liver gallbladder, ascending colon, pancreas, right kidney
RUQ pain
stomach, pancreas, descending colon, kidney
LUQ pain
appendix, ileum, cecum, ovary
RLQ pain
sigmoid colon, ovary, diverticulitis
LLQ
Bladder, uterus, rectum
Suprapubic pain
Midepigastric pain radiates to midback
Pancreatitis
Has positive PSOAS and obturator signs,
Dx - pancreatic enzymes, liver enzymes and leukocytosis, US and/or CT
Tx - refer to ED
Acute appendicitis
- Symptoms worsen with fatty meals or when supine, decreased lower esophageal sphincter tone,
- risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil
Tx - first line is lifestyle changes then H2 blockers first then PPI
GERD
Cure ulcers faster than H2
PPI’s
- metaplastic columnar epithelium replaces the stratified squamous
epithelium that normally lines the distal esophagus [1,2]. The metaplastic epithelium is acquired as a consequence of chronic gastroesophageal reflux disease and predisposes to cancer development.
Dx - upper endoscopy with biopsy, Refer to oncology!
Tx - PPI omeprazole,
Barret’s esophagus
- Small pouch like herniations, acute onset of fever, LLQ pain, anorexia, N/V,
Dx - CBC, leukocytosis, shift bands to left,
Tx - fluoroquinolone, flagyl, if severe refer to ER
Diverticulitis
DESCENDING COLON CANCER caused by constipation, colorectal cancer, fecal impaction, polyps, abdominal hernias, anorectal strictures, distended or stretched colon and twisted bowel or volvulus, crohns, ulcerative colitis, IBS,
Tx - Refer to GI for colonoscopy
Pencil like stool
- Narrowing of pyloric sphincter causing eventual obstruction, characterized by forceful vomiting in young infants, projectile post prandial nonbilious vomiting, olive shaped mass palpable RUQ, hunger and weight loss and dehydration, 2 weeks of age
Dx - US,
Tx - surgical
Pyloric stenosis
Tx - fiber, avoid gas foods, antispasmodics, decrease life stress
IBS
- Helicobacter pylori, pain relieved by foods and or antacids,
Dx - gold standard upper endoscopy and biopsy gastric/duodenal tissues, detect h pylori infection,
Dx - CBC, if positive, refer to gastro, urea breath test, stop NSAIDS, smoking,
Tx - PPI or H2 blockers is initial, H. Pylori, ranitidine, famotidine, cimetidine, H. pylori- positive ulcers require 14-day treatment (amoxicillin, azithromycin, doxycycline) Triple - therapy is clarithomycin, amoxicillin, and omeprazole
PUD
Tx - CAO
