What is a sign?
Externally visible and detectable to someone other than the patient
What is a symptom?
Internally experienced by the patient and impossible to detect by others
What are some general symptoms of GI tract disease?
- Anaemia
- Anorexia
- Weight loss
- Malaise
What are some symptoms associated with upper GI tract disease?
- haematemesis (vomiting blood)
- melaena (blood in stool)
- Nausea and vomiting
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Heartburn (caused by acid regurgitation)
- Acid regurgitation (acid entering oesophagus)
- Belching
- Chest pain
- Epigastric pain (pain in central upper abdomen, below chest pain area)
What can cause stool to be black?
Upper GI bleeding which travels through the GI tract. The pigment is altered by gut flora, digestive enzymes and secretions, which change the colour
What are some symptoms that are associated with hepatobiliary disorders?
- RUQ pain (liver and gallbladder here)
- Biliary colic (gallbladder pain caused by gallbladder contraction against downstream obstruction)
- jaundice
- dark urine (high bilirubin)
- pale stool
- ascites (cancer, liver failure and malnutrition)
What causes jaundice?
An increase in circulating bilirubin. This is usually because the hepatobiliary system is unable to process the amount of bilirubin in the blood for pre-hepatic, hepatic or post-hepatic reasons.
What causes pale stool?
The normal brown colour of faeces is due to the presence of stercobilin. This pigment arises from bilirubin that enters the gut through bile secretion, so if bilirubin doesn’t make it into the gut then stercobilin concentration will go down and stools will become pale.
What are some symptoms associated with mid GI tract disorders?
- Abdominal pain
- Steatorrhoea
- Diarrhoea (sign of digestive failure - reduced lipase or bile)
- Abdominal distention (excessive gas or ascites)
What are some symptoms associated with lower GI tract disorders?
- Abdominal pain
- Rectal bleeding (bright red)
- Constipation (reduced gut motility which allows longer for water absorption)
- Diarrhoea
- Incontinence (bladder +/ rectum causes by neural damage to sphincter or mechanical or diarrhoea)
- ## Flatulence
What are some general signs of GI disease (whole body)?
- Cachexia (muscle wasting)
- Obesity
- Lymphadenopathy (enlargament of lymphoid tissue)
- Jaundice (hallmark of liver failure)
What are some general signs of GI disease (hands)?
- Koilonychia
- Leuconychia
- Nail clubbing
- Dupytren’s contractures
- Tachycardia
- Tremor
What is koilonchycia and what is it a sign of?
Spooning of the nails of the fingers. This is a common sign of iron-definicient anaemia.
What is leuconychia and what can it indicate?
Partial or complete whitening of the nails, which are usually pink. It can reflect a dietary nutrient deficiency.
What is nail clubbing and what does it indicate?
Nails of the fingers having an enlarged concave appearance. This is usually a sign of malabsorption, Crohn’s or cirrhosis.
What is dupytren’s contractures and what is it associated with?
A deformity of the hand that usually develops over years. Caused by the layer of tissue that lies under the skin of your palm in which thickened cords of tissue develop that can pull one or more fingers into a bent position. Associated with persistent uncontrolled diabetes and excess alcohol consumption.
What are some general signs of GI disease (abdomen)?
- palpable organ enlargement (welling or the affected organ)
- abdominal tenderness (local obstruction or infection can lead to swelling and tenderness in the tissue)
- distension
What are some general signs of GI disease (anus and rectum)?
- Haemorrhoids (AKA piles which are swollen superficial vessels that are prone to bleeding and itchy)
- Fistula (alternative pathway)
- Fissure (tear or ulceration of the mucosal lining of the peri-anal tissue. Prone to infection and can become rather painful during bowel movements)
- Procitis (inflammation of inside of rectum)
What is an anal fistula?
Any pathway from the anus/rectum to the outside environment not directly through the entire anal canal.
What is the difficulty with addressing abdominal pain?
The size and number of organs in the abdomen is large, so abdominal pain can reflect a wide range of health problems, some of which are medical emergencies.
When pain is being described both subjectivity and interpretability must be considered.
What are the causes of right hypochondriac pain?
Gall stones, gall bladder infection, pulled muscles, hepatitis, kidney stone, pneumonia
What are the causes of epigastric pain?
Acid reflux, heartburn, heart attack, gastritis, stomach ulcer, duodenal ulcer, pancreatitis, epigastric hernia
What are the causes of left hypochondriac pain?
Pneumonia, spleen infection, splenomegaly, hepatitis, kidney stone, constipation, trapped wind
What are the causes of left lumbar pain?
Constipation, trapped wind, diverticulitis, IBS, kidney stone, kidney infection, Crohns, ulcerative colitis
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Oesophagus and stomach42
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Liver44
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Small intestine45
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Pancreas43
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Introduction31
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Liver Failure and Jaundice48
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The large intestine43
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Ions, vitamins and minerals46
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Embryology6
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Infection and immunology of the gut50
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Nutrition17
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Cancer of gut23
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Abdominal pain and pancreatitis23
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Appetite regulation18
