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Hernia
- 3 classifications for hernia
- Reducible
- Able to be reduced (placed back into the abdomen) at bedside
- Incarcerated
- Cannot be reduced but not severely tender or erythematous
- Can occasionally cause bowel obstructions
- Strangulated
- Cannot be reduced but LOSING BLOOD SUPPLY
- Extremely tender and abnormal exam
- Needs emergent surgical consult
- Reducible
Esophageal Varices
- Classic presentation
- Hematemesis/Melena
- Chronic liver disease (hepatitis, alcoholics)
- Treatment
- Fluid bolus if hypotensive
- Octreotide
- Ceftriaxone
- Transfuse blood as needed
- If hemoglobin <7 transfuse
- If patient actively bleeding and level <8 transfuse
- Consult GI for endoscopy
Hepatic Encephalopathy
- Common findings
- Altered mental status
- Asterixis
- Elevated ammonia level
- Treat with lactulose or rifamixin
Peptic Ulcer Disease
- History
- Hematemesis or Melena
- Epigastric abdominal pain
- Chronic NSAIDS or steroids
- Treatment
- PPI (such as pantoprazole)
- Works better than an H2 blocker
- PPI (such as pantoprazole)
Cholecystitis
- RUQ ultrasound
- Thickened gallbladder wall
- Distended gallbladder
- Pericholecystic fluid
- Obvious impacted stone
- HIDA scan
- Inject radioactive material
- Absorbed by hepatocytes
- Secreted into biliary tree into small intestine
- If gallbladder not visualized
- Cystic duct obstruction
- If common bile duct cannot be visualized
- Choledocolithiasis
- If gallbladder not visualized
Ascending Cholangitis
- Charcots Triad
- Fever
- RUQ Pain
- Jaundice
- Patient requires ERCP (gastroenterology consult)
- Give antibiotics
Acute Pancreatitis
- Diagnosis
- Classic description
- Epigastric pain radiating to back
- Severe vomiting
- Lipase
- >3x upper limit of normal is diagnostic
- CT scan to look for complications of pancreatitis
- Classic description
Additional Reading
- RUQ Abdominal Pain (EM Clerkship)
- Biliary Diseases and Pancreatitis (EM Clerkship)