Abdominal Pain

First Set: GERD, Gastric CA, Peptide Ulcer Disease

GERD
- Hx: Epigastric pain, “Heartburn” + regurgitation, relieved by antacids
- Clinical: Dental cavities, halitosis
- Labs: Barret’s Esoph (Biopsy w/ intestinal metaplasia + Eosinophilia)
- Treatment = Proton Pump Inhibitor (omeprazole)

Gastric CA
- Hx: Early satiety, Japanese, Smoked foods, Older individual, frequently
alcoholics, wt. loss, loss of appetite
- Clinical: (+) Virchow’s node, Acanthosis nigricans, Linitis Plastica
- Labs: GIST (+ CD117, + CD34), spindle cell/mesenchymal
Lymphoma (+CD45) – lumpy bumpy
Adenocarcinoma
- Signet Ring Cell (metastasize to ovaries = Krukenberg)

Peptic Ulcer Dz
- Hx: Duodenal
- Decreased PAIN after eating
- Weight gain
Gastric
- Increase PAIN after eating
- Weight loss
- Chronic NSAIDS
- BOTH = Dark stools, hematemasis
- Labs: Biopsy = H. Pylori  NO pleomorphism, no dysplasia, no N/C ratio
Uremia breath test
Fe deficiency anemia
Mucosal damage extending into submucosa
- Tx: PPI (omeprazole), Amoxicillin, clarithromycin, metronidazole

Second Set

Acute Viral Hepatitis A, Chronic Alcoholic Hepatitis w/ Cirrhosis, Cholelithiasis w/

acute cholecystitis

Acute Viral Hepatitis A

- Hx: Traveler, Day-care, N/V, suspicious food + H20
- Clinical: Jaundice (later onset), Scleral Icterus, fever, abdominal pain
- Labs: Increased AST/ALT, (+) anti-HAV IgM
Chronic Alcoholic Hepatitis with Cirrhosis
- Hx: Heavy drinker (chronic), past hx of liver dysfunction
- Clinical: Ascites, Caput medusa, spider angioma, esophageal varices palmar
erythema, gynecomastia, hepatorenal syndrome, encephalopathy
Labs: AST >ALT, increased INR, decreased albumin, hyperbilirubinemia

Ascending Cholangitis
- Hx: Cholelithiasis/Choledocolithiasis
- Female, fat, forty, fertile
- Cholesterol stones more common, Mixed stones most common,
pigmented stones in SickleCell patients
- Clinical: Charcot’s Triad
- Fever
- Jaundice
- RUQ pain
- Lab: Increased Alk phosphatase

Third Set

Campylobacter Jejuni Infection

- Hx: Undercooked chicken, Guilan-barre (cross rxn of Abs to myelin),
dysentery = bloody diarrhea
- Labs – G(-) motile, oxidative (+), comma shaped, (+) neutrophils in stool
- Tx = Azithromycin

Celiac Disease
- Hx: Infant just weaned from breast feeding, irritable, foul smelling diarrhea,
poor feeding, diffuse vesicular rash (Dermatitis Herpetiformes)
- Labs = (+) AGA, IgG (infant), (+) tTG in adults; Histology = loss of villus
structures in small intestine

Inflammatory Bowel Disease

- Hx: Diarrhea +/- blood (UC = blood), malabsorption; Extra-intestinal =
rheumatologic, erythema nodosum, eye sx (uveitis)  From immune
complex disease
- Crohn’s
- Ankylosing spondylitis (HLA-B27), migratory arthritis
- Abdominal pain, no bleeding usually
- Can affect entire thickness of wall  fistulas, perforations, etc
- The whole GI tract can be affected
- Usually terminal ileum
- Patchy distribution
- Cobblestoning, STRICTURES (cause N/V in crohns)
- Granulomas form
 - Lab test = ASCA (+)
- Rectum spared (jumps to anus)
- UC
- Pyoderma granulosum – Sterile abscess on ankle
- Bloody Diarrhea
- Affects mucosal layer
- More associated with adenocarcinoma of the colon
- Large bowel
- associated with PSC
- Frequently affects rectum
- Lab test = pANCA (+)

Group 4

Appendicitis
- Hx: Loss of appetite, nausea, vomiting, can’t pass gas, abdominal swelling,
fever
- Physical: Rovsing’s sign, psoas sign, obturator sign, rebound tenderness,
tender to palpation
- Lab: Neutrophilic WBC elevation, Ultrasound, CT more accurate, urine test
to rule out UTI/(ectopic) Pregnancy
- Treatment = remove appendix

Pelvic Inflammatory Disease

- Hx: Bilateral lower abdominal pain, vaginal discharge (irregular bleeding),
lower back pain, fever
- Physical: Chandelier’s sign (Cervical motion tenderness), mucopurulent
cervical discharge
- Labs: Most common = N. Gonorrrhoeae + C. trachomatis; neutrophilic WBC
elevation w/ wet mount
- Prognosis  Can get infertility due to hydrosalpinx, increased risk for
ectopic pregnancy
-Tx = antibiotics

Ectopic Pregnancy
- Hx: Sudden lower abdominal pain, light vaginal bleeding, cramping on one
side of pelvix; IF RUPTURES  Sharp stabbing pain in pelvis, abdomen,
shoulder,neck, dizziness, nausea, strong urge to defecate
- PE: Pelvic exam, check for pain, tenderness, mass in fallopian tube/ovary
- Labs: I/c bHCG, (elevated), Ultrasound (confirmation), blood tests
- Complication = loss of repro organs/infertility; rupture fallopian  life
threatening bleeding
- Treatment = medically if early enough ; if this does not work or later on in
growth  surgical