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*
Written by Michael Mitchell, MD.

Chapter
5

Digestive Diseases

L. Michael Snyder and Michael J. Mitchell

Disease States Associated with Abdominal Pain (Acute and Chronic)

Disease States Associated with Abdominal Pain

Disorders of the Esophagus

Mallory-Weiss Syndrome

Perforation of the Esophagus, Spontaneous

Plummer-Vinson Syndrome

Disorders of the Stomach

Gastritis, Chronic

Carcinoma of the Stomach

Disorders of the Pancreas

Carcinoma of the Pancreas

Cystic Fibrosis of the Pancreas

Macroamylasemia in Vivo Artifact

Pancreatitis

Pseudocyst of the Pancreas

Dyspepsia and Peptic Ulcer Disease

Ascites

Disorders of the Peritoneum Associated with Ascites

Chronic Liver Disease

Infected Ascitic Fluid

Secondary Peritonitis

Continuous Ambulatory Peritoneal Dialysis

Pancreatic Disease

Malignant Ascites

Ascites in Fetus or Neonate

Peritonitis, Acute

Diarrhea

Diarrhea, Acute

Osmotic Diarrhea

Secretory (Abnormal Electrolyte Transport) Diarrhea

Exudative Diarrhea (Inflammatory Causes)

Motility Disturbances

Infectious Gastrointestinal Diseases

Diarrhea, Chronic

Other Gastrointestinal Conditions Associated with Chronic Diarrhea

Diverticulosis, Colon

Enterocolitis, Necrotizing, in Infancy

Inflammatory Bowel Disease

Regional Enteritis (Crohn Disease)

Ulcerative Colitis, Chronic Nonspecific

Malabsorption

Carbohydrate Absorption Indices

Celiac Disease (Gluten-Sensitive Enteropathy, Nontropical Sprue, Idiopathic Steatorrhea)

Enteropathy, Protein Losing

Colitis, Collagenous

Colitis, Pseudomembranous

Gallstone Ileus

Gastroenteritis, Eosinophilic

Gastrointestinal Bleeding

Upper Gastrointestinal Bleeding (Adult)

Gastrointestinal Bleeding, Small Intestine

Lower Gastrointestinal Bleeding (Adult), Acute

Hepatomegaly

Fatty Liver

Neoplasms of the Liver: Hepatocellular Carcinoma (Hepatoma)

Jaundice (See Hepatomegaly)

Hyperbilirubinemia

Diseases Associated with Jaundice

Conjugated Hyperbilirubinemia/Hepatocellular Jaundice

Infectious Disease: Viral Hepatitis

Vascular and Ischemic Disorders of the Liver

Biliary Extrahepatic Obstruction, Complete

Diseases of the Gallbladder and Biliary Tree (Intrahepatic or Extrahepatic) (See Abdominal Pain)

Cancer of the Gallbladder and Bile Ducts

Cholangitis, Acute

Cholangitis, Primary Sclerosing

Cholecystitis, Acute

Cholecystitis, Chronic

Choledocholithiasis

Atresia, Extrahepatic Biliary, Congenital

Other Considerations

Intrahepatic Obstruction Cholestasis

Cirrhosis, Primary Biliary (Cholangiolitic Cirrhosis, Hanot Hypertrophic Cirrhosis, Chronic Nonsuppurative Destructive Cholangitis, Etc.)

Congenital Conjugated Hyperbilirubinemia

Rotor Syndrome

Causes of Unconjugated Hyperbilirubinemia

Unconjugated Bilirubinemia

Physiologic Jaundice

Nonphysiologic Jaundice

Hereditary and/or Congenital Causes of Unconjugated Hyperbilirubinemia

Crigler-Najjar Syndrome (Hereditary Glucuronyl-Transferase Deficiency)

Gilbert Disease

Neonatal Jaundice: Breast Milk Jaundice

Lucey-Driscoll Syndrome (Neonatal Transient Familial Hyperbilirubinemia)

Wilson Disease

Traumar

This Chapter focuses on several common GI clinical presentations: abdominal pain (acute and chronic); ascites; diarrhea (acute and chronic); GI bleeding upper and lower; hepatomegaly; jaundice and associated diseases, including hepatitis. When appropriate, the discussion includes radiologic and endoscopic procedures as part of the diagnostic evaluation.

DISEASE STATES ASSOCIATED WITH ABDOMINAL PAIN (ACUTE AND CHRONIC)

   Definition

Acute abdomen is defined as an episode of severe abdominal pain that lasts several hours or longer and requires medical attention. The acute abdomen usually, but not necessarily, has a surgical cause. However, the term “acute abdomen” should not be equated with a need for emergency surgery. The history and physical examination remain the most important aspects of diagnosis. The key feature in the evaluation of patients with acute abdomen is early diagnosis.

   Differential Diagnosis