Pancreatitis, gastroenteritis Flashcards
How do you diagnose a patient with suspected kidney stones (Left sided colicky pain in LUQ/LLQ, microscopic hematuria)?
noncontrast helical CT scan to look for kidney stones
How many patients with kidney stones have hematuria on UA?
almost 90%
how small of a kidney stone can noncontrast helical CT pick up?
1 mm diameter
Are x-rays good tests for picking up kidney stones?
Not really; They have low sensitivity (not pick up small stones or radiolucent stones) and low specificity (vascular calcifications)
what is the #2 choice for evaluating kidney stones if you can’t do noncontrast helical CT scan?
IV pyelography. It is sensitive and specific. But, it requires bowel prep and iodine contrast so you can’t use in those with AKI or CKD
What is an “acute abdomen”?
Sudden severe abdominal pain (less than 24 hrs)
How do you evaluate an acute abdomen? Why?
supine and upright CXR!!
To exclude bowel obstruction (air-fluid levels) or perforation (free peritoneal air)
What are 2 signs of peritonitis?
- Rebound tenderness
2. Severe diffuse abdominal pain
What are the 3 categories of etiologies of acute abdominal pain?
- Infectious
- Ischemic
- Inflammatory
*memory: Think of the roman number III (three I’s)
All patients with acute abdominal pain should have what lab test done?
Lipase and amylase
What are the 3 herald signs of AAA rupture?
Sudden abdominal pain, back pain, and syncope
What 2 things MUST be present to diagnose hemolytic uremic syndrome (E. Coli O157:H7, shiga toxin, undercooked beef)?
- Thrombocytopenia (platelet count)
- Hemolytic anemia (blood smear)
^This shows thrombotic microangiopathy
AKI and headache/confusion may also be seen but are not required for diagnosis
How do you treat hemolytic uremic syndrome in children?
Not antibiotics!! No benefit in children. Treatment with supportive (fluids, CBC, BMP daily, dialysis if renal failure).
What do routine stool cultures test for?
Salmonella, shigella, campylobacter
What are the 3 classic findings of chronic pancreatitis?
- Mid-epigastric abdominal pain
- Postprandial diarrhea
- Diabetes mellitus
How do you diagnose chronic pancreatitis?
Symptoms can be enough. If symptoms unclear (ex: diffuse abdominal pain, normal pancreatic enzyme levels) then look for calcifications on abdominal X-ray (30% sensitive) or CT scanning (90% sensitive)
Symptoms of C. Difficile infection
- Diarrhea 10-15xday
- lower abdominal pain
- cramping
- fever
- WBC >15,000
How do you treat severe C. Difficile infection?
Oral vancomycin and IV metronidazole
How do you treat salmonella gastroenteritis?
Usually self-limited requiring no treatment. If he gets dehydrated, replace fluids and electrolytes. Do not give loperamide/imodium, because its a potentially invasive species and you want it out
How do you treat salmonella gastroenteritis for pts 50 yrs old?
Ciprofloxacin
Which groups requiring more aggressive salmonella treatment?
- Immunocompromised (ex: on steroids)
- 50 yrs old
- Hospitalized bc sick for another reason
- Have atherosclerotic plaques (salmonlla can seed there)
- Have bone prosthesis (salmonlla can seed there)
When would you need jejunal enteral feedings in a patient with pancreatitis?
If expect the patient wont be able to eat for a long time
What are the 2 most common causes of pancreatitis?
- Gallstones
- Alcohol
Together these make up 80% of cases
A patient has pancreatitis but no stone is seen in the CBD. What findings would cause you to think gallstone pancreatitis is the cause ANYWAY?
- stones in the gallbladder
- dilated bile duct
- elevated ALT and AST
Ultrasound is only 50% sensitive for choleDOCHOlithiasis (although almost 100% sensitive for cholelithiasis) so keep in mind a stone could STILL be there even though you dont see it
