MDM – GI/ABD

General Abd Pain

Differential diagnosis includes: ***. Abdominal exam without peritoneal signs. No evidence of acute abdomen at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng acute cholecystitis), acute pancreatitis, PUD (including perforation), acute infectious processes (pneumonia, hepatitis, pyelonephritis), acute appendicitis, vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of abdominal pain at this time.

Plan: labs, UA, CTAP***, pain control, serial reassessment

RUQ Pain

This is a @AGE@ @SEX@ with RUQ abdominal pain, consistent with ***. Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of acute abdomen at this time. Well appearing. Moderate suspicion for acute hepatobiliary disease (includng acute cholecystitis). Less likely to represent acute pancreatitis, PUD (including perforation), acute infectious processes (pneumonia, hepatitis, pyelonephritis), atypical appendicitis, vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of abdominal pain at this time.

Plan: labs, UA, pain control, RUQ US***, serial reassessment

RLQ Pain

This is a *** with RLQ pain, most concerning for ***. Differential diagnoses: appendicitis, ***. Abdominal exam without peritoneal signs. No evidence of acute abdomen at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng acute cholecystitis), acute infectious processes (pneumonia, hepatitis, pyelonephritis), vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of abdominal pain at this time.

Plan: labs, UA, CT AP ***, pain control, fluids, serial reassessment

Epigastric Pain

Presentation consistent with acute epigastric abdominal pain. Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of acute abdomen at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng acute cholecystitis), acute pancreatitis, PUD (including perforation), acute infectious processes (pneumonia, hepatitis, pyelonephritis), atypical appendicitis, vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of abdominal pain at this time.

Plan: labs, UA, GI cocktail, RUQ US ***, serial reassessment

Gallstones

This patient presents with abdominal pain, most consistent with acute, uncomplicated biliary colic. Bedside ultrasound demonstrating visible gallstones without overt signs of cholecystitis (thickened GB wall, pericholecystic fluid, CBD dilatation). Patient is afebrile and not jaundiced or altered, lowering my suspicion for cholangitis. Presentation not consistent with acute pancreatitis at this time. Low suspicion for bowel obstruction, viscus perforation, vascular catastrophe, or atypical appendicitis. Presentation not consistent with other acute, emergent causes of abdominal pain at this time. Plan for formal RUQ U/S to evaluate gallbladder pathology.***

Plan: labs, LFTs, lipase, RUQ U/S***, pain control, supportive care, serial reassessment

UGIB

This patient with *** presents with symptoms concerning for acute, upper GI bleed, likely secondary to ***.

Differential diagnoses includes peptic ulcer disease (PUD = most common) versus less likely gastritis versus Mallory-Weiss tear versus AVM. Presentation not consistent with esophageal or gastric variceal bleeding or Boerhaave’s syndrome. Presentation not consistent with other etiologies upper GI bleeding at this time. No red flag features or high risk bleeding. No evidence of hemorrhagic shock. Glasgow-Blatchford Bleeding (GBS) score: ***. Based on this well validated study, the patient can safely be discharged for ***outpatient therapy // is “high risk” for needing a medical intervention to include transfusion, endoscopy or surgery. Plan to check labs to evaluate the extent of bleeding, including H/H. Will initiate treatment with PPI. No indication for octreotide or antibiotics given low likelihood of variceal bleeding from portal hypertension and cirrhosis.*** No indication for abdominal imaging at this time.

Plan: labs, LFTs, close hemodynamic monitoring, serial reassessment, PPI therapy, Octrotide/CTX***

LGIB

This patient presents with symptoms concerning for a lower GI bleed. Differential diagnoses include diverticulitis (most common cause) versus hemorrhoids. Less likely etiologies include angiodysplasia, cancer, IBD. Presentation not consistent with mesenteric ischemia or ischemic colitis, brisk or life threatening upper GIB as patient has no evidence of hemorrhagic shock. Plan to check labs to evaluate the extent of bleeding, including H/H. Will consent patient for blood and transfuse to goal Hb of >7 if necessary. No indication for abdominal imaging at this time.***

Plan: labs, LFTs, close hemodynamic monitoring, serial reassessment, CT AP***

Gastroenteritis

This patient presents with *** nausea, vomiting & diarrhea. Differential diagnoses includes possible acute gastroenteritis. Abdominal exam without peritoneal signs. Currently ***euvolemic without evidence of dehydration. No evidence of surgical abdomen or other acute medical emergency including bowel obstruction, viscus perforation, vascular catastrophe, atypical appendicitis, acute cholecystitis at this time. Presentation not consistent with other acute, emergent causes of vomiting / diarrhea at this time. No indication for abdominal imaging.

Plan: supportive care, oral // IV rehydration ***, serial abdominal exam, reassess

Constipation

This is a @AGE@ presenting with symptoms consistent with constipation. Differential diagnosis includes ***. Presentation not consistent with acute bowel obstruction caused by tumor, stricture, hernia, adhesion, volvulus or fecal impaction. Low suspicion for etiology related to new medications including opiates, antipsychotics, anticholinergics, antacids, or antihistamines. Presentation not consistent with acute anorectal disorders. Low suspicion for chronic causes of constipation including hypothyroidism or electrolyte disorders. Presentation not consistent with other acute, emergent causes of constipation at this time.

Plan: supportive care, Rx ***, XR abdomen***, electrolytes***

Diarrhea

This patient presents with diarrhea consistent with likely viral enteritis. Doubt acute bacterial diarrhea. Considered, but think unlikely, partial SBO, appendicitis, diverticulitis, other intraabdominal infection. Low suspicion for secondary causes of diarrhea such as hyperadrenergic state, pheo, adrenal crisis, hyperthyroidism, or sepsis. Doubt antibiotic associated diarrhea.

Plan: PO rehydration, reassess, discharge with OTC antidiarrheal meds//short course antibiotics