1. Common abdominal syndromes

2. Gastroesophageal reflux disease - GERD n History: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia, odynophagia, extraesophageal: cough, asthma, noncardiac chest pain n Characteristics: increase in laying position night symptoms resolve after antacids n Physical findings: n Diagnosis: history, endoscopy, pH-monitoring, barium swallow

3. Esophageal cancer n History: dysphagia, odynophagia, pain, vomiting, weight loss n Characteristics: older males, alcoholics, smokers progressive dysphagia (solid  softer  liquid) vomiting just after meals n Physical finding: general tumor signs n Diagnosis: barium swallow, endoscopy

4. Peptic ulcer (duodenal, gastric) n History: epigastric pain n 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

5. Peptic ulcer (duodenal, gastric) n Physical finding: epigastric/RUQ tenderness n Diagnosis: endoscopy or barium study gastric ulcer: always indication for endoscopy and biopsy

6. Peptic ulcer - complications n Bleeding: melena, hematemesis, (rarely: hematochezia) rectal digital examination n 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

7. Peptic ulcer - complications n Obstruction a. reversible b. irreversible (scar) History: vomiting of undigested food fullness, pain Physical signs: succussion splash tenderness Diagnosis: gastric emptying study (barium) endoscopy

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

9. Gastric cancer n History: epigastric pain, fullness, vomiting, weight loss n Characteristics: older people, pain arise at meals dull, progressive pain n Physical findings: epigastric pain, epigastric mass Virchow’s lymph node general tumor signs occult bleeding n Diagnosis: barium study, endoscopy, US

10. Intestinal obstruction (ileus) 1. Mechanical n History: altered bowel habits, constipation, fullness, meteorism, cramping pain, vomiting (bile, fecal material) n Characteristics: variable or progressive n Physical finding: meteorism increased bowel sound splash signs of underlying disease n Diagnosis: plain abdominal x-ray searching for the cause

11. Intestinal obstruction (ileus) 2. Paralytic n History: signs of the underlying disease, constipation, fullness, meteorism, cramping pain, vomiting n Physical finding: meteorism absent bowel sound splash signs of the underlying disease n Diagnosis: plain abdominal x-ray searching for the cause

13. Colorectal cancer n History: positive family history altered bowel habits bleeding (occult or manifest) late: signs of obstruction cramping pain general tumor signs n Physical finding: rectal digital examination late: mass, ileus n Diagnosis: barium study, endoscopy, US

14. Acute hepatitis n History: asymptomatic after flu-like symptoms jaundice anorexia, dyspepsia RUQ pain n Physical finding: jaundice enlarged liver: smooth, soft, round, tender n Diagnosis: liver tests, virus tests

15. Chronic hepatitis n History: symptoms: not characteristic anorexia, dyspepsia later: symptoms of cirrhosis n Physical finding: enlarged liver (can be normal) n Diagnosis: US, liver biopsy, serology

16. Liver cirrhosis n History: alcohol consumption, chr. hepatitis (HBV, HCV, HDV, HGV, autoimmune), anorexia, dyspepsia, nausea ascites, edemas, portal encephalopathy jaundice, bleeding n Physical findings: first: enlarged liver micronodular: alcoholic macronodular: chr. virus or autoimmune hepatitis- postnecrotic cirrhosis end stage: small liver

17. Liver cirrhosis n Physical findings: skin: palmar and plantar erythema spider naevi icterus (scratching) gynecomasty testicular atrophy signs of portal hypertension: ascites (transsudate) caput Medusae splenomegaly edema n Diagnosis: US, liver biopsy, laboratory

18. Biliary colic n History: pain after fatty meals nausea, vomiting (often bile) fullness, meteorism n Characteristics: RUQ-pain, radiates to the back (scapula, right shoulder) mostly females n Physical finding: RUQ tenderness n Diagnosis: US

19. Acute cholecystitis n History: like in biliary colic + fever n Physical finding: Murphy’s sign n Diagnosis: US, laboratory: signs of inflammation Choledocholithiasis n History: like in biliary colic + obstr. jaundice n Diagnosis: US, ERCP, CT, PTC

20. Acute pancreatitis n History: gallstone disease, fatty meal, alcohol epigastric pain fullness, nausea, vomitus fever jaundice hypotony, shock n Characteristics: band-like, cramping pain radiates to the back

21. Acute pancreatitis n 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 n Diagnosis: pancreatic enzimes, US, CT

22. Chronic pancreatitis n History: cramping pain anorexia, dyspepsia, nausea, vomitus gallstone or alcohol consumption weight loss steatorrhea n Characteristics: pain in the back increases after meals n Physical finding: epigastric tenderness epigastric mass (pseudocyst) sometimes jaundice n Diagnosis: plain abd. X-ray, US, CT, ERCP