Adult Abdominal Pain: How to Work Up, When to Refer. Objectives. History 10/10/2013. By Michael Blew

Size: px
Start display at page:

Download "Adult Abdominal Pain: How to Work Up, When to Refer. Objectives. History 10/10/2013. By Michael Blew"

Transcription

1 Adult Abdominal Pain: How to Work Up, When to Refer By Michael Blew Objectives Determine the correct assessments to perform on initial abdominal pain exam Evaluate the value of diagnostics and labs in the abdominal pain workup Initiate care and follow up for common causes of abdominal pain History Most important part of the exam Onset- is this acute or chronic Provocation- does anything make it better or worse Quality- is it visceral, parietal, or referred Radiation- does the pain go anywhere else Severity- how bad is the pain 1

2 Other questions History of the same problem/feeling Nausea/Vomiting Changes in stool Weight loss Medications Recent injuries Discharge Recent trauma Assessment Inspection- Round, hernia, bruising, pulsation Auscultation- Can be normal even with serious pathology. Listen before touching. Palpation- Light then deep. Start away from focal pain. Liver and spleen may be palpated. Percussion- Kidneys, liver, spleen 2

3 Assessment Findings Red Flags Signs of shock, sepsis, or dehydration such as hypotension, tachycardia, tachypnea, or confusion Pain prior to vomiting (more often surgical) No bowel sounds after 3 minutes (somewhat unreliable) Blood in stool or bloody emesis Patient lying still or writhing Involuntary guarding Tenderness to percussion Abdominal pain localized to the periphery of the abdomen or pelvis Laboratory Data Driven solely by assessment and exam findings CBC with diff, CMP, Lipase, Amylase, Lactic Acid, ESR, CRP, H Pylori, HIV, Hep Panel Urinalysis, Urine Culture, HCG Heme Stool, stool wbc, stool culture 3

4 Radiographic and Diagnostic Testing Xray- May miss a large amount of diagnoses, but does have specific indications CT- Gold standard. Needs IV contrast for organ and blood flow evaluation. May need by mouth contrast as well. Ultrasound- Can eval pregnancy and other uses EGD/Colonoscopy- Invasive, but can show ulcers, cancer, GERD, etc. Ectopic Pregnancy Must be a consideration in all women of childbearing age Sudden onset LLQ or RLQ pain Check HCG Normal increases in hcg and Progesterone levels not seen Need an ultrasound Refer to a surgeon Can be life threatening emergency Appendicitis Caused by obstruction of the lumen Most common in young, white, male patients Look for rebound tenderness and other exam discussed earlier Typically pain then nausea worsening over a few hours Urinalysis and CT will assist with diagnosis Ultrasound may be obtained in pregnant patients Can be surgical emergency 4

5 AAA Seen typically in men who are older and tobacco abusers Often time incidental finding Size and growth rate determine surgical need When leaking begins, typically tearing pain in back Poor survival of rupture Cholecystits Mostly females over 40. Obesity also risk factor. Pain is often preceded by fatty meals May have pain in RUQ or epigastric area Jaundice, fever, nausea, and vomiting are often seen in the acute patient Pain can radiate to infrascapular region Diagnosed with ultrasound or CT Labs include WBC, Alk phos, AST, ALT, Bili Cholecystitis Often finding is incidental on CT, does not need further workup unless symptomatic If symptomatic, refer to surgeon for cholecystectomy. If stone in CBD may need ERCP IVF is appropriate in most patients, ABX may be utilized in high risk populations If it is acute, requires hospitalization otherwise can be referred as outpatient 5

6 Sepsis Multiple potential sources such as liver, pancreas, abscess Important to find potential exposures of past medical infections or procedures Deep palpation may reveal prominent organs CT will often times show inflammation or abscess Sepsis CBC, sed rate, crp, procalcitonin, lactic acid may be useful Abscess may need to be drained, there may be other surgical needs IVF volume resuscitation is needed Usually broad spectrum abx used such as flagyl, cipro or levaquin, and zosyn Follow labs and patient assessment findings Obstruction Usually visceral pain and increased bowel sounds with rapid onset pain. Illeus may have decreased bowel sounds and longer onset Emesis of partially digested food Medical history important (opioids, decreased movement, surgical history) Distended abdomen, often times can see on CT (transition Point) and plain film Up to 25% abdominal pain in the elderly Can be hernia, carcinoma, adhesions, impaction/constipation 6

7 Treatment of Obstruction Bowel rest NGT (also assists with patient comfort with decompression) Can be surgical emergency if ischemia or perforation seen Pain can be managed with NSAIDs such as Toradol if there aren t other contraindications Avoid opiods if possible Significant amount of IVF are helpful GI Hemorrhage Upper vs Lower H+H Heme stool/heme emesis EGD/Colonoscopy Capsule Endoscopy Bleeding Scan Need for hospitalization? Peptic Ulcer Sharp pain after eating and at night Stress, ETOH, smoking, NSAIDs, steroids are risk factors as well as H pylori Can perforate and require surgery Can occur in gastric or duodenal area Often treated with PPIs If bleeding apparent or if dysphagia, weight loss, or persistent vomiting, probably needs endoscopy 7

8 H Pylori Common cause of peptic ulcers Diagnosed by egd with biopsy or c-labeled urea breath test Three treatment modalities: Amoxicillin or Tetracycline 500 mg QID plus Metronidazole 250 mg QID, plus Pepto Bismol tablets 2 QID for 7-14 days Metronidazole 500 mg BID plus Omeprazole 20 mg BID plus Clarithromycin 250 mg BID for 7-14 days Clarithromycin 500 mg TID plus Omeprazole 40 mg qd (or 20 mg BID) for 14 days GERD Described as heat burn, acid taste in mouth, dysphagia, chronic cough Motility disorder caused by reflux of acid Very prevalent especially in pregnant individuals Can perform 24hr esophageal ph monitoring EGD/bronchoscopy may show evidence of reflux GERD treatment Lifestyle modification PPIs (prilosec, prevacid, protonix, nexium) H2 Blockers (pepcid, zantac, tagamet) Antacids may help occasional symptoms Prokinetic agents may also be helpful in certain cases 8

9 Diverticulitis Diverticulosis may be found on colonoscopy Diverticulitis often times shows with pain in LLQ and other signs of infection Hx of alternating diarrhea and constipation CT will show the inflamation Bowel rest, hydration, abx (flagyl and floroquinolone) High fiber diet recommended for Diverticulosis Colonoscopy not recommended during diverticulitis due to risk of perforation Hemorrhoids Caused by increased pressure in veins Symptoms include painless bleeding, perianal soiling, itching Coagulation studies and rectal exam May be internal or external Hydrocortisone cream may help itching Stool softeners, sitz baths for non prolapsed Surgery is usually required for prolapsed Pancreatitis Epigastric tenderness and sudden, severe pain May also hear hypoactive bowel sounds History of ETOH or thiazide diuretics or mumps Pain usually worse with food improved with sitting up Check CT, CBC, Amylase, Lipase, CMP 9

10 Pancreatitis Needs hospitalization and close monitoring of electrolytes as well as for perforation (Cullen s or Ggrey Turner s signs) Surgical referral for stones, perforated ulcer, abscess NPO until nausea and pain improves (consider NGT) IVF, possible TPN Chronic pancreatitis occurs when there is persistent inflammation. More in males than females Pyelonephritis Presents with flank pain, fever, n/v U/A, Urine Culture, CBC Signs of sepsis indicate need for hospitalization Look for signs of dehydration for possible need for IVF ABX Ulcerative Colitis Bleeding reported in the acute phase Needs colonoscopy will possible biopsy Prednisone, aminosalicylates may help management Patients may need GI referral for continued care including biologics and immunosuppressive therapies 10

11 Crohns Diarrhea often times with blood, n/v, weight loss Colonoscopy, small bowel follow through will assist with diagnosis It may occur anywhere in the GI tract Skip lesions are seen as well as fistulas, and thickened bowel wall Similar treatment to Ulcerative Colitis Hernia Often benign finding Monitor for incarceration or strangulation Acute colicky pain and n/v may indicate emergent situation May increase risk of GERD Refer to surgeon Hepatitis Best treatment is prevention Vaccine for hep b and hep a, none for hep c A: self limiting seen in contaminated water, institutionalized adults, children in daycare. LFTs 8x normal. Outpatient follow up. B: Highly contagious. Seen in dialysis patients. 5-10% develop chronic HBV. 90% recovery. C: Common cause of nonalcoholic liver dz. Mostly in high risk groups. Often asymptomatic, persistent infection with chronic hepatits common. GI referral 11

12 IBS 75% of patients are female 15-20% of individuals have IBS Diagnosed by abdominal pain for at least 12 weeks plus at least two of the following Change in frequency or consistency of stool Mucus in stool Bloating or abdominal distention Straining, urgency, or inability to empty bowels IBS Treatment depends on predominant symptoms Food diary with stool chart can be very useful Constipation: increase fiber, stool softer, osmotic laxative, prokinetics Diarrhea: Imodium, lomotil, fiber Pain/Bloating: anticholimergics, antidepressants, prokinetics Ensure realistic goals are set 12

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

Appendicitis National Digestive Diseases Information Clearinghouse

Appendicitis National Digestive Diseases Information Clearinghouse Appendicitis National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH The appendix is a small, tube-like structure

More information

The Acute Abdomen. Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital

The Acute Abdomen. Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital The Acute Abdomen Dr. Ed Snyder Dr. Melanie Walker Huntington Memorial Hospital Causes of the Acute Abdomen Hemorrhage in the GI tract Blood vessel GU tract Perforation of the GI tract Ulcer Infection

More information

Gastrointestinal Bleeding

Gastrointestinal Bleeding Gastrointestinal Bleeding Introduction Gastrointestinal bleeding is a symptom of many diseases rather than a disease itself. A number of different conditions can cause gastrointestinal bleeding. Some causes

More information

Nash Heartburn Treatment Center

Nash Heartburn Treatment Center Nash Heartburn Treatment Center a division of Nash Health Care NHCS Mission Statement: To provide superior quality health care services and to help improve the health of the community in a caring, efficient

More information

Introduction. Physiology of the Abdomen. Anatomy & Physiology. Abdominal Pain Introduction (2 of 2) Gastrointestional and Urologic Emergencies

Introduction. Physiology of the Abdomen. Anatomy & Physiology. Abdominal Pain Introduction (2 of 2) Gastrointestional and Urologic Emergencies Gastrointestional and Urologic Emergencies Introduction Abdominal pain is a common complaint. Cause of abdominal pain is often difficult to determine. As an EMT: You do not need to determine exact cause.

More information

Emergencies in Post- Bariatric Surgery Patients

Emergencies in Post- Bariatric Surgery Patients Emergencies in Post- Patients Disclosures Dr. Birnbaumer has no financial disclosures Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator

More information

Acute abdominal conditions Key Points

Acute abdominal conditions Key Points 7 Acute abdominal conditions Key Points 7.1 ASSESSMENT AND DIAGNOSIS Referred abdominal pain Fore gut pain (stomach, duodenum, gall bladder) is referred to the upper abdomen Mid gut pain (small intestine,

More information

Acute Abdominal Pain: Other causes

Acute Abdominal Pain: Other causes Acute Abdominal Pain: Other causes Vishal Gupta, MCh Associate Professor Deptt Surg. Gastroenterology KGMU Definition Acute abdominal pain: Presentation of previously undiagnosed abdominal pain Lasting

More information

Guide to Abdominal or Gastroenterological Surgery Claims

Guide to Abdominal or Gastroenterological Surgery Claims What are the steps towards abdominal surgery? Investigation and Diagnosis It is very important that all necessary tests are undertaken to investigate the patient s symptoms appropriately and an accurate

More information

It s A Gut Feeling: Abdominal Pain in Children. David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians

It s A Gut Feeling: Abdominal Pain in Children. David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians It s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians Introduction Common Symptom Affects 10-15% of school-aged children Definition (Dr.

More information

Marginal Ulcers. Marginal Ulcers. Gastric Remnant Ulcers. Double Balloon Enteroscopy. Marginal Ulcer. Gastrojejunal Stricture.

Marginal Ulcers. Marginal Ulcers. Gastric Remnant Ulcers. Double Balloon Enteroscopy. Marginal Ulcer. Gastrojejunal Stricture. Upper Abdominal Pain in the Bariatric Surgery Patient Martin L. Freeman, M.D., FASGE,FACG Professor of Medicine Director, Pancreaticobiliary Endoscopy Fellowship Interim Director, Division of GI, Hepatology

More information

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis

More information

Upper Gastrointestinal Tract KNH 406

Upper Gastrointestinal Tract KNH 406 Upper Gastrointestinal Tract KNH 406 Upper GI A&P GI tract long tube ~ 15 ft. Upper GI mouth, pharynx, esophagus, stomach Accessory organs pancreas, biliary system, liver Four basic functions: motility,

More information

Gallbladder Diseases and Problems

Gallbladder Diseases and Problems Gallbladder Diseases and Problems Introduction Your gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. There are many diseases and problems that

More information

GI Assessment, Diagnosis and Case Studies. Jami Windhorn, RN BSN SOAR Session #6

GI Assessment, Diagnosis and Case Studies. Jami Windhorn, RN BSN SOAR Session #6 GI Assessment, Diagnosis and Case Studies Jami Windhorn, RN BSN SOAR Session #6 Abdominal Assessment 4 Quadrants: * Right Upper * Right Lower * Left Upper * Left Lower Abdominal Assessment 9 Regions: Abdominal

More information

The Anorexic Cat For this reason, any cat that stops eating for any reason is considered an emergency situation.

The Anorexic Cat For this reason, any cat that stops eating for any reason is considered an emergency situation. The Anorexic Cat Introduction Any cat that stops eating (anorexic) or begins to eat much less than their normal amount should be seen by a veterinarian right away. The primary reason why a cat stops eating

More information

Chronic abdominal pain of childhood

Chronic abdominal pain of childhood Chronic abdominal pain of childhood Sandra I. Escalera, M.D. ProHealth Physicians Associate Clinical Professor Department of Pediatrics Yale University School of Medicine Objectives Brief overview of approach

More information

Learning Objectives. Introduction to Medical Careers. Vocabulary: Chapter 16 FACTS. Functions. Organs. Digestive System Chapter 16

Learning Objectives. Introduction to Medical Careers. Vocabulary: Chapter 16 FACTS. Functions. Organs. Digestive System Chapter 16 Learning Objectives Introduction to Medical Careers Digestive System Chapter 16 Define at least 10 terms relating to the digestive Describe the four functions of the digestive Identify different structures

More information

Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. By: Jalal Hejazi PhD, MSc.

Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. By: Jalal Hejazi PhD, MSc. Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders By: Jalal Hejazi PhD, MSc. Digestive Disorders Common problem; more than 50 million outpatient visits per year Dietary habits and nutrition

More information

Care and Problems of the Digestive System. Chapter 18 Lesson 2

Care and Problems of the Digestive System. Chapter 18 Lesson 2 Care and Problems of the Digestive System Chapter 18 Lesson 2 Care of the Digestive System Good eating habits are the best way to avoid or minimize digestive system problems. Eat a variety of foods Avoid

More information

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation I have nothing to Disclose Ramsey Dallal, MD, FACS Vice Chair Department of Surgery Chief Bariatric i and Minimally i Invasive Surgery Einstein Healthcare Network Nemacolin, PA 2014 Covered Stents discussed

More information

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

GASTROESOPHAGEAL REFLUX DISEASE (GERD) GASTROESOPHAGEAL REFLUX DISEASE (GERD) Gastroesophageal reflux disease is a clinical scenario where the gastric or duodenal contents reflux back up into the esophagus. Reflux esophagitis, however, is a

More information

ABDOMINAL PAIN. Epigastric Pain. Right Upper Quadrant Pain. Location Work-up Acute pain syndromes Chronic pain syndromes

ABDOMINAL PAIN. Epigastric Pain. Right Upper Quadrant Pain. Location Work-up Acute pain syndromes Chronic pain syndromes ABDOMINAL PAIN Location Work-up Acute pain syndromes Chronic pain syndromes Epigastric Pain PUD GERD MI AAA- abdominal aortic aneurysm Pancreatic pain Gallbladder and common bile duct obstruction Right

More information

Abdominal Pain. Charles Henley, DO, MPH Department of Family Medicine. OSU College of Osteopathic Medicine (Revised 9/2002)

Abdominal Pain. Charles Henley, DO, MPH Department of Family Medicine. OSU College of Osteopathic Medicine (Revised 9/2002) Abdominal Pain Charles Henley, DO, MPH Department of Family Medicine OSU College of Osteopathic Medicine (Revised 9/2002) Common Causes of Abdominal Pain Infants - colic, gastroenteritis, constipation,

More information

Peptic Ulcer. Anatomy The stomach is a hollow organ. It is located in the upper abdomen, under the ribs.

Peptic Ulcer. Anatomy The stomach is a hollow organ. It is located in the upper abdomen, under the ribs. Peptic Ulcer Introduction A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. Peptic ulcers may also develop in the esophagus. Nearly

More information

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions

Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions Laparoscopic Surgery of the Colon and Rectum (Large Intestine) A Simple Guide to Help Answer Your Questions What are the Colon and Rectum? The colon and rectum together make up the large intestine. After

More information

Problems of the Digestive System

Problems of the Digestive System The American College of Obstetricians and Gynecologists f AQ FREQUENTLY ASKED QUESTIONS FAQ120 WOMEN S HEALTH Problems of the Digestive System What are some common digestive problems? What is constipation?

More information

CHOC CHILDREN SUROLOGY CENTER. Constipation

CHOC CHILDREN SUROLOGY CENTER. Constipation Constipation What is constipation? Constipation is a condition in which a person has uncomfortable or infrequent bowel movements. Generally, a person is considered to be constipated when bowel movements

More information

Chapter 6 Gastrointestinal Impairment

Chapter 6 Gastrointestinal Impairment Chapter 6 Gastrointestinal This chapter consists of 2 parts: Part 6.1 Diseases of the digestive system Part 6.2 Abdominal wall hernias and obesity PART 6.1: DISEASES OF THE DIGESTIVE SYSTEM Diseases of

More information

Bile Duct Diseases and Problems

Bile Duct Diseases and Problems Bile Duct Diseases and Problems Introduction A bile duct is a tube that carries bile between the liver and gallbladder and the intestine. Bile is a substance made by the liver that helps with digestion.

More information

Peptic Ulcer Disease and H. pylori

Peptic Ulcer Disease and H. pylori Peptic Ulcer Disease and H. pylori National Digestive Diseases Information Clearinghouse What is a peptic ulcer? A peptic ulcer is a sore on the inner lining of the stomach or duodenum the first part of

More information

ABDOMINAL PAIN. 2. Name the most common abdominal emergencies for each of the major anatomic areas of the abdomen

ABDOMINAL PAIN. 2. Name the most common abdominal emergencies for each of the major anatomic areas of the abdomen ABDOMINAL PAIN Objectives: 1. Distinguish between somatic and referred pain 2. Name the most common abdominal emergencies for each of the major anatomic areas of the abdomen 3. Understand age-related differences

More information

Steven B. Goldin, MD, PhD University of South Florida Dimitrios Stefanidis, MD, PhD

Steven B. Goldin, MD, PhD University of South Florida Dimitrios Stefanidis, MD, PhD RUQ Abdominal Pain Steven B. Goldin, MD, PhD University of South Florida Dimitrios Stefanidis, MD, PhD Mrs. Stone 41 year-old woman in the ER presenting with 12 hours duration of progressively worsening

More information

National Digestive Diseases Information Clearinghouse

National Digestive Diseases Information Clearinghouse Gastritis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is gastritis? Gastritis is a condition in which the stomach

More information

Homeostatic Imbalances of the Digestive System

Homeostatic Imbalances of the Digestive System Homeostatic Imbalances of the Digestive System Sign or Disease Description, Causes, Etc. 1 Abdominal Adhesions Fibrous bands that form between tissues and organs, often as a result of injury during surgery;

More information

GI Bleeding. Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics

GI Bleeding. Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics GI Bleeding Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics Overview Because GI bleeding is internal, it is possible for a person to have GI bleeding without symptoms. Important to recognize

More information

RENAL ANGIOMYOLIPOMA EMBOLIZATION

RENAL ANGIOMYOLIPOMA EMBOLIZATION RENAL ANGIOMYOLIPOMA EMBOLIZATION The information about renal angiomyolipomas on the next several pages includes questions commonly asked about the embolization procedure. Please take a few moments to

More information

understanding GI bleeding

understanding GI bleeding understanding GI bleeding a consumer education brochure American College of Gastroenterology 4900B South 31st Street, Arlington, VA 22206 703-820-7400 www.acg.gi.org American College of Gastroenterology

More information

Amylase and Lipase Tests

Amylase and Lipase Tests Amylase and Lipase Tests Also known as: Amy Formal name: Amylase Related tests: Lipase The Test The blood amylase test is ordered, often along with a lipase test, to help diagnose and monitor acute or

More information

Digestive System (continued) Digestive System. Stomach. Peptic Ulcer Disease

Digestive System (continued) Digestive System. Stomach. Peptic Ulcer Disease Digestive System Digestive System (continued) Responsible for breaking down food, absorbing nutrients, eliminating wastes Alimentary canal Also known as gastrointestinal tract Reaches from mouth to anus

More information

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Gallbladder removal is one of the most commonly performed surgical procedures. Gallbladder removal surgery is usually performed

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

Colorectal Cancer Care A Cancer Care Map for Patients

Colorectal Cancer Care A Cancer Care Map for Patients Colorectal Cancer Care A Cancer Care Map for Patients Understanding the process of care that a patient goes through in the diagnosis and treatment of colorectal cancer in BC. Colorectal Cancer Care Map

More information

Laparoscopic Repair of Hernias. A simple guide to help answer your questions

Laparoscopic Repair of Hernias. A simple guide to help answer your questions Laparoscopic Repair of Hernias A simple guide to help answer your questions What is a hernia? A hernia is defined as a hole or defect in the abdominal (belly) wall. A hernia can either be congenital (a

More information

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy Laparoscopic Cholecystectomy Gallbladder removal is one of the most commonly performed surgical procedures in the United States. Today,gallbladder surgery is performed laparoscopically. The medical name

More information

GI Bleed. Steven Lichtenstein, D.O. Chief, Division of Gastroenterology Mercy Health System. Director, Endoscopy/GI Lab Mercy Fitzgerald Hospital

GI Bleed. Steven Lichtenstein, D.O. Chief, Division of Gastroenterology Mercy Health System. Director, Endoscopy/GI Lab Mercy Fitzgerald Hospital October 3, 2015 GI Bleed Steven Lichtenstein, D.O. Chief, Division of Gastroenterology Mercy Health System Director, Endoscopy/GI Lab Mercy Fitzgerald Hospital Clinical Associate Professor of Medicine

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

Colon and Rectal Cancer

Colon and Rectal Cancer Colon and Rectal Cancer What is colon or rectal cancer? Colon or rectal cancer is the growth of abnormal cells in your large intestine, which is also called the large bowel. The colon is the last 5 feet

More information

Abdominal Wall Pain. What is Abdominal Wall Pain?

Abdominal Wall Pain. What is Abdominal Wall Pain? Abdominal Wall Pain What is Abdominal Wall Pain? Abdominal Wall Pain is a syndrome (an experience) of abdominal pain that can occur at any time of life and is not unique to children. It is diagnosed by

More information

Differential diagnosis of abdominal pain. Lakatos Péter László

Differential diagnosis of abdominal pain. Lakatos Péter László Differential diagnosis of abdominal pain Lakatos Péter László Precise anamnesis Physical examination are prognosticated to the cause of the pain Anamnesis Sudden pain Perforation Mesenteric infarction

More information

Upper Endoscopy (EGD)

Upper Endoscopy (EGD) Upper Endoscopy (EGD) Appointment Information: Patient Name: MRN: Physician Name: Location: _ For information on Directions, please visit: http://www.brighamandwomens.org/general/directions/directions.aspx

More information

Femoral Hernia Repair

Femoral Hernia Repair Femoral Hernia Repair WHAT IS A FEMORAL HERNIA REPAIR? 2 WHAT CAUSES A FEMORAL HERNIA? 2 WHAT DOES TREATMENT/ MANAGEMENT INVOLVE? 3 DAY SURGERY MANAGEMENT 3 SURGICAL REPAIR 4 WHAT ARE THE RISKS/COMPLICATIONS

More information

FUNCTIONAL BOWEL DISORDERS

FUNCTIONAL BOWEL DISORDERS FUNCTIONAL BOWEL DISORDERS Contributed by the International Foundation for Functional Gastrointestinal Disorders (IFFGD) and edited by the Patient Care Committee of the ACG. INTRODUCTION Doctors use the

More information

ENDOSCOPIC ULTRASOUND (EUS)

ENDOSCOPIC ULTRASOUND (EUS) ENDOSCOPIC ULTRASOUND (EUS) What you need to know before your procedure Your Doctor has decided that an EUS is necessary for further evaluation and treatment of your condition. This information sheet has

More information

What can I eat? Peptic ulcers. What are peptic ulcers? What tests are needed? Will the ulcer come back? What causes a peptic ulcer?

What can I eat? Peptic ulcers. What are peptic ulcers? What tests are needed? Will the ulcer come back? What causes a peptic ulcer? In association with: INFORMATION ABOUT Peptic ulcers www.corecharity.org.uk What are peptic ulcers? What causes a peptic ulcer? How are NSAIDs and aspirin involved? How do I know if I ve got an ulcer?

More information

SOD (Sphincter of Oddi Dysfunction)

SOD (Sphincter of Oddi Dysfunction) SOD (Sphincter of Oddi Dysfunction) SOD refers to the mechanical malfunctioning of the Sphincter of Oddi, which is the valve muscle that regulates the flow of bile and pancreatic juice into the duodenum.

More information

CHOP Chemotherapy Regimen for Lymphoma Information for Patients

CHOP Chemotherapy Regimen for Lymphoma Information for Patients CHOP Chemotherapy Regimen for Lymphoma Information for Patients The Regimen Contains: C: Cytoxan (cyclophosphamide) H: Adriamycin (hydroxy doxorubicin) O: vincristine (Oncovin ) P: Prednisone How Is This

More information

Medication Guide. Serious loss of body fluid (dehydration) and changes in blood salts (electrolytes) in your blood.

Medication Guide. Serious loss of body fluid (dehydration) and changes in blood salts (electrolytes) in your blood. Medication Guide MoviPrep (moo-vee-prěp) (PEG 3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate, and ascorbic acid for oral solution) Read this Medication Guide before you start

More information

Inguinal Hernia (Female)

Inguinal Hernia (Female) Inguinal Hernia (Female) WHAT IS AN INGUINAL HERNIA? 2 WHAT CAUSES AN INGUINAL HERNIA? 2 WHAT DOES TREATMENT / MANAGEMENT INVOLVE? 3 DAY SURGERY MANAGEMENT 3 SURGICAL REPAIR 4 WHAT ARE THE RISKS/COMPLICATIONS

More information

Motility Disorders that are Commonly Mistaken for Reflux by Susan Agrawal

Motility Disorders that are Commonly Mistaken for Reflux by Susan Agrawal www.complexchild.com Motility Disorders that are Commonly Mistaken for Reflux by Susan Agrawal A surprisingly large number of children with motility disorders experience the same progression of events

More information

Chemotherapy Side Effects Worksheet

Chemotherapy Side Effects Worksheet Page 1 of 6 Chemotherapy Side Effects Worksheet Medicines or drugs that destroy cancer cells are called cancer chemotherapy. It is sometimes the first choice for treating many cancers. Chemotherapy differs

More information

Patient information regarding care and surgery associated with ULCERATIVE COLITIS

Patient information regarding care and surgery associated with ULCERATIVE COLITIS Patient information regarding care and surgery associated with ULCERATIVE COLITIS by: Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J. Stefanou, M.D. location: Michigan Heart & Vascular Institute,

More information

MEDICAL HISTORY AND SCREENING FORM

MEDICAL HISTORY AND SCREENING FORM MEDICAL HISTORY AND SCREENING FORM The purpose of preventive exams is to screen for potential health problems and provide education to promote optimal health. It is best practice for chronic health problems

More information

PREPARING FOR YOUR STOMA REVERSAL

PREPARING FOR YOUR STOMA REVERSAL PREPARING FOR YOUR STOMA REVERSAL Information Leaflet Your Health. Our Priority. Page 2 of 6 Introduction- What you need to know As part of your bowel operation you may have had a temporary stoma formed.

More information

G E R D. (Gastroesophageal Reflux Disease)

G E R D. (Gastroesophageal Reflux Disease) G E R D (Gastroesophageal Reflux Disease) What is GERD? Gastroesophageal reflux disease (GERD) is a disorder caused by gastric acid flowing from the stomach into the esophagus. What are the symptoms of

More information

Healthletter. Hernias They Should not be Ignored. August 2009

Healthletter. Hernias They Should not be Ignored. August 2009 Healthletter August 2009 Hernias They Should not be Ignored Did you know that over five million Americans suffer from some type of hernia? For many of these people, this condition causes substantial pain

More information

THE KIDNEY. Bulb of penis Abdominal aorta Scrotum Adrenal gland Inferior vena cava Urethra Corona glandis. Kidney. Glans penis Testicular vein

THE KIDNEY. Bulb of penis Abdominal aorta Scrotum Adrenal gland Inferior vena cava Urethra Corona glandis. Kidney. Glans penis Testicular vein 29 THE KIDNEY 9. Recurrent urinary tract infections Recurrent urinary tract infections The urinary tract consists of the urethra, the bladder, the ureters, the kidneys and in men the prostate gland. An

More information

Peptic Ulcer Disease and Dyspepsia. John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital

Peptic Ulcer Disease and Dyspepsia. John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital Peptic Ulcer Disease and Dyspepsia John M. Inadomi, MD Professor of Medicine UCSF Chief, Clinical Gastroenterology San Francisco General Hospital Case History 49 y/o woman complains of several months of

More information

Excision of Vaginal Mesh

Excision of Vaginal Mesh What is excision of vaginal mesh? This procedure is done to remove mesh from the vagina. When is this surgery used? If mesh has eroded into the vagina, bladder, urethra, or bowel If there is pain associated

More information

Dallas Neurosurgical and Spine Associates, P.A Patient Health History

Dallas Neurosurgical and Spine Associates, P.A Patient Health History Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of

More information

Abdominal Wall (Ventral, Incisional, Umbilical) Hernia Repair Postoperative Instructions

Abdominal Wall (Ventral, Incisional, Umbilical) Hernia Repair Postoperative Instructions Abdominal Wall (Ventral, Incisional, Umbilical) Hernia Repair Postoperative Instructions No lifting greater than 10 15 lbs for the first three weeks following your surgery. Walking around the house, office

More information

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name

Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy. Patient Name Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Vertical Sleeve

More information

Surgical Weight Loss. Mission Bariatrics

Surgical Weight Loss. Mission Bariatrics Surgical Weight Loss Mission Bariatrics Obesity is a major health problem in the United States, with more than one in every three people suffering from this chronic condition. Obese adults are at an increased

More information

Laparoscopic Cholecystectomy (Removal of the Gallbladder)

Laparoscopic Cholecystectomy (Removal of the Gallbladder) Laparoscopic Cholecystectomy (Removal of the Gallbladder) The gall bladder is a small pear-shaped organ that lies in the right upper quadrant of your abdomen under your liver (under your ribs). The liver

More information

GASTRIC BYPASS SURGERY CONSENT FORM

GASTRIC BYPASS SURGERY CONSENT FORM Page 1 of 6 I, have been asked to read carefully all of the (name of patient or substitute decision-maker) information contained in this consent form and to consent to the procedure described below on

More information

Diseases of peritoneum Lect. Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32

Diseases of peritoneum Lect. Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32 Diseases of peritoneum Lect Al Qassim University, Faculty of Medicine Phase II Year III, CMD 332 Pathology Department 31-32 Describe the etiology, pathogenesis and types of peritonitis Define ascites and

More information

Millions of Americans suffer from abdominal pain, bloating, constipation and diarrhea. Now new treatments can relieve your pain and discomfort.

Millions of Americans suffer from abdominal pain, bloating, constipation and diarrhea. Now new treatments can relieve your pain and discomfort. 3888-IBS Consumer Bro 5/8/03 10:38 AM Page 1 TAKE THE IBS TEST Do you have recurrent abdominal pain or discomfort? YES NO UNDERSTANDING IRRITABLE BOWEL SYNDROME A Consumer Education Brochure Do you often

More information

Abdominal Anatomy & Physiology

Abdominal Anatomy & Physiology CHAPTER 18 Acute Abdominal Emergencies Abdominal Anatomy & Physiology Abdominal A & P 1 Abdominal A & P Most organs contained in the peritoneum Visceral Peritoneum Covers organs Parietal Peritoneum Attached

More information

Epigastric Hernia Repair

Epigastric Hernia Repair Epigastric Hernia Repair WHAT IS EPIGASTRIC HERNIA REPAIR? 2 WHAT CAUSES IT? 2 WHAT DOES TREATMENT/MANAGEMENT INVOLVE? 2 WHAT WOULD HAPPEN IF THE HERNIA WAS NOT TREATED? 3 EPIGASTRIC HERNIA REPAIR 3 WHAT

More information

Borland-Groover Clinic PATIENT GENERATED MEDICAL HISTORY Name: DOB: Email: Primary Care Physician: Pharmacy: Pharmacy Phone #:

Borland-Groover Clinic PATIENT GENERATED MEDICAL HISTORY Name: DOB: Email: Primary Care Physician: Pharmacy: Pharmacy Phone #: PATIENT GENERATED MEDICAL HISTORY Name: DOB: Email: Primary Care Physician: Referring: Pharmacy: Pharmacy Phone #: Place Sticker Here Directions: Please circle any of the following you have personally

More information

Understanding. Pancreatic Cancer

Understanding. Pancreatic Cancer Understanding Pancreatic Cancer Understanding Pancreatic Cancer The Pancreas The pancreas is an organ that is about 6 inches long. It s located deep in your belly between your stomach and backbone. Your

More information

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name

Informed Consent for Laparoscopic Roux en Y Gastric Bypass. Patient Name Informed Consent for Laparoscopic Roux en Y Gastric Bypass Patient Name Please read this form carefully and ask about anything you may not understand. I consent to have a laparoscopic Roux en Y Gastric

More information

Abdominal Pain in Adults

Abdominal Pain in Adults 1 Abdominal Pain in Adults Abdominal pain is the most common complaint seen in emergency departments in the United States and one of the 10 most common complaints in family medicine outpatient settings.

More information

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy Laparoscopic Cholecystectomy Removal of Gall Bladder Page 12 Patient Information Further Information We endeavour to provide an excellent service at all times, but should you have any concerns please,

More information

Understanding Laparoscopic Colorectal Surgery

Understanding Laparoscopic Colorectal Surgery Understanding Laparoscopic Colorectal Surgery University Colon & Rectal Surgery A Problem with Your Colon Your doctor has told you that you have a colon problem. Now you ve learned that surgery is needed

More information

What Is Clostridium Difficile (C. Diff)? CLOSTRIDIUM DIFFICILE (C. DIFF)

What Is Clostridium Difficile (C. Diff)? CLOSTRIDIUM DIFFICILE (C. DIFF) What Is Clostridium Difficile (C. Diff)? Clostridium difficile, or C. diff for short, is an infection from a bacterium, or bug, that can grow in your intestines and cause bad GI symptoms. The main risk

More information

Scleroderma Education Program. Chapter 4. Gastrointestinal Tract

Scleroderma Education Program. Chapter 4. Gastrointestinal Tract Scleroderma Education Program Chapter 4 Gastrointestinal Tract Chapter 4-1 Chapter Highlights 1. Learn about how the GI tract works. 2. What happens when things go wrong? -Appetite loss -Difficulty chewing

More information

The digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies

The digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies The digestive system Medicine and technology Normal structure and function Diagnostic methods Example diseases and therapies The digestive system An overview (1) Oesophagus Liver (hepar) Biliary system

More information

Biliary Stone Disease

Biliary Stone Disease Biliary Stone Disease Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm You have

More information

Laparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery?

Laparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery? Laparoscopic Colectomy What do I need to know about my laparoscopic colorectal surgery? Traditionally, colon & rectal surgery requires a large, abdominal and/or pelvic incision, which often requires a

More information

What is the Sleeve Gastrectomy?

What is the Sleeve Gastrectomy? What is the Sleeve Gastrectomy? The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for

More information

Patient Information Form Pain Management Center at Phoebe

Patient Information Form Pain Management Center at Phoebe Patient Information Form Pain Management Center at Phoebe Please complete the following form, so that we may facilitate your visit Occupation: or (circle) Retired, Disabled Homemaker, Full time student

More information

Diagnostics: Page 2 of 5

Diagnostics: Page 2 of 5 Proteinuria Proteinuria is a condition in which there are increased amounts of protein in the urine. There are a number of different diseases which can result in proteinuria. In the early stages of the

More information

Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES

Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Surgery for "Heartburn" If you suffer from moderate to severe "heartburn" your surgeon may have recommended Laparoscopic Antireflux

More information

Treating Chronic Hepatitis C. A Review of the Research for Adults

Treating Chronic Hepatitis C. A Review of the Research for Adults Treating Chronic Hepatitis C A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* has told you that you have chronic hepatitis C.

More information