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 (solidsofterliquid)
vomiting just after meals
Physical finding: general tumor signs
 Diagnosis: barium swallow, endoscopy

Peptic ulcer (duodenal, gastric)
History: epigastric pain
 Characteristics:
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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