GI Symptoms

Question 1

What is anorexia?

Answer 1

Anorexia is loss of appetite and/or lack of interest in food.

Question 2

What is weightloss?

Answer 2

Weight loss is usually the result of reduced energy intake, not increased energy expenditure.

This can result from:

• Dieting
• Loss of appetite
• Malabsorption or Malnutrition

Question 3

How can diabetes mellitus contribute to weightloss?

Answer 3

Glycosuria can cause energy loss in uncontrolled diabetes

Question 4

What can lead to increased energy expenditure?

Answer 4

Hyperthyroidism
Fever
Adoption of more energetic lifestyle

Question 5

What is the likeliest diagnosis when heartburn is the principle symptom?

Answer 5

GORD

Question 6

How do you differentiate heartburn from cardiac chest pain?

Answer 6

Burning quality
Upward radiation
Association with acid reflux
Occurrence on lying flat or bending forward

Question 7

What is waterbrash?

Answer 7

Sudden appearance of fluid in the mouth due to reflex salvation as a result of GORD or rarely PUD

Question 8

How common is dyspepsia?

Answer 8

Affects 80% of the population at some time.

In the majority no functional cause is found

Question 9

How do you classify dyspepsia?

Answer 9

Clusters of symptoms used to classify

Reflux like dyspepsia = heartburn predominant dyspepsia

Ulcer like dyspepsia = epigastric pain relieved by for or antacids)

Dysmotility like dyspepsia = Nausea, belching, bloating and premature satiety

Question 10

What is the classical symptom of PU?

Answer 10

Dyspepsia that is worse with an empty stomach and is eased by eating

Question 11

What is odynophagia?

What does it possibly indicate?

Answer 11

Pain on swallowing
Can be present with or without dysphagia.
May indicate active oesophageal ulceration from peptic oesophagi’s or oesophageal candidiasis.

It implies intact mucosal sensation, making oesophageal cancer unlikely

Question 12

Visceral abdominal pain is conducted via what nerves?

Answer 12

Sympathetic splanchnic nerves

Question 13

Describe somatic pain

Answer 13

Conducted via intercostal nerves

Pain from the parietal peritoneum and abdominal wall

Question 14

Where would diverticular pain of the sigmoid colon be felt?

Answer 14

Left iliac fossa

Inflammation may cause localised pain

Question 15

Sudden onset of severe abdominal pain, rapidly progressing to become generalised and constant suggests what?
What preceding features may you have and what do they suggest?

Answer 15

Hollow viscous perforation
A ruptured abdominal aortic aneurysm
Mesenteric infarction

Preceding constipation suggests CRC or diverticular disease as cause of perforation
Prior dyspepsia suggests peptic ulceration

Question 16

What does development of circulatory failure following the onset of pain suggest?

Answer 16

Intra-abdominal sepsis or bleeding

e.g. ruptured AAA or ectopic pregnancy

Question 17

Inflammation and obstruction are the principle pathological processes producing acute abdominal pain.
Describe inflammatory pain

Answer 17

Inflammation usually produces constant pain exacerbated by movement or coughing

Question 18

What is colicky pain?

Answer 18

Arises from hollow structures e.g. small or large bowel obstruction, or the uterus during labour.

It lasts for a short period of time (seconds or minutes), eases off and then returns “waxes and wanes”

Question 19

Give examples of radiation in abdominal pain

Answer 19

Pain radiating from right hypochondriac to the shoulder or inter scapular region may reflect diaphragmatic irritation e.g. acute cholecystitis

Pain radiating from the loin to the groin and genetalia = renal colic

Central upper abdominal pain radiating through to back, partially relieved by sitting forward = pancreatitis

Central abdominal pain which later shifts to the RIF = acute appendicitis

The combination of severe back and abdominal pain may indicate a ruptured or dissecting AAA

Question 20

Abdominal pain persisting for hours or days suggests what?

Answer 20

Inflammatory disorder such as:

• Acute appendicitis
• Cholecystitis
• Diverticulitis