GIGU Case Presentation

Question 1

What encompasses Pyelonephritis?

Answer 1

• Fevers
• Flank Pain
• CVA tenderness
• N/V
• also encompasses normal UTI complaints such as:
  
  • dysuria
  • Urinary frequency
  • Urinary urgency
  • Suprapubic pain
  • Hematuria

Question 2

When do you order imagining for pyelonephritis cases?

Answer 2

• sepsis and shock
• concern for obstruction
• No improvements after 48 hours of antibiotics

Question 3

What special test would you use for suspected kidney iinflammation?

Answer 3

• Lloyd’s punch
• Implies pyelonephritis and ureterolithiasis

Question 4

OE of pyelonephritis, where are SD commonly found?

Answer 4

T12-L2

Question 5

Where are chapmans points for pyelonephritis?

Answer 5

Anterior:

• 1 in lateral and 1 in superior to umbilicus
  
  • 10 and 2 o’clock position

Question 6

What is an Ileus?

Answer 6

Psuedo-obstruction, dysmotility that prevents intestinal content from moving

• common post op occurrence
• Opiates
• Intestinal Ischemia
• Sepsis
• Elecctrolyte imbalance
• Olgilvie’s syndrome (acute dilation of colon)

Question 8

What are the GI sympathetics?

Answer 8

T9–L2

Question 9

What are chapmans points for small intestines and colon?

Answer 9

• SI: 8-10th intercostal space bilaterally
• Colon: Anterior IT band

Question 10

Management of bowel obstruction?

Answer 10

• Pain control
• Decomrpess stomach and intestines via NG tube to suction
• Nothing by mouth
• Surgical consultation
• Parental fluids and electrolyte releacements prn
• +/- antibiotics if concerned for ischemic bowel

Question 11

What labs are ordered for suspected AKI?

Answer 11

• BMP
• UA with urine microscopy
• If proteinuria get urine albumin/creatinine ratio

Question 12

How do you treat a pre renal AKI?

Answer 12

• IV fluid
• mostly supportive
• Correct underlying disease if possible