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ComPbms. ABD

Pancreatitis, Diverticulitis, Appendicitis, Cholecystitis

QuestionAnswer
Appendicitis; (REFER) S All cases require removal of the inflamed appendix. Left shift, obturator & psoas signs. Periumbilical/epigastric pain. Abdominal tenderness with rebound tenderness. Rigid abdomen should cause concern for peritonitis.
Pancreatitis; (REFER) S Epigastric pain radiating to back Nausea, vomiting, diarrhea. Fever/chills. Grey-Turner's sign. Cullen's sign. Leukocytosis, amylase, fever, mild jaundice.
Pancreatitis: Diagnostics Lipase; highly specific. Amylase increase too. CT. MRI. Endoscopic U/S
Appendicitis; Diagnostics CT scan or u/s. Left shift in CBC.
Diverticulitis, what? Diverticulosis : Mucosal out pouching through colon wall. Diverticulitis: infection and/or inflammation.
Diverticulitis; S Left lower quadrant pain (can be right). Fever. Leukocytosis. Nausea, diarrhea (can be constipated). Severe left lower quadrant tenderness.
Diverticulitis; Dx's & Tx Tests: CBC and CT. Treatment: Low residue diet. Antibiotics. Usually a quinolone & flagyl or augmentin.
Cholelithiasis/Cholecystitis:(REFER) S Pain in the right upper quadrant (constant, severe). May be felt to the right flank or right scapular region. Often, pain occurs after eating greasy or fatty foods. Low grade fever, nausea and vomiting. Murphy’s sign, possible left shift.
Cholelithiasis/Cholecystitis: S&S ‘charcot’s triad’: pain, fever/chills, jaundice characteristic of cholangitis: need IV antibiotics.
Cholelithiasis/Cholecystitis: Testing and Tx: Dx: CT or u/s. Other labs to consider; Liver enzymes, ALT, AST, Amylase & Lipase. Tx: Abx eg. fluroquinolone, zosyn, unasyn, and surgery.
Created by: DianaB
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