Abdominal Pain

if patient reports local abdominal pain what should we think?

parietal peritoneum or organ capsule irritation

if patient is having abdominal pain that is referring to the back or groin, what is the likely cause?

renal/ureter issue 

if a patient reports sudden abrupt abdominal pain, what is the likely diagnosis?

non-intestinal lumen blockage, rupture or vascular event

if patient had RLQ pain what should we be thinking?

appendicitis, ectopic pregnancy, PID, renal issue

if patient has RUQ what should we be thinking?

appendicitis, cholelithiasis/cystitis, hepatitis, Fitz-Hugh-Curtis

what are the S&S of appendicitis?

nausea, mid-abdominal pain that moves to RLQ, pain occurring before vomiting constant pain that is worse with jarring

what tests will be positive for appendicitis?

psoas, obturator and rebound tenderness 

how is appendicitis diagnosed?

ultrasound or CT

what is the treatment for appendicitis?

laparoscopic appendectomy

what will labs reveal with appendicitis?

moderate leukocytosis with neutrophilia

what are the S&S of pelvic inflammatory disease (PID)?

lower abdominal pain after cycle, fever, chills, dyspareunia and vaginal discharge

what causes PID?

polymicrobial infection usually from C.trachomatis, N.gonorrhoeae

what labs are ueful for PID?

culdocentesis or gram stain of discharge will identify underlying cause

how is PID most definitively diagnosed? 

lararoscopy 

what is the treatment for PID?

antibiotics, ceftriaxone, doxycycline, metronidazole

what are the complications of PID?

Fitz-Hugh-Curtis, ectopic pregnancy, fertility problems, chronic pelvic pain

what labs will be elevated with PID?

elevated ESR and C-reactive protein

what are S&S of ectopic pregnancy?

same as regular pregnancy

what will an exam and labs reveal for ectopic pregnancy?

pregnancy test positive, RLQ pain, hCG will be present

what is used to diagnosis ectopic pregnancy?

diagnostic ultrasound

what is the treatment for ectopic pregnancy?

laparoscopy, methotrexate to destroy the placenta

what are the S&S of kidney/ureter stones?

severe pain at costovertebral area of lower posterior ribs into anterior groin, no position relieves pain 

how are kidney/ureter stones diagnosed?

hematuria, KUB x-ray or ultrasound

what labs need to be monitored for kidney/ureter stones?

renal function — creatinine, electrolytes, Calcium and phosphorus

what is the treatment for kidney stones?

80% will pass spontaneously, calcium channel blockers and lithotripsy if needed

what are S&S of cholelithiasis/cholecystitis? 

nausea/vomiting/pain after fatty meals 

severe RUQ pain that refers to R inferior scapula 

what will labs show for cholelithiasis/cholecystitis? 

mild leukocytosis with shift to left, elevated AP in some cases

what will physical exam show with cholelithiasis/cholecystitis? 

jaundice and positive murphy’s sign

what is the diagnostic test for cholelithiasis/cholecystitis? 

diagnostic ultrasound

what is the treatment for cholelithiasis/cholecystitis? 

lap choli, lithotripsy, bile salt dissolution, chemically dissolve stone 

how is hepatitis A spread?

contaminated food or water

what are the S&S of hepatitis A?

malaise, myalgia, arthralgia, easy fatiguability, upper respiratory symptoms, anorexia

what labs are elevated with hepatitis?

ALT, AST, bilirubin, AP

what is hepatitis B?

pre-cancerous that is spread through blood, saliva, semen/vaginal fluids 

what is hepatitis C?

liver destruction passed though blood, saliva, semen/vaginal fluids

what are causes of epigastric pain?

reflux esophagitis, peptic ulcer, pancreatitis

when is the pain with reflux esophagitis worse?

with a full stomach and recumbency

when is the pain for peptic ulcer more prominent?

recurrent empty stomach pain that is relief with antacids, no relief position 

what are S&S of peptic ulcer disease?

dyspepsia, gnawing/dul/achying hunger like pain

what will labs show for peptic ulcer disease?

anemia from blood loss, leukocytosis if ulcer is perforated

what is the treatment for peptic ulcer?

proton pump inhibitors

what are the S&S of pancreatitis?

radiating back pain, nausea, vomiting, fetal position for relief, hypotensive, mild fever, distended/tender upper abdomen 

what may history reveal in a patient with pancreatitis?

mumps, gallstones, corticosteroids

what will examine show with pancreatitis?

absent bowel sounds, mild jaundice, flank discoloration, umbilicus discoloration

what is the sign for flank discoloration?

grey-turner sign

what is the named sign for umbilicus discoloration?

cullen sign 

how is pancretitis diagnosed?

elevated p-amylase, lipase and a CT

what is the treatment for pancreatitis?

nothing by mouth, rest, most have spontaneous resolution

if patient has chronic recurrent abdominal pain with diarrhea/constipation, what should we be thinking?

IBS, spastic colon

if patient has chronic recurrent abdominal pain with primary diarrhea and secondary low back pain, what should we be thinking?

UC, Chrohn’s, pancreatic cancer 

if patient has chronic recurrent abdominal pain with sharp increase in pain with period, what should we be thinking?

endometriosis or pelvic tumor 

what may mask the symptoms of diverticulitis?

corticosteroids or NSAIDs

what are the S&S of diverticulitis?

elderly patient with lower abdominal pain in the LLQ, low fever, blood in stook and mild leukocytosis

what will be seen on an x-ray of diverticulitis?

free air

what is necessary to diagnose diverticulitis when patient is hospitalized?

out patient barium study or colonoscopy, CT is choice procedure

how is diverticulitis treated?

increase fiber and reduce meds that may mask symptoms

what are S&S of ulcerative colitis?

bloody poop, heavy bouts of diarrhea, LLQ pain only 

common in younger population 

what will labs show in patients with UC?

HLA-B27+, pANCA+, decreased hematocrit and albumin, elevated ESR and CRP

how is UC diagnosed?

sigmoidoscopy will show granular mucosa with erosions in rectal/sigmoid area

how is UC treated?

reduce stress and NSAIDs, decrease red meat and alcohol, anti-diarrheal/immunosuppressive med

what medications are treatment for UC?

infliximab or vedolizumab

what are the S&S of crohn’s disease?

pain in RLQ most commonly

what will history reveal in patients with crohn’s?

yound adults, macrocytic anemia from malabsorption

what will labs reveal in crohn’s disease?

HLA-B27+, increased ESR/MCV, leukocytosis, decreased albumin 

how is crohn’s diagnosed?

colonoscopy or barium study will show skip lesions (cobblestone appearance)

what are the S&S of colorectal cancer?

narrow or bloody stool, weight loss, fatigue, abdominal pain/cramping

what are the risk factors for colorectal cancer?

> 50, smoker, inactivity, family history or history of IBD

what exams need to be done with colorectal cancer?

occult blood test, sigmoidoscopy, colonoscopy 

what is the treatment for colorectal cancer?

surgical removal, chemo, avatin