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Fat, forty, female, fertile w/ RUQ pain

Cholelithiasis or Cholecystitis

Fever, RUQ pain, radiation to back


Elevated Alkaline phosphatase, urinary bilirubin


F, RUQ pain, Jaundice, gallstones & dilated common duct on US

Ascending cholangitis (Charcot's triad)

Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation

Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)

Elevated AST, ALT, indirect bilirubin


Isolated elevated indirect bilirubin

Gilbert's syndrome

Elevated indirect bilirubin w/ defective glucuronyl transferase

Crigler-Najjar Dz

Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility


H.pylori gastritis

2antibiotics & PPI

Chronic cough, bitter taste in mouth or throat, dyspepsia


Multiple or constant GI ulcer pain despite medications

Zollinger-Ellison Syndrome

N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals

Acute pancreatitis

Peri-umbilical or flank ecchymosis

Acute pancreatitis (Cullen & Grey Turner's Sign)

Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles


Air fluid levels on upright abd plain film


Air under diaphragm, rigid board-like abdomen

Perforated viscus, perforated ulcer

>60yo F, LLQ pain

Diverticulitis. IV Abx, fluids, NPO.

Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial

Mesenteric ischemia

Neonate w/ projectile vomiting. Olive sized mass.

Pyloric stenosis

Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life

Tracheoesophageal fistula

Painless rectal bleeding in pediatrics

Meckel's diverticulum

Alcoholic with massive hemoptysis

Esophageal varicies (Tx w/ octreotide)

Female with recurrent abdominal pain, alternating diarrhea, constipation. Pain relieved with defecation

IBS. TCA's (nortriptyline) good if diarrhea predominant symptom

Bloody Diarrhea

Ulcerative colitis

Supraclavicular LAD (L > R)

Virchow's node - metastatic abdominal cancer

Hard periumbilical nodule

Sister mary Joseph nodule = indicates metastatic gastric and pancreatic cancers

PUD, Pernicious anemia (Type A Gastritis), H. pylori

Gastric Ca

Apple core lesion

Colon Cancer

Elderly with positive hemmocult

Colon Cancer - get colonoscopy


Colon Carcinoma

Family history of young age colon cancer, multiple polyps found on colonoscopy

Familial adenomatous polyposis (Gardner's syndrome)


Hepatocellular carcinoma, testicular seminoma (germ cell tumor)

CA 19-9

Pancreatic Ca


Ovarian Carcinoma

Chemotherapy induced N&V

Treat with Ondansetron (Zofran) (5-HT3 blockers)

Traveler's Diarrhea

E. coli is cause. Hydration & Cipro to treat

Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 "eyes". Water, travel, camping history


Afebrile, watery or loose stool. No blood or mucus

Viral Gastroenteritis

Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise

Staphylococcus aureus infectious diarrhea

Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea

Campylobacter jejuni - most common cause of acute bacterial diarrhea

Painless rectal bleeding. Bulging perianal mass w/ straining

Internal hemorrhoids

Pediatric with perianal pruritis esp. at PM. Positive cellophane tape test

Pruritis ani - Pinworms (enterobiasis). Tx is Mebendazole

Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods

Celiac Sprue

Anti-endomysial antibodies

Celiac Sprue


Thiamine; Alcoholics, Neuro Sx


Niacin (4D's dermatitis, diarrhea, dementia, death), bright red tongue


Vit C (easy bleeding, bruising, hair & tooth loss, joint pain & swelling)


Vit D (Osteomalacia)

Night blindness

Vit A deficiency

Magenta tongue

Riboflavin deficiency (B2)

s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding

Dumping syndrome

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