GI +GU ER Flashcards
What tests do all women need in the ED who present with abdominal or pelvic pain
PRegnancy test
Basic work up for abdominal pain
U-preg, UA, CBC, CMP, Amylase, lipase
Do all abdominal pain pts require imaging
No
Give me some medications if I am vomiting
IVF and anti-emetics
Give me some medications if I have diarrhea
IVF
I have a positive pregnancy test, what next
Where is it?
What will confirm your suspicion of an ectopic pregnancy
visualization of adenexal mass
What is the most common surgical emergency of the elderly
Cholecystitis
What percentage of mesenteric ischemia patients present with diarrhea
31-40%
What are some comon problems for bariatric patients
Anastomotic leak, bowel obstruction, dumping syndrome, electrolyte disturbances……
What is the most common cause of travlers diarrhea
E. coli
What are some treatments for diarrhea
Antimotility (Loperamide), Antibiotics (Cipro, metro), BRAT, fluids
I am coming to your ED with a chrons exacerbation please treat me
STEROIDS!! Antibiotics(Cipro), liquid diet
What are the labs to order on a chrons patient
CBC, CMP, UA, and CRP
I am coming to your ED with a UC exacerbation treat me
PAin meds, cipro 1.0-1.5mg/kg/day and metronidazole 10-20mg/kg/day
What is a possible complication of UC wher my abdomen is distened tender and tympanic
Toxic megacolon
What is severe diarrhea
> 10 BM per day
Treat my hyperkalemia
Amp dextrose, 10 units IV insulin, Amp of calcium gluconate
I have coffee ground emesis what labs will you get for me
UGIB- CBC. CMP. amylase, lipase, PT/INR, type and screen
My hemoglobin in 8, do you transfuse me?
Yes- transufse if less than 9
How do you treat esophageal varacies
Octreotide or vasopressin
I have guaiac positive stools, what will you start me on while adimiting me
PPI- Peptic ulcer
What is the # 1 cause of an LGIB
UGIB
Do diverticular bleeds typically need to be treated
No- 90% resolve spontaneously
If you are found to have a GI bleed what will you probably have in the near future
Endoscopy/colonoscopy
I bring in my 2 year old who was chocking and gagging earlier- help her
FB- IM or glucagon
I was eating a huge steak and now I cant keep down my food - treat me
Glucagon- 1-2mg then if not passed in 20min give 2 more mg IV
What is the max length a bolus should be allowed to stay in you for
12-24 hours
I have a AP film and the face of the coin is facing you- what tube?
Esophagus
Is pancreatitis dangerous
Yes 20-30% mortality rate
I have pain in my epigastric area radiating to my back- why did I get this and treat me
Pancreatitis- 1) ETOH 2) Admit, NPO,
When would you consider antibiotics for pancreatitis
Necrotic, abcess
How do you assess the severity of pancreatitis
Ransons criteria
What will my labs show with pancreatits
Amylase and lipase tripled
I have RUQ pain radiating to the right shoulder what is the work up
CBC, CMP, UA, amylase, lipase, US
Describe murphys sign
Sudden cessation of deep inspiration due to pain when the infamed gallblader is pressed on
How do you treat my symptomatic gallstones
Cholecystectomy, 3rd gen cephalosporin ad unycin metronidazole
I have fever, jaundice and RUQ pain treat me in the ED
Cholangitis - IVF, broad spectrum antibiotics, consult surgery
Acetaminophen accounts for _____% of liver failure anually
42%
Treat my acetaminophen toxicity
NAC (Mycomyst), admit, follow up tylenol levels, call poison control
AST:ALT ratio greater than 2 is a common finding in….
Alcoholic hepatitis
I have know ascitis with abdomial pain and fever, what special test do I need
Paracentesis with fluid analysis - Spontaneous bacterial peritonitis
Will a retrocecal appendix have peritonitis signs
No- will not cause peritoneal irritation
What is the test used to diagnose appendicitis
CT abd and pelvis with IV and PO contrast
What are the preop antibiotics for appendicitis
IV Unasyn 3grams
I have LLQ pain, fever and leukocystosis work me up
Diverticulitis- CBC, CMP, UA, CT with IV and PO contrast
What antibiotics do yo give me if I have diverticulitis and you are discharging me
Metronidazole 500mg PO Q8h and Cipro 500mg Q12h
What antibiotics do yo give me if I have diverticulitis and you are admiting me
Unacyn 3grams IV Q6hr, cipro, or metronidazole
DO you need to treat adynamic ileus
No- self limiting
MCC of SBO
Adhesion
MCC of LBO
neoplasms
You see a step ladder appearance on uprigh x ray- why
SBO
What is the diagnostic method of choice for diagnosing a bowel obstruction
CT with oral and IV contrast
Treat my obstruction
Surgical intervention, NG tube, IV fluid replacement, antibiotics,
Do hernias hurt
Not unless there is a problem
Work up for a possible hernia
CT with IV and PO contrast
I have a hernia that has popped out and isnt going back in help me
Push it back in as long as not necrotic
I have a very tender hernia and it looks black treat me
Surgical emergency - broad spectrum IV antibiotics
I have ainless red lumps near my anus what do you do to treat me
Internal- Push them back in
What is the MCC of rectal bleeding
External hemorrhoids
I have blue and black purple that are painful treat me
Sits bath, tucks, proctofoam,
I have acute sharp cutting pain while defecating can you treat me
Anal fissures- Clean area, sitz baths, stool softeners
I am a middle aged male and now I have a very painful rectal exam and painful defecation what is my treatment
Isolated- I/D in ER
The rest- Drain in OR
I have itching burning, painful lesions on my anus treat me
Acyclovir
My rectum has prolapsed when should you nor reduce it manually
If it looks necrotic or strangulated
I stuck a bottle up my ass treat me
If I can feel it I will and pull it out. If I can’t we need to go to surgery
It’s summer and I am a truck driver and now my lower back/ butt hurts treat me
Pilonidal cyst- I&D
I have clear fishy discharge with clue cells treat me
BV - PO metroidazole
I have white curd, itchy diacharge treat me
Diflucane, fluconazole topical or PO
I have frothy malodorus discharge, puritis and irritation treat me
Flagyl and partner needs treatment
What other GU infection should you consider treating me for if I have Trich
Gonorrhea and chlamydia
MCC of PID
Chlamydia
Treat me outpatient for PID
Doxy- 100mg PO BID for 14 days OR Azithromycin 1 gram weekly for 2 weeks
Tx me if I have a tuboovarian abcess
Clinda 450 mg POQID or metronidazole with doxy
I had PID and now I have RUQ pain
Fitz-Hugh- Curtis syndrome
Work up for Renal failure in the ED
CBC, CMP (Bun/Cr), UA,
MCC of rhabdomyolysis
Alcohol/drugs, statins, elderly who have fallen
I have dark urine what lab value of mine will be distinctive
CK
How do you treat my rhabd
IVF!!
I am a healthy young female coming in complaining on burning with urination, urgency and frequency treat me
Uncomplicated- Bactrim DS for 3 days, macrobid, cipro
Can pyelonephritis go home
Yes- if normal BUN/Cr and able to take PO
MCC of hematuria
Infection
Work up for hematuria
UA, UC, CBC, CMP, PT/INR
MCC of urinary retention
BPH
Treat my urinary retention
Foley, admit if older, dishcharge if younger and healthy
Who gets fourniers gangrene
diabetics, obese and alcoholics
tx my fourniers gangrene
IV Imepnim and vancomycin
What diagnostic tests are needed for fourniers gangrene
CTpelvis with IV contrast
I am a young male with acute severe pain in my testicle what test is 99% sensitive to diagnose me
absence of cremasteric reflex
Treat my testicular torsion
Can open like a book or call urology
I have right flank pain radiating down with hematuria work me up
UA dry CT of abd+pelvis
