Causes: Alcohol, gallstones, high triglycerides, hypercalcemia, drugs, mumps, trauma
CBC, chem 7, LFT's, amylase, lipase, EKG
IVF, IVF, IVF!!!
Pain control - anti emetics
Main cause - hernias and adhesions. Other causes: CA, IBD, bezoar, gallstones, intussusception, Ascaris worm if travel
Diagnostic Tests = KUB --> look or air/ fluid
levels and dilated loops of bowel, also CT scan
Labs: CBC, chem 7, LFT's, UA
Tx: IVF, pain control, npo, antiemetics, NGT to suction, ABX (levo or flagyl), surgery cx
- S/S - PAIN OUT OF PROPORTION TO ABDOMINAL EXAM - benign compared to pain
- At risk pts: elderly, vasculopaths, pts with afib, pts in cardiogenic shock/cardiopulm bypass or on high dose pressors
- most occur in SMA (ie intracardiac embolus)
- Dx: CBC, chem 7, LFT's, amylase, lipase, UA, HCG, HIGH LACTATE PT/Ptt (if coumadin/heparin), EKG
- IF HIGH LACTIC ACID LEVELS --? do full workup with CT scan, ABX, surgery
* CT angiography* - po and IV contrast
- TX: IVF, O2, broad spectrum antix (levo, Flagyl, Unaxyn), ? laparotomy w/ embolectom and SBR of necrotic bowel.
- school/work outbreak
- Common viruses: rotavirus, norwalk, adenovirus, astrovirus
- last 24 to 48 hours
- ALWAYS DX as VOMITING AND DIARRHEA - never use the term viral gastroenteritis (CYA medicine)
Tx: CBC, chem 7, LFT's, lIpase, UA, generally don't need imagin,
- Stool cultures - r/o giardia, shigella, salmonella,c diff toxin, Ova and parasites if travel.
- IVF, antiemetics
- Abx if suspect bacteria or protozoal infection
1) Salmonella - gram negative, bad eggs, dairy, poultry.
S/S: bloody diarrhea, fever, abd pain
Resolves in 10-14 days.
2) Shigella -gram negative, contaminated salads (mayo), dairy, mean. Severe Dysentery (bloody diarrhea)'
3) Campylobacter - chinese food bug!!
Fever, abdo pain, blood diarrhea, lasts x 1 week.Get from dirty wateror poultry, may cause/trigger Guillan Barre
4) Yersinia- directly invades the intestine, s/s abd pain, watery or bloody diarrhea, vomiting
5) E coli - esp O157: H7 causes enterohemorrhagic diarrhea.
Inundercooked beef - complicated by hemolytic uremic syndrome and TTP
-Giardia (dirty water sources) -explosive, frothy and foul smellng diarrhea
- Entamoeba hystlytica, crypto, isospora (HIV)
- Prolonged/ more severe angina that doens't resolve with rest
- 50% triggered by event: stress, exercise, surgery, illness
- More common in early am
- substernal pain elephant in chest, crushing, heavy +/- radiation to left arm, jaw, neck, may hear a mitral murmur if papillary muscles are injured
- Assoc symptms: weakness, diaphoresis, pallorN/V, anxiety, epigastric pain/heartburn, HA (elderly and DM may have a painless MI)
- Time is essential - may be complicated by arrythmias (v fib!)
- Def: elevated Bp with signs of end organ damage to brain, eyes, heart or kidney.
- Organ damage risk increases when diastolic Bp > 115-130
- HTN urgency if see high Bp but no signs of organ damage yet
- Get a head CT ASAP!!
Head: HA, confusion, N/V
Eyes: Blurred vision, diplopia
Cardiac: chest pain, dyspnea, palpitations
Renal: hematuria, oliguria, edema, generalized weakness, nocturia
Tx: Nitroprusside drip or Labetolol.
Reduce BP slowly to baseline (or may have coronary/brain insufficiency)
- goal can be a 40 pt drop in diastolic Bp
Def: Defect in the intimal layer of the aorta allows for blood to enter space between
- Risk actors: age, HTN, Connective tissue dz (marphans), bicuspid aortic valve, coarctation of the aorta, inflam dz of aorta, atherosclerosis, pregnancy, smoking
- S/S - SUDDEN, TEARING CHEST PAIN THAT RADIATES TO THE BACK, syncope
- potential symptoms of complications: hemplegia/paraplegia, hoarseness, dyspnea, wheeze, stridor, dysphagia, N/V, epigastric pain, lumbar pain
- abnormal dilatation of the arterial wall
- most common in abdominal area below renal arteries
- risk factors; atherosclerosis, age, HTN, smoking, connective tissue dz, fam hx, hyperlipidemia, DM
- S/S : often ASYMPTOMATIC, dull abd or back pain.
- ruptured AAA - severe abdominal pain radiating to back with syncope
- check Bp in both arms, listen for cardiac murmurs, JVP, adominal bruits or pulsatile mass, pulses
Risk Factors: PID, Mirena IUD, tubal surgery, pelvic surgery, endometriosis, IVF,DES exposure
S/S - R or L adnexal tenderness, R shoulder pain could be referred pain from intraabdominal hemorrhage (gallbladder, liver also)
Workup -CBC, Chem 7, HCG quant, ABO/Rh
** PELVIC ULTRASOUND (more visible in transvaginal US), may see an adnexal mass, free fluid in the pelvis or an extrauterine mass
- DOPPLER picks up fetal HR by 8-13 weeks gestation
Spontaneous abortion - Never CALL IT ABORTION IN FRONT OF PATIENT
- Early miscarriage (20 weeks) - due to chromosomal abnormalities, check Rubella
a) Threatened abortion if, 1st trimester vag bleed, < 20 weeks GA, os closed, membranes intact, some cramping.
Tx - pelvic rest, bed rest, close OB GYN f/u
b) Inevitable abortion - if < 20 weeks GA, vaginal bleeding, os open and membranes ruptured
Tx: D and C/E (dilatation and curittage or dilation and evacuation)
c)Incomplete abortion: same as above, os open, bleeding, but some POC's (prod of conception) expelled. TX: D & C
d) Complete AB: same as above, but OS closed and all POC's expelled
e) Missed Abortion: no bleeding, no fetal cardiac activity, uterus small, os closed, retained fetal tissue
Tx: D and C
* Can have sepsis due to retained tissue/ fetus. Treat with IV abx (ampicillin and gentamycin),
- Can give Misoprostol and cytotec (to dilate cervix) or D and C
premature separation of the implanted placenta
- S/S: abdominal pain, dark vaginal bleeding,hypertonic and tender uterus, fetal distress
- may see signs of shock without visible bleeding if intrauterine bleeding
Risk factors: HTN, pelvic trauma, cocaine or tobacco use, AMA
Tx: NO digital vag exam!, IVF w crystalloids, Rho Gam. O2, FEtal heart test (monitor contractiosn), non stress test, CBC, chem 7, PT/PTT, UA, ABO/Rh toxicologies, ultrasound to check placenta, look for ruptures
- testis twists on a spermatic cord, restore blood flow in 6 hours or may have infertility
- common at puberty and in 1 year olds
- High risk - Bell Clapper Deformity (tunica vaginalis isterts high on the spermatic cord), horizontal lie spermatic cord
S/S - enlarged testicles, tenderness, erythema, edema, horizontal lie testicle, high riding testes, ipsilateral loss of cremasteric reflex
Work up:CBC, chem 7, UA, testicular ultrasound with doppler flow!!
Tx: Urology cx, surgical detorsion or orchiopexy
- cysts rupture and cause pelvic bleeding --> peritonitis --> hypotension --> shock
S/S: unilateral sharp, lower abd pain
- work up: IVF w. crystalloids,, O2 prn, CBC, chem 7, HCG, UA, ABO/Rh, PT/PTT
** Pelvic ultrasound with color doppler flow
- Tx: if hemorrhagic - admit for serial HCT and drainage, OR if needed
- If simple d/c homewith close GYN f/u
- Most due to E coli
- Lower UTI - bladder and /or urethra
- Upper UTI: bladder, urethra and kidneys (so ureters to)
S/S: dysuria, urgency and frequency - may be asymptomatic in prego, elderly and immunosuppressed - may see confusion or AMS
Tx: Urinalysis (don't always need blood - more in elderly), ? CBC, chem 7, HCG
- Simple UTI --> treat for 3 days (Cipro, Bactrim, Nitro)
-Complex:--> treat for 7-10 days pregnancy, males, > 3 episodes (Amoxicillin, Nitro, Cipro - just for men, not for prego!!)
- Urology cx fr males
- 10-14 days for pyelonephritis (kidneys infected) - prego women require admission, stable pts can d/c home
A) Gonorrhea - (common)
S/S: skin pustules, fever, monarticular septic arthritis. , may be asymptomatic in females, or cervicitis, PID
Males: epididimytis, urethritis, prostatitis
Dx: cervical or urethral culture swab
Tx: Ceftriaxone IM x 1or Cefixime 400 mg po x 1 (gram negative)
B) Chlamydia: (common)
similar presentation as above - may have pus when milking urethra
Common cause of infertility
Dx: PCR of urine, fluorescent antibody testing, cervical or urethral culture swab
Tx: Asithromycin 1 g po x 1 or Doxy x 7 days (atypical)
C) Syphillis - rare, increaseing now, due to AIDs
S/S - rash or chancre, serologic testing of blood or CSF
TxL Benzathine penicillin or Doxy x 2 weeks
D) Genital Herpes - due to HSV-1
S/S: painful vesicles after 1-2 weeks of exposure, HA, fever, dysuria, myalgias.
First outbreak lasts 2-3 weeks, likely to recur
DxL PCR from vesicular fluid
Tx: Acyclovir 400 mg po TID x 2 weeks or Valacyclovir x 10 days.
Most pts remain on suppressive tx