Evaluation of Abdominal Pain in PC (final) Flashcards

1
Q

The most common GI complaint in PC is _________

A

Constipation

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2
Q

Almost 50% of GI referrals eventually get diagnosed with ________

A

IBS

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3
Q

The most common cause of acute abdominal pain presenting to PC is _________________

A

Appendicitis

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4
Q

T/F: Hardly any differences in dx b/w pts who had complaints <1 wk vs >1 wk before presenting

A

True

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5
Q

Upwards of ___% of abdominal complaints can be managed in primary care.

A

80%

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6
Q

Can you name 11 DDx for acute abd pain?

A
  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Diverticulitis
  • Perforation
  • Obstruction
  • Acute ischemia
  • AAA
  • Ectopic
  • PID
  • Nephrolithiasis
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7
Q

Can you name 8 DDx for chronic (>6 months) abdominal pain?

A
  • PUD
  • Esophagitis
  • IBD (CD & UC)
  • Chronic pancreatitis
  • Diabetes - gastroparesis
  • IBS
  • Abdominal wall
  • Functional
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8
Q

Your history in a RUQ pain pt should focus on differentiating b/w _____________, ______________, and ______________ pain.

A

Pulmonary, urinary, hepatobiliary

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9
Q

Test of choice for evaluating RUQ pain?

A

US

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10
Q

If a pt has colicky RUQ pain, you should consider a ____________ cause or ____________.

A

Hepatobiliary; nephrolithiasis

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11
Q

RUQ US is + for stones, but labs are WNL. Next step?

A

Watch and wait.

  • Up to 50% of pts with gallstones will not require a cholecystectomy.
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12
Q

RUQ is + for gallstones and CBC, CMP are abnl. Next step?

A
  • ER or general surgery
    • Cholecystectomy within 72 hours ideal
  • Pain control
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13
Q

Describe the timing/durationg of pain in cholecystitis

A

Pain persists beyond 5-6 hrs and often reoccurs.

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14
Q

What percentage of cholecystitis pts will have a fever?

A

35%

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15
Q

Roughly 40% of dyspepsia cases are caused by _______ and _______

A

GERD and PUD

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16
Q

If ____________ and ______________ are the dominant sx, then GERD is the likely diagnosis.

A

Heartburn and regurgitation

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17
Q

With the exception of _________________, PEx is usually unremarkable in pts with uncomplicated dyspepsia.

A

Epigastric TTP

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18
Q

T/F: an association b/w dental erosions and GERD has been found

A

True

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19
Q

Aside from DM, acanthosis nigricans can be a sign of _____________

A

Gastric cancer

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20
Q

Dyspepsia + melena should make you think of…..

A

PUD

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21
Q

What is the gold standard test to exclude gastroduodenal ulcers, reflux esophagitism, and upper GI cancers?

A

Endoscopy

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22
Q

T/F: Empiric tx of dyspepsia with acid suppression will not mask the sx of malignancy.

A

False. Acid suppression may mask the sx of malignancy.

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23
Q

Gold standard test for H pylori?

A

Urea breath test

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24
Q

Sensitivity and specificity of fecal H pylori test?

A
  • Sensitivity: 94%
  • Specificity: 98%
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25
T/F: In general, once pts are positive serologically for H pylori, they will remain positive for the rest of their lives.
True
26
T/F: Most evidence widely favors empiric eradication of H. pylori
False.
27
What is the best, EBM-supported, approach to treating H pylori?
Test for H. pylori and treat if test is positive (as opposed to treating empirically prior to testing, or testing and then endoscopy)
28
If confirmed H pylori, you should treat with H2 blocker or PPI?
PPI
29
If not H pylori, your go-to empiric dyspepsia med should be H2 blocker or PPI?
H2 blocker - tend to be helpful in 50-70% of pts, cheaper, and fewer interactions than PPI.
30
Which meds are H2 blockers?
* Ranitidine (Zantac) * Cimetidine (Tagamet) * Famotidine (Pepcid)
31
Which meds are PPIs?
* Omeprazole (Prilosec) * Esomeprazole (Nexium)
32
MCC of PUD?
* Occurs in 5-10% of pts w/ long-term NSAID use * H. pylori - 90% of duodenal ulcers and 70-90% of gastric ulcers
33
\_\_\_% of pts with PUD will have a GIB
25%
34
T/F: H. pylori resistance to abx is surprisingly not a problem
False. It is.
35
H. pylori triple therapy consists of....
* PPI * Clarithromycin 500 mg BID x 14d * Amoxicillin 1 g BID x14d (or Flagyl 500 mg)
36
H. pylori quadruple therapy consists of....
* Bismuth * Tetracycline 500 mg QID * Flagyl 500 mg TID * Prilosec 20 mg BID
37
Most gastric ulcers heal within ___ wks, whereas most duodenal ulcers heal within ___ wks.
Gastric: 8 wks Duodenal: 4 wks
38
What lipase and amylase values are diagnostic for pancreatitis?
* Lipase \>540 (3x nl) * returns to nl in 1-2 wks * Amylase \>360 (3x nl) * returns to nl in 48-72 hrs
39
If you are concerned for complications or first episode of pancreatitis, which imaging should you order?
CT abd/pelv w/ contrast
40
If someone with known chronic/recurrent pancreatitis comes into your PC office with an exacerbation, what 3 things would make you comfortble sending them home?
* Stable VS * Tolerating PO * Pain controlled
41
You send your chronic pancreatitis pt home because their VS are stable, their pain is under control, and they are tolerating PO. What is your outpatient treatment?
* Clear liquid diet * Pain control * Anticipate improvement in 3-7 days in 90% of cases
42
Imaging of choice to evaluate RLQ pain?
* CT with contrast * Abdominal or transvaginal US for females
43
If your RLQ pt's H&P is not consistent with appendicitis, what else should you consider on your DDx?
* Urinary * UTI * Pyelonephritis * Nephrolithiasis * Females: * Ovarian cyst * Torsion * Tubo-ovarian abscess * Ectopic * Colon: * Colitis * Obstruction * IBD
44
With appendicitis, does vomiting typically occur before or after onset of pain?
After (100% sensitivity)
45
Diverticulitis should be at the top of your DDx in pts with LLQ pain. But what if the H&P isn't consistent with diverticulitis? What else should be on your DDx?
* Urinary * UTI * Pyelo * Nephrolithiasis * Females: * Ovarian cyst * Torsion * TOA * Ectopic * Colon: * Colitis * Obstruction * IBD
46
You are unsure if your pt has diverticulitis. What imaging should you get?
CT w/ IV contrast
47
\_\_\_% of diverticulitis pts will present with LLQ pain
92% \*Approx 68% willl have leukocytosis
48
When is outpatient tx for diverticulitis indicated?
* Stable VS * Tolerating PO * Pain controlled
49
Tx for diverticulitis includes....
* Clear liquid diet → high fiber diet * Flagyl 500 TID 7-10 days PLUS * Cipro 500 BID 7-10 days * Levaquin 750 QD 7-10 days * Bactrim BID 7-10 days * Pain control * Anticipate improvement in 48-72 hrs
50
What are some common sx seen with IBD?
* Bowel alterations * Mucous stools (40%) * Sensation of incomplete emptying, aka tenesmus (70%)
51
What are the names of the 2 diagnostic scoring criteria for IBS?
* Rome III * Manning \*If meet criteria, go ahead and treat
52
53
What are some red flag sx to look out for with IBD?
* Stool incontinence * Nighttime awakenings (pain or BMs) * Wt loss, fever, night sweats * Heme + * Family h/o colon cancer * Lab anormalities (leukocytosis, anemia, +ESR)
54
How do you tx IBD?
* Diet * Stress reduction * Sx directed
55
\_\_\_% of nephrolithiasis cases have hematuria
90%
56
Gold standard imaging for first time or uncertain dx of nephrolithiasis?
CT abd/pelv without contrast
57
Imaging of choice for hydronephrosis?
Renal US
58
A pt with h/o CKD comes in with acute L flank pain and you confirm it is a stone. Their VS are stable, they are tolerating PO, and you have controlled their pain in the clinic. Can this pt be treated outpatient?
No, because they have a h/o CKD.
59
Pharmacologic tx for uncomplicated nephrolithiasis without infection?
* Push fluids * Pain control * NSAIDs (Toradol IM) * Narcotics * Alpha blocker x 14 days (Flomax 0.4 mg QD)
60
Your pt has a kidney stone. At what point should you consult Urology?
* Stone not passed in a few days * Stone \>7mm with hydro * All pts with stones \>10 mm
61
Calculi \<5 mm will pass spontaneously in \_\_\_% of pts
90%
62
Calculi 5 mm will pass spontaneously in \_\_\_% of cases
50%
63
Calculi 7 mm will pass spontaneously in \_\_\_% of pts
10%
64
Calculi 10 mm will pass spontaneously in \_\_\_% of cases
10 mm won't pass
65
Postoperative adhesions account for 50-60% of cases of \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Small bowel obstruction
66
MC sx of SBO?
Constipation (LR 8.8)
67
Colicky abdominal pain with distension and tympany on percussion makes you think of....
SBO
68
You are concerned for SBO. Which labs do you want to order?
* CBC * CMP * Lactate
69
What is/are your imaging of choice for SBO?
* Mild/stable start with KUB * 60% sensitivity * False negative early in process * High suspicion → CT abd/pelv w/ contrast * 90% sensitive
70
Tx options for SBO?
* Imaging → send to ER * NPO * NG tube for decompression * Surgery
71
Sx of ectopic pregnancy typically start around ___ wks of gestation
7
72
What percentage of ectopic pts will have vaginal bleeding?
70%
73
Imaging of choice to r/o ectopic?
Transvaginal US should be performed regardless of bHCG level when ectopic pregnancy is considered * 40% of US-diagnosed ectopics had bHCG \<1000
74
In PC, what is your tx for ectopic?
Send to ER/OBGYN
75
T/F: Elderly pts (\>65 y/o) with abdominal pain are twice as likely than younger pts to require surgery
True
76
Why are you supposed to knock on the fridge door before opening it?
In case there's a salad dressing