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

night symptoms

resolve after antacids Physical findings: Diagnosis: history, endoscopy, pH-

monitoring, barium swallow

Esophageal cancer

History: dysphagia, odynophagia, pain, vomiting, weight loss

Characteristics: older males, alcoholics, smokers

progressive dysphagia (solidsofterliquid)

vomiting just after meals Physical finding: general tumor signs Diagnosis: barium swallow, endoscopy

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, gastric)

Physical finding: epigastric/RUQ tenderness Diagnosis: endoscopy or barium study

gastric ulcer: always indication for endoscopy and biopsy

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 - 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 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)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 (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 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

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

History: symptoms: not characteristic

anorexia, dyspepsia

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

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 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 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 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 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 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 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