Key Concepts Adnexal torsion is easily missed on initial presentation and should be considered in any patient with known risk factors, even if symptoms are subtle or atypical. Doppler ultrasound is the preferred initial imaging study for suspected adnexal torsion.…
Key Concepts Urinary obstruction should be considered in patients with a urinary tract infection (UTI) with risk factors for obstruction. Urinary obstruction should be ruled out in patients presenting in septic shock. Patients presenting with acute ureteral obstruction require a…
Key ConceptS The emergency department (ED) diagnosis of sexually transmitted infections (STIs) is often based on clinical findings. Empirical antibiotic treatment is warranted to cover the most likely infecting organisms based upon history and physical examination findings. Rapidly available diagnostic…
Key Concepts The causes of acute kidney injury (AKI) can be classified as prerenal, postrenal, and intrinsic renal disorders. Abrupt cessation of glomerular filtration typically results in a rise of the serum creatinine level of 1 to 2 mg/dL per…
Key Concepts Anorectal conditions can be approached using an algorithm that addresses the presence or absence of pain, bleeding, swelling, and pruritus, in combination with an assessment of the patient’s overall health (see Fig. 82.2 ). Patients who seek treatment…
Key Concepts Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a chronic disorder that includes both abdominal pain and bloating and is either diarrhea-predominant, constipation-predominant, or a mixed picture. Treatment of IBS is challenging and commonly involves a combination of…
Key Concepts Gastroenteritis is usually self-limited and requires supportive care only. Routine laboratory testing or stool cultures are not indicated for most patients. Patients with gastroenteritis associated with fever, dysentery, bloody stools, severe dehydration, sepsis, a suspicion for Clostridium difficile,…
Key Concept Appendicitis is a progressive illness caused by appendiceal luminal distention followed by appendiceal wall ischemia, transmural inflammation, and eventual perforation, with resulting peritonitis. Clinical history, physical examination, and laboratory findings need to be combined to formulate a comprehensive…
Small Bowel Obstruction Key Concepts Small bowel obstruction (SBO) is a common clinical condition accounting for 2% of patients presenting to the emergency department with abdominal pain, leading to an estimated 300,000 hospitalizations annually in the United States. The most…
Key Concepts Acute pancreatitis represents a wide spectrum of disease, ranging from mild to severe life-threatening disease with a mortality rate as high as 30%. The most common causes of acute pancreatitis are gallstones and chronic alcohol consumption. Acute pancreatitis…