Common abdominal syndromes
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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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Common abdominal syndromes

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Common abdominal syndromes

Common abdominal syndromes


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

    tenderness

    Diagnosis: gastric emptying study (barium)

    endoscopy


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

    splash

    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

    splash

    signs of the underlying

    disease

  • 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)

    gynecomasty

    testicular atrophy

    signs of portal hypertension:

    ascites (transsudate)

    caput Medusae

    splenomegaly

    edema

  • 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

    Choledocholithiasis

  • 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

    fever

    jaundice

    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

    sounds)

    skin signs: Cullen’s sign-periumbilical

    ecchymoses

    Grey-Turner’s sign- lumbar

    ecchymoses

  • Diagnosis: pancreatic enzimes, US, CT


Chronic pancreatitis

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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