1) ACHALASIA MALLORY WEISS TEAR -Due to alcoholism-retching- inc. oesophageal pressure -melena-BLEEDING STOPS AT 24-48 HRS.

. -ENDOSCOPY- definitive dx -ANTIEMETIC/PROMOTILITY as meds -NO ASPIRIN 2) GASTRITIS -stomach lining a) Erosive(acute, stress ulcers) -due to ALCOHOLISM -relieved by BELCHING -caused by trauma(erosive gastritis) -CURLING`s ULCER- happens after a major burn -CUSHING`s ULCER- happens after cranial nerve accident b) Non erosive(chronic) -chronic alcoholics -NOT RELIEVED by antacids -Dx: gastric analysis, Hgb&RBC, Serum Vit. B12 ENDOSCOPY,biopsy test, H. Pylori test -PPI, H2R, SUCRALFATE(prevents damaging effect of acid and pepsin), METRONIDAZOLE&CLARITHR OMYCIN with PPI Metro, PPI, TETRACYCLINE -ACTIVE CHARCOAL given after gastric lavage

4) DIARRHEA -Dx: WBC(5-10 million),Hgb&Hct(DHN), BUN&Crea -BRAT- duet -NO IMODIUM -ANTIDIARRHEAL(Lomotil)-suppresses peristalsis -OPIOID- contraindicated for respiratory depression -ADSORBENT AND EMULSION(Loperamide)soothing effect; contraindicated for fevr and bloody diarrhea(impaction) -PROBIOTIC(Lactobacillus acidophilus, Lactobacillus clausi-ERCIFLORA)-used when bulkforming laxatives are not effective -40-50 sec HANDWASHING

5) PEPTIC ULCER -ulceration, CIRCUMSCRIBED BREAKS @ duodenum, stomach, distal esophageal, jejunum -riskfactor: H. PYLORI, NSAIDS and ASPIRIN, inc physical stress, psychological stress, genetic -contibutors: alcohol, aspirin, bile acid
a) Gastric-stenosis -DULL, ACHING PAIN, BURNING @ the UPPER EPIGASTRIUM (30min-1hr), UNRELIEVED by vomiting

b) Duodenal -GNAWING PAIN @ RIGHT EPIGASTRIUM (23hrs) after meals. May awaken pt at night. RELIEVED BY EATING -GASTROSCOPY- dx of choice -SUCRALFATE, BISMUTH, ANTACID(Maalox), MISOPROSTOL(cytotec) -PARTIAL GASTRECTOMY(antrum and pylorus) -VAGOTOMY(danger- BACTERIAL PROLIFERATION) -PYLOROPLASTY BILLROTH 1(gastroduodenostomy) BILLROTH 2(gastrojejunostomy) P-ain U-lcers bleed D-rug timing c) Zollinger-ellison Syndrome -tumor in pancreas/upper SI -DIEULAFOYS LESION-stomach and SI 6) IRRITABLE BOWEL SYNDROME a) Spastic colon/colitis -seen during XCR -motility disorder of lower GI -UNKNOWN cause

3) GASTROENTERITIS -hypermotility of the GIT due to villi destruction -riskfactors: food poisoning(s. Aureus, salmonella, shigelle), amoeba(entamoeba hystolitica), parasites(ascaris, enterobius), nonbacterial food poisoning, and side effect of drugs -6 fs of transmission(finger, food, fluid, flies, feces, fomites) Travelers diarrhea(e. coli) b) Staphylococcal food poisoning c) Cholera(vibrio cholera) d) Hemorrhagic colitis e) Salmonellosis f) Shigellosis/dysentery g) Clostridium deficile colitis -ROTATEQ for ROTAVIRUS in infants(6mos.) NORWALK in adults
a)

-tenesmus -dx: LIT(r/o lactose intolerance) SIGMOISODSCOPY(differentiate IBD) RECTAL BIOPSY(r/o malignancy) 30-40 GRAMS/DAY OF FIBER -METAMUCIL for constipation -ANTISPASMODIC(buscopan) -TRICYCLIC ANTIDEPRESSANTS b) Celiac sprue -fat absorption impaired due to villi damage -UNKNOWN -triggered by GLUTEN -ABDOMININAL PAIN-initial sign -steatorrhea -NO BROW DIET -TETRACYCLINE AND FOLIC ACID THERAPY

-pouchlike herniation -commonly at SIGMOID COLON a) Diverticulosis(asymptomatic; true/false) b) Diverticulitis c) Meckels diverticulum(@ ileum) -due to LOW FIBER DIET(inc, <50 y/o, constipation, indigestible fibers -LEFT LOWER ABDOMINAL PAIN(diverticulitis) -RIBBON LIKE STOOL(chronic diverticulosis) -CXR first; FECAL OCCULT BLOOD-colon cancer Ttt: NO LAXATIVE/ NO MORPHINE -PENTAZOCINE-to relieve pain COLACE- stool softener COLON RESECTION-restore patency 10) APPENDICITIS -@CECUM -peaks at 10-30 y/o -tissue necrosis for 24-36 hrs -EPIGASTRIC/PERIUMBILICAL AREA @ UR ABDOMEN -2-12 hrs, pain intensifies -McBURNEYs point -BLUMBERG SX -ROVSING SX -PSOAS -OBTURATOR Dx: U/A(r/o urinary disorders) UTZ(r/o ectopic pregnancy) Ttt: APPPENDSECTOMY EXPLOR LAP-if appendix has ruptured NO HEAT ON ABDOMEN NO STRONG NARCOTICS/ENEMA/LAXATIVE Peritonitis-reaches diaphragm-should be at semi fowler Pain then absent pain-notify physician

7) HERNIA a) Incisional- nagpapasurgery b) Epigastric-due to fatty tissue c) Umbilical- <2y/o d) Inguinal- luslos e) Femoral Reducible Incarcerated/irreducible Strangulated Sliding(due to muscle weakness) -heartburn Rolling- paraesophageal hernia(anatomic defect) -fullness after eating Dx: PA Ttt: HERNIORRHAPHY Srgl Mgt: NEISSEN FUNDOPLICATION PNEUMONIA-common complication 8) INTESTINAL OBSTRUCTION -ADHESION-main cause a) Mechanical(adhesion, intussusceptions,volvulus,tumor) b) Neurogenic(paralytic ileus) c) Vascular -colicky type of abdominal pain -SEPTECEMIA,GANGRENE,PERFORATIONPERITONITIS Ttt: ILEOSTOMY/COLOSTOMY -NO OPIOID -POTASSIUM SUPPLEMENT(renal fxn) -MEPERIDINE

11)

9) DIVERTICULAR DISEASE

INFLAMMATORY BOWEL DISEASE a) Ulcerative colitis -inflammation and ulceration of the colon -begins in the rectum and sigmoid colon -UNKNOWN cause -peaks at 15-25/55-65 -INTESTINAL OBSTRUCTION-complication -20/MORE STOOL -ABDOMINAL PAIN LLQ -tenesmus -potential comp: OBS,PERF,ANEM,COLON CA -COLONOSCOPY(contraindicated if bleeding) -MEDS: SULFASALAZINE(topical anti inflam) -PROCTOCOLECTOMY(colon-rectum-anus) -ILEOANALANASTOMOSIS(ileum attach to the anus; problem-DIARRHEA) b) Crohn`s disease

MEDS 1) Achalasia 2) Gastritis

Pain reliever PPI, H2R, SUCRALFATE(prevents damaging effect of acid and pepsin), METRONIDAZOLE&CLARITH ROMYCIN or TETRACYCLINE&PPI ROTATEQ ANTIDIARRHEAL(Lomotil)suppresses peristalsis -OPIOID- contraindicated for respiratory depression -ADSORBENT AND EMULSION(Loperamide)- soothing effect; contraindicated for fevr and bloody diarrhea(impaction) -PROBIOTIC(Lactobacillus acidophilus, Lactobacillus clausiERCIFLORA)-used when bulkforming laxatives are not effective SUCRALFATE, BISMUTH, ANTACID(Maalox), MISOPROSTOL(cytotec) METAMUCIL for constipation -ANTISPASMODIC(buscopan) -TRICYCLIC ANTIDEPRESSANTS TETRACYCLINE AND FOLIC ACID THERAPY

2) 3) 4) 5) 6) 7) 8) 9) 10)

3) Gastroent eritis 4) Diarrhea

Gastritis Gastroenteritis Diarrhea Peptic Ulcer Irritable Bowel Disease Hernia Intestinal Obstruction Diverticular Disease Appendicitis

Right/Upper Epigastrium Crampy abdominal Pain

11) Inflammatory Bowel Disease PLACE OF OCCURENCE 1) Achalasia 2) Gastritis 3) Gastroenteritis 4) Diarrhea 5) Peptic Ulcer 6) Irritable Bowel Disease 7) Hernia 8) Intestinal Obstruction 9) Diverticular Disease 10) Appendicitis 11) Inflammatory Bowel Disease

Left lower abdominal pain Epigastric/periumbilical area @ upper right abdomen Abdominal pain LLQ

esophagus stomach GIT Duodenum,stomach,distal esophagus, jejunum Lower GI

5) Peptic Ulcer 6) Irritable Bowel Disease

Sigmoid colon cecum colon

7) Hernia 8) Intestinal Obstructi on 9) Diverticul ar Disease 10) Appendici tis 11) Inflammat ory Bowel Disease

-POTASSIUM SUPPLEMENT(renal fxn) -MEPERIDINE -PENTAZOCINE-to relieve pain COLACE- stool softener Cephalosporin SULFASALAZINE(topical anti inflam)

REFERRED PAIN 1) Achalasia