC site of ectopic?
fallopian tube
TOC for ectopic?
Transvaginal u/s should be performed regardless of bHCG level when ectopic is considered
These are findings in what disease?
+bhcg, + pelvic pain +/- vaginal bleeding
ectopic –> send to ER
Imaging that should be done in elderly patients since they have a diminished sense of abd pain?
CT
Consider ________ in all patients who have abd pain and an appendix, esp in patients with the presumed dx of gastroenteritis, PID or UTI
appendicitis
Any women with childbearing potential and abd pain has an ________ until preg test comes back negative
ectopic
An elderly pt with abdominal pain has what?
A high liklihood of surgical disease
Obtain an _______ in elderly patients and those with cardiac risk factors presenting with pain
ECG
