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.