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)