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Common abdominal syndromes

Common abdominal syndromes. Gastroesophageal reflux disease - GERD. History: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia, odynophagia, extraesophageal: cough, asthma, noncardiac chest pain Characteristics: increase in laying position

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Common abdominal syndromes

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  1. Common abdominal syndromes

  2. Gastroesophageal reflux disease - GERD • History: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia, odynophagia, extraesophageal: cough, asthma, noncardiac chest pain • Characteristics: increase in laying position night symptoms resolve after antacids • Physical findings: • Diagnosis: history, endoscopy, pH-monitoring, barium swallow

  3. Esophageal cancer • History: dysphagia, odynophagia, pain, vomiting, weight loss • Characteristics: older males, alcoholics, smokers progressive dysphagia (solidsofterliquid) vomiting just after meals • Physical finding: general tumor signs • Diagnosis: barium swallow, endoscopy

  4. Peptic ulcer (duodenal, gastric) • History: epigastric pain • Characteristics: • radiates to the back • duodenal: younger people, hyperacid symptoms, relapsing disease, more symptoms in spring and fall, pain resolves after meals and recur after 2 hours, night pain, resolve using antacids • gastric: older people, pain just after meals, weight loss • smokers • NSAID (aspirin) use

  5. Peptic ulcer (duodenal, gastric) • Physical finding: epigastric/RUQ tenderness • Diagnosis: endoscopy or barium study gastric ulcer: always indication for endoscopy and biopsy

  6. Peptic ulcer - complications • Bleeding: melena, hematemesis, (rarely: hematochezia) rectal digital examination • Perforation: acute onset very sharp pain (knife-like) liver/splenic dullnes: absent peritoneal signs: defence (guarding), rebound tenderness, no bowel sounds Dg: abdominal plain film study with water-soluble contrast agent

  7. Peptic ulcer - complications • Obstruction a. reversible b. irreversible (scar) History: vomiting of undigested food fullness, pain Physical signs: succussion splash tenderness Diagnosis: gastric emptying study (barium) endoscopy

  8. Gastric cancer • History: epigastric pain, fullness, vomiting, weight loss • Characteristics: older people, pain arise at meals dull, progressive pain • Physical findings:epigastric pain, epigastric mass Virchow’s lymph node general tumor signs occult bleeding • Diagnosis: barium study, endoscopy, US

  9. Intestinal obstruction (ileus) 1. Mechanical • History: altered bowel habits, constipation, fullness, meteorism, cramping pain, vomiting (bile, fecal material) • Characteristics: variable or progressive • Physical finding: meteorism increased bowel sound splash signs of underlying disease • Diagnosis: plain abdominal x-ray searching for the cause

  10. Intestinal obstruction (ileus) 2. Paralytic • History: signs of the underlying disease, constipation, fullness, meteorism, cramping pain, vomiting • Physical finding: meteorism absent bowel sound splash signs of the underlying disease • Diagnosis: plain abdominal x-ray searching for the cause

  11. Colorectal cancer • History: positive family history altered bowel habits bleeding (occult or manifest) late: signs of obstruction cramping pain general tumor signs • Physical finding:rectal digital examination late: mass, ileus • Diagnosis: barium study, endoscopy, US

  12. Acute hepatitis • History: asymptomatic after flu-like symptoms jaundice anorexia, dyspepsia RUQ pain • Physical finding: jaundice enlarged liver: smooth, soft, round, tender • Diagnosis: liver tests, virus tests

  13. Chronic hepatitis • History: symptoms: not characteristic anorexia, dyspepsia later: symptoms of cirrhosis • Physical finding: enlarged liver (can be normal) • Diagnosis: US, liver biopsy, serology

  14. Liver cirrhosis • History: alcohol consumption, chr. hepatitis (HBV, HCV, HDV, HGV, autoimmune), anorexia, dyspepsia, nausea ascites, edemas, portal encephalopathy jaundice, bleeding • Physical findings: first: enlarged liver micronodular: alcoholic macronodular: chr. virus or autoimmune hepatitis- postnecrotic cirrhosis end stage: small liver

  15. Liver cirrhosis • Physical findings: skin: palmar and plantar erythema spider naevi icterus (scratching) gynecomasty testicular atrophy signs of portal hypertension: ascites (transsudate) caput Medusae splenomegaly edema • Diagnosis: US, liver biopsy, laboratory

  16. Biliary colic • History:pain after fatty meals nausea, vomiting (often bile) fullness, meteorism • Characteristics: RUQ-pain, radiates to the back (scapula, right shoulder) mostly females • Physical finding: RUQ tenderness • Diagnosis: US

  17. Acute cholecystitis • History: like in biliary colic + fever • Physical finding: Murphy’s sign • Diagnosis: US, laboratory: signs of inflammation Choledocholithiasis • History: like in biliary colic + obstr. jaundice • Diagnosis: US, ERCP, CT, PTC

  18. Acute pancreatitis • History: gallstone disease,fatty meal,alcohol epigastric pain fullness, nausea, vomitus fever jaundice hypotony, shock • Characteristics: band-like, cramping pain radiates to the back

  19. Acute pancreatitis • Physical findings: epigastric tenderness/guarding peritoneal signs signs of paralytic ileus (meteorism, no bowel sounds) skin signs: Cullen’s sign-periumbilical ecchymoses Grey-Turner’s sign- lumbar ecchymoses • Diagnosis: pancreatic enzimes, US, CT

  20. Chronic pancreatitis • History: cramping pain anorexia, dyspepsia, nausea, vomitus gallstone or alcohol consumption weight loss steatorrhea • Characteristics: pain in the back increases after meals • Physical finding: epigastric tenderness epigastric mass (pseudocyst) sometimes jaundice • Diagnosis: plain abd. X-ray, US, CT, ERCP

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