Diffuse

• Early appendicitis
• AAA
• Inflammed Bowel Dz
• Peritonitis
• Trauma- seat belt
• obstruction

Epigastric
• Peptic Erosion Dz
• GB dz
• Hepatic dz- cirrhosis, hepatitis (alcoholic m/c, infectious- hep C, worldwide- hep
C)
• Cardiac dz-
• Pancreatitis acute/chronic acute-very painful, eats itself
o Chronic alcoholic hepatitis

Right Upper Quadrant

• Biliary tree dz- branched –larger-rt and lft hepatic duct- cystic duct
• PUD- associated w/ Duodenum
• Pancreatitis- head
• Renal dz- kidney stones, polynephritis-retrograde migration of bacteria from
bladder, renal cell carcinoma- no early sx-hematuria and flank pain, no trauma
• Cardiopulmonary dz-

Left Upper Quadrant

• Peptic ulcer dz
• Pancreatitis- tail
• Splenic dz- cellular filter (kidneys, liver is chemical filter) anemias, mono,
Epstein-barr virus, polycythemia vera, portal venous hypertension cause
splenomegaly

Right Lower Quadrant

• Late appendicitis
• Crohn’s dz- granulomatus inflammation of iliocecal region or any GI
• Obstruction –volvulous (twists on cecum)
• UC- uterus, ovarian cysts, cancer, PID, ectopic pregnancy, inflammation of
falopian tube, AAA
• Reproductive dx
• AAA

Left lower quadrant

• Diverticulosis/it is
 • Obstruction
• UC
• Reproductive dz
• AAA

Perumbilical- mostly diffuse pain occurs here

• Obstruction-
• Early appendicitis
• AAA
• Mesenteric thrombosis- ischemia, severe periumbilical pain
• Pancreatitis

9/27/06
Page 3, slide 6
Abdominal Aortic Aneurysm
• Saccular- localized football shaped enlargement, can be painful itself
• Dissecting aneurism- separation of walls, fill up w/ blood
o Bleed to death w/o losing outside body
o Exsanguinate- bleed to death
• Abdominal aorta is 3.5cm, any larger is aneurism (up to 10,11 cm)
• Usually pushes away from spine, left
• Pain usually suggests rupture

Dissecting AAA
• Tunica media and tunica adventicia
• Tearing sensation

Abdominal Aortic Aneurysm

• Treatment depends on size and surgical risk

Anorexia
• Loss of appetite, caused by anything

Belching, bloating, flatulence

• Mostly because of swallowing air

GI Bleeding
• GI is the most vascular area
• Ligament of treats divides uppert GI and Lower GI, also called suspensory
ligament of the duodenum
• Upper gi- m/c cause is peptic ulcers
• m/c cause of death is esophageal varicies
• hematemesis is vomiting bright red blood, acute
 • emituresis is coffee ground look, chronic
• upper gi blood can cause fecal blood
• lower gi m/c caused by hemoroids
• also colon cancer and diverticulitis
• meckel’s diverticulum is m/c congenital anomaly- vitaline duct, falomesenteric
duct
• peptic ulcer disease is caused by this
• hematochesia, brbpr bright red blood per rectum, streaking fecal

10/3/06 page 5, slide 3

Hemocult Testing
• false positive from pepto bismol, red meat
• any bleeding gives positive

Constipation/diarrhea
• stretch reflex in colon
• gastro-colic reflex, when you eat – usually in the morning
• decrease in amount or frequency
• usually dry, rabbit pellet like
• causes: lack of exercise, lack of fluid, lack of fiber
• Colon cancer-mass inside the colon, gets large enough to where feces cannot pass,
body produces water to flood feces—alternation in constipation, diarrhea -also
pencil thin stools- mass can only allow pencil size stool (low level colon cancer)
• IBD- medications, stress
• Hemorrhoids- hurts to shit
• Poor bowel hygiene- don’t go when needed
• Diarrhea – increase in frequency and h2o in stool
o Infection- stomach flu
o Ulcerative colitis- bloody diarrhea in a young patient (teens – young 20’s)

Nausea and vomiting

• Feeling of impending vomiting
• Vomiting- retrograde expulsion of gastric contents through mouth
o Rid of “bad contents”- emetic center of the brain
o Conditioned response, memory, hormone changes, severe pain,
cardiovascular- reduce blood supply to stomach
o Obstruction can cause

Heartburn, indigestion
• Dyspepsia- pain
• Indigestion- gassy pain, bloated
o Overeating, overdrinking
• Hemoragic gastritis- coffee grind and hemorrhagic
Hepatosplenomegaly
• Filters red blood cells -120days
• Pressure of portal venous system gows up
• Large influx of cells
• Can occur with enlargement of the liver
• Anemia- alter change in shape of cells (sickle cell anemia)
• Polycythemia- too many cells
• Mono –epstein barr virus
• Leukemia- malignancy of white blood cells-
• White blood cells about 10K- normal, leukemia = 110K
• Cholangitis- inflammation of bile ducts

Hernias
• Protrusion through a hole, anatomical or surgical

Hiccoughs
• Sucks air back into glottis
• Uremia is m/c cause of persistent
• CO2 in the blood is registered in the brain to control respiratory rate

Jaundice
• Sclera of eye (bc its thin) –ictherus
• Excess bilirubin
• Condition of some other condition
• Excoriate their skin- scratch
• Conjugated bilirubin because its not water soluble

Rectal Pain and itching

• Hemorrhoid –varicose veins
• m/c cause is poor hygiene

GU signs and symptoms

• kidneys – water soluble chemical filter
o erythropoesis-
o acid/base
o fluid balance
o blood pressure
• uretors- carry urine, peristalsis
• bladder- storage, distends –micturition( stretch reflex)

10/4/06
CVA Pain
• protects kidney
• nephrolithiasis- acute attack is called renal colic
• pyelonephritis- retrograde infection from the bladder
• no positional pain relief, laboratory findings- increased wbc’s, blood in urine,
bacteruria
• glomerulonephritis- usually after strep infection, anemic-decrease erythropoesis
• renal cancer- rapidly advancing
• renal abcess-
• spinal disorder- quad. Lumb.-

Dysuria
• painful urination, assoc. w/ pain w/ cystitis
• cystitis- suprapupic region, m/c cause of dysuria (women short urethra, close to
rectum)
• urethritis- std’s (m/c Chlamydia)- ngu non gonococal urethritis- 2nd m/c
• vaginitis- urethra inflamed w/ it

Polyuria
• frequency and/or amount
• frequency is usually non systemic
• volume is usually systemic- common cause-diabetes, both forms, chf, renal failure

Hematuria
• casts suggests renal disease
• over 50 yo usually have cysts

oliguria/anuria
• 1500-3000 ml/day
• Less than 600ml is oliguria –damage to 75% of kidneys b4 sx
• Less than 100-200 ml/day is anuria
• Usually from exercise and low fluid intake
• Chf--- chronic renal failure, heart sends blood to itself and brain, not kidneys
• Diabetes- first poly, late failure

Pelvic Pain
• 1/3 causes have a non-organic cause
• m/c cause is menstrual cramps, uterine contractions
• fibroids- uterine myeloma
• cystitis m/c cause of organic pain
• endometriosis- abnormal deposition of endometrial tissue outside the uterus
• IBD- ulcerative colitis, and crohn’s
Proteinuria
• Glomerulus pores leaking protein
• Idiopathic transient proteinuria- small chain proteins leak out
• CHF

Esophagus