GPA - Abdominal Pain Flashcards
Key PE for Abdominal pain:
Heart, Lung, Full abdominal,
Murphy, Psoas, obturatory, CVA, Rectal and pelvic exam
DDX - Abdominal Pain sudden onset colicky rt side flank pain Radiate to testicles N/V Hematuria CVA tenderness
Nephrolithiasis: colicky pain
Pyelonephritis: CVA, N/V, Hematuria
Renal cell carcinoma: CVA
Appenticitis: right side, N/V
Workup - Abdominal Pain sudden onset colicky rt side flank pain Radiate to testicles N/V Hematuria CVA tenderness
UA: Culture and sensitivity BUN/CR: kidney function Ultrasound: Renal CMP: electrolites CT: abdomen
DDX - Abdominal Pain Dull epigastric pain, radiate to back Wt loss Dark urine Clay colored stool Heavy drinker, smoker
Pancratic cancer Hepatitis: acute Pancreatitis: chronic Cholecystitis/choledocholithiasis Peptic ulcer disease Abdominal Aortic aneurysm
Workup - Abdominal Pain Dull epigastric pain, radiate to back Wt loss Dark urine Clay colored stool Heavy drinker, smoker
Rectal exam: CA CBC Electrolytes, Amylase, Lipase, Bilirubin, Alk Phos: pancreas US abdomen: Stones CT abdomen
DDX - Abdominal Pain Sever mid-epigastric radiates to back Improves when lean foreward anorexia, N/v Alcholic, 3 day bender
Acute pancreatitis: mid epigastric to back, better leaning foreward. PUD Cholecystitis Choledocholithiasis Gastritis: Abdominal aortic aurism Mesenteric ischemia Mallory weiss tear
Workup - Abdominal Pain Sever mid-epigastric radiates to back Improves when lean foreward anorexia, N/v Alcholic, 3 day bender
Rectal exam: CA
CBC,
Electrolytes, BUN:CR,
Amylase, Lipase, Bilirubin, Alk Phos: pancreas
US abdomen: Stones
CT abdomen
HIDA scan: liver gall bladder, bile ducts
DDX - Abdominal Pain 41, female, obease RUQ pain, radiate to rt scapula N/V, Fever: 101.5 onset after fatty food previous last a few hours \+ murphy sign
Ascending cholangitis: infection of bile duct (fever)
Acute: cholecystitis: inflammation of GB probably from stone in duct
Hepatitis
Choledocholithisitis: stone in common bile duct
Sclerosing cholangitis: fibrosing obstruction of bile ducts
Fits Hugh Curtis syndrome
Workup - Abdominal Pain 41, female, obease RUQ pain, radiate to rt scapula N/V, Fever: 101.5 onset after fatty food previous last a few hours \+ murphy sign
CBC: infection
CMP: AST, ALT, biliruben, Alk phos
Hepatitis serologies
US: abdominal
MRCP: Magnetic resonance cholangiopancreatography
ERCP: study the bile ducts, pancreatic duct and gallbladder
DDX - Abdominal Pain 25yo F RUQ pain Fever, N/V anorexia Dark urine, clay stoole
Hepatitis: acute (dark urin, clay stool) Cholecystitis: acute ascending cholangitis Choledococystitis Pancreatitis: Acute glomerulonephritis (kidneay in RUQ)
Workup - Abdominal Pain 25yo M/F RUQ pain Fever, N/V anorexia Dark urine, clay stoole
Rectal exam,pelvic CBC: infection CMP: AST, ALT, biliruben, Alk phos Hepatitis serologies US: abdominal UA: in case of kidney
DDX - Abdominal Pain 35yo M Burning epigastric pain 2-3 hrs after meals, Releaved by food and antacids
PUD: Buring pain Gastritis GERD: buring pain Cholecystitis: food worse Chronic pancreatitis : food worsee Mesenteric ischemia:food worse MI
Workup - Abdominal Pain 35yo M Burning epigastric pain 2-3 hrs after meals, Releaved by food and antacids
Rectal exam,pelvic CMP: AST, ALT, biliruben, Alk phos Endoscopy H. Pylori testing Upper GI series, Xray, barium
DDX - Abdominal Pain Sever epigastric pain N/V, mild fever Toxic appearance Hx of intermittend releaved by food and antacids Smoker takes arcid
PUD perforation Acute pancreatitis; Sever pain Cholecystitis Choledocholithiasis Hepatitis Mesenteric ischemia: smoker
Workup - Abdominal Pain Sever epigastric pain N/V, mild fever Toxic appearance Hx of intermittend releaved by food and antacids Smoker takes arcid
Rectal exam,pelvic CMP: AST, ALT, biliruben, Alk phos KUB: Xray Kidney, ureter, bladder CT abdoment Upright CXR Endoscopy H. Pylori testing
