Case 15 - 42 yo RUQ pain Flashcards
Risky/hazardous drinking
alcohol consumption exceeds 14 drinks per week for a male 7 drinks per week for female but does not show signs of abuse or dependence
Alcohol abuse
maladaptive pattern associated with one or more of the following:
- failure to fulfill work, school or social obligations
- recurrent substance use
- recurrent legal problems
- continued use despite alcohol-related social problems
Alcohol dependence
Three of more of the following:
tolerance
withdrawal
substance taking in larger quantity than intended
desire to cut down
time spent obtaining, using or recovering from alcohol
ROS for RUQ
Dysuria, polyuria, diarrhea, constipation, n/v, cough, SOB, chest pain, rash, trauma, fever, weight loss
Screening for alcohol abuse/dependence
CAGE: need to cut down annoyed with criticism guilty eye opener
2+ positive responses is a positive screen
PE for RUQ
jaundice, inspect abdomen, palpate abdomen, check for Murphy’s sign
Signs for appendicits
Psoas sign (asking pt to flex thigh and hip causes pain) Obturator sign (examiner externally and internally rotates patient's hip causes pain)
DDx for RUQ in 42 yo male
More likely: cholecystitis, biliary colic, duodenal ulcer, hepatitis, pancreatitis
Less likely: pneumonia, MI, renal pain, pyelo, herpes zoster, appendicits
Studies for RUQ
CBC (look at WBC), electrolytes, LFTs to evaluate liver and biliary tract involvement, EKG and troponin, amylase/lipase, U/A to r/o renal, U/S to evaluate gallbladder
Management of biliary colic
Surgical consultation for cholecystectomy
HIDA Scan - for biliary colic with no stones on U/S
ERCP - for choledocholithiasis or post cholecystecomy with concern for common bile duct injury
MRCP - diagnostic only
Management of risky/hazardous drinking behavior
Brief intervention by family physician
Referral for motivational enhancement therapy or cognitive behavioral therapy
participation in AA
