GI Infections
Pain migrates to RLQ with anorexia and nausea.
Appendicitis – NPO, IV fluids, analgesics, antibiotics, surgical consult.
Postprandial RUQ pain radiates to right shoulder, gallstones on US.
Acute cholecystitis – NPO, IV fluids, analgesics, surgery consult.
Sudden severe abdominal pain in elderly with atrial fibrillation.
Acute mesenteric ischemia – IV fluids, NG tube, broad-spectrum antibiotics, early surgical consult.
Blunt abdominal trauma, seatbelt sign, hypotension.
Hemorrhagic shock from solid organ injury – ABCDEs, IV fluids, blood products, surgery.
Crampy abdominal pain, vomiting, distention, X-ray shows air-fluid levels.
Small bowel obstruction – NPO, NG tube, IV fluids, surgery if high-grade/closed loop.
RLQ tenderness in children or teens with recent URI.
Mesenteric adenitis – Supportive care, hydration, analgesics.
RUQ pain, fever, jaundice, hypotension
Ascending cholangitis – IV fluids, antibiotics, urgent biliary drainage, ICU
Tachycardia, hypotension, positive FAST after trauma.
Intra-abdominal hemorrhage – Emergent surgery, IV fluids, blood products.
Ecchymosis of flanks (Grey-Turner) or umbilicus (Cullen).
Retroperitoneal bleeding – IV fluids, labs, surgical/IR consult.
LLQ pain, fever, CT shows colonic diverticula, no peritonitis.
Uncomplicated diverticulitis – Bowel rest, antibiotics optional, outpatient management
Watery diarrhea, fever, diffuse crampy pain.
Gastroenteritis – Hydration, antiemetics, supportive care.
Stone in common bile duct causing obstructive labs.
Choledocholithiasis – ERCP, NPO, IV fluids, analgesics
Abdominal pain with peritoneal signs, free air under diaphragm.
Perforated viscous – Emergent laparotomy, IV fluids, antibiotics
Penetrating abdominal trauma, hypotensive.
Emergent laparotomy, IV fluids, blood products
Upper GI bleeding in patient with portal hypertension.
Variceal bleed – IV fluids, antibiotics, octreotide, EGD banding.
Bloody diarrhea, abdominal pain, toxic megacolon risk.
IBD flare – NPO, IV fluids, steroids, surgical consult if toxic
Epigastric pain radiates to back, lipase >3x ULN
Acute pancreatitis – NPO, aggressive IV fluids, analgesics, admit if unable to tolerate PO.
Ascites in cirrhotic patient with fever and diffuse abdominal tenderness.
Spontaneous bacterial peritonitis – IV antibiotics, albumin, admission.
Positive FAST with hemodynamic instability.
Intra-abdominal bleeding – Emergent surgical consult, blood products, stabilization.
Free air under diaphragm with severe abdominal pain.
Perforated peptic ulcer – Emergent surgery, IV fluids, IV PPI, antibiotics.
Hematochezia or melena with hemodynamic instability.
GI bleed – Large-bore IVs, fluids, transfusion, PPI, GI consult, ICU if unstable.
Fever, RUQ pain, wall thickening on US in critically ill.
Acalculous cholecystitis – IV fluids, antibiotics, surgery consult.
Non-reducible, tender inguinal mass with nausea.
Strangulated hernia – NPO, IV fluids, analgesics, antibiotics, emergent surgery.
Suspected urethral injury with pelvic fracture.
Avoid foley, IV fluids, surgical consult, imaging.
Dysphagia, drooling, history of swallowing a button battery.
Esophageal foreign body – Emergent EGD.