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AbdominalPain

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SGEM#97: Hippy Hippy Shake – Ultrasound Vs. CT Scan for Diagnosing Renal Colic

Guest Skeptic: Dr. Tony Seupaul and Dr. Spencer Wright. Tony is the Chairman of the Department of Emergency Medicine, University of Arkansas.  
thesgem.com
over 4 years ago
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SGEM#71: Like a Rolling Kidney Stone (A Systematic Review of Renal Colic)

Classic Guest Skeptics: Dr. Anthony (Tony) Seupaul Chairman of the Department of Emergency Medicine, University of Arkansas for Medical Sciences and Dr. Joshua Hughes one of his star residents.  
thesgem.com
over 4 years ago
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SGEM#32: Stone Me (Fluids and Diuretics for Renal Colic)

Case Scenario: A 46yo man presents to the emergency department doing the renal colic shuffle (not the Harlem Shake). He has a history of kidney stones. Nothing in his physical examination or investigations suggest anything other than another renal colic attack. He wants to know if there is a way to flush the stone out.  
thesgem.com
over 4 years ago
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Podcast #12: Oh Dance-a-tron (Ondansetron for Pediatric Vomiting)

Dehydration in children is a common presentation to the emergency department. A main cause of dehydration in this age group is gastroenteritis which is charaterized by acute onset diarrhea with or without nausea, vomiting, fever and abdominal pain. The scope of the problem was quantified by Glass in 1991. This study showed the following:  
thesgem.com
over 4 years ago
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Podcast#4: Getting Un-Stoned (Renal Colic and Alpha Blockers)

Vincendeau et al. Tamsulosin Hydrochloride vs Placebo for Management of Distal Ureteral Stones. Arch Intern Med. 2010;170(22):2021­2027 PMID: 21149761  
thesgem.com
over 4 years ago
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A young woman with recurrent perianal sepsis

A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, and episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, and she was started on oral and topical mesalazine. In the following months she was admitted twice with acute perianal sepsis, which required examinations under anaesthesia and drainage of an intersphincteric abscess. She later presented after feeling generally unwell for four days with “flu-like” symptoms and perianal pain. On examination she had tenderness and fluctuance in the region of the right ischial tuberosity, with an external fistula opening visibly in the perineum. Her blood tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) and mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only.  
feeds.bmj.com
over 4 years ago
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9

A young woman with recurrent perianal sepsis

A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, and episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, and she was started on oral and topical mesalazine. In the following months she was admitted twice with acute perianal sepsis, which required examinations under anaesthesia and drainage of an intersphincteric abscess. She later presented after feeling generally unwell for four days with “flu-like” symptoms and perianal pain. On examination she had tenderness and fluctuance in the region of the right ischial tuberosity, with an external fistula opening visibly in the perineum. Her blood tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) and mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only.  
feeds.bmj.com
over 4 years ago
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4

Ustekinumab and briakinumab for the treatment of active Crohn's disease | Cochrane

What is Crohn's disease? Crohn's disease is a long-term (chronic) inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus. Symptoms include abdominal pain, non-bloody diarrhea and weight loss.  
cochrane.org
over 4 years ago
Sinaiem dark
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bloated-and-upset

47 y/o female PMH appendectomy presents with three days of worsening abdominal pain and constipation. Over the past day she has had persistent vomiting. She appears ill and has a diffusely tender abdomen. You quickly order labs and an obstructive series with upright chest XR with concern for a perforated viscus. To your surprise the CXR shows no signs of air under the diaphragm. Are there other signs of pneumoperitoneum could you look for on abdominal films?  
sinaiem.org
over 4 years ago
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5

Emergency Medicine Literature of Note: Finally, an End to Tamulosin for Renal Colic?

Great post Ryan. Keep up the good work.I particularly like your comment about the notion p-values. Intellectually there is really no difference in a p-value of 0.04 and 0.06. But we pretend that this dichotomous cut-off has some holy meaning. There are those that advocate abandoning p-values all together as they are so often misunderstood and misinterpreted. 95% confidence intervals are probably a better focus.Enjoy the Sunnyside.  
emlitofnote.com
over 4 years ago
Sinaiem dark
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burning-up

62 y/o M PMH of hep C cirrhosis, HTN, and anemia presents with fever to 101.6 and diffuse abdominal pain. Your patient has jaundice and abdominal distension and tenderness with shifting fluid wave. You work him up with labs, including a tap to rule out SBP. Can you safely use tylenol to control his fever?  
sinaiem.org
over 4 years ago
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Budesonide for treatment of people with active Crohn's disease. | Cochrane

What is Crohn's disease? Crohn's disease is a debilitating long-term (chronic) inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus. Symptoms include abdominal pain, non-bloody diarrhea and weight loss. The most common initial treatment of the Crohn's disease is oral steroid therapy. Unfortunately, traditional steroids are usually absorbed into the body and cause significant unwanted side effects. These may include but are not limited to weight gain, diabetes, growth retardation, acne, mood instability, and high blood pressure. When people with Crohn's disease are experiencing symptoms of the disease it is said to be ‘active’; periods when the symptoms stop are called ‘remission’.  
cochrane.org
over 4 years ago
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Lab Case 62

A 62 year old man presents to your ED by ambulance. He has had vomiting and diarrhoea for the last week and complains of abdominal pain. He is unable to keep anything down, has severe weakness with inability to stand.  
emergucate.com
over 4 years ago
Www.bmj
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Irritable bowel syndrome: new and emerging treatments

Irritable bowel syndrome is one of the most common gastrointestinal disorders in developed nations. It is characterized by abdominal pain, altered bowel habits, and bloating. Several non-pharmacological and pharmacological agents, which target the peripheral gastrointestinal system and central nervous system, are used to treat the syndrome. The individual and societal impact of investigating and managing the syndrome is substantial, and despite newer treatments, many patients have unmet needs. Intense research at many international sites has improved the understanding of pathophysiology of the syndrome, but developing treatments that are effective, safe, and that have tolerable side effects remains a challenge. This review briefly summarizes the currently available treatments for irritable bowel syndrome then focuses on newer non-pharmacological and pharmacological therapies and recent evidence for older treatments. Recent guidelines on the treatment of irritable bowel syndrome are also discussed.  
feeds.bmj.com
over 4 years ago
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Nonsteroidal anti-inflammatory drugs are effective treatment for acute renal colic | Cochrane

Acute renal colic is the pain caused by the blockage of urine flow secondary to urinary stones. The prevalence of kidney stone is thought to be between 2% to 3%, and the incidence has been increasing in recent years due to changes in diet and lifestyle. The renal colic pain is usually a sudden intense pain located in the flank or abdominal areas. This usually happens when a urinary stone blocks the ureter (the tube connecting the kidneys to the bladder). Different types of pain killers are used to ease the discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) and antispasmodics (treatment that suppresses muscle spasms) are used commonly to relieve pain and discomfort. This review aimed to assess the effectiveness of commonly used non-opioid pain killers in adult patients with acute renal colic pain. Fifty studies enrolling 5734 participants were included in this review. Treatments varied greatly and combining of studies was difficult. We found that overall NSAIDs were more effective than other non-opioid pain killers including antispasmodics for pain reduction and need for additional medication. We also found that the combining NSAIDs with antispasmodics did not increase the efficacy. No serious adverse effects were reported by any of the included studies.  
cochrane.org
over 4 years ago
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18

Ultrasound For the Win! Case: 38-year-old pregnant woman with acute right-sided abdominal pain #US4TW

Ultrasound For the Win! Case: 38-year-old pregnant woman with acute right-sided abdominal pain #US4TW by Dr. Jeff Shih  
aliem.com
over 4 years ago
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Medical Expulsion Therapy with Tamsulosin in Ureteral Colic - emdocs

emDocs post containing very useful emergency medicine information  
emdocs.net
over 4 years ago
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Lab Case 66

A 75 year old female presents to your ED with abdominal pain and nausea. She has a history of irritable bowel disease and gets recurrent abdominal pain.  
emergucate.com
over 4 years ago
Www.bmj
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10

An elderly woman with chest pain and constipation

An 89 year old woman with chronic obstructive pulmonary disease presented to the emergency department with worsening shortness of breath (87% oxygen saturation in room air), retrosternal chest pain, mild abdominal pain, and subacute partial bowel obstruction over the past six days. On physical examination she was dehydrated and she had tachycardia (105 beats/min), diffusely decreased breath sounds, audible crackles at the base of the right lung, and absent breath sounds on the left side pulmonary base. Her abdomen was distended but soft overall, the epigastrium and right hypochondium were slightly tender on deep palpation, and her rectum was empty. Her blood pressure was 130/85 mm Hg. Electrocardiography and troponin (measured at admittance and checked again after six and 12 hours) excluded myocardial infarction. Laboratory studies were unremarkable except for a mild microcytic anaemia (haemoglobin 115 g/L (reference range 120-160), mean cell volume 78.6 fL (80-96). Urgent chest radiography was requested (fig 1⇓).  
feeds.bmj.com
over 4 years ago
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31

Drug treatment of adults with nausea and vomiting in primary care

A usually healthy 25 year old man presents to you as his general practitioner at 9 am. He has had fluctuating nausea with four vomits and one loose stool overnight, associated with colicky central abdominal pain. No blood was present in the vomit or stool, and he reports that his girlfriend was recently diagnosed as having “viral gastro.” He is afebrile, intermittently uncomfortable, but otherwise well, with mild epigastric tenderness but no guarding or rebound. Clinically, you believe viral gastroenteritis is the most likely cause of his symptoms, and you consider his request for treatment that will help to stop his vomiting so that he can get to his evening shift at a factory.  
feeds.bmj.com
over 4 years ago