1. Digestive System Mouth Esophagus Stomach Small Intestines Large Intestines and Rectum Anus Pancreas Liver and biliary Tract See Overhead

2. Adult Prevalence of GI Conditions percentCondition 50-80 30-70 30-50 20-50 Hemorrhoids (piles) Dyspepsia Abdominal pain Diverticulosis Hiatal hernia

3. Adult Prevalence of GI Conditions percentCondition 14-17 10-32 09-30 08-40 Unreported symptoms of IBS Gallstones Constipation Colonic polyps

4. Abdominal pain Gastroenteritis

5. Objectives: You students will be able to  determine the origin of abdominal pain from particular attention to a detailed description of the pain and associated symptoms.  get the differential diagnosis (DD) depending on physical finding and proper diagnostic approach.  recognize and treat Gastroenteritis.

6. 6 Evaluation of Acute Abdominal Pain  History  Physical Exam  Laboratory Analysis  Imaging  Endoscopy  Invasive Techniques  Treatment

7. Basic Evaluation  CBC  Chemistry  Electrolytes  Renal function  Liver function  Pancreatic enzymes  Urinanalysis  Pregnancy test

8. Additional Evaluation  CT abdomen and pelvis  Ultrasound  IVP  GI contrast studies  Endoscopy  Laparoscopy  Abdominal exploration

9. Abdominal Pain DD

10. Structural approach to the DD of Acute Abdominal Pain A.Thoracic structure 1. Cardiac (e.g. MI) 2. Pulmonary (e.g. pneumonia) 3. Esophageal 4. Vascular (e.g. aneurysm)

11. DD (cont.): B. Abdominal structures 1. liver 2. Gallbladder 3. pancreas 4. Stomach 5. Small Intestine 6. Large Intestine 7. kidney, ureters, bladder 8. Female reproductive organs 9. Blood vessels 10. Rectum 11. Musculoskeletal 12. Vascular - aneurysm

12. DD (cont.): C. Miscellaneous 1. Psychogenic 2. Metabolic (e.g. diabetes) 3. abscess 4. Infectious 5. Neoplastic 6. trauma/obstruction

13. Acute Abdominal Pain One working definition of acute abdominal pain is pain so bad that the patient cannot wait until tomorrow or next week for a physician appointment.

14. Final Diagnosis for the PrSy of Abd Pain (Acute and Chronic) in FP offices Frequency (%)Diagnosis 250 (50.4) 51 (9.2) 37 (6.7) 32 (5.8) 21 (3.8) Abdominal pain, cause undocumented Acute GE UTI IBS PID

15. Differential Diagnostic: RLQ Pain  Appendicitis  Urolithiasis  Cholecystitis  Diverticulitis  Colon  Meckel's  Gastroenteritis  Mesenteric Adenitis  Crohn’s Disease  Malignancy  Obstruction  PID  Ovarian Cyst  Ruptured  Torsed  Ectopic Pregnancy  Muscular  Hematoma  Strain  Hernia  Intussusception

16. Gastroenteritis

17. What is gastroenteritis? It is an inflammation of the gastrointestinal tract. It is sometimes referred to as “stomach flu”, even though it is not related to influenza.

18. Causes Viral Bacterial Parasitic

19. Common routes of infection Food Contaminated water Contact with an infected person Unwashed hands Dirty utensils

20. Symptoms Diarrhea Abdominal pain or cramping Nausea Vomiting Fever Poor feeding (in infants)

21. Symptoms (continued) Unintentional weight loss (a sign of dehydration) Excessive sweating Clammy skin Muscle pain or joint stiffness Incontinence (loss of stool control)

22. Signs of dehydration Extreme thirst Dark urine Dry skin Dry mouth Sunken cheeks or eyes In infants, dry diapers (for more than 4-6 hours)

23. Diagnosis Medical history Physical examination Stool culture

24. DD Pneumonia Septicemia UTI Meningitis Appendicitis Intussusception Hirschsprung’s disease

25. Treatment Replacement of fluids and electrolytes Antibiotics if it’s bacterial

26. Prevention Washing hands Cleaning and disinfection Safe water Food sanitation

27. Objectives: You students will be able to determine the origin of abdominal pain from particular attention to a detailed description of the pain and associated symptoms. get the DD depending on physical finding and proper diagnostic approach. Recognize and treat GE.