G: ABDOMINAL

abdominal-regions

After your Airway, Breathing Cardiovascular D(neuro) E(endo) and F(fluids, fertility) systems comes G. To help think about the GI system, think ABDOMINAL. You can think about this as you examine the patient from RUQ to LUQ, down through the mid abdomen to the lower quadrants, and around for the rectal exam, and consider what further tests might be required

Ammonia/ascites: liver disease –> liver enzyme and function

  • acute hepatitis: viral, toxic, auto-immune
  • chronic cirrhoisis: alcoholic, non-alcoholic
  • ascites: tense ascites, peritonitis
  • complications: Albumin low  Bacterial peritonitis Coagulopathy Dextrose decrease Encephalopathy Fail kidney (hepato-renal) GI bleed (variceal)

Biliary disease –> ultrasound

  • gallstones: POCUS stones –> elective surgery
  • cholecystitis: inflammed gallbladder: POCUS thick and tender wall +/- fluid –> surgery
  • choledocholithiasis: gallstone in common bile duct: dilated CBD –> ERCP
  • cholangitis: RUQ pain, fever, jaundice + sepsis –> antibiotics, resucitation and surgery
  • gallstone pancreatitis

Dyspepsia: gastric-esophageal –> endoscopy

  • peptic ulcer disease: NSAID, H Pylori, cancer –> PPI, scope, +/- transfuse
  • esophageal varices –> octreotide, transfuse, scope

Organomegaly of spleen –> ultrasound

  • splenomegaly
  • hypersplenism: anemia
  • splenic rupture: POCUS free fluid –> tranfuse, surgery

Mesenteric ischemic –> lactate, angiogram

  • embolic, thrombotic, low-flow state
  • pain out of proportion, elevated lactate –> CTA, surgery

Islets of pancreas: pancreatitis –> lipase

  • cause: gallstone, alcohol
  • complication: pleural effusion, shock, hypoglyemia/calcemia, abscess, pseudo-cyst –> fluids, CT

No motion –> Xray/CT

  • small bowel obstruction: adhesion, hernia, carcinoma/lymphoma, Crohns, intussusception
  • large blowel: carcinoma, volvulus

Appy (RLQ), diverticulitis (LLQ) –> US/CT

  • appy: MANTREL score: Migratory, Anorexia Nausea/vomit Tender Rebound Elevate temp Leukocyte shift –> US +/- CT
  • diverticulitis: LLQ pain –> Abx, CT r/o abscess, scope r/o tumour

Loose stool: colitis –> culture, colonoscopy

  • infectious colitis, including C Dif –> culture
  • inflammatory colitis (IBD):–> fluids, antibiotics, steroids, CT, scope
    • BOWEL complication: Bleed Obstruct Wall-off abscess Enteral fistula Leak anastamosis
    • extra-intestinal complications: oral ulcer, episcleritis, renal stone, anemia, arthritis, sacro-iliitis

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