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By A. B.; Shaffer, E. A.; Astra Inc., Staff; Canadian Association of Gastroenterology Staff Thomson

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Additional info for First Principles of Gastroenterology : The Basis of Disease and an Approach to Management 5th ed

Sample text

1 Liver As a subdiaphragmatic organ, the liver moves downward with inspiration. This anterior organ has an easily palpable lower border, which permits assessment of its consistency. A bruit or venous hum can be heard in certain conditions. An enlarged left lobe can usually be felt in the epigastric area. 2 Right kidney The kidney may protrude anteriorly when enlarged and be difficult to differentiate from a Riedel’s lobe of the liver. It may be balloted. 3 Gallbladder This oval-shaped organ moves downward with inspiration and is usually smooth and regular.

Obstruction of the common bile duct with a stone results in pain, jaundice and sometimes fever (cholangitis). Pancreatitis is a devastating illness, with steady epigastric pain radiating to the back and sometimes accompanied by shock. It almost always requires admission to hospital. Ischemic bowel disease, subacute bowel obstruction caused by Crohn’s disease, neoplasm or volvulus may present with recurrent bouts of abdominal pain, often related to eating. These conditions are usually progressive and accompanied by physical signs.

Of course, chronic abdominal pain may be caused by many organic diseases. Peptic ulcer generally produces pain after meals or on an empty stomach and is relieved by food or antacid. Abdominal pain awakening the patient at night is a particularly discriminating feature. Peptic ulcers are now more common in the elderly, especially women on NSAIDs. In them the pain may be atypical. Biliary colic may be due to cystic or common bile duct obstruction by a stone. Characteristically this pain is significant enough to awaken the patient at night or require a visit to the emergency room for analgesia.

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