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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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