Wednesday Lectures, 8/5/2015

TTHM a2.3 Abdominal Pain Day (Tint: 74, 82, 84, 85, 100, 124)

10a ~ Diverticulitis (Kloss)
preceded by diverticulosis, low residue diets? Seeds & grains NOT implicated. Microperforations in colon create inflamed area, possibly associated c abscess, obstruction, fistula… Abx first but may require surgical correction. Beware of “constipation” vs “fullness” sensation. Can go home with Abx in many cases, either Augmentin (after Zosyn dose in ED) or Cipro/Flagyl combo, after CT to r/o abscess or perf… Sepsis or poor follow-up or new onset may be good reasons to ADM…

1030 ~ Appy (Kloss)
Visceral Pain may be nonspecific, especially at first… Anorexia is most common associated Sx. Fever is a Late finding! Typically a disease of younger ppl, but does happen in elderly, who wait longer to present & get perforation, sepsis, higher M&M…

11a ~ Small Groups (Paolo/Prasad)
Cases: SBO, Mesenteric Ischemia, AAA, Sepsis,
Rigler Sign ~ Pneumatosis Intestinalis, needs Gen SG for removal of ischemic gut. Lower rectal temp = bad. Normally rectal ~1*F higher than oral. Mesenteric Ischemia mortality 60 to 80% acutely! Nonocclusive mesenteric ischemia well correlated with digoxin use. Intestinal Angina can occur with pain after eating.
SIM: 80M emesis abd pain, hx clots & afib, SIGMOID VOLVULUS! with ischemia & Sepsis, esp in RN home pts… AXR not sensitive but may be specific/helpful in very old & very young.

1230 ~ Jr/Sr (Cantor/Prasad)
Palpable BG ~ Pancreatic CA… Courvoisiers Sign…
Grey Turner Sign, Cullen Sign.

2p ~ Female Abd Pain (Sarsfield)
Pregnancy, TOA, Ovarian Torsion, Ectopic…

230p ~ Neonatal Abdominal Emergencies (Greenfield)
Volvulus 1/6000, Malrotation 1/600, Gastroschisis, Omphalocele, Pyloric Stenosis…
Volvulus: Upper GI series > Double Bubble AXR.
Intussusception… Can be absorption/electrolyte issues.
https://en.m.wikipedia.org/wiki/Volvulus
https://en.m.wikipedia.org/wiki/Intestinal_malrotation
https://en.m.wikipedia.org/wiki/Gastroschisis
https://en.m.wikipedia.org/wiki/Omphalocele
https://en.m.wikipedia.org/wiki/Pyloric_stenosis
https://en.m.wikipedia.org/wiki/Pyloromyotomy
https://en.m.wikipedia.org/wiki/Intussusception_(medical_disorder)

3p ~ Abd Pain in Children (Thabet)
DDx based on age… Cases: 8yo M colicky abd pain ~ Functional Constipation Criteria…
Miralax/PEG works well.

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