define acute abdomen:
- sudden, spontaneous, non traumatic abdominal pain
- most common etiologies: cholecystitis, appendicitis, bowel obstruction, cancer, and acute vascular conditions
- Radiologic evidence of distal esophageal narrowing.
- Absence of esophageal peristalsis on esophageal manometry.
What is PUD?
gastric and duodenal ulcers
whats the incidence of PUD?
about 10% during lifetime
pain, hemorrhage, perforation, obstruction
what bacteria is associated with PUD?
What is the tx for H. pylori infection?
14 days of
MOC = metronidazole, omeprazole, clarithromycin
ACO = ampicillin, clarithromycin, omeprazole
What's the epidemiology of duodenal ulcers?
What's the classic pain response to food intake?
food relieves duodenal ulcer pain!
(think Duodenum=Decreased with food)
What's the cause of duodenal ulcer?
What syndrome should you always think of?
Increased production of gastric acid
Medical tx of duodenal ulcers?
PPIs, or H2 receptor antagonists
tx for H. pylori
When is surgery indicated for duodenal ulcers? (IHOP)
I - intractability
H - hemorrhage (massive or relentless)
O - obstruction (gastric outlet obstruction)
P - perforation
What is the purpose of the Ranson criteria?
predict mortality after pancreatitis
What are the elements of the Ranson criteria and how is the score interpreted?
Criteria present at 0 hours:
- Age >55 years old (1 point)
- WBC >16,000/mm(3) (1 point)
- Glucose >200 mg/dL (1 point)
- LDH >350 U/L (1 point)
- AST >250 U/L (1 point)
Criteria present at 48 hours:
- Hematocrit fall of 10% or greater (1 point)
- BUN rise of 5 mg/dL or more despite fluids (1 point)
- Serum Calcium <8 mg/dL (1 point)
- pO2 <60 mmHg (1 point)
- Base deficit >4 meq/L (1 point)
- Fluid sequestration >6000 mL (1 point)
0-2 Points: Mortality 0-3 percent
3-5 Points: Mortality 11-15 percent
6-11 Points: Mortality >=40 percent
When may splenectomy be considered?