NBME Shelf Review (Part 8) – Abdominal Pain
Summary: <br> Acute Mesenteric Ischemia<br> <br> <br> <br> * History of atrial fibrillation* “Pain out of proportion to exam”<br> <br> <br> <br> Bowel Obstruction<br> <br> <br> <br> * History* Abdominal pain* Bloating/Distention* Vomiting* Decrease stool/flatus* Exam* Abdominal tenderness and distention* If guarding/rigidity/rebound tenderness (aka peritonitis)* Consider perforated bowel* Testing* Obtain CT abdomen with IV contrast* Treatment* Fluids* NPO* NG Tube<br> <br> <br> <br> Acute Diverticulitis<br> <br> <br> <br> * NOTE: DiverticulOSIS is what causes GI bleeding* History/Exam* Fever* Left lower quadrant pain/tenderness* Testing/Treatment* CT abdomen with IV contrast* Liquid diet* Antibiotics* Complications* Abscess* Stricture* Fistula* Perforation* Obstructions<br> <br> <br> <br> Abdominal Aortic Aneurysm<br> <br> <br> <br> * If suspected, perform bedside ultrasound of the abdomen* Aortic diameter >3 cm<br> <br> <br> <br> Spontaneous Bacterial Peritonitis<br> <br> <br> <br> * Diagnose by performing a paracentesis* Look for >250 white blood cells* Treat with ceftriaxone<br> <br> <br> <br> Kidney Stones<br> <br> <br> <br> * CT without contrast* If the stone is <5mm* Treat with analgesics and tamsulosin* If the stone is >5mm* Consult urology<br> <br> <br> <br> Common Indications for Emergency Dialysis<br> <br> <br> <br> * Mnemonic: AEIOU * Acidosis (pH <7.1)* Electrolytes (K > 6.5)* Intoxication* Lithium* Ethylene Glycol* Methanol* Aspirin* Overload of volume resistant to diuresis* Uremia that is symptomatic* Altered mental status* Pericarditis<br> <br> <br> <br> Ectopic Pregnancy<br> <br> <br> <br> * Testing* BhCG QUANTITATIVE* Type and screen for Rh Status* Pelvic ultrasound* IUP = Gestational sac PLUS a Yolk sac* Beware “heterotopic” pregnancy in fertility treatment patients (IVF)* Treatment* If no IUP visualized, ectopic pregnancy is a possibility, and management depends on hCG* If <1500* Consider sending stable patients home and repeat hCG in 48 hours* If >1500* Ectopic until proven otherwise, consult OBGYN* Rh- needs RhoGAM* Prevents complications in future pregnancies<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Ectopic Pregnancy <a href="http://www.emclerkship.com/ectopic-pregnancy/">(EM Clerkship)</a>* Abdominal Aortic Aneurysm <a href="http://www.emclerkship.com/abdominal-aortic-aneurysm-critical-diagnosis/">(EM Clerkship)</a><br>
