9 emergent causes of RUQ Pain
- Biliary Colic
- Acute Cholecystitis
- Acute Cholangitis
- Sphincter of Oddi Dysfunction
- Acute Hepatitis
- Perihepatitis (Fitz-Hugh-Curtis Syndrome)
- Liver Abscess
- Budd-Chiari Syndrome
- Portal Vein Thrombosis
9 emergent causes of epigastric pain
- Acute MI
- Acute Pancreatitis
- Chronic Pancreatitis
- PUD
- GERD
- Gastritis
- Dyspepsia
- Gastroparesis
- Early appendicitis
4 Emergent Causes of LUQ Pain
Splenomegaly
Splenic Infarct
Splenic Abscess
Splenic Rupture
Which sign?
RLQ pain with palpation of LLQ
Rovsing
Which sign?
RLQ pain with internal rotation and flexion of the hip
obturator sign
Which sign?
RLQ pain with passive hip extension or active flexion against resistance
Psoas sign
Imaging of choice for suspected appendicitis…
abdominal CT and/or appy ultrasound
Which sign for acute cholelithiasis?
referred right subscapular pain…
boas sign
Cholestatic pattern of LFTs…
elevated alk phos and conjugated bili
5 Fs of cholecystitis…
female, fat, forty, fertile, fair
1st test for acute cholecystitis and gold standard test…
1st: US
gold standard: HIDA
3 diagnostic features of acute cholecystitis on US…
> 3mm wall thickening
pericholecystic fluid accumulation
stone visualization
Gold standard dx test for choledocolithiasis…
ERCP
a 37-year-old male complaining of rapid onset of severe mid-epigastric pain with radiation to the back after eating a large meal.
The pain lessens when she leans forward or lies in the fetal position.
Acute pancreatitis
Physical exam shows low-grade fever, epigastric tenderness, diminished bowel sounds, and bruising of the flanks.
An abdominal CT scan shows localized dilation of the upper duodenum and a small collection of fluid in the left pleural cavity.
acute pancreatitis
GET SMASHHED mnemonic for acute pancreatitis causes…
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion Hypercalcemia/lipidemia ERCP Drug use
Bruising at umbilicus. present in suspected acute pancreatitis.
cullen’s sign
Flank bruising present in suspected acute pancreatitis
grey turner’s sign
Tx of acute pancreatitis…
- admit
- IV fluids
- pain mgmt
- npo
1st thought for patient presenting to ED with anorexia…
appendicits
Typical 4 step migration for appendicitis
crampy periumbilical pain –> N/V –> anorexia –> RLQ migration of intense pain
5 causes of constipation in the ED…
CRC obstruction volvulus ileus gastroparesis
vomiting, abd. pain, fullness after eating small amounts…
Can occur in DM
gastroparesis
Belly pain, bloating, nausea, bloody stools and constipation.
X Ray showing colonic distension
volvulus
