Presenting problems in gastrointestinal disease
It is defined as difficulty in swallowing It must be distinguished from: Globus sensation Odynophagia.All esophageal dysphagia need endoscopy . Esophagitis & stricture could be caused by eosinophilic esophagitis & drugs e.g bisphosphonates
Mys
Systemic sclerosis
Sideropenic WebAchalasia
Malignant stricturePeptic stricture
Dyspepsia (indigestion) is a collective term for any symptoms thought to originate from the upper GIT. Although symptoms often correlate poorly with the underlying diagnosis, a careful history is important to: Elicit symptoms classical of specific disorders like peptic ulcer. Detect alarm features requiring urgent investigation Detect atypical symptoms more suggestive of other disorders e.g. myocardial ischemia.Upper GI disorders: Peptic ulcer disease Acute gastritis Gallstones Motility e.g. esophageal spasm Functional (non-ulcer dyspepsia & IBS)
Other GI disorders: Pancreatic disease (cancer, chronic pancreatitis) Hepatic disease (hepatitis, metastases) Colonic carcinoma
Systemic disease: Renal failure Hypercalcemia
Drugs: NSAIDs Iron & potassium supplements Corticosteroids Digoxin Others: Alcohol Psychological e.g. anxiety, depressionWeight loss Anemia Vomiting Hematemesis and/or malena Dysphagia Palpable abdominal mass
Dyspepsia
Are there “alarm features”? NoYes
Endoscopy
> 55 years
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Endoscopy
Test for H pylori
Negative
Positive
Treat Symptomatically or Consider other diagnosis
H pylori eradication
Symptoms resolve
Symptoms persist
No follow up
Synchronous contraction of the diaphragm, intercostal muscles, & abdominal muscles
Increases intra-abdominal pressureRelaxation of the lower Esophageal sphincter
Forcible ejection of Gastric contents
Infections: Gastroenteritis Hepatitis Urinary tract infection Drugs: NSAIDs Antibiotics Opiates Digoxin Cytotoxic drugs
Acute abdominal disorders: Appendicitis Cholecystitis Pancreatitis Intestinal obstruction CNS disorders: Vestibular neuritis Migraine Meningitis Raised intracranial pressure
Metabolic:Diabetic ketoacidosisUremiaAddison’s disease.Others:Any severe pain e.g. myocardial infarction. PsychogenicAlcoholismpregnancy
Vomiting is usually associated with: Nausea Retching Salivation Anorexia Or dyspepsia You must distinguish between: True vomiting & regurgitation Acute & chronic vomiting.
You must ask about: Abdominal pain Fever Diarrhea Relationship to food Drug ingestion Headache Vertigo Weight loss
Examination may reveal: Signs of dehydration, fever & infection. Evidence of abdominal mass Evidence of peritonitis Evidence of intestinal obstruction Neurological signs including: Papilledema Nystagmus Photophobia Neck stiffness. Other findings suggestive of: Alcoholism Pregnancy or Bulimia