NBME Shelf Review (Part 7) – Abdominal Pain

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 11 November 2018

⏱️ 11 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Hernia

* 3 classifications for hernia* Reducible* Able to be reduced (placed back into the abdomen) at bedside* Incarcerated* Cannot be reduced but not severely tender or erythematous* Can occasionally cause bowel obstructions* Strangulated* Cannot be reduced but LOSING BLOOD SUPPLY* Extremely tender and abnormal exam* Needs emergent surgical consult

Esophageal Varices

* Classic presentation* Hematemesis/Melena* Chronic liver disease (hepatitis, alcoholics)* Treatment* Fluid bolus if hypotensive* Octreotide* Ceftriaxone* Transfuse blood as needed* If hemoglobin <7 transfuse* If patient actively bleeding and level <8 transfuse* Consult GI for endoscopy

Hepatic Encephalopathy

* Common findings* Altered mental status* Asterixis* Elevated ammonia level * Treat with lactulose or rifamixin

Peptic Ulcer Disease

* History* Hematemesis or Melena* Epigastric abdominal pain* Chronic NSAIDS or steroids* Treatment* PPI (such as pantoprazole)* Works better than an H2 blocker

Cholecystitis

* RUQ ultrasound* Thickened gallbladder wall* Distended gallbladder* Pericholecystic fluid* Obvious impacted stone* HIDA scan* Inject radioactive material* Absorbed by hepatocytes* Secreted into biliary tree into small intestine* If gallbladder not visualized* Cystic duct obstruction* If common bile duct cannot be visualized* Choledocolithiasis

Ascending Cholangitis

* Charcots Triad* Fever* RUQ Pain* Jaundice* Patient requires ERCP (gastroenterology consult)* Give antibiotics

Acute Pancreatitis

* Diagnosis* Classic description* Epigastric pain radiating to back* Severe vomiting* Lipase* >3x upper limit of normal is diagnostic* CT scan to look for complications of pancreatitis

Additional Reading

* RUQ Abdominal Pain (EM Clerkship)* Biliary Diseases and Pancreatitis (EM Clerkship)

Transcript

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0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
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0:24.7	Focus your energy on what matters, providing good patient care.
0:29.5	Use coupon code EM50 to save 50% the first month you try it,
0:34.1	and you can cancel at any time if you decide it's not right for you. You can learn more
0:38.9	at www.gitfreed.a.i. Hey guys, what's going on? This is Mike Estefan from the University of
0:49.3	Rochester School of Medicine, bringing you episode seven of the Emergency Medicine Shelf Exam Review Series.
0:56.5	In this week's episode, we're going to be covering some of the causes of abdominal pain
1:00.8	that are high yield for your exam.
1:03.2	Let's start off with something quick and easy, hernias.
1:06.5	For the exam, you only need to know some terminology and just a little bit of management. So there are three
1:12.1	different classifications for hernias. You can have a reducible hernia, an incarcerated hernia,
1:18.7	and a strangulated hernia. Reducible hernias are simply just that. You can reduce them.
1:25.3	Incarcerated hernias cannot be reduced. However, they are neither tender nor
1:30.1	erythematous on exam, and they have a preserved blood supply. These can also cause bowel obstructions,
1:37.2	so a surgical consult is usually warranted on your exam. However, there is no need for an emergent
1:44.0	surgical consult.
1:45.0	A strangulated hernia, just like an incarcerated hernia, can also not be reduced.
1:51.0	The key difference here is that a strangulated hernia has lost its blood supply and the bowel is dying.
1:58.0	As a result, these are extremely tender to palpation and very erythematous on exam.
	...

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