11.11.2018 - By Zack Olson, MD and Michael Estephan, MD
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)