abdo cases Flashcards by Julia Fong

n and v hx

acuity / onset, abdo pain, pre or postprandial or food poisoning, pregnancy, gi or abdo pain, neuro (headache, stiff neck, vertigo, numb or weak), urinary, exacer/alleviate, meds, hx abdo sx

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n and v ex

vitals, ent (press on sinuses), fundoscopic ex (due to increased icp), abdo ex. heart, lung, rectal, pelvic ex

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n and v ix

preg: urine hCG, pelvic ex, pelvic us
ubc, euc, ca, glucose
ua, HIV Ab

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n and v ddx

pregnancy, gastritis, hyperCa2++, DM, UTI, depression

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preggers

morning n and v, fatigue, polyuria, LMP over a month ago, breasts full and tender, actives sans contraception

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abdo pain hx

socrates/liqraa (timing; associated constitution, gi, heart, lung, renal pelvic)
abdo surgeries, trauma, gallstones, renal stones, atherosclerosis
meds (NSAIDS, steroids), etoh/drugs, needles, violence, stress/anxiety, sexual, preggers

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abdo pain ex

tenderness, guarding rebound, Murphy’s (arrest of inspiration when pressing on RUQ), posas /obdurator/Rovsing signs, CVA percussion, bowel sounds, aortic bruits (AAA, carotids). rectal, pelvis (for women)

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sudden colicky R flank pain. rads to testicles, n,v,hematuria, cva tenderness

nephrolithiasis, rcc, pyeloneph, GI (appendicitis)

ix: ua, urine culture and sensitivity / cytology, bun/cr, ct abdo, us renal, kub, ivp, bc (blood culture)

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dull epigastric pain, rads to back. weight loss, dark urine, clay stools. jaundice, smoker, drinker

pancreatic ca, cholangioca (also jaundice and stool/urine combo). chronic pancreatitis.
acute viral or alcoholic hepatitis. cholecystitis/choledocholithais.
aaa, peptic ulcer

cbc, euc, lipase (more specific for pancreas), amylase, lfts (ast/alt/bilirubin/alp), us or ct abdo

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midepigastric rads to back, improves with forward lean. anorexia, n,v, etoh (binge)

acute pancreatitis, cholecystitis/choledocholithiasis
PUD, gastritis
AAA, mesenteric ischemia, alocholic hepatitis, Boorhave’s (no vomiting blood doe)/Mallory Weiss

cbc, euc, bun/cr, lfts, amylaes/lipase, us or ct abdo, upper endoscopy, ecg

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40s, obese, female, ruq pain rads to R scapula/back, n,v,fever,after ingesting fatty food. +Murphy’s

acute cholecystitis, choledocolithiasis, hepatitis, ascending cholantigis
PUD, fitx-hugh-curtis, acute subhepatic appendicitis

cbc, lfts, us or ct abdo, bc (blood culture)

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40s obese female, ruq pain, fever, JAUNDICE. gallstones a yr ago, HYPOtensive

ascending cholantitis, acute gallstone cholangitis, acute cholecystitis, hepatitis, sclerosing cholangitis, fitz hugh

cbc, lfts, bc, viral hepatitis serology, us abdo, mrcp/ercp

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25 m ruq, fever, anorexia, n,v. dark urine, clay stools

acute hepatitis, acute cholecystitis (but urine adn stool), asending cholantitis/choledoco, pancreatitis, acute glomerulonepth

cbc, amylase/lipase, lfts, viral hepatitis serology, ua, us abdo

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35 m, burning epigastric pain, postprandial, relieved by food/antacids

PUD, gastritis, gerd
cholecystitis, chrnoic pancreatitis, mesenteric ischemia

rectal, fobt, amylase/lipase/lactate, lft’s, upper endoscopy (H pylori-also test with breath, blood or stool exam), upper gi series

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abdo pain key features

pancreas-epigastric, rads to back (alcohol, smoking exacerbates)

gall bladder-RUQ, fat, female, forty, tachycardio/hypotensive

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37 m severe epigastric pain, n, v, fever, toxic. PHx relieved by food, antacids, smokes

perforated peptic ulcer
acute pancreatitis, hepatitis, cholecystitis, gallstone cholangitis, mesenteric ischemia

cbc, euc, amylase/lipase/lactate, lfts, bc
rectal, cxr, kub, ct abdo, upper endoscopy

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luq abdo pain rads to L scapula, mono previously

splenic rupture, splenic infarct, kidney stone, rib fracture, pneumonia, perforated peptic ulcer

cbc, euc, cxr, ct or us (if hemodynamically unstable) abdo

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crampy abdo, v, distended, can’t pass flatus/stool. abdo surgeries

intestinal obstruction (from adhesions, ie sbo), ileus, sb/colon ca, volvulus, gastroenteritis, food poisoning, hernia

rectal ex, cbc, euc, axr, ct abdo pelvis +/- contrast, colonoscopy

elderly, acute onset severe, crampy pain. n,v, big dark stool. phx: chf, af

mesenteric ischemia/infarction, diverticulitis, PUD, gastroenteritis, acute pancreatitis, cholecystitis

rectal, cbc, euc, amylase/lipase/lactate, ecg, axr, ct abdo, mesenteric angio, barium enema

20s F acute severe RLQ pan, n,v.cyst R ovary

ovarian torsion, ruptured ovarian cyst (but would be more acute), ectopic, PID
appendicitis, nephrolithiasis, bowel infarction/perforation

pelvic ex, urine hCG, doppler us pelvis, rectal
ua, cbc, NAAT chlamydia gono, vdrl/rpr
ct abdo, laparoscopy

older M, LLQ abdo pain, fever chills 3 days. alternating diarrhea and constip. low fiber, high fat diet

diverticulitis, crohn’s, UC, gastroenteritis, abcess

recral ex, cbc, euc, cxr, axr, ct abdo, bc

20s RLQ abdo,n,v. periumbilical dull to RLQ sharp. mcBurney’s, Murphey’s, psoas +

acute appendicitis, gastroentero, divertculitis, crohn’s, volvulus/obstruction, perforation
neprolithiasis, acute cholecystitis

30s F perumbilical 6 mo, relieved by defecation, worsens when upset/stress, alternating constip and diarr.

IBS, celiac, chron’s, diverticulosis (but would be older), chronic pancreatisis, parasitic infection (amebiasis, giardiasis), endometriosis

rectal, fobt, pelvic, urine hcg
cbc, euc, stool for o and p, e histolytica antigen
colonoscopy, ct abdo pelvis

20s F, bilat lower abdo pain, started with first day menstrual period. fever, thick green yellow discharge, unprotected sex

PID, endometirosis, dysmenorrhea, vaginitis, cystitis, pyelo, spontaneous abortion

pelvic, urine hcg, cervical cultures
cbc, esr, ua, u culture, pelvis us

bloody stool hx ex

melena/dark vs bright red blood, in the bowl or on the tp, amount, duration, associated ssx (b sx, abdo/rectal pain, tenesmus, difficulty passing/straining, c/d), trauma, Hx similar. hx colonoscopy, meds (esp anticoagulants), menstrual cycle hx easy bleeds/atherosclerotic vascular dz, renal, aortic valve, liver dz. aaa repair. etoh. Fhx colon ca ex: vitals, orthostatic bp, abdo, rectal

elderly, weight loss, bloody stool, c, FHx colon ca

colorectal ca. anal fissure (brighter blood), hemorrhoids, diverticulosis, ischemic bowel dz, angiodysplasia, upper gi bleed, inflam bowel dz ix: rectal, cbc, lfts, inr/pt, cea, colonoscopy, ct abdo

30s F rectal bleeding, d, lower abdo pain, tenesmus for months

UC (rectal vs skip lesions), chron's, proctitis, anal fissure, hemorrhoids, diverticulosis, dysentery rectal, cbc, pt/ptt, colonoscopy, ct abdo/pelvis

older M painless bright red blood per rectum, chronic c, low fiber

diverticulosis, anal fissure, hemorr, angiodysplasia, colorectal ca rectal, cbc, blood type/cross, pt/ptt, euc, tagged rbc scan colonoscopy, ct abdo pelv

upper gi bleeds hx ex

amt, duration, context/tiing (after vomiting, etoh, nosebleeds), associated sx (b, n,abdo pain, dyspepsia), meds (anticoag, nsaids, steroids). hx PUD, liver dz, AAA repair, easy bleeding ex: vitals/orthostatic, *ent, heart,lung,abdo,rectal

40s F coffee ground emesis, dark tarry stools, intermittent epigastric pain relieved by food/antacids

bleeding peptic ulcer, gastritis, gastric ca, esophageal varices

40s F epigastric pain coffee ground vomit, RA treated with NSAIDS, etoh

gastritis, bleeding peptic ulcer, gastric ca, varicess, mallory weiss tear

upper gi bleeds ix

rectal, cbc, blood typing, euc, lfts, inr, upper endoscopy (H pylori tests if ulcer)

constip / diarrhea hx

freq / duration of change, color, oder, volume, mucus, flatulence, flating stools. ``` associated sx (b, abdo pain, bloating, tenesmus, straining, melena, hematochezia) thyroid dz (palpitations, hot, weight loss) ``` diet (fiber, fluids), meds (antibiotics/cdiff), sick contacts, travel, camping. HIV rfs, abdo sx (adhesions obstructing), diabetes, pancreatitis, etoh and drug use, FHx colon Sx

constip / diarrhea ex

vitals, thyroid, endo, abdo, rectal, pelvic for females

constip / diarrhea ix

rectal, fobt, cdiff toxin, stool leukocytes and culture,stool o and p, giardia antigen, entamoeba histolytica antigen cbc, euc, lfts, tsh/t4, utox, viral hep serology, hydrogen/urea breath test, 5-hiaa (carcinoid) colonoscopy, barium enema, ct abdo pelvis, small bowel series

33 M water diarrhea, diffuse abdo pain, weight loss 3 w. hx apthous ulcers

crohn's, uc, gastroentero, celiac, hperthyroidism, pseudomembrane colitis, small bowel lymphoma, carcinoid

watery diarr, abdo cramps, bloating, post milk relieved by fasts

lactose intolerance, gastroenero, inflam or irritiable bowel dz, hyperthy

watter diarrhea, cramps, Mexico

traveler's d (e coli), giardiasis, emebiasis, food poisoning, hep a

40s F, watery diarrhea, abdo cramps, UTI antibiotics recently

pseudomembranous colitis, gastroentero, cryptosporidiosis, food poisoning, inflam bowel dz

watery dia, v, diffuse abdo pain (vs cramps-more infectious etiology), fever, sick contacts

gastroenter (infecious via bacteria, virus, parasites, protozoa), food poisoning

alternating c and d, abdo pain, relieved by defecation.

irritable bowel, inflam, celiac, chronic pancreatitis, lactose intolderance, gi parasite (ascariasis, giardiasis)

c (hard stool), poor diet

low fiber diet, depression, irritibal bowel, hypothyroid, substance abuse

elderly alternating d and c, decreased stool caliber (obstructing lesion on left, look for anemia on right), blood in stool, unintentional weight loss. FHx

colon/colorectal ca, diverticulosis, irritable bowel, inflam bowel, gi parasite