Common abdominal syndromes

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Common abdominal syndromes

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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

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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

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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

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Peptic ulcer (duodenal, gastric)

• Physical finding epigastric/RUQ tenderness
• Diagnosis endoscopy or barium study
  gastric ulcer always indication for endoscopy
  and biopsy

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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

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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

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Functional dyspepsia

• Symptoms 1. ulcer-like
  
  
• 2.
  dysmotility-type
• 3. indeterminate
• Physical finding no or light tenderness
• Diagnosis in young therapeutic trial
  
• in olds thorough
  examination to
• rule out
  organic lesions

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Gastric cancer

• History epigastric pain, fullness, vomiting,
  
• weight loss
• Characteristics older people,
• pain arise at
  meals
• dull,
  progressive pain
• Physical findingsepigastric pain, epigastric
  mass
• Virchows
  lymph node
• general
  tumor signs
• occult
  bleeding
• Diagnosis barium study, endoscopy, US

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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

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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

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Colorectal cancer

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

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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

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Chronic hepatitis

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

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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

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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

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Biliary colic

• Historypain 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

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Acute cholecystitis

• History like in biliary colic fever
• Physical finding Murphys sign
• Diagnosis US, laboratory signs of inflammation
• Choledocholithiasis
• History like in biliary colic obstr. jaundice
• Diagnosis US, ERCP, CT, PTC

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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

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Acute pancreatitis

• Physical findings
• epigastric tenderness/guarding
• peritoneal signs
• signs of paralytic ileus (meteorism, no
  bowel
• 
  sounds)
• skin signs Cullens sign-periumbilical
  
• 
  ecchymoses
• Grey-Turners sign-
  lumbar
• 
  ecchymoses
• Diagnosis pancreatic enzimes, US, CT

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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