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Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx

  • Labs

    • CBC (infection/blood loss)

    • Amylase + lipase (pancreatitis)

    • LFT (RUQ pain)

    • Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone)

    • Beta hcg (women in childbearing age)

    • Chlamydia + gonorrhea (women @ risk of STIs)

  • Imaging (based on location)

    • U/S (RUQ pain)

      • abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain

      • Transvag u/s for ectopic pregnancy

    • CT w/ IV contrast media (adults w/ acute RLQ pain)

    • CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis

    • LUQ pain (many causes so depends)

      • Suggested esophageal/gastric patho = endoscopy or upper GI series

      • Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature)

    • Xray

      • Free air under diaphragm (=perforation of GI tract)

      • Abn calcifications (10% gallstones, 90% kidney stones)

      • Mult dilated loops of bowel & air-fluid lvls (bowel obstruction)

        • May see with paralytic ileus

    • *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt

      • CONSIDER IN ALL OLDER PTS w/ abdo pain

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Abdo Pain
#13; Appendicitis Acute cholecystitis Diverticulitis Acute pancreatitis Perforated ulcer Bowel infarction <span>Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss) Amylase + lipase (pancreatitis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectopic pregnancy CT w/ IV contrast media (adults w/ acute RLQ pain) CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis LUQ pain (many causes so depends) Suggested esophageal/gastric patho = endoscopy or upper GI series Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature) Xray Free air under diaphragm (=perforation of GI tract) Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain Initial investigations & basic management for chr/recurrent abdo pain IBS Exercise: vigorous 3-5/week (all types of IBS)


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