ملخص

Dysphagia: means difficulty in swallowing

Odynophagia: Painful swallowing
Causes of dysphagia
Oesophageal causes: food sticking after swallowing
due to malignant tumors, of oesophagus and strictures or it my be due to motility disorders like achalasia
Oropharyngeal: difficulty in initiation of act of swallowing
Bulbar or pseudobulbar palsy and myasthenia gravis

Dyspepsia (indigestion)

Definition: dysphagia is chronic or recurrent pain or discomfort centered in the upper abdomen
In dyspepsia:
Detect symptoms suggest specific disorders like peptic ulcer.
Detect “alarm features” (weight loss, anaemia, vomiting, haematemesis, dysphagia and palpable abdominal mass) which need urgent endoscopy.
Detect atypical symptoms more suggestive of other disorders
Causes of dyspepsia

A. Common causes:

1. Functional dyspepsia
2. Organic:
peptic ulcer diseases
GERD
Gastric or oesophageal cancer


B. Rare causes:
Pancreatic and hepato-biliary, colonic diseases, systemic diseases
Investigation
1. Early endoscopy
If patient is above 55 years Or alarm features are present
2. Test for H. pylori and Anti-
H. pylori (age below 55). if Negative Symptomatic treatment
Or If it is positive eradication of H.pylori

Upper GIT bleeding

Causes
1-peptic ulcer
2-gastric erosion
3-oesophagitis
4-oesophagial varices
5-vascular malformation

Melena: Passage of tarry black stool per rectum

Haematemesis: Vomiting of blood, usually coffee ground materials

LOWER GIT BLEEDING

Subacute or chronic lower gastrointestinal bleeding
to haemorrhoids or anal fissure
Other causes: Inflammatory bowel disease, Carcinoma, Large polyps, Angiodysplasia


Severe acute lower gastrointestinal bleeding
medical emergency. Patients present with profuse red diarrhoea and with shock
causes :
Diverticular disease
Angiodysplasia
Ischaemia
Meckel's diverticulum

OCCULT GASTROINTESTINAL BLEEDING :

blood or its breakdown products are present in the stool but cannot be seen Any cause of gastrointestinal bleeding may be responsible but the most important is colorectal cancer
, investigation of the gastrointestinal tract should be considered whenever a patient presents with unexplained iron deficiency anaemia. Testing the stool for the presence of blood is unnecessary because bleeding from tumours is often intermittent and a negative faecal occult blood (FOB) test does not exclude important gastrointestinal disease.

OBSCURE MAJOR GASTROINTESTINAL BLEEDING

patients who present with major gastrointestinal bleeding, upper endoscopy and colonoscopy fail to reveal a diagnosis

Causes of vomiting :

Weight loss : Weight loss may be 'physiological' or the decreased nutritional intake or weight loss may signify disease; a loss of more than 3 kg over 6 months is significant
Causes :

Diarrhea

increased stool frequency and loose or watery stools.. the passage of more than 200 g of stool daily
Acute diarrhea: This is extremely common and usually due to faecal-oral transmission of bacteria, their toxins, viruses or parasites
variety of drugs, including antibiotics, cytotoxic drugs, proton pump inhibitors and NSAIDs, may be responsible for acute diarrhoea.

Chronic or relapsing diarrhea

The most common cause is irritable bowel syndrome . most severe before and after breakfast. and 24-hour stool volume is less than 200 g

Colonic diarrhea

Blood and mucus in stool , causes : Inflammatory bowel disease. Neoplasia Investigations: Colonoscopy with biopsies

Malabsorption diarrhea Steatorrhoea. Undigested food in the stool. causes:

Pancreatic (Chronic pancreatitis, cancer of pancreas)
Enteropathy (Coeliac disease)
Obstructive Jaundice
Investigations: (US, CT scan)


Small bowel diarrhea
Large volume watery stool causes: VIPoma. Drug induced (NSAIDs, Aminosalicylates, SSRIs).
Investigations: Stool volume .

ABDOMINAL PAIN

There are four types of abdominal pain
Visceral.
Parietal.
Referred pain.
Psychogenic

CAUSES OF ACUTE ABDOMINAL PAIN :

Inflammation: Appendicitis, Diverticulitis, Cholecystitis
Perforation/rupture: Peptic ulcer, Diverticular disease
Obstruction: Intestinal obstruction

CONSTANT ABDOMINAL PAIN Patients with chronic pain which is constant or nearly always present suggest the underlying diagnosis, e.g. malignancy (gastric, pancreatic, colonic, hepatic metastases), chronic pancreatitis or intra-abdominal abscess. In a minority no cause will be found despite thorough investigation .