0071643192.pdf

TREATMENT

■ Proton pump inhibitors
■ Resect local disease if found before it has metastasized to the liver.

Gastric Cancer

Adenocarcinoma is the most common worldwide. This is a highly aggressive
cancer with a poor prognosis.

SYMPTOMS

■ Usually asymptomatic until the disease is advanced
■ Abdominal pain, weight loss, anemia, GI bleeding

DIFFERENTIAL

PUD, GERD, gastritis

EXAM

■ Lymphadenopathy
■ Sister Mary Joseph nodule, which is a firm, red, nontender nodule from
metastatic spread within the falciform ligament

DIAGNOSIS

■ Abdominal CT scan
■ Endoscopy

TREATMENT

Surgery, chemotherapy, palliative care

COMPLICATIONS

Gastric-outlet obstruction, anemia, dehydration, blood loss, bowel obstruction,
death

SMALL INTESTINE

Crohn Disease

Crohn disease is a chronic, recurrent, inflammatory disease of the GI tract
that may affect any segment from mouth to anus. Crohn disease has a propen-
sity for the ileum and proximal colon (see Table 11.3). Incidence is higher
among Ashkenazi Jews, smokers, and those with a family history. All layers of
the bowel wall are involved, and the disease may extend to mesenteric lymph
nodes. The disease is discontinuous, with skip areas that are free of ulceration.
Deep ulcerations of the bowel wall →fistulas and abscesses.

SYMPTOMS

Abdominal pain, anorexia, diarrhea, fever, weight loss, malaise, extra-intestinal
complications

EXAM

Abdominal tenderness, abdominal mass, anal fissures, fistulas

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Eighty percent of ZES is

sporadic, whereas 20% is

associated with multiple

endocrine neoplasia type 1

(MEN 1).

Twenty-five to thirty percent of

patients with Crohn disease

will manifest extraintestinal

complications.