NBME Shelf Review (Part 8) – Abdominal Pain

Acute Mesenteric Ischemia * History of atrial fibrillation* “Pain out of proportion to exam” Bowel Obstruction * 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 Acute Diverticulitis * 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 Abdominal Aortic Aneurysm * If suspected, perform bedside ultrasound of the abdomen* Aortic diameter >3 cm Spontaneous Bacterial Peritonitis * Diagnose by performing a paracentesis* Look for >250 white blood cells* Treat with ceftriaxone Kidney Stones * CT without contrast* If the stone is <5mm* Treat with analgesics and tamsulosin* If the stone is >5mm* Consult urology Common Indications for Emergency Dialysis * 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 Ectopic Pregnancy * 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 Additional Reading * Ectopic Pregnancy (EM Clerkship)* Abdominal Aortic Aneurysm (EM Clerkship)