Type 1 diabetes_____polyuria,polydispia,polyphagia,weight loss,diabetic ketoacidosis & anti islet cells,

anti glutamic acid decorbyoxylase(anti GAD) antibodies,anti insulin antibodies,anti ZN transporter

antibodies in serum,RPG >200mg/dl,FPG>126mg/dl,PPG>200mg/dl and diabetes symptoms,HB
A1C>6.5℅ & insulin injections

Type 2 diabetes mellitus______hyperglycemia,polyuria,polydispia,polyphagia,blurred

vision,fatigue,obesity,rapid weight gain,+family history,sedantary lifestyle,increased age & treated by
weight loss,avoiding saturated fats,avoiding added sugars,doing exercise,use of
metformin,sulfonyleurea,thiazolidinediones,alpha glucosides inhibitors,DDP_4
inhibitors(sitagliptin),incretin(exanatide),SGLT 2 inhibitors,insulin injections & causing hyperosmolar non
ketogenic hyperglycemia

Diabetic ketoacidosis_____T 1DM,stresz,non complaince with insulin therapy,abdominal

pain,nausea,vomitting, & kassumal respiration,mental status changes,fruity acetone breath odour, &
G>280mg/dl,metabolic acedosis(bicarbonate<18m eq/l),raised urine ketones,raised serum
ketones,raised anion gap,normal serum osmolarity, & treated by giving fluids,k+,continous insulin,po4
bicarbonate(treatment monitered by closure of anion gap)

Hyperosmolar hyperglycemia_____T 2DM,diatery indiscretion,prolonged dehydration, & mental status

changes(more than in case of DKA), & G>600mg/dl,,no acidosis(bicarbonate>18m eq/l),no normal anion
gap,serum osmolarity >320mg/dl, & treated by aggressive fluid,electrolytes replacement,insulin
injection

Metabolic syndrome( insulin resistance syndrome or syndrome x)_____ abdominal obesity,high

bp,impaired glycemic controle,dyslipidemia, & increased waist grith>40 inches(120cm), & raised
triglyceride>150mg/dl,low HDL(40 mg/dl), high bp> 130/85mm HG, & FBG>100mg/dl, & treated by
intensive weight loss,cholesterole reduction,bp controle,use of metformin,lifestyle modification

Hyperthyroidisim(thyrotoxicosis)_____increased synthsis of T3, T4, increased level of T3/T4, & grave

disease,toxic adenoma(toxic multinodular goiter),thyroiditis,fetal thyrotoxicosis, & weight loss,heat
intolerance,anxiety,palpitation,increased bowel frequency,myopathy(proximal muscles weakness),
insomnia,menstural abnormities,warm and moist skin,goiter,sinus tachycardia,atrial fibrillation,fine
tremor,lid lag,hyperactive reflexes,exopthalmos(direct stimulation of orbital fiberoblasts by
antibodies),peritibial edema,thyroid bruits,raised TSH level,raised T4 and T3,RAI scaning findings, &
treated with propranolol(managing adrenergic symptoms),antithyroid drugs(methimazole and
propylethiouracil),radioactive iodine,thyroid ablation,total thyroidectomy,levothyroxine,steroid for
treatment of opthalmoplegia,potassium iodide

Grave's disease_____hyperthyroidisim,autoimmune,TS antibodies(increased synthesis og T3 and T4

Toxic adenoma_____(toxic multinodular goiter),hyperthyroidisim,autonomous hyperactive thyroid

nodules

Thyroiditis_____initial hyperthyroidisim followed by hypothyroidisim,then normal level

Fetal thyrotoxicosis_____infant born of mother having grave disease,TSH stimulating

antibodies,igGvrossing the placenta

Hypothyroidisim_____hoshimoto thyroiditis,thyroiditis,secondary hypothyroidisim,congenital

,fatigue,cold intolerance,constipation,weight gain,weakness,menstural irrigularities,hoarseness of
voice,depression,hair losz,myopathy,dry and cold skin,puffy skin,edema,bradycardia,deel tendon
reflexes delayed relaxation,raised TSH,raised free T4,raised LDL,raised triglycerides,raised
CK,hypothermia,treated by levothyroxin

Hoshimoto thyroiditis_____hypothyoidisim,autoimmune,anti thyroglobulin antibodies,anti thyroid

peroxidase(anti_TPO)antibodies

Thyroiditis(post partum,post viral,subacute)____subacute granulomatous ,radiation induced,

autoimmune,post partum,drug induced(amiodarone ),immediate hyperthyroidisim,late permanant
,tender thyroid,maise,URI symptoms,painless goiter(except subacute form),low uptake of labelled
iodine on RAI, & treated by beta blockers,levothyroxine,NSAID,oral corticosteroid

Secondary hypothyroidisim_____pituatary tumors,pituatary surgery

Congenital hypothyroidisim_____thyroid dysgenesis,failure to thrive,hypotonia,umblical
hernias,prolonged jaundice

Myxedema coma_____hypothyroidisim,low mental

status,hypothermia,hypotension,bradycardia,hypoventillation,treated by iv levothyroxin,iv
hydrocortisone

Thyroid's neoplasms_____papillary(75_80℅ thyroid cancer,orphan annie nuclei,F/M_3:1, slow

growing,follicularcells,lymphaticspread),follicular(17℅,follicular cells,haematological
spread),medullary(8℅thyroid cancer,calcitonin producing c cells,prognosis related to degree of
invasion,good prognosis,assosiated with MEN2 A), & 95℅benign,hyperthyroidisim,pressure effect
trachea(hoarseness of voice,dypsnea,cough,chocking,symptoms),pressure symptoms on
esophagus(dysphagia),RAI scan,cervical lymphadenopathy,benign FNA,ultrasonography,treated by
surgical resection(hemi/total),adjunctive radioactive ablation,excision

Osteoporosis_____low bone mass,post menopausal women,old age,hip fractures,loss of

height,progressive thoracic kyposis,colles fractures,DEXA scan,normal(ca++,po4_,parathyroid harmone,x
ray films(global demineralizations),treated by ca++,vitD supplementations,weight bearing
exercises,Bisphophonates(alandronates,zolendronic acid),anti resorptive agents(selective estrogen
receptor modulators(relaxifens), intradermal calcitonin, ****denosumack,(monoclonal antibodies to
RANK_L),anabolic agents(triparatide)analogue of parathyroid harmone

Paget's disease_____increased rate of bone turnover,mosaic lamellar bone patteren(both excessive

resorption and formation of bone),latent viral infection,in genetically susceptible individuals,aching
bone,joint pain,headache(skull involvement),bony deformaties,fracture at pagetoid site,nerve
entrapement(leading to loss of hearing),x rays(lytic,sclerotic lesions),raised serum alkaline
phosphatase,normal ca++, po4_ _,level,treated with ca+
+,vitD,bisphophonates,calcitonin,NSAID,acetaminophen

Hyperparathyroidisim______1°(single hyperfunctioning adenoma 80℅,parathyroid hyperplasia

15℅,parathyroid carcinoma),2°(physiological increase of PTH,renal insufficiency, decreased production
of 1,25 dihydroxyvitamin D,ca++ deficiency,vitD deficiency),3°(hyperplasia of PT gland,autonomous PG
gland,dialysis patient
****

Pseudohypotyroidisim______PTH resistance,raised PTH ineffective at target

organs,hypocalcemua,hypophosphotemia

Hyperparathyroidisim_____hypercalcemia,hypophosphotemia,hypercalciuria,PTH,DEXA,99mTC,thyroid
ultrasonography, & treated by parathyroidectomy,(iv fluids,loop diuretics,iv bisphophonates for acute
hypercalcemia),oral po4_ _ binders(ca++ salts,sevelamers hydrochloride,lanthanum carbonate)in renal
insufficiency,cinacalcet for lowering serum PTH( calcimimetic)

Hypercalcemia_____stones,bones,moans,groans,psychiatric overtones

Hypopituitarisim_____pituitary lesions(tumors,cysts),surgery,radiation,sheehan's
syndrome,apoplexy,infilterative disorders,infections,8AM cortisole level,freeT4,testosterone
level,estradiol level,insulin like growth factor level

****

Cushing syndrome_____increased cortisole,cushing disease,bilateral adrenal

hyperplasia,adenoma,adrenal cancer,ectopic ACTH production,moon facies,buffalo hump,thin wrinkled
skin,abdominal striae,amenorrhea,osteoporosis,obesity,hypertension,purpura,skin ulcer(poor
healing),muscle weakness,emotional disturbances,overnight dexamethasone suppression test,plasma
ACTH level, plasma cortisole level,MRI of pituatary gland,petrosal sinus sampling with CRH, treated by
surgical resection,permanant harmone replacement

Acromegaly_____at adult's age,raised GH level,benign pituatary GH secreting adenoma

****
Gigantism_____in children,raised GH level,benign pituatary GH secreting adenoma,enlargement of
the(frontal bossing and wide spread teeth),large hands,large feets,large tongue,coarsening of facial
features,skin's tags,carpal tunnel syndrome,obstructive sleep apnea,type 2 DM, heart's
diseases(diastolic dysfunction),hypertension,colon cancer,arthritis,bitemporal hemianospia(compression
of optic disc by pituatary adenoma),glucose intolerance,diabetes,cardiomyopathy,IG F1 level raised,MRI
for a sellar lesion,external beam radiation,treated with octreotide(somastatin analouge),pigvisomant(GH
receptor antagonist)

Hyperprolactenemia_____prolactinoma,pituatary stalk
compression(craniopharyngioma),meningioma,non secreting pituatary tumors,drugs(dopamine
antagonists),renal failure,cirrhosis, raised prolactin level,decreased GnRH level,low LH,low
FSH,infertility,galectonorrhea,amenorrhea,bitemporal hemianospia,treated by Dopamine
agonists(cabergoline,bromocriptine),surgical resection

Diabetic insipidus_____diluted urine,polydispia,polyuria,persistant thirst,(when limited access to

water(dehydration),severe hypernatremia,altered mental status,lathergy,seizures,coma),wated
deprivation test,desmopressin acetate replacement test,MRI,treated by
DDAVP(intravenously,intranasaly,orally),salt restriction,water restriction,thiazide diuretics

Central diabetes insipidus_____failure of posterior pituatary to secrete ADH,tumor,pituatary

ischemia(sheehan syndrome),pituatary hemorrhage,traumatic brain injury,infection,metastatic diseases,
autoimmune disorders

Nephrogenic DI_____(ADH resistance),failure of kidney to responds to circulating ADH,renal

diseases,drugs(lithium,demeclocycline)

SIADH______evolemic hyponatremia,persistant ADH release(independant of serum osmolarity),CNS

diseases(head injury,tumor),pulmonary diseases(sarcodosis,COPD,pneumonnia),ectopic tumor
production,paraneoplastic syndrome(small cell lung carcinoma),drugs(anti psychotic,anti
depressants,NSAID,),increased urine osmolarity,raised urinary Na+ level,treated by restricting
fluids,hypertinic saline,demeclocycline(ADH receptors antagonists),conivaptan(vasopressin receptor
antagonists)
Addison's disease_____autoimmune,adrenal cortical
destruction,hyperpigmentation,weakness,fatigue,anorexia,weight loss,8AM plasma cortisole
level,serum ACTH level,synthtic ACTH stimulation (cosyntropin)test,treated by
glucocorticoid,mineralocorticoids,iv steroids in adrenal crises,electrolytes balancing,50℅ dextrose for
hypoglycemia,volume resuscitations

Pheochromocytoma______chromaffin tissue tumor,secreting catecholamine,paraxysmal

tachycardia,palpitations,chest pain,diphoresis,hypertension,headache,tremors,anxiety,assosiations with
MEN 2A/2,Von Hippel Lindau and neurofibromatosis diseases,CT,MRI,nuclear MIBG scan(localizing extra
adrenal lesions and metastatic disease),raised plasma free metanephrines, 24 hrs urinary
metanephrines,urinary catecholamines,treated by surgical resection,first alpha adrenergic drugs for bp
controle and then beta blocker drugs for tachycardia controle.

Hyperaldosteronisim_____increased aldosterone,adrenocortical hyperplasia,Conn's syndrome(unilateral

adrenal adenoma),hypertension,headache,polyuria,muscle's weakness,hyperkalemia,metabolic
alkalosis,hypomagnesemia,hyperaldosteronisim,increased aldosterone to plasma renin activity
ratio,CT,MRI, for adrenal mass,adrenal venous sampling ,treated by surgical resection,aldosterone
receptors antagonists(eplerenone),spiranolactone

Congenital adrenal hyperplasia______inherited enzyme defects,impaired cortisole synthesis,increased

cortisole precursors,95℅ 21_hydroxylase deficiency,5℅ 11/17 hydroxylase deficiencies,electrolytes
abnormalities(hyponatremua,hyperkalemia,metabolic acidosis), salt wastining,increased
17_hydroxyprogesterone level,treated by fluids,salt repletion,iv cortisole,surgical correction of
ambiguous genitalia

17 alpha hydroxylase dedficiency_____increased mineralocorticoids, decreased sex harmones,raised

bp,low k+,decreased aldostenediones level,pseudo hermaphroditisim(ambiguous
genitallia,undescended testes),xx(lack of secondary sexual developement)

21___hydroxylase deficiency_____decreased mineralocorticoids,increased sex harmones,low bp,raised

k+,increased renin activity,increased 17__hydroxyprogesterone,salt wastining,precocious puberty,x:
verilization
11 B__hydroxylase deficiency______decreased aldosterone ,increased 11__deoxycortisone level(low
bp),increased sex harmones,high bp,low k+,decreased renin activity,xx:virilization

MEN type 1(wermer syndrome)_____pancreatic islet's cell tumors(eg gastrinoma),zollinger_Ellison's

syndrome,insulinoma,vipoma,parathyroid hyperplasia,pituatary adenoma

MEN type 2A(sipple syndrome)_____medullary carcinoma of thyroid,pheochromocytoma,adrenal

hyperplasia,parathyroid gland hyperplasia,RET proto_oncogene mutations

MEN type 2 B_____medullary carcinoma of thyroid,pheochromocytoma,mucosal neuromas,marfinoid

habitus,RET proto_oncogene mutation

GIT

Oropharyngeal dysphagia(odynophagia)_____difficult initiation of swallowing,aspiration of food into

lungs,coughing,chocking,drooling,stroke,parkinson's disease, mysthenia gravis,prolonged
intubation,zinker diverticulla,dificulty with liquid ingestion

Esophageal dysphagia_____esophageal(obstruction,strictures,schatzkir rings,webs), esophageal ,motility

disorders(achalasia,scleroderma,esophageal spasm),difficulty with solid ingestion,goiter,neck
tumor,video fluroscopic swallowing exam,esophago gastro deudo dinoscopy(EGD),manometry

Diffuse(distal)esophageal spasm____high amplitude non peristaltic contractions,heart burns,chest

pain,dysphagia,odynophagia,prcipitated by ingestion of hot and cold liquids,relieved by
nitroglycerine,investigated by EGD,barrium swallow(corck screw shaped esophagus),manometry,treated
by ca++channel blocjers,tri cyclic antidepressant s(TCAs),nitrates,esophageal myometry

Achalasia_____impaired LES relaxation,loss of lower 2/3 esophagus peristalsis,

myenteric's(auerbach)plexus's inhibitory neurons degenaration,progressive dysphagia,regurgitation of
undigested food,nocturnal cough,chest pain,weight loss,EGD,barrium swallow(bird's beak
tapering),manometry(increased resting LES pressure,incomplete relaxation,decreased peristalsis in
esophagus body,treated by nitrates,ca++ channel blockers,endoscopic botulinum toxin injection in
LES,pneumatic baloon dilation,haller's myotomy.
Esophageal diverticula(zinker diverticulam)_____dysphagia,regurgitation of undigested
food,halitosis,chest pain,on examination,bowel sound audible,treated with surgical excision,myotomy

Esophageal cancer____progressivd dysphagia,weight loss,odynophagia,GERD,gi bleeding,vomitting,on

examination bowel sound audible,investigated with EGD,biopsy,CT,endoscopic ultrasound,treated with
chemoradiation,surgical resection

Gastroesophageal reflux disease____beart burnafter meal worsening with reclining and improving with
antacid,sour taste in mouth,morning hoarseness,chest pain mimecking CAD, unexplained cough,
investigated by EGD,biopsy,24hrs ph monitering with impedance,barrium swallow,esophageal
manometry,treated by weight loss,elevation of bed's head,avoiding (alchohol,chocolates, coffee),use of
antacids,H2 receptors antagonists(cimetidine),PPI(omeprazole),Nissen fundoplication

Hiatal hernia____GERD,investigated with chest xray,barrium swallow,EGD, treated by shrgical

gastropexy

Gastritis____type A(autoimmune autoantibodies to parietal cells,pernicious anemia),type B(NSAID,h

pylori infection) epigastric pain ,nausea,vomitting,hematemisis,melana,NSAID use,alchohol
drinking,HPylori infection,stree(burns,CNS,injury),treated by avoiding NSAID, alchohol,use of
antacid,sucralfate,h2receptors blockers,ppi,tripple therapy(amoxicilline,clarithromycin,omeprazole),
or(metranidazole,clarithromycin,omeprazole),lli for stress ulcers(icu)patients

Gastric cancer____abdominal pain,weight loss,upper gi bleeding,indigestion,loss of

appetite,investigated by upper gi endiscopy,biopsy,treated by surgical excision

Peptic ulcer disease_____impaired mucosal defence,increased acidic contents,h pylori infection(>90℅of

deuodenal ulcer and >70℅of gastric ulcers),(use of NSAID,alchohol,tobacco use,corticosteroids),more in
male gender,dull burning epigastric pain related to meal,radiatin to back,nausea,hematemisis(coffee
ground emesis),hematochazia(blood in stool),epigastric tenderness,investigated by stool
guaiac,KUB,upper endiscopy,CT abdomen,biopsy,h pylori testing,serum gastrin level(zollinger ellison
syndrome),treated with antacids,ppi,h2 blockers,tripple therapy,avoiding(alcohole,tobacco),parietal
cells vagotomy
Zollinger ellison's syndrome_____recurrent gnawing burning abdominal pain unreslonsive to
tratment,nausea,weight loss,gi bleeding,investigated with increased fasting serum gastrin level,raised
gastrin secretion with administeration of secretin,CT, treated with surgical resection,octreotide use

Diarrhea____rotavirus infection(secretory)carcinlid tumors,vipomas,bacterial overgrowth,pancreatic

insufficiency,mucosal damage,lactose intolerance,celiac disease,laxative abuse,post surgical short bowel
syndrome,inflammatory,infections(IBD),increased motility(IBS),investigated by stool anysis(leucocytes
,culture,c difficile toxin,ova,parasite exam), sigmidoscopy,low osmotic gap(bacterial toxins,cholera,E
coli,vipoma,gastrinoma,medullary carcinoma of thyroid),high osmotic vap(celiac disease,whipple
disease,pancreatic i sufficiency,laxative abuse), treated by oral
rehydration,antiboitic(metronidazole),anti diarrheal agents(loperamide,bismith salicylate)

Malabsorption (maldigestion)_____frequent loose watery stools(carbohydrate malabsorption),pal foul

smelling bulky stools(steatorrhea,fat maldigestion),abdominal pain,flatues,fatigue,bloating,weight
loss,nutritional deficiencies,investigated with biopsy,treated with immunosuppressants ,anti
inflammatory drugs

Lactose intolerance_____abdominal bloating,flatuence,cramping,watery diarrhea following milk

ingestion,investigated by hydrogen breath test,treated by avoidance of diary products,oral lactase
enzyme replacement

Caecinoid syndrome____cutaneous flushing ,diarrhea,abdominal ceamps,wheezing,right side cardiac

valvular lesions,investigated with raised urinary serotonin metabolites 5_HIAA,CT,in_111 octreotide
scan,treated by octreotide,surgical resection

Irritable bowel syndrome_____chronic intermittent abdominal pain,changes in bowel habits,comorbid

psychiatric disorders(depression,anxiety,fibromyalgia),abdominal pain releived by bowel
movements,diarrhea,constipation,abdominal distension,mucous stools,stress related awaking the
patient from sleep,vomitting,ROME 111 diagnostic criteria(cbc, electrolytes,stool culturss,abdominal
films,barrium contrast studies,colonoscopy,biopsy)treated by psycosocial treated management,diet
modification(fibers supplements,psyllium) excude gas producing foods,use of anti spasmodic,TCAs,SSRIs

Small bowel obstruction_____crampy abdominal pain at 4 to 5mintes intervals,vomitting,on

examination abdominal distension,and tenderness,prior surgical scars,hernias,hyperactive bowel
sounds(high pitched tinkling peristaltic rushes),investigated with abdominal films(stepladder pattren of
dilated small bowel loops),air fluid levels,CT,cbc,dehydration ,metabolic alkalosis,lactic acidosis,treated
with fluid ressuscitations,npo,ng suction,iv hydration,electrolytes balancing,foley's catheterization,use of
opiods,anticholenergics

Illeus_____diffuse constant abdominal discomfort,nausea,vomitting,absence of flatus,absence of bowel

movements,on examination abdominal distension,tenderness,decreased bowel sounds,unvestigated by
abdominal films(distented loop of small and large bowel,air seen throughout the colon,rectum having
no air,distal to obstruction,treated with bowel rest,bowel decompression(ng suction,parenteral
feeds),avoiding narcotics,bowel motility reducing substances,electrolytes balancing,iv fluids
hydration,risk factors of recent surgery,gi procedures,immobility,hypokalemia,hypothyroidisim,diabetes
mellitus,drugs(slowing gi motility antacids,*****anti cholenergics,opiod

Mesenteric ischemia_____severe abdominal pain out of proportion to the

examination,nausea,vomitting,diarrhea,bloody stools,prior episodes of abdominal pain after eating
(intestinal angina),investigated by AXR,CT(thumbprinting),air withi bowel wall(pneumotosis
intestinalis),mesenteric /CT angiography,treated with volume ressusctation ,broad spectrum
antibiotics,anticoagulation,laparotomy,angiography for acute arterial thrombosis,embolisim

*****appendicitis______

Diverticular disease______(diverticulosis)sudden intermittent painless bleeding ,anemia symptoms

(fatigue,lightheadedness,dyspnea on exertion in severe bleeding),(diverticulitis)LLQ abdominal
pain,fever,nausea,vomitting,shock,peritonitis in case of perforation,investigated by
cbc(leucocytosis,anemia),CTscan,colonoscopy,treated with high fiber diet intake,fibers
supplements,blood transfusion,hydration,colonoscopic hemostasis,angiographic
embolization,surgery,npo,ng tube,antibiotic,colonoscopy,surgical resection of perforated
segment,Hartman's procedure with temporary colonostomy

Large bowel obstruction_____constipation,obstipation,deep cramping abdominal pain,nausea,feculant

vomitting,on examination(abdominaldistension,tympwny,tenderness),peritoneal irritation,peritoneal
,fever,shock(perforation),high pitched"tinkling"bowel sounds,absent of bowel sounds later on
,investigated by cbc,electrolytes,lactic acids,AXR,CT scan,water contrast
enema,sigmoidoscopy,colonoscopy,treated by gastro graffin enema,colonoscopy,rectal
tube,surgery,colectomy,diverting cectomy
Colorectal cancer_____(right side lesion)weight loss,vague abdominal pain,(left side
lesion)obstruction,change in bowel habbits,blood streakes in stool,bright red blood per
rectum,tenesmus,rectal pain,rectal bleeding,anemia(chronic occult blood
loss),anorexia,diarrhea,weakness,old age,heriadetery polyposis syndrome,positive family
history,IBD,adenomatous polyposis,(high fat,low fibers diet),investigated by
colonoscopy,biopsy,CXR,LFT,abdominal and pelvic CT,(for metastasis staging),treated with surgical
resection,adjuvant chemotherapy

Ischemic colitis_____crampy lower abdominal pain followed by bloody diarrhea after

meals,ecertion,and in the heat, fever,peritoneal sepsis(bowel necrosis),investigated bg scan with
contrast,colonoscopy(pale mucosa and petechial bleeding),treated with bowel rest ,iv
fluids,antibiotics,surgical bowel resection(infarction,fulminant colitis,obstruction)

Upper gi

bleeding_____hematemesis(coffeegroundemesis),hematochezia,hypovolumia,
(tachycardia,lightheadedness,hypotension),ng tube,gastric lavage,endoscopy for diagnosis,treated with
iv fluid ,packed rbc transfusion

Lower gi
bleeding____hematochezia>melana,nglavage,anoscopy,sigmoidoscopy,colonoscopy,arteriography,explo
ratory laparotomy,treated with iv fluid blood transfusion,endoscopic therapy(epinephrine
injectiin,cauterization,clio placement),intra arterial vasopressin infusion,embolization,surgery

Ulcerative colitis_____bloody diarrhea,lower abdominal cramps,tenesmus,urgency,abdominal

tenderness,frank blood on rectal examination,apthous stomatitis,episcliritis,uveitis,arthritis,primary
sclerosing cholangitis,erythema nodosum,pyoderma gangrenosum,cbc,AXR,stool cultures,stool assay
for(ova,parasite,c difficile),colonoscopy(diffuse continouse rectal
involvement,friability,edema,pseudopolyps,biopsy,treated with 5HSA agent(sulfasalazine),topical and
oral corticosteroid,immunemodulators(azathioprine),biologuc(infliximab),total
protocolectomy(standing,fulminant colitis,toxic megacolon)

Crohn disease____abdominal pain,abdominal mass,low grade fever,weight loss,watery

diarrhea,fever,abdominal tenderness,abdominal mass,perianal fistulas,fissures,tags,apthous
stomatitis,episcleritis,uveitis,arthritis,primary sclerosing cholangitis,erythema nodosum,pyoderma
gangrenosum,fistulas(to skin,bladder,between bowel loops),cbc,CBC,AXR,stool cultures
for(ova,parasites,stool assay for c difficile),upper gi series,small bowel follow
through,colonoscopy(apthoid linear stellate ulcers,strictures,cobble stones appearances, skip
lesions,creeping fat,investigated by biopsy,treated by ASA
agents,corticosteroids,immunomodulators,biological agents,surgical resection(suspected
perforations,strictures,fistulas,abscess)

Indirect inguinal hernia____abdominal contents herniation through both external and internal
rings,lateral to inferior epigastric vesseles,most common ,from congenital patent processes vagianlis

Direct inguinal hernia_____herniation through floor of hesselbach triangle,medial to epigastric

vessels,mechanical breakdownin tranversalis fascia resulting from age

Femoral hernia_____herniation below inguinal ligamwnt through femoral canal,below and lateral to the
pubic tubercle,increased intra abdominal pressures,weakened pelvic floor,in womem more common

Cholelethiasis(billiary colic)_____RUQ postparandial abdominal pain radiating to right subscapular

area,epigastrium,assosiated with nausea,vomitting,dyspepsia,flatuence,gallstones(RUQ tenderness
palpable gallbladder),investigated bg RUQ ultrasound,treated with cholecystectomy

Acute cholecystitis_____RUQ pain,nausea,vomitting,fever,RUQ tenderness,murphey's sign(inspiratory

arrest with deep palpation of RUQ),low grade fever,investigated by ultrasound(demonstrating
stones,bile sludge,pericholecystic fluid,thickened gallbladder,ultrelasonic murphey's sign,HIDA scan(non
visualization of gallbladder after radiotracer excreted through billiary system suggesting acute
cholecystitis),treated with iv antibiotics,iv fluids,cholecystectomy,increased wbc