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21 Cards in this Set
- Front
- Back
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High mortality causes of abdominal pain
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Mid-upper: MI
Periumb: SBO, mesenteric ischem, AAA rupt/diss Suprapupic: ectopic preg Diffuse: Uremia, heavy metal intox, opiate withdrawal |
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Labs ordered for abdom pain
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CMP, CBC, coags
Amylase and lipase UA bHCG Lactate |
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What clinical sign Often signals an intraabdominal catastrophe
Perforation, big abscess, severe bleeding |
Peritonitis
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WBC range in appendicitis
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WBC range from 10,000-16,000
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Signs of distal obstuction
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distention, tympany, absent or high-pitched bowel sounds
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signs of proximal obstruction
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similar to distal, but may not see distention and tympany
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Symptoms of mesenteric ischemia
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Symptoms include pain OUT OF PROPORTION TO EXAM
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What's the dx?
History of cholelithiasis or ETOH abuse Pain steady and boring, unrelieved by position change - LUQ with radiation to back - nausea and vomiting, diaphoretic |
PANCREATITIS
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Labs to order for pancreatitis
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CBC
Ultrasound Serum amylase and lipase Amylase rises 2-12 hour after onset and returns to normal in 2-3 days Lipase is elevated several days after attack |
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Management of pt with pancreatitis
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Management: admission
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Tx for Cholangitis
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Treatment is antibiotics (GN), ERCP - Endoscopic retrograde cholangiopancreatography
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Labs of cholangitis
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Labs show leukocytosis with elevated AP and bilirubin
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Labs of cholecystitis
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Labs with leukocytosis and left shift, often NORMAL LFTs
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Tx of cholecystitis
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Treatment is antibiotics, surgery, percutaneous cholecystostomy if critically ill or poor surgical candidate
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Intermittent RUQ pain associated with fatty meal
Starts 30-40 minutes after starting eating, spikes early, then tapers over a few hours |
Choledocholithiasis (biliary colic)
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Tx of Choledocholithiasis (biliary colic)
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Treatment is cholecystectomy
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Labs of Choledocholithiasis (biliary colic)
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Labs normal
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CBC of DIVERTICULITIS
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CBC - will not always see leukocytosis
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management of diverticulitis
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Spontaneous resolution common with low-grade fever, mild leukocytosis, and minimal abdominal pain
Treat at home with limited physical activity, reducing fluid intake, and oral antibiotics (bactrim DS bid or cipro 500mg bid & flagyl 500 mg tid for 7-14 days) Treatment is usually stopped when asymptomatic Patients who present acutely ill with possible signs of systemic peritonititis, sepsis, and hypovolemia need admission |
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Red Flags in The History of abdom pain (i.e. These can mean “badness”)
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Inability to maintain p.o. intake
Projectile vomiting Overt GI blood loss Syncope Pregnancy in conjunction with pain Recent surgery or endoscopy Fever Caustic or foreign body ingestion Pathologic changes in vital signs Bloody, maroon, or melenic stools Hernia (incarcerated and tender) Hypoxia Cyanosis Altered mentation Jaundice Peritoneal signs Abdominal pain out of proportion to exam Renal failure Metabolic acidosis Leukocytosis Elevated transaminases Elevated alkaline phosphatase and bilirubin Anemia or polycythemia ↑ Lipase, ↑ Amylase Changes in blood sugar ↑ or ↓ |
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Red Flags in Radiography for abdom pain
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Abdominal Free Air
Gallbladder wall thickening Pericholecystic fluid Dilated biliary tree Bowel wall thickening Air fluid levels Air in the Portal Venous System (Maybe after liver transplant. ) Pneumatosis Intestinalis |
