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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
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