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CDM2 - Final > Jaynstein - Abdominal Pain > Flashcards

Jaynstein - Abdominal Pain Flashcards

1
Q

mc GI complaint in primary care

A

constipation

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2
Q

6 mc GI complaints in primary care

A
  1. constipation
  2. diarrhea
  3. abd pain
  4. gastric pain
  5. nausea
  6. regurgitation
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3
Q

__% of abdominal concerns do not need GI referral

A

75%

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4
Q

__% of GI complaints can be managed in primary care

A

80

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5
Q

almost 50% of GI referrals eventually get diagnosed as __

A

IBS

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6
Q

mc dx related to acute abdominal pain in primary care

A

no clinical dx/unknown/functional

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7
Q

causes of acute abdominal pain

A

appendicitis -> mc
cholecystitis
SBO
gynecological
pancreatitis
renal colic
diverticulitis
perforation
ischemia
peptic ulcer
AAA
ectopic
PID
nephrolithiasis
cancer

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8
Q

goal of abdominal pain management in primary care

A

determine who needs work up and how extensive that work up should be

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9
Q

3 options for management of abdominal pain in primary care

A

symptomatic care -> watch and wait
labs/diagnostics
referral

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10
Q

4 GI complaints that can usually be managed in primary care w. minimal work up

A

diarrhea
constipation
gastroenteritis
food related (celiac, lactose)

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11
Q

chronic abdominal pain lasts > __

A

6 months

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12
Q

causes of chronic abdominal pain

A

PUD
esophagitis
IBD
chronic pancreatitis
gastroparesis
IBS
abdominal wall (muscle strain, hernia)
functional

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13
Q

what do you think when you see abdominal pain out of proportion

A

acute ischemia

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14
Q

mc age for abdominal ischemia

A

60-70

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15
Q

huge do not miss red flag w. abdominal pain that providers commonly get sued over

A

AAA

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16
Q

4 indications for emergent care w. abdominal pain complaint

A

unstable
toxic
extreme pain
potential surgical complaint

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17
Q

ddx w. RUQ pain

A

cholecystitis and biliary colic
hepatitis
pancreatitis
appendicitis
perforated duodenal ulcer
right lower lobe PNA
MI
hepatic abscess

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18
Q

ddx for diffuse abd pain

A

pancreatitis
AAA
SBO
early appendicitis
gastroenteritis
mesenteric ischemia
perforated viscous
peritonitiis
sickle cell crisis

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19
Q

ddx for LUQ pain

A

pancreatitis
gastric ulcer
gastritis
left lower lobe PNA
MI
splenic enlargement/rupture

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20
Q

LLQ pain is mc

A

diverticulitis

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21
Q

RLQ pain is mc

A

appendicitis

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22
Q

RUQ pain work up should focus on differentiating what 3 general causes

A

pulmonary
urinary
hepatobiliary

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23
Q

first step in work up of RUQ pain if UTI is suspected

A

UA

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24
Q

4 indications for US w. RUQ pain

A

colic
fever
steatorrhea
(+) murphy’s

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25
Q

gs diagnostic test for eval of RUQ pain

A

US

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26
Q

RUQ pain + pulmonary sx makes you think (2)

A

PE
PNA

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27
Q

work up of RUQ pain w. pulmonary sx

A
  1. CXR
  2. Ddimer vs CT
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28
Q

RUQ pain + urinary sx makes you think of (2)

A

UTI
nephrolithiasis

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29
Q

gs imaging for nephrolithiasis

A

CT w.o contrast

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30
Q

RUQ w. colic makes you think (2)

A

hepatobiliary cause
nephrolithiasis

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31
Q

work up of RUQ pain w. colic

A
  1. US
  2. if negative -> consider nephrolithiasis
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32
Q

t/f: most people w. cholecystitis need lap chole

A

f!
only 300,000 out of 20 million diagnosed

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33
Q

most sensitive PE test for cholecystitis

A

Murphy’s sign

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34
Q

diagnosis of cholecystitis focuses on differentiating cholecystitis from __

A

cholelithiasis

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35
Q

labs to order for acute cholecystitis work up

A

CBC
CMP

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36
Q

when would you order lipase for suspected cholecystitis (2)

A

if GERD/indigestion issues
if they are toxic appearing

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37
Q

indication for US w. cholecystitis

A

suspect gallstones
PLUS
abnormal labs

can usually watch and wait if labs are nl

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38
Q

t/f: most patients w. cholelithiasis need cholecystectomy

A

f!

50% don’t

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39
Q

indications for cholecystectomy w. cholelithiasis

A

(+) US
PLUS
abnormal labs

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40
Q

ideal window for cholecystectomy in pt. w. cholelithiasis and abnormal labs

A

w.in 72 hr

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41
Q

gallbladder US evaluates

A

structure -> wall, stones, etc

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42
Q

HIDA scan of gallbladder evaluates

A

fxn -> contraction etc

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43
Q

__ is never first line imaging choice for gallbladder work up

A

HIDA

US is first line

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44
Q

ddx for epigastric pain (9)

A

PUD
GERD
esophagitis
gastric/esophageal ca
biliary dz
gastritis
pancreatitis
med s.e
cardiopulmonary

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45
Q

2 do not miss vascular causes of epigastric pain

A

ACS
AAA

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46
Q

generalized term for epigastric discomfort

A

dyspepsia

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47
Q

common complaints related to dyspepsia (5)

A

pain
discomfort
burning
nausea
vomiting

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48
Q

acid-related causes of dyspepsia (2)

A

GERD
PUD

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49
Q

inflammatory causes of dyspepsia (2)

A

h.pylori
NSAID erosions

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50
Q

3 cancers associated w. dyspepsia

A

gastric
esophageal
pancreatic

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51
Q

__ and __ are responsible for 40% of dyspepsia

A

GERD
PUD

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52
Q

2 symptoms that strongly suggest dyspepsia related to GERD

A

heartburn
regurgitation (almost always GERD)

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53
Q

3 rf for PUD

A

stress
caffeine
smoking

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54
Q

6 indications of dyspepsia related to GERD

A

burning
belching
chronic cough
worse w. food/regurgitation
worse when lying down
relief w. OTC meds

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55
Q

__ can aid in the diagnosis of GERD

A

relief w. TUMS

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56
Q

6 causes of dyspepsia

A

PUD
GERD
biliary dz
pancreatitis
ca
meds

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57
Q

3 indications of dyspepsia elated to biliary dz

A

jaundice
dark urine
worse after eating

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58
Q

4 indications of dyspepsia related to pancreatitis

A

stabbing pain radiating to the back
etoh
prev hx pancreatitis
severe, abrupt pain

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59
Q

indications of dyspepsia related to ca

A

wt loss
f/c/night sweats
dysphagia
age > 50
prolonged vomiting
smoker

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60
Q

indications for DRE

A

you have a finger, they have melena

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61
Q

PE clue for PUD

A

melena

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62
Q

PE clue for GERD

A

dental erosions

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63
Q

PE clue for pancreatitis

A

uncontrolled pain

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64
Q

PE clues for biliary dz

A

jaundice
(+) murphy

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65
Q

5 PE clues for ca

A

wt loss
(+) FOBT
palpable mass
virchow nodes
acanthosis ingrains

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66
Q

gs imaging for pt w. dyspepsia and alarming sx

A

endoscopy

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67
Q

5 indications for endoscopy w. dyspepsia

A

age > 50
dysphagia
wt loss/f/c/night sweats
GI bleed
prolonged vomiting

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68
Q

if a pt has no alarming sx related to dyspepsia, what are your work up/tx options

A
  1. endoscopy
  2. empiric acid suppression
  3. test for h.pylori and tx if positive
  4. empiric eradication of h.pylori
  5. test for h.pylori and perform endoscopy if (+)
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69
Q

endoscopy is gs test to exclude (3)

A

gastroduodenal ulcers
reflux esophagitis
upper GI cancers

70
Q

gs test for dyspepsia in general

A

endoscopy

71
Q

t/f: once a pt tests positive for h.pylori using a blood test, they will remain positive fo’ life

A

t!

can only use it for initial dx or if pt tested negative on prior test

72
Q

advantage of empiric eradication of h.pylori

A

avoids cost of h.pylori testing and endoscopy

73
Q

3 disadvantage of empiric eradication of h.pylori

A

increases abx resistance
increases complications
complicated drug regimen

74
Q

advantages of h.pylori work up and endoscopy if test if (+)

A

endoscopy identifies multiple conditions
prior testing minimizes abx resistance

75
Q

what conditions is endoscopy useful for detecting (4)

A

gastric ulcers
duodenal ulcers
reflux esophagitis
upper GI cancers

76
Q

disadvantages of h.pylori testing and endoscopy if (+)

A

invasive procedure w. risks
unnecessary if h.pylori test is (+)

77
Q

3 medication options for dyspepsia

A

empiric abx
ppi
h2 blockers

78
Q

MOA for both ppi’s and h2 blockers

A

reduce acid secretion

79
Q

how long should antisecretory drug trial be

A

daily for 2-4 weeks

80
Q

first line antisecretory med for dyspepsia

A

h2 blockers:
cimetidine (tagamet)
famotidine (pepcid)

81
Q

2 indications to use ppi for dyspepsia

A

h2 blocker not working
h.pylori confirmed

82
Q

major disadvantage of ppi

A

lots of ddi

83
Q

PUD occurs in 5-20% of ppl who use long-term ___

A

NSAIDs

84
Q

mc cause of gastric and duodenal ulcers

A

h.pylori

85
Q

4 red flags with PUD

A

age > 55
wt loss/anorexia
persistent vomiting
jaundice/anemia

86
Q

2 complications of PUD

A

GIB
perforation

87
Q

which antisecretory drug is most effective for PUD

A

ppi

88
Q

triple antibiotic therapy for h.pylori

A

ppi
clarithromycin
amoxicillin

89
Q

quadruple antibiotic therapy for h.pylori

A

tetracycline
omeprazole
metronidazole
bismuth

90
Q

duodenal ulcers usually heal w.in __ weeks

A

4

91
Q

gastric ulcers usually heal w.in __ weeks

A

8

92
Q

5 causes of pancreatitis

A

cholelithiasis
etoh
hypertriglyceridemia
congenital
med s.e

93
Q

mc cause of pancreatitis

A

cholelithiasis

94
Q

most sensitive and specific lab for pancreatitis

A

lipase

95
Q

lipase is __ x nl in pancreatitis

A

3 x
> 540

96
Q

t/f: lipase trends down as pancreatitis resolves

A

t!

97
Q

t/f: leukocytosis is commonly seen w. pancreatitis

A

t

98
Q

imaging of choice for pancreatitis

when is it indicated (3)

A

CT abd/pelvis w. contrast
for first episode
suspect gallstones (US)

99
Q

2 complications of pancreatitis

A

necrosis
pseudocysts

100
Q

when would you order US for pancreatitis

A

if you suspect gallstones

101
Q

3 indications for emergent care for pancreatitis pt

A

unstable
severe pain
intractable vomiting

102
Q

when can a pancreatitis pt be d.c’ed (3)

A

vss
tolerating PO
pain controlled

103
Q

op tx for pancreatitis (2)

A

CLD
pain control

104
Q

when can pt expect to see improvement in pancreatitis

A

3-7 days

105
Q

what do you think of when you see RLQ pain

A

appendicitis

106
Q

3 urinary causes of RLQ pain

A

UTI
pyelo
nephrolithiasis

107
Q

4 female GU causes of RLQ pain

A

ovarian cyst
torsion
TOA
ectopic

108
Q

2 colon-related causes of RLQ pain

A

colonitis
IBD

109
Q

imaging of choice to evaluate RLQ pain

A

CT w. contrast

110
Q

imaging of choice if you suspect scary ovary stuff

A

transvaginal US

CT won’t show the scaries and most ovarian differentials are emergent

111
Q

describe appendicitis pain

A

usually starts somewhere else (mc epigastric) and then migrates to RLQ

112
Q

what pt pop gets a CT 95% of the time if they present w. new onset abdominal pain

A

> 65 yo

113
Q

what symptom has 100% sensitivity for appendicitis

A

pain before vomiting

114
Q

mc age for appendicitis

A

10-30 yo

but can occur at any age

115
Q

management of appendicitis in op setting (2)

A

NPO
ER

116
Q

what condition do you think of when you see LLQ

A

diverticulitis

117
Q

other causes of LLQ besides diverticulitis

A

same as RLQ

118
Q

imaging of choice for eval of LLQ

A

CT
transvaginal US for females

119
Q

sx of diverticulitis (4)

A

LLQ
abd distension
abd tenderness
rectal bleeding

120
Q

2 complications of diverticulitis

A

perforation
abscess

121
Q

indications for imaging w. diverticulitis

A

first episode
dx unclear
atypical presentation
other dx of similar likelihood
mod-severe sx
can’t tolerate po fluids
peritoneal signs
no improvement 2-3 days after starting abx

122
Q

management of diverticulitis (3)

A

start w. CLD diet -> move to high fiber
abx
pain control

123
Q

abx regimen for diverticulitis

A

flagyl 500 tid x 7-10 days
PLUS
cipro

alt flagyl plus levaquin or bactrim

124
Q

when can you expect to see improvement in diverticulitis pt

A

48-72 hr

125
Q

mc condition seen by GI

A

IBD

126
Q

peak dx age of IBD

A

20-39

127
Q

3 diagnostic keys for IBD

A

bowel alterations
mucous stools
sensation of incomplete emptying

128
Q

2 diagnostic criteria for IBD

A

ROME III
Manning

if they meet criteria -> just treat - don’t usually need full work up

129
Q

red flags w. IBD (6)

A

stool incontinence (not including urgency)
nighttime awakenings (pain or BMs)
wt loss/fever/night sweats
heme (+)
fam hx colon ca
leukocytosis, anemia, (+) ESR

130
Q

management of IBD (4)

A

diet
stress reduction
sx directed
GI referral -> scope

131
Q

risk of recurrence w. nephrolithiasis

A

50%

132
Q

diagnostic keys for nephrolithiasis

A

unilateral flank pain
hematuria

133
Q

indications for imaging w. nephrolithiasis (2)

A

first time
uncertain dx

134
Q

3 imaging options for nephrolithiasis

A

CT abd/pelvis w.o contrast
renal US
KUB

135
Q

gs imaging for nephrolithiasis

A

CT abd/pelvis w.o contrast

136
Q

when would you order US for nephrolithiasis

A

suspected hydronephrosis

137
Q

KUB can detect __% of kidney stones

A

60%

138
Q

when can nephrolithiasis be managed op

A

vss
tolerating po
pain controlled
no h.o CKD

139
Q

management of nephrolithiasis (4)

A

fluids
NSAIDs vs toradol vs narcotics
flomax x 14 days
urology consult

140
Q

indications for emergent care w. nephrolithiasis (5)

A

uti
aki
sig hydro
vs unstable
intractable pain

141
Q

3 indications for urology consult w. nephrolithiasis

A

stone not passed in a few days
stone > 7 mm w. hydro
all pt w. stones > 10 mm

142
Q

calculi < __ mm pass 90% of the time

A

5 -> no consult

143
Q

calculi __ mm pass in 50% of cases

A

5-7

144
Q

calculi __ mm pass in 10% of cases

A

7

145
Q

what size stone won’t pass

A

10 mm or larger

146
Q

mc place for kidney stone

A

UVJ

147
Q

flomax works best for __ stones

A

distal

148
Q

true pyelonephritis is characterized by __ flank pain

A

bilateral

149
Q

true kidney stones are characterized by __ flank pain

A

unilateral

150
Q

4 complications of nephrolithiasis

A

concurrent UTI/infxn
obstruction
AKI

151
Q

greatest rf for SBO

A

adhesions

152
Q

diagnostic keys for SBO

A

adhesions/h.o GI surgery
constipation
colicky abd pain w. dissension and tympany to percussion

153
Q

mc sx of SBO

A

constipation

154
Q

garbage PE exam that really shouldn’t be used in work up of SBO

A

bowel sounds

155
Q

if you do get a question about bs related to SBO, how do you describe early vs late

A

early: high pitched, hyperactive
late: hypoactive, absent

156
Q

KUB can show __% of obstructions

A

90

157
Q

gs imaging for SBO

A

CT abd/pel w. contrast

158
Q

management of SBO (4)

A

ER
NPO
NGT
+/- surgery

159
Q

sx of ectopic usually start around __ weeks gestation

A

6-7

160
Q

describe abd pain w. ectopic

A

non specific
poorly localized

161
Q

what should you do if you have any suspicion for ectopic whatsoever

A

transvaginal US

even if bHCG is negative

162
Q

transvaginal US has 95% sensitivity for detecting ectopic if bHCG is > __

A

25

163
Q

abd pain is ectopic until proven otherwise in what pt pop

A

any patient with baby making parts of child bearing age

164
Q

5 considerations for management of abd pain in the elderly

A

diminished pain sensation
comorbid dz
polypharmacy
vague, nonspecific presentations
> 65 yo 2x more likely to need surgery

165
Q

6 abd pain related dx’s commonly missed in elderly

A

diverticulitis
sepsis from UTI
occult UTI
perforated viscus
AAA
ischemic bowel

166
Q

what GI sx occurs in 40% of pt’s w. ACS

A

vomiting

167
Q

always think about appendicitis if you have what 3 conditions on your differential

A

gastroenteritis
PID
UTI

168
Q

always order what test in elderly patients with abd pain and cardiac rf

A

EKG

169
Q

3 indications for ER with any abd pain

A

uncontrolled pain
vs unstable
can’t tolerate PO

170
Q

2 basic indications for CT w. contrast

A

infxn
vascular concerns

171
Q

3 basic indications for CT w.o contrast

A

stones
bones
blood in the brain

CDM2 - Final (9 decks)

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