Irritable Bowel Syndrome Chiefly a motility disorder Pain / cramps often relieved with BM Chronic constipation, chronic diarrhea, or some combination, with change in stool appearance Cause(s) Treatments: anti-spasmodics, anti-diarrheals, anti-constipation agents, SSRIs, reassurance

Diverticular Disease Fairly common in those over 60 Due to fiber-deficient diet Diverticulosis Diverticulitis

Appendicitis Signs Periumbilical pain, migrates Iliopsoas and obturator signs Rovsing’s sign McBurney’s sign Cutaneous hyperesthesia Periumbilical pain, migrates N / V, anorexia, obstipation, fever Tx: surgical. Complicated with perforation

Gallbladder disease Cholecystitis Cholelithiasis Cancer / Tumor Female, fat, forty, flatulent, fertile Tx: medical, surgical Cholelithiasis Cancer / Tumor Gallstone pancreatitis Biliary tract obstruction

Hepatitis N / V, anorexia, malaise, fever, jaundice Causes: viral, EtOH, drugs, autoimmune, toxins Exam: check for liver tenderness, hepatomegaly, caput medusa Tx: remove offending agent, tx viral types if possible

Inflammatory Bowel Diseases Crohn’s disease Bouts of fever, RLQ pain, diarrhea Perianal abscess, fistulas Extra-colonic manifestations Tx: diet, 5-ASA, steroids, anti-TNF drugs Ulcerative colitis Bloody diarrhea, fecal urgency Tx: 5-ASA, steroids, surgery Increased risk of colon CA

Ulcers Gastric – usually worse with intake Duodenal – often relieved with intake

Gastritis Usually benign and self-limiting with proper approach Nausea, vomiting, cramping, fever Caused by GI irritants, infection, stress Tx: clear fluids for 24-48 hrs, then BRAT

Pancreatitis EtOH abuse # 1 cause Also due to large fatty meals Exam: Cullen’s sign, tender LUQ Tx: IV fluids, NPO

GERD EtOH, chocolate, tobacco, caffeine, mint, tomato sauce/salsa, lying flat Problem with LES Often abdominal obesity, poor eating habits Sour brash, retrosternal pain, cough, voice changes Tx: H2 blockers, PPIs, diet changes, wt loss