Presenting GI complaints
- Abdominal pain, acute and chronic
- Indigestion, nausea, vomiting including blood, loss of appetite, early satiety
- Dysphagia +/or odynophagia
- Change in bowel pattern
- Diarrhea, constipation
- Weight loss (unintentional)
9 sections of abdomen
Location of spleen
lateral to and behind stomach, just above left kidney in left midaxillary line.
upper margin rests against dome of diaphragm.
Which ribs protect most of the spleen?
9, 10, 11
Presenting urinary and renal sx
- Suprapubic pain
- Dysuria, urgency, or frequency
- Hesitancy, decreased stream
- Polyuria or nocturia
- Urinary incontinence
- Kidney or flank pain
- Ureteral colic
Types of abdominal pain
Visceral Pain: organ pain, often in hollow organs – intestine, biliary tree. Also liver. Dull & achy, difficult to localize
Parietal Pain: often caused by peritoneum. Often sharp, can be localized and very severe. Aggravated by movement/coughing
Referred Pain: occurs elsewhere - sites innervated at approximately same spinal levels as disordered structures. Radiating. Superficial or deep but usually localized. E.g. shoulder in cholecystitis
Types of visceral pain
Visceral pain: RUQ/epigastric
biliary tree & liver
Visceral pain: epigastric
stomach, duodenum, pancreas
Visceral pain: periumbilical
small intestine, appendix, proximal colon
Visceral pain: suprapubic or sacral
Visceral pain: hypogastric
colon, bladder, uterus
colonic pain may be more diffuse than illustrated
Referred pain: duodenal or pancreatic origin
to the back
Referred pain: biliary tree
right shoulder or right posterior chest
Referred pain: plueurisy or inferior wall MI
Possible movement of pain from appendicitis, visceral & parietal
visceral periumbilical pain in early acute appendicitis from distention of inflamed appendix
Gradually changes to parietal pain in RLQ from inflammation of adjacent parietal peritoneum
Doubling over w/cramping colicky pain indicates...
Sudden knifelike epigastric pain indicates...
Epigastric pain commonly...
gastritis and GERD
RUQ pain and upper abdominal pain, think first of....
chronic or recurrent discomfort or pain centered in upper abdomen
subjective negative feeling that is nonpainful, can include bloating, nausea, upper abdominal fullness, heartburn, etc.
Do bloating, nausea, or belching alone meet the criteria for dyspepsia?
No. Can be seen w/other d/os.
E.g., bloating w/IBD and belching w/aerophagia (swallowing air)
Functional / nonulcer dyspepsia: what is it?
3 month history of nonspecific upper abdominal discomfort or nausea not attibutable to structural abnormalities or PUD. Sx usually recurring and present >6mths
multifactorial, including delayed gastric emptying, gastritis from H. pylori, PUD, psychosocial factors
Diagnostic criteria for GERD
- chronic abdominal discomfort/pain w/primary symptoms of heartburn, acid reflux, regurgitation >once/week
- mucosal damage on endoscopy
Risk factors GERD
- reduced salivary flow - prolongs acid clearance by damping action of bicarbonate buffer
- delayed gastric emptying
- selected medications
- hiatal hernia
Foods and positions that aggravate heartburn
etoh, chocolate, citrus, coffee, onions, peppermint
bending over, exercising, lifting, lying supine
atypical respiratory symptoms of GERD
cough, wheezing, aspiration pneumonia
pharyngeal symptoms: hoarseness, chronic sore throat, laryngitis