Lab Medicine Stuff Flashcards
dx for abdominal pain before vomiting or abdominal pain with nausea or vomiting
Appendicitis
Dx for abdominal pain with nausea or abdominal pain with vomiting
Acute cholecysitis
Dx for dyspepsia with vomiting or dyspepsia with water brush (regur of sour or tasteless fluid)
Peptic ulcer dz
Dx for N/V associated with diarrhea, headache and myalgias
viral gastroenteritis
Dx for bilious vomiting and study you should get
Small bowel obstruction
gastric emptying study
Dx for continuous vomiting and study to get
Conversion disorders
get electrolyte levels
Dx for delayed vomiting (more than one hour after meals)
gastric obstruction
gastroparesis
Study to get for suspected obstruction
abdominal x-ray
study to get for potential gastroparesis
gastric emptying study
dx for feculent or foul odor to vomitus
intestinal obstruction
dx for habitual postprandial, irregular vomiting
major depression
Dx for insidious onset N/V
GERD gastroparesis medication related effect metabolic disorder pregnancy
Labs to get for metabolic disorder
pulse ox
ABGs
serum chemistries
chest x-ray
Dx for projectile vomiting, may not be preceded by nausea
intracranial disorders, increased intracranial pressure (or could be normal emesis)
dx for regurgitation of undigested food
Achalasia
esophageal stricture
zenker diverticulum
Dx for vomiting before breakfast
alcohol ingestion
increased ICP
pregnancy
uremia
Studies for uremia
Renal function testing
electrolyte levels
Dx for vomiting during or soon after meals
anorexia
bulimia
Dx for vomiting partly digested food or chyme several hours after meals
Gastric outlet obstruction, gastroparesis
man with stage 4 colon cancer and metastasis, AAA repair. Hx of HTN, hyperlipidemia. Has been constipated x 2 weeks.
elevated urea nitrogen, glucose, WBC
low calcium, RBC, hemoglobin, crit
CT- AAA had gas in it
aortic-enteric fistula
most common cause of periaortic ectopic gas in a patient with repaiared AAA
stent graph infection
aortic-enteric fistula
common complication of AAA. Gas is uncommon
endoleak
CT can see this. Infection from staph aureus.
stent graph infection
often due to exaggerated local inflammatory infection due to aortic arteriosclerosis. Usually no gas on CT, has more symptoms than the patient did
retroperitoneal fibrosis
CT sign is gas, common complication AAA
Gi bleeding, abdominal pain, pulsatile abdominal mass
aortic-enteric fistula
most common sign/ symptom of aortic-enteric fistula in order of occurrence
GI bleeding
sepsis (predominant clinical manifestations)
abdominal pain
back pain
tests for aortic-enteric fisultas
upper GI endoscopy
CT
where do aortic-enteric fistulas occur most commonly
duodenum
how do you treat an aortic enteric fistula?
surgery
35 year old male with fever and abdominal pain
crampy, intermittent, not associated with BMs in RLQ. Has loose, non-bloody stools. Acute promyelocytic leukemia and last chemo was 10 days ago. PE shows 38.4 C 108/56 BP R-20. Port doesn’t appear infected. Moderate tenderness to RLQ palpation. No lesions in perianal area.
Low hemoglobin, platelets slightly low
extremely low leukocyte (0.1), low neutrophils.
low alkaline phosphatase.
typhlitis (neutropenic entercolitis)
most important initial medical therapy in patient with fever and neutropenia?
antipseudomonal beta lactam+ vanco (skin/ catheter)+ metronidazole (c. Diff) within 60 minutes of presentation
persist with neutropenic fever after 4-7 day of antimicrobial therapy what should you ad?
Anti-fungal therapy
least appropriate test for evaluating symptoms in the 35 year old male.
colonoscopy
what labs should you get on the 35 year old male
blood cultures from peripheral and port
stool sample for C. Diff
CBC
Ultrasound
why should the 35 year old male not get a colonoscopy or barium enema?
Bacteremia or perf
most appropriate management of typhlitis
broad spectrum antibiotics, bowel rest, G-CSF (granulocyte site stimulating colony therapy)
surgery indicated with ileus
consider floroquinolone prophlaxis in future
what is the Nadir
after 7-14 days of chemo
lowest neutrophil count
