Digestive System•Mouth
•Esophagus
•Stomach
•Small Intestines
•Large Intestines and Rectum
•Anus
•Pancreas
•Liver and biliary Tract See Overhead
Adult Prevalence of GI Conditions
Conditionpercent
Hemorrhoids (piles)
Dyspepsia
Abdominal pain
Diverticulosis
Hiatal hernia
50-80
50-80
30-70
30-50
20-50
Adult Prevalence of GI Conditions
Conditionpercent
Unreported symptoms of IBS
Gallstones
Constipation
Colonic polyps
14-17
10-32
09-30
08-40
Abdominal pain
Gastroenteritis
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
Evaluation of Acute Abdominal Pain
History Physical
Exam Laboratory
Analysis Imaging Endoscopy Invasive
Techniques Treatment
Basic Evaluation
CBC Chemistry
Electrolytes Renal function Liver function Pancreatic enzymes
Urinanalysis Pregnancy test
Additional Evaluation
CT abdomen and pelvis Ultrasound IVP GI contrast studies Endoscopy Laparoscopy Abdominal exploration
Abdominal Pain
DD
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)
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 vessels10. Rectum11. Musculoskeletal12. Vascular -
aneurysm
DD (cont.): C. Miscellaneous
1. Psychogenic 2. Metabolic (e.g. diabetes) 3. abscess 4. Infectious 5. Neoplastic 6. trauma/obstruction
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.
Final Diagnosis for the PrSy of Abd Pain (Acute and Chronic) in
FP officesDiagnosisFrequency(%)
Abdominal pain, cause undocumented
Acute GE
UTI
IBS
PID
250) 50.4(
51) 9.2(
37) 6.7(
32) 5.8(
21) 3.8(
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
Gastroenteritis
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.
Causes
• Viral
• Bacterial
• Parasitic
Common routes of infection
• Food
• Contaminated water
• Contact with an infected person
• Unwashed hands
• Dirty utensils
Symptoms
• Diarrhea
• Abdominal pain or cramping
• Nausea
• Vomiting
• Fever
• Poor feeding (in infants)
Symptoms (continued)
• Unintentional weight loss (a sign of dehydration)
• Excessive sweating• Clammy skin• Muscle pain or joint stiffness• Incontinence (loss of stool
control)
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)
Diagnosis
• Medical history
• Physical examination
• Stool culture
DD
• Pneumonia
• Septicemia
• UTI
• Meningitis
• Appendicitis
• Intussusception
• Hirschsprung’s disease
Treatment
• Replacement of fluids and electrolytes
• Antibiotics if it’s bacterial
Prevention
• Washing hands
• Cleaning and disinfection
• Safe water
• Food sanitation
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.
