SUMMARY

I. Disorders of the Upper GI Tract (Mouth, Esophagus, Stomach)

A. Oral Cavity
1. Cancer of the Oral Cavity
Risk Factors: Smokers, alcoholics.
Types: Lip Ca (pipe smokers, good prognosis), Tongue Ca (metastasis to neck
common), Submaxillary gland Ca (highly malignant).
S/Sx: Alteration of taste, leukoplakia (precancerous white patches), pain (late sign).
B. Esophagus and Diaphragm
2. Hiatal Hernia (Diaphragmatic Hernia)
Pathophysiology: Enlarged cardiac sphincter allows part of the stomach to pass into
the thoracic cavity.
Types:
Sliding Hernia: Upper stomach and GEJ displace above the diaphragm.
Rolling (Paraesophageal) Hernia: GEJ stays below, but fundus pushes through into
the thorax.
1. Gastroesophageal Reflux Disease (GERD)
Pathophysiology: Backward flow of gastric contents into the esophagus due to an
incompetent Lower Esophageal Sphincter (LES).
Risk Factors: Obesity, pregnancy, high-fat diet, smoking, caffeine, chocolate.
C. Stomach
4. Gastritis
Pathophysiology: Inflammation of the gastric mucosa.
Types:
Acute: Ingestion of chemical irritants (NSAIDs, alcohol, food poisoning).
Chronic Type A: Autoimmune.
Chronic Type B: H. pylori infection.
Other forms: Superficial, Atrophic (leads to pernicious anemia), Hypertrophic.
1. Gastric Cancer
Risk Factors: Middle-aged men, excessive cured/raw food, smoking, achlorhydria,
atrophic gastritis.
S/Sx: Early satiety, indigestion, UGI bleeding, palpable mass.
2. Peptic Ulcer Disease (PUD)
Pathophysiology: Ulceration in the mucosal wall accessible to gastric secretions.
Risk Factors: Stress, smoking, alcohol, ulcerogenic drugs (ASA, NSAIDs,
Steroids), H. pylori, Type A personality, Blood Type O.
Specific Types:
Gastric Ulcer: "Poor man's ulcer," pain 1-2 hours before eating. Caused by a
break in the mucosal barrier.

SUMMARY 1
 Duodenal Ulcer: "Rich man's ulcer," pain 2-4 hours after eating. Characterized
by high gastric acid secretion.
Curling's Ulcer: Occurs 48-72 hours after burns.
Cushing's Ulcer: Due to head trauma.
Post-Surgical Syndrome:
Dumping Syndrome: Rapid emptying of gastric contents into the small intestine
after gastric resection, causing shock-like manifestations.

II. Disorders of the Intestines

A. Small and Large Intestine
7. Appendicitis
Pathophysiology: Inflammation of the vermiform appendix.
Cause: Obstruction, low-fiber diet.
S/Sx: Pain migrating to McBurney's point, nausea/vomiting, fever, rebound tenderness.
1. Peritonitis
Pathophysiology: Inflammation of the peritoneum, often caused by leaking GI
contents.
S/Sx: Abdominal rigidity and distention, paralytic ileus, fever, signs of early shock.
2. Diverticulitis
Pathophysiology: Inflammation of diverticula (outpouchings of the mucosal lining).
Cause: Low-fiber diet.
S/Sx: Cramping pain (LLQ), constipation with diarrhea, occult blood.
B. Chronic Inflammatory Bowel Disease (IBD)
10. Regional Enteritis (Crohn's Disease)
Location/Site: Transmural; ileum to ascending colon.
Characteristics: "Cobblestone" appearance, fistulas common.
1. Ulcerative Colitis
Location/Site: Mucous ulceration; lower rectum.
Characteristics: Severe bleeding, 20-30 watery stools/day, surgery more likely.
2. Complications of IBD:
Intractability, Perforation, Fistula Formation, Hemorrhage, Toxic Megacolon,
Obstruction, Malabsorption, Susceptibility to Neoplasia.
C. Colorectal and Anal Disorders
13. Colorectal Cancer
S/Sx: Change in bowel habits, tenesmus, bleeding.
Screening: DRE, Occult Blood, Proctosigmoidoscopy.
Surgical Procedure: Abdomino-Perineal Resection (APR) with permanent colostomy.
1. Hemorrhoids
Pathophysiology: Varicosities beneath the skin lining in the anal canal.
Causes: Chronic constipation, pregnancy, obesity, prolonged sitting.

SUMMARY 2
 S/Sx: Constipation, bleeding, pruritus ani.
D. Intestinal Obstructions
15. Intussusception and Volvulus
Intussusception: Telescoping of one part of the intestine into another.
Volvulus: Twisting of the intestine.

III. Disorders of the Hepatobiliary System (Liver, Gallbladder, Pancreas)

A. Liver
16. Cirrhosis
Pathophysiology: Chronic progressive damage to liver cells with fibrosis and nodular
regeneration.
Causes: Alcohol ingestion, viral hepatitis, toxins.
Key Manifestations:
Portal Hypertension: Esophageal varices, splenomegaly, caput medusae, ascites.
Coagulation Defects: Bleeding tendencies.
Jaundice: Inability to metabolize bilirubin.
Asterixis: Flapping tremors due to high ammonia (Hepatic Encephalopathy).
Ascites: Due to portal hypertension, hypoalbuminemia, hyperaldosteronism.
1. Hepatitis
Pathophysiology: Inflammation of the liver due to infection or toxic injury.
Types by Transmission:
A & E: Fecal-oral.
B, D, & probably C: Blood and body fluids.
Stages: Preicteric (prodromal), Icteric (jaundice), Posticteric (recovery).
B. Gallbladder
18. Cholecystitis & Cholelithiasis
Pathophysiology:
Cholelithiasis: Gallbladder stone formation (cholesterol, bile salts, bilirubin).
Cholecystitis: Gallbladder inflammation.
Predisposing Factors: The 5 F's (Fat, Forty, Female, Fertile, Fair).
S/Sx: Fat intolerance, Murphy's Sign, RUQ pain, jaundice, acholic stool, tea-colored
urine.
C. Pancreas
19. Pancreatitis
Pathophysiology: Inflammation and autodigestion of the pancreas.
Causes: Alcohol, drugs, autoimmune, biliary obstruction.
S/Sx: LUQ pain, severe dehydration, increased amylase/lipase, hyperglycemia.
Signs: Grey Turner's sign (bruising of flanks), Cullen's sign (periumbilical bruising).

SUMMARY 3
 I. Disorders of the Pituitary Gland
A. Growth Hormone (Somatotropin) Disorders
1. Hypofunction:
Dwarfism (in children)
Cachexia (in adults) – metabolic derangements.
2. Hyperfunction:
Gigantism (in children, before epiphyseal closure): Exaggerated growth in height
and weight.
Acromegaly (in adults, after epiphyseal closure): Enlarged hands and feet,
prognathism, organomegaly, visual disturbances.
B. Prolactin (Lactotropic Hormone) Disorders
1. Hypofunction: Agalactorrhea (absence of milk production during lactation).
2. Hyperfunction: Galactorrhea (excessive or inappropriate milk production).
C. Adrenocorticotropic Hormone (ACTH) Disorders
1. Hypofunction: Secondary Adrenal Hypofunction (due to lack of ACTH stimulation).
2. Hyperfunction: Secondary Cushing's Syndrome (Cushing's Disease).
D. Thyroid-Stimulating Hormone (TSH) Disorders
1. Hypofunction: Secondary Hypothyroidism.
2. Hyperfunction: Secondary Hyperthyroidism.
E. Gonadotropins (FSH, LH) Disorders
1. Hypofunction: Failure to develop secondary sex characteristics, infertility, decreased
libido.
2. Hyperfunction: Precocious Puberty.
F. Melanocyte-Stimulating Hormone (MSH) Disorders
1. Hypofunction: Hypopigmentation (Albinism).
2. Hyperfunction: Hyperpigmentation ("Eternal Tan").
G. Antidiuretic Hormone (ADH) Disorders
1. Hypofunction: Diabetes Insipidus (DI)
Types: Neurogenic, Nephrogenic, Psychogenic.
S/Sx: Polyuria (5-24L/day), polydipsia, dehydration.
2. Hyperfunction: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
S/Sx: Fluid overload, edema, hypertension, dilutional hyponatremia.
Common Cause: Oat cell carcinoma of the lung.
H. Pan-Pituitary Disorders
1. Hypopituitarism: Decreased function leading to loss of gonadotropins, TSH, and ACTH.
2. Hyperpituitarism: Oversecretion of one or more hormones, usually from a benign
adenoma (e.g., Prolactinoma).
Surgical Management: Transsphenoidal Hypophysectomy.

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 II. Disorders of the Thyroid Gland
A. Structural/General
1. Goiter: Enlargement of the thyroid gland due to increased TSH stimulation. Can be
associated with both hypo- and hyperthyroidism.
B. Hypofunction (Hypothyroidism)
1. Hypothyroidism
Causes: Hashimoto's Thyroiditis (autoimmune), overuse of radioactive
iodine/lithium, dietary iodine deficiency.
S/Sx: "All is Low and Dry" - fatigue, weight gain, cold intolerance, bradycardia,
constipation, dry skin/hair.
2. Myxedema Coma: Extreme, life-threatening hypothyroidism with profound depression
of vital signs.
3. Cretinism: Congenital hypothyroidism leading to stunted physical and mental growth.
C. Hyperfunction (Hyperthyroidism)
1. Hyperthyroidism / Thyrotoxicosis
Types: Grave's Disease (most common, with ophthalmopathy and dermopathy),
Toxic Nodular Goiter.
S/Sx: "All is High and Wet" - heat intolerance, tachycardia, weight loss, diarrhea,
diaphoresis.
Ophthalmopathy: Exophthalmos, Dalrymple's Sign, Von Graefe's Sign.
2. Thyroid Storm / Crisis: Uncontrolled, life-threatening exacerbation of hyperthyroidism.

III. Disorders of the Parathyroid Gland

A. Hypofunction
1. Hypoparathyroidism
Pathophysiology: Hyposecretion of PTH causing hypocalcemia and
hyperphosphatemia.
S/Sx: Increased neuromuscular excitability (paresthesia, muscle spasms,
laryngospasm), Chvostek's Sign, Trousseau's Sign.
B. Hyperfunction
1. Hyperparathyroidism
Pathophysiology: Hypersecretion of PTH causing hypercalcemia and
hypophosphatemia, bone demineralization.
S/Sx: Decreased neuromuscular excitability (fatigue, weakness), bone
pain/pathologic fractures, kidney stones (nephrolithiasis).

IV. Disorders of the Adrenal Gland

A. Adrenal Cortex
1. Hypofunction: Adrenocortical Insufficiency
Addison's Disease (Primary): Due to destruction of the adrenal cortex.

SUMMARY 5
 S/Sx: Hyponatremia, hyperkalemia, hypoglycemia, hyperpigmentation ("Eternal
Tan" due to high ACTH/MSH), loss of body hair.
Secondary Adrenocortical Insufficiency: Due to lack of ACTH from pituitary.
Addisonian Crisis: * Acute, life-threatening exacerbation with vascular collapse and
shock.
2. Hyperfunction:
Cushing's Syndrome: * Excessive corticosteroids (especially cortisol).
S/Sx: Truncal obesity, "moon face," "buffalo hump," thin skin/striae,
hyperglycemia, hypertension, virilism.
Conn's Syndrome (Primary Aldosteronism): * Excessive aldosterone secretion.
S/Sx: Hypernatremia, hypokalemia, hypertension, muscle weakness.
B. Adrenal Medulla
1. Hyperfunction:
Pheochromocytoma: * Catecholamine-secreting tumor (usually benign).
S/Sx: Severe hypertension (paroxysmal), headache, tachycardia, palpitations,
diaphoresis.

V. Disorders of the Pancreas (Endocrine)

A. Diabetes Mellitus (DM)
1. Type 1 Diabetes Mellitus (Insulin-Dependent)
Pathophysiology: Absolute insulin deficiency due to beta-cell destruction.
Onset: Typically < 30 years old.
Acute Complication Prone: Diabetic Ketoacidosis (DKA).
2. Type 2 Diabetes Mellitus (Non-Insulin-Dependent)
Pathophysiology: Insulin resistance with relative insulin deficiency.
Onset: Typically > 30 years old.
Acute Complication Prone: Hyperglycemic Hyperosmolar Nonketotic Coma
(HHNK/HHNC).
3. Other Specific Types
Due to genetic defects, pancreatic diseases (pancreatitis, cancer),
endocrinopathies (Cushing's, acromegaly), or drugs (corticosteroids, thiazides).
4. Gestational Diabetes Mellitus (GDM)
Glucose intolerance with onset or first recognition during pregnancy.
B. Acute Complications of Diabetes Mellitus
1. Hypoglycemia: Blood glucose <60 mg/dL.
2. Diabetic Ketoacidosis (DKA): Hyperglycemia, ketosis, metabolic acidosis, dehydration.
3. Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK/HHNC): Extreme
hyperglycemia (600-2000 mg/dL), severe dehydration,
hyperosmolarity, without significant ketosis.
C. Chronic Complications of Diabetes Mellitus
1. Macroangiopathy: Cerebrovascular disease, CAD, PVD.

SUMMARY 6
 2. Microangiopathy: Diabetic Retinopathy, Diabetic Nephropathy.
3. Neuropathy: Peripheral Neuropathy, Autonomic Neuropathy (gastroparesis, sexual
dysfunction).
4. Integumentary: Acanthosis Nigricans (sign of insulin resistance), Diabetic Feet.

SUMMARY 7