BOOK
Abdominal and Gastrointestinal Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book
Joseph P. Martinez | Autumn C. Graham
(2016)
Additional Information
Book Details
Abstract
This issue of Emergency Medicine Clinics, edited by Drs. Joseph Martinez and Autumn Graham, focuses on Abdominal and Gastrointestinal Emergencies. Articles include: Gastrointestinal Bleed ; Abdominal pain in the Immuncompromised Patient Lower Abdominal Pain: Diverticulitis, Colitis, Inflammatory Bowel Disease and Appendicitis;Acute Abdominal Pain in the Bariatric Surgery Patient;The Vomiting Patient: Bowel Obstruction, Cyclic Vomiting and Gastroparesis; Diarrhea; Non-abdominal Abdominal Pain; Evidence Based Approach to Abdominal Pain;Abdominal Pain in the Geriatric Patient; Abdominal Pain in Children; Evaluating the patient with Right upper quadrant abdominal pain, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Abdominal and Gastrointestinal Emergencies\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: “Oh, My Aching Belly!”\r | vii | ||
| Preface: Abdominal and Gastrointestinal Emergencies\r | vii | ||
| Evidence-Based Medicine Approach to Abdominal Pain\r | vii | ||
| Approach to Patients with Epigastric Pain\r | vii | ||
| Evaluating the Patient with Right Upper Quadrant Abdominal Pain\r | vii | ||
| Lower Abdominal Pain\r | vii | ||
| Anorectal Complaints in the Emergency Department\r | viii | ||
| The Vomiting Patient: Small Bowel Obstruction, Cyclic Vomiting, and Gastroparesis\r | viii | ||
| Diarrhea: Initial Evaluation and Treatment in the Emergency Department\r | viii | ||
| Gastrointestinal Bleeding\r | viii | ||
| Abdominal Vascular Catastrophes\r | ix | ||
| Pediatric Abdominal Pain: An Emergency Medicine Perspective\r | ix | ||
| Abdominal Pain in the Geriatric Patient\r | ix | ||
| Abdominal Pain in the Immunocompromised Patient—Human Immunodeficiency Virus, Transplant, Cancer\r | ix | ||
| Acute Abdominal Pain in the Bariatric Surgery Patient\r | x | ||
| Abdominal Pain Mimics\r | x | ||
| EMERGENCY MEDICINE\rCLINICS OF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| August 2016 | xi | ||
| November 2016 | xi | ||
| February 2017 | xi | ||
| RECENT ISSUES | xi | ||
| February 2016 | xi | ||
| November 2015 | xi | ||
| August 2015 | xi | ||
| CME Accreditation Page | xiii | ||
| PROGRAM OBJECTIVE | xiii | ||
| LEARNING OBJECTIVES | xiii | ||
| ACCREDITATION | xiii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xiii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xiii | ||
| TO ENROLL | xiii | ||
| METHOD OF PARTICIPATION | xiv | ||
| CME INQUIRIES/SPECIAL NEEDS | xiv | ||
| Foreword: “Oh, My Aching Belly!”\r | xv | ||
| Preface: Abdominal and Gastrointestinal Emergencies\r | xvii | ||
| Evidence-Based Medicine Approach to Abdominal Pain | 165 | ||
| Key points | 165 | ||
| INTRODUCTION | 165 | ||
| HISTORY OF PRESENTING ILLNESS | 165 | ||
| Onset | 166 | ||
| Location | 166 | ||
| Character | 167 | ||
| Radiation | 167 | ||
| Palliative, Provoking, or Associated Factors | 167 | ||
| Past Medical, Surgical, and Social History | 167 | ||
| PHYSICAL EXAMINATION | 168 | ||
| General Appearance | 169 | ||
| Vital Signs | 169 | ||
| Approach to Unstable Patients with Abdominal Pain | 169 | ||
| Physical Examination Findings | 169 | ||
| Inspection | 169 | ||
| Auscultation | 170 | ||
| Palpation | 171 | ||
| Guarding | 172 | ||
| Rebound Tenderness and Alternative Techniques | 172 | ||
| Localized Tenderness | 172 | ||
| Special Examination Techniques to Help with Specific Diagnoses | 172 | ||
| Rectal Examination | 173 | ||
| Extra-abdominal Examination | 173 | ||
| LABORATORY TESTING IN ABDOMINAL PAIN | 173 | ||
| White Blood Cell Count | 174 | ||
| C-Reactive Protein | 174 | ||
| Procalcitonin | 175 | ||
| D Dimer | 175 | ||
| Intestinal Fatty Acid Binding Protein | 175 | ||
| Lactate | 175 | ||
| Lipase/Amylase/Liver Function Tests | 176 | ||
| DIAGNOSTIC IMAGING MODALITIES | 176 | ||
| Plain Radiographs | 177 | ||
| Computed Tomography Scan | 177 | ||
| Ultrasound | 180 | ||
| THERAPEUTIC MANAGEMENT AND DISPOSITION | 182 | ||
| Gastrointestinal Cocktail | 182 | ||
| Antiemetics | 182 | ||
| Use of Pain Medication with Abdominal Pain | 182 | ||
| Disposition | 183 | ||
| Serial abdominal examinations | 183 | ||
| REFERENCES | 184 | ||
| Approach to Patients with Epigastric Pain | 191 | ||
| Key points | 191 | ||
| INTRODUCTION | 191 | ||
| Peptic Ulcer Disease/Gastritis | 192 | ||
| Complications | 194 | ||
| Hemorrhage | 194 | ||
| Perforation | 195 | ||
| Obstruction | 195 | ||
| ESOPHAGEAL EMERGENCIES | 195 | ||
| Food Bolus (Foreign Body) Impaction | 195 | ||
| Pediatrics | 198 | ||
| Caustic Ingestions | 198 | ||
| Boerhaave Syndrome | 198 | ||
| Esophagitis | 199 | ||
| Special Populations | 199 | ||
| Eosinophilic Esophagitis | 200 | ||
| PANCREATITIS | 200 | ||
| Necrotizing Pancreatitis | 205 | ||
| Hemorrhagic Pancreatitis | 206 | ||
| Management of Acute Pancreatitis | 206 | ||
| Pearls | 206 | ||
| Pitfalls | 206 | ||
| REFERENCES | 208 | ||
| Evaluating the Patient with Right Upper Quadrant Abdominal Pain | 211 | ||
| Key points | 211 | ||
| DIFFERENTIAL DIAGNOSES OF RIGHT UPPER QUADRANT DISORDERS | 213 | ||
| Disorders of the Liver, Biliary System, Pancreas, and Small Intestine | 214 | ||
| Biliary Disorders | 216 | ||
| Pancreatic Disorders | 217 | ||
| Other Abdominal Pathology Presenting as Right Upper Quadrant Pain | 218 | ||
| Nonabdominal Causes of Right Upper Quadrant Pain | 218 | ||
| EVALUATION TOOLS IN THE WORKUP OF THE PATIENT WITH RIGHT UPPER QUADRANT PAIN | 219 | ||
| Physical Examination | 219 | ||
| Laboratory Testing | 220 | ||
| Imaging | 220 | ||
| Plain Radiographs | 220 | ||
| Ultrasonography | 221 | ||
| Computed Tomography | 222 | ||
| Other Imaging Modalities | 222 | ||
| MANAGEMENT AND TREATMENT OF RIGHT UPPER QUADRANT DISORDERS | 223 | ||
| Surgical Treatment for Right Upper Quadrant Disorders | 224 | ||
| Medical Management of Right Upper Quadrant Disorders | 224 | ||
| SUMMARY | 225 | ||
| REFERENCES | 225 | ||
| Lower Abdominal Pain | 229 | ||
| Key points | 229 | ||
| ACUTE APPENDICITIS | 229 | ||
| Epidemiology | 229 | ||
| Disparities | 230 | ||
| Symptoms | 230 | ||
| Classic appendicitis | 230 | ||
| Atypical appendicitis | 230 | ||
| Special populations | 231 | ||
| Mimics | 231 | ||
| Diagnosis | 231 | ||
| Laboratory testing | 232 | ||
| Imaging | 232 | ||
| Computed tomography | 233 | ||
| Ultrasonography | 233 | ||
| MRI | 234 | ||
| Imaging recommendations | 234 | ||
| Decision rules | 234 | ||
| Treatment | 235 | ||
| Surgical treatment | 235 | ||
| Antibiotic treatment | 235 | ||
| Antibiotic choice | 235 | ||
| INFLAMMATORY BOWEL DISEASE | 235 | ||
| Epidemiology | 236 | ||
| Clinical Presentation | 236 | ||
| Management | 237 | ||
| Emergency Department Treatment | 238 | ||
| DIVERTICULITIS | 239 | ||
| Epidemiology | 239 | ||
| Incidence and risk factors | 239 | ||
| Age | 240 | ||
| Gender | 240 | ||
| Diagnosis | 240 | ||
| Clinical evaluation | 240 | ||
| Computed tomography and other imaging modalities | 241 | ||
| Management | 241 | ||
| Antibiotics | 241 | ||
| Indications for admission | 241 | ||
| Indications for surgery | 242 | ||
| Discharge considerations: diet and exercise | 242 | ||
| SUMMARY | 242 | ||
| PEARLS AND PITFALLS | 243 | ||
| REFERENCES | 243 | ||
| Anorectal Complaints in the Emergency Department | 251 | ||
| Key points | 251 | ||
| INTRODUCTION | 251 | ||
| HEMORRHOIDS | 252 | ||
| Pathophysiology | 252 | ||
| Clinical Features | 253 | ||
| Management | 253 | ||
| ANAL FISSURES | 255 | ||
| Pathophysiology | 255 | ||
| Clinical Features | 255 | ||
| Management | 256 | ||
| ANORECTAL ABSCESSES/CRYPTITIS | 256 | ||
| Pathophysiology | 256 | ||
| Clinical Features | 257 | ||
| Management | 257 | ||
| ANORECTAL FISTULA | 258 | ||
| PILONIDAL ABSCESSES/CYSTS | 258 | ||
| Pathophysiology | 258 | ||
| Clinical Findings | 259 | ||
| Management | 259 | ||
| PROCTALGIA FUGAX | 260 | ||
| PRURITUS ANI | 260 | ||
| Pathophysiology | 260 | ||
| Clinical Findings | 261 | ||
| Management | 261 | ||
| PROLAPSE | 262 | ||
| Pathophysiology | 262 | ||
| Clinical Findings | 262 | ||
| Management | 262 | ||
| FOREIGN BODIES/TRAUMAS | 263 | ||
| Pathophysiology | 263 | ||
| Clinical Findings | 263 | ||
| Management | 264 | ||
| RECTAL SEXUALLY TRANSMITTED INFECTIONS | 264 | ||
| Pathophysiology | 264 | ||
| Clinical Findings/Management | 265 | ||
| PROCTITIS | 265 | ||
| Pathophysiology | 265 | ||
| Clinical Findings | 265 | ||
| Management | 265 | ||
| RECTAL CANCER | 267 | ||
| Clinical Findings | 267 | ||
| Management | 268 | ||
| SUMMARY | 268 | ||
| REFERENCES | 268 | ||
| The Vomiting Patient | 271 | ||
| Key points | 271 | ||
| APPROACH TO VOMITING PATIENTS | 272 | ||
| SMALL BOWEL OBSTRUCTION | 273 | ||
| Introduction | 273 | ||
| Pathophysiology | 273 | ||
| Presentation and Diagnosis | 274 | ||
| Evaluation in the Emergency Department | 275 | ||
| Treatment | 275 | ||
| Summary | 277 | ||
| CYCLIC VOMITING | 277 | ||
| Introduction | 277 | ||
| Pathophysiology | 277 | ||
| Presentation and Diagnosis | 278 | ||
| Emergency Department Evaluation | 280 | ||
| Treatment | 280 | ||
| Summary | 281 | ||
| GASTROPARESIS | 281 | ||
| Introduction | 281 | ||
| Pathophysiology | 282 | ||
| Presentation and Diagnosis | 282 | ||
| Emergency Department Evaluation | 283 | ||
| Treatment | 283 | ||
| Metoclopramide | 284 | ||
| Domperidone | 284 | ||
| Erythromycin | 284 | ||
| Antiemetic agents | 284 | ||
| Interventional therapy | 284 | ||
| Summary | 286 | ||
| SUMMARY: PEARLS AND PITFALLS | 286 | ||
| Small Bowel Obstruction | 286 | ||
| Cyclic Vomiting | 286 | ||
| Gastroparesis | 287 | ||
| REFERENCES | 287 | ||
| Diarrhea | 293 | ||
| Key points | 293 | ||
| INTRODUCTION | 293 | ||
| GENERAL DIAGNOSTICS AND MANAGEMENT | 294 | ||
| ACUTE INFECTIOUS ETIOLOGIES | 298 | ||
| Viral | 298 | ||
| Selected Bacterial Etiologies | 298 | ||
| Bacterial Traveler’s Diarrhea | 301 | ||
| Clostridium difficile | 301 | ||
| PERSISTENT AND CHRONIC ETIOLOGIES | 302 | ||
| Parasitic | 303 | ||
| Human Immunodeficiency Virus, AIDS, and Diarrhea | 304 | ||
| Celiac Disease | 305 | ||
| REFERENCES | 305 | ||
| Gastrointestinal Bleeding | 309 | ||
| Key points | 309 | ||
| INTRODUCTION | 309 | ||
| EPIDEMIOLOGY | 309 | ||
| RISK STRATIFICATION OF GASTROINTESTINAL BLEEDING | 311 | ||
| Prognosis | 311 | ||
| Historical Features and Physical Examination Findings | 312 | ||
| Laboratory Studies | 312 | ||
| Prediction Scores | 312 | ||
| Summary | 313 | ||
| LOCALIZATION OF THE BLEED | 313 | ||
| Examination of Stool | 315 | ||
| Nasogastric Tube Aspiration | 315 | ||
| Blood Urea Nitrogen:Creatinine Ratio | 315 | ||
| Age | 315 | ||
| TREATMENT | 315 | ||
| Red Blood Cell Transfusion | 316 | ||
| Platelet Transfusion | 317 | ||
| Anticoagulation Reversal | 317 | ||
| Proton Pump Inhibitor | 317 | ||
| Somatostatin/Octreotide | 317 | ||
| Vasopressin | 317 | ||
| Antibiotics | 318 | ||
| Tranexamic Acid | 318 | ||
| Balloon Tamponade | 318 | ||
| IMAGING AND ENDOSCOPY | 318 | ||
| Upper Endoscopy | 318 | ||
| Colonoscopy | 319 | ||
| Angiography | 319 | ||
| Nuclear Scan | 319 | ||
| VARICEAL BLEEDING | 319 | ||
| PEARLS AND PITFALLS | 320 | ||
| REFERENCES | 320 | ||
| Abdominal Vascular Catastrophes | 327 | ||
| Key points | 327 | ||
| Pediatric Abdominal Pain | 341 | ||
| Key points | 341 | ||
| BACKGROUND | 341 | ||
| EPIDEMIOLOGY | 341 | ||
| HISTORY | 342 | ||
| PHYSICAL EXAMINATION | 342 | ||
| IMAGING | 344 | ||
| PEDIATRIC CAUSES OF ABDOMINAL PAIN | 344 | ||
| Diagnosis and Workup | 345 | ||
| Management | 345 | ||
| PYLORIC STENOSIS | 345 | ||
| Diagnosis and Workup | 346 | ||
| Management | 347 | ||
| INTUSSUSCEPTION | 347 | ||
| Diagnosis and Workup | 347 | ||
| Abdominal radiographs | 347 | ||
| Abdominal ultrasound | 348 | ||
| Abdominal computed tomography/MRI | 348 | ||
| Fluoroscopy enema | 348 | ||
| Management | 348 | ||
| MALROTATION WITH OR WITHOUT MIDGUT VOLVULUS | 349 | ||
| Diagnosis and Workup | 349 | ||
| Abdominal Pain in the Geriatric Patient | 363 | ||
| Key points | 363 | ||
| INTRODUCTION | 363 | ||
| GENERAL APPROACH | 364 | ||
| Limitations to History-Taking | 364 | ||
| Limitations to Physical Examination | 364 | ||
| Imaging | 364 | ||
| General Treatment and Disposition Considerations | 365 | ||
| SPECIFIC ABNORMALITIES | 365 | ||
| Small-Bowel Obstruction | 365 | ||
| Large-Bowel Obstruction | 365 | ||
| Biliary Tract Disease | 366 | ||
| Pancreatitis | 366 | ||
| Peptic Ulcer Disease | 367 | ||
| Diverticular Disease | 367 | ||
| Appendicitis | 368 | ||
| Extra-Abdominal Causes of Abdominal Pain | 369 | ||
| Constipation | 370 | ||
| Malignancy | 370 | ||
| Pharmacology | 371 | ||
| Disposition/Special Considerations | 371 | ||
| SUMMARY | 371 | ||
| REFERENCES | 372 | ||
| Abdominal Pain in the Immunocompromised Patient—Human Immunodeficiency Virus, Transplant, Cancer | 377 | ||
| Key points | 377 | ||
| INTRODUCTION | 377 | ||
| HUMAN IMMUNODEFICIENCY VIRUS/AIDS | 378 | ||
| Diagnostic Considerations | 378 | ||
| Opportunistic Infections | 379 | ||
| CYTOMEGALOVIRUS | 379 | ||
| MYCOBACTERIUM AVIUM COMPLEX | 379 | ||
| ABDOMINAL TUBERCULOSIS | 380 | ||
| AMEBIC COLITIS | 380 | ||
| OTHERS | 380 | ||
| Treatment Regimen Complications | 380 | ||
| Other Complications | 381 | ||
| SOLID ORGAN TRANSPLANT | 381 | ||
| Diagnostic Considerations | 381 | ||
| Infections | 381 | ||
| First month | 382 | ||
| Months 1 to 6 | 382 | ||
| Months 6 to 12 | 382 | ||
| Other Postoperative Complications | 382 | ||
| Pancreatitis | 382 | ||
| Graft-versus-host disease | 383 | ||
| Abdominal compartment syndrome | 383 | ||
| CHEMOTHERAPY/NEUTROPENIA | 383 | ||
| Diagnostic Considerations | 383 | ||
| Opportunistic Infections | 383 | ||
| Other Immunocompromised Patients | 384 | ||
| PEARLS AND PITFALLS | 384 | ||
| REFERENCES | 384 | ||
| Acute Abdominal Pain in the Bariatric Surgery Patient | 387 | ||
| Key points | 387 | ||
| INTRODUCTION | 387 | ||
| OBESITY | 388 | ||
| CONVENTIONAL THERAPY | 388 | ||
| BARIATRIC SURGERY ON THE RISE | 388 | ||
| INCLUSION CRITERIA FOR BARIATRIC SURGERY | 388 | ||
| BARIATRIC SURGERY PROCEDURES | 389 | ||
| MIXED MALABSORPTIVE/RESTRICTIVE PROCEDURES | 389 | ||
| Roux-en-Y Gastric Bypass | 389 | ||
| Biliary Pancreatic Diversion without and with Duodenal Switch | 390 | ||
| RESTRICTIVE PROCEDURES | 392 | ||
| Laparoscopic Adjustable Gastric Banding | 392 | ||
| Sleeve Gastrectomy | 392 | ||
| INTRAGASTRIC DUAL-BALLOON | 393 | ||
| APPROACH TO THE BARIATRIC PATIENT WITH ABDOMINAL PAIN IN THE EMERGENCY DEPARTMENT | 394 | ||
| Airway | 394 | ||
| Breathing | 394 | ||
| Circulation | 394 | ||
| Other General Considerations | 394 | ||
| NONEXCLUSIVE COMPLICATIONS | 395 | ||
| Surgical Site Infection | 395 | ||
| Cholelithiasis | 395 | ||
| Postoperative Bleeding | 395 | ||
| Small Bowel Obstruction | 396 | ||
| SURGICAL COMPLICATIONS BY PROCEDURE | 396 | ||
| ROUX-EN-Y GASTRIC BYPASS | 396 | ||
| Anastomotic or Staple Line Leak | 396 | ||
| Anastomotic Stenosis | 398 | ||
| Dumping Syndrome | 398 | ||
| Gastric Remnant Dilatation | 398 | ||
| Marginal or Stomal Ulcers | 398 | ||
| Internal Hernia | 399 | ||
| Ventral Incisional Hernia | 399 | ||
| BILIARY PANCREATIC DIVERSION WITHOUT AND WITH DUODENAL SWITCH | 400 | ||
| LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING | 400 | ||
| Esophagitis | 400 | ||
| Hiatal Hernia | 400 | ||
| Gastroesophageal Dilatation | 401 | ||
| Band Erosion | 401 | ||
| Band Slippage and Gastric Prolapse | 401 | ||
| StomaL Obstruction | 401 | ||
| Port Infection | 402 | ||
| SLEEVE GASTRECTOMY | 402 | ||
| Gastric Leak | 402 | ||
| Gastric Stenosis | 402 | ||
| Gastroesophageal Reflux Disease | 402 | ||
| SUMMARY | 403 | ||
| REFERENCES | 403 | ||
| Abdominal Pain Mimics | 409 | ||
| Key points | 409 | ||
| CANNOT MISS DIAGNOSES | 411 | ||
| Acute Coronary Syndrome | 411 | ||
| Diabetic Ketoacidosis | 411 | ||
| Pulmonary Embolism | 412 | ||
| Congestive Heart Failure | 412 | ||
| CONDITIONS REQUIRING URGENT EVALUATION | 412 | ||
| Community-Acquired Pneumonia | 413 | ||
| Sickle Cell Disease | 413 | ||
| Hereditary Angioedema | 414 | ||
| Amanita Intoxication | 414 | ||
| Black Widow Spider Envenomation | 415 | ||
| Adrenal Crisis | 416 | ||
| Hematologic Malignancies | 416 | ||
| UNUSUAL CAUSES TO CONSIDER | 417 | ||
| Acute Intermittent Porphyria | 417 | ||
| Systemic Lupus Erythematosus | 418 | ||
| Henoch-Schönlein Purpura | 418 | ||
| Polyarteritis Nodosa | 418 | ||
| Lemierres Syndrome | 418 | ||
| Tuberculosis | 419 | ||
| Lyme Disease | 419 | ||
| Varicella Zoster | 419 | ||
| Abdominal Epilepsy | 419 | ||
| Abdominal Migraine | 420 | ||
| PEARLS AND PITFALLS | 420 | ||
| REFERENCES | 420 | ||
| The Opioid Epidemic in the United States | e1 | ||
| Key points | e1 | ||
| INTRODUCTION | e1 | ||
| EPIDEMIOLOGY | e3 | ||
| Opioid Prescription Epidemic | e3 | ||
| Morbidity and Economic Burden | e4 | ||
| Demographics: Who Is at Risk? | e4 | ||
| Which Prescription Opioids Are Most Common? | e4 | ||
| Limitations of Data | e5 | ||
| RECENT TRENDS | e5 | ||
| HEROIN EPIDEMIC | e6 | ||
| Demographics: Who Is at Risk? | e6 | ||
| Limitations of Data | e7 | ||
| OPIOID ANTAGONIST AGENTS | e7 | ||
| Take Home Naloxone | e8 | ||
| OPIOID ANTAGONISTS AND PUBLIC HEALTH LAWS: BARRIERS AND SOLUTIONS | e10 | ||
| Laws Encouraging Access to Naloxone by Limiting Liability | e11 | ||
| Laws to Promote Prescribing of Opioid Antagonists | e11 | ||
| Good Samaritan Laws: Providing Immunity to Bystanders Who Report Overdose | e11 | ||
| SAFE OPIOID PRESCRIBING PRACTICE IN THE EMERGENCY DEPARTMENT | e13 | ||
| SUMMARY | e15 | ||
| REFERENCES | e16 | ||
| Index | 425 |