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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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gastroesophageal reflux disease gerd
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
esophageal cancer
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
peptic ulcer duodenal gastric
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
peptic ulcer duodenal gastric1
Peptic ulcer (duodenal, gastric)
  • Physical finding: epigastric/RUQ tenderness
  • Diagnosis: endoscopy or barium study gastric ulcer: always indication for endoscopy and biopsy
peptic ulcer complications
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

peptic ulcer complications1
Peptic ulcer - complications
  • Obstruction a. reversible

b. irreversible (scar)

History: vomiting of undigested food

fullness, pain

Physical signs: succussion splash


Diagnosis: gastric emptying study (barium)


gastric cancer
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
intestinal obstruction ileus
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


signs of underlying disease

  • Diagnosis: plain abdominal x-ray

searching for the cause

intestinal obstruction ileus1
Intestinal obstruction (ileus)

2. Paralytic

  • History: signs of the underlying disease, constipation, fullness, meteorism, cramping pain, vomiting
  • Physical finding: meteorism

absent bowel sound


signs of the underlying


  • Diagnosis: plain abdominal x-ray

searching for the cause

colorectal cancer
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
acute hepatitis
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
chronic hepatitis
Chronic hepatitis
  • History: symptoms: not characteristic

anorexia, dyspepsia

later: symptoms of cirrhosis

  • Physical finding: enlarged liver (can be normal)
  • Diagnosis: US, liver biopsy, serology
liver cirrhosis
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

liver cirrhosis1
Liver cirrhosis
  • Physical findings:

skin: palmar and plantar erythema

spider naevi

icterus (scratching)


testicular atrophy

signs of portal hypertension:

ascites (transsudate)

caput Medusae



  • Diagnosis: US, liver biopsy, laboratory
biliary colic
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
acute cholecystitis
Acute cholecystitis
  • History: like in biliary colic + fever
  • Physical finding: Murphy’s sign
  • Diagnosis: US, laboratory: signs of inflammation


  • History: like in biliary colic + obstr. jaundice
  • Diagnosis: US, ERCP, CT, PTC
acute pancreatitis
Acute pancreatitis
  • History: gallstone disease,fatty meal,alcohol

epigastric pain

fullness, nausea, vomitus



hypotony, shock

  • Characteristics: band-like, cramping pain

radiates to the back

acute pancreatitis1
Acute pancreatitis
  • Physical findings:

epigastric tenderness/guarding

peritoneal signs

signs of paralytic ileus (meteorism, no bowel


skin signs: Cullen’s sign-periumbilical


Grey-Turner’s sign- lumbar


  • Diagnosis: pancreatic enzimes, US, CT
chronic pancreatitis
Chronic pancreatitis
  • History: cramping pain

anorexia, dyspepsia, nausea, vomitus

gallstone or alcohol consumption

weight loss


  • 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