Evaluating Abd Pain Flashcards
What is the most sensitive physical exam finding for cholecystitis?
Murphy’s sign
A patient with RUQ pain has a RUQ US + for gal stones and normal labs. What should you do?
Watch and wait. Cholelithiasis is not emergent, but if it becomes cholecystitis, the patient will need surgery.
A patient with RUQ pain has a + RUQ US and abnormal labs. What should you do next?
Send to ER if not at the ER, general surgery consult.
What labs should be included in your cholecystitis work up?
CBC, CMP (lipase)
Do most patients with cholecystitis have fever?
No, only 35%.
What is on your differential diagnosis for epigastric pain?
PUD, GERD, esophagitis, gastric/esophageal cancer, biliary disease, gastritis, pancreatitis, medication SE, ACS, AAA.
What are the most common causes of dyspepsia?
GERD and PUD make up 40% of cases.
Is the pain from a duodenal ulcer relieved or exacerbated by eating?
Relieved
Is the pain from a gastric ulcer relieved or exacerbated by eating?
Exacerbated.
What signal nodes may be found on physical exam in gastric cancer?
Virchow’s nodes
What signal nodes my be found on physical exam in pancreatic cancer?
Sister Mary Joseph nodes
What physical exam finding commonly associated with diabetes can also be a sign of malignancy?
Acanthosis nigricans
What is the gold standard test for H. pylori?
Urea breath test
What medications must be discontinued prior to H. pylori testing?
PPIs for 1-2 weeks prior to testing
Bismuth 4 weeks prior to testing
Antibiotics 4 weeks prior to testing
What is the triple therapy for H. pylori? How effective is it?
PPI + clarithromycin 500mg BID x 14 days + amoxicillin 1gm BID x 14 days
It is 75% effective
What is the quadruple therapy for H. pylori?
Bismuth + tetracycline 500mg QID + metronidazole 500mg TID + prilosec 20mg BID
How long does it take for most duodenal ulcers to heal?
4 weeks
How long does it take for most gastric ulcers to heal?
8 weeks
What is the most common cause of prancreatitis?
Cholelithiasis (40% of cases)
What lab findings would you expect to see in prancreatitis?
Lipase 3x nl
Amylase 3x nl
Leukocytosis 15-20k is not unusual
If a patient has chronic/recurrent pancreatitis, can they be treated at home?
If VSS, tolerating PO’s, and pain is controlled, they can go home.
Do you need to get a CT on every patient you suspect pancreatitis in?
Only if it is their first episode, if concerned for complications.
What does outpatient treatment of pancreatitis consist of?
Clear liquid diet, pain control.
What diagnosis should be considered in all patients with RLQ pain?
Appendicitis
What diagnosis should be considered in all patients with LLQ pain?
Diverticulitis
What are the two main concerns of diverticulitis?
Abscess and perforation
What is the treatment for diverticulitis?
Clear liquid, high fiber diet.
Metronidazole 500mg TID x 7-10 days + one of the following: Cipro 500mg BID, levofloxacin 750mg QD, Bactrim DS BID.
Pain control
What diagnostic criteria can be used for irritable bowel disease?
ROME III or Manning criteria
What are the most common complaints in irritable bowel disease?
Sensation of incomplete emptying - 70%
Mucous stools - 40%
What are the ROME III criteria?
- Abdominal pain or discomfort accompanied by at least two of the following symptoms 25% of the time.
a. Improvement of defecation
b. Onset assoicated with change in frequency of stools.
c. Onset associated with a change in form of stools. - No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the symptoms.
What lab abnormalities are present in irritable bowel disease?
None
What is the risk of reoccurrence after 1 episode of nephrolithiasis?
50% to have another episode. 10% have >3 episodes.
What is the gold standard for diagnosis of nephrolithiais?
CT abd/pelvis without contrast
What percentage of stones can be identified on KUB XR?
60%
What medications are indicated for pain control for nephrolithiasis?
NSAID’s, Toradol IM (CHECK RENAL FUNCTION BEFORE GIVING TORADOL)
What must you rule out in a patient with kidney stones?
UTI (Infected stone)
What size of stones will not pass?
> 10mm
What medication can help pass stones?
Alpha blocker (flomax/tamsulosin)
What medication can help pass stones?
Alpha blocker (flomax/tamsulosin)
What is the most common cause of small bowel obstructions?
Adhesions
What would be found on percussion of the abdomen in a small bowel obstruction?
Tympany
What would be found on percussion of the abdomen in a small bowel obstruction?
Tympany
What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?
Initially: High pitched, hyperactive
Late: Hypoactive or absent
What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?
Initially: High pitched, hyperactive
Late: Hypoactive or absent
What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?
Initially: High pitched, hyperactive
Late: Hypoactive or absent
What imaging is most sensitive for small bowel obstruction?
CT abd/pel with contrast
If you suspect small bowel obstruction in a patient who has mild symptoms and stable vital signs, what imaging would you order?
KUB
What is the treatment for a small bowel obstruction?
NPO
NG tube for decompression
Surgery
What is the treatment for a small bowel obstruction?
NPO
NG tube for decompression
Surgery
How far along into gestation do symptoms of ectopic pregnancy start?
Around 7 weeks gestation
What imaging should be ordered if ectopic pregnancy is considered?
Transvaginal US
