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R =
P =
C = RUQ pain, nausea, vomiting, fever, jaundice, bilirubinemia
D = LFTs (AST, ALT, bilirubin, alk phosphatase), INR, acute hepatitis panel, acetaminophen level
Tx = *Treat underlying cause
Comp =
Hepatic Abscesses
R =
P =
C = RUQ pain, fever, nausea, vomiting, clay-colored stool, dark urine, jaundice, right pleural effusion
D = CT abd/pelvis. (Work-up: CBC, BMP, liver panel, coags, blood cx, amebic and echinococcal serologies, ultrasound, CT)
Tx = IV antibiotics, diagnostic aspiration and drainage (followed by placement of drainage catheter) or surgical drainage
Comp =
Cholelithiasis
R =
P =
C = Constant RUQ pain that lasts 1-5hr and then remits, no pain during fasting, radiation to right shoulder, benign physical exam compared to cholecystitis
D = RUQ U/S. (also LFT, CBC)
Tx = *IV/IM ketorolac vs morphine. Prescription for ibuprofen or opioid
Comp =
Cholecystitis *I did calculous
R =
P =
C = RUQ pain, Murphy sign, fever, nausea, vomiting, jaundice for acalculous
D = Combination of clinical, labs, imaging. Biliary U/S, HIDA scan, leukocytosis, LFT abnormalities
Tx = Antibiotics, Surg consult for cholecystectomy
Comp = Gangrene, perforation, gallstone ileus, emphysematous cholecystitis, Mirizzi Syndrome,
Cholangitis
R =
P =
C = Charcot's Triad (fever, jaundice, RUQ pain), Reynold's Pentad (triad + hypotension + AMS)
D = RUQ U/S, ERCP, CBC, alk phos, conj bilirubin, GGT, blood cx
Tx = Antibiotics, sepsis resuscitation, GI consult for ERCP, Surg consult for cholecystectomy
Comp =
------------------------------------
Unstable angina
R =
P =
C = Chest pain (radiating both arms > R arm > L arm, assoc with diaphoresis, assoc with nausea/vomiting, with exertion)
D =
Tx = dual antiplatelet therapy and antithrombotic therapy. Med mgmt vs cath determined by risk for CV events
Comp =
Coronary vasospasm
Pericarditis
Myocarditis
Pneumothorax
Mediastinitis
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