Signs & Symptoms of GI Disorders Flashcards
Give some examples of causes of intra-peritoneal abdominal pain.
Epigastric pain (foregut)
- ulcers
- pancreatitis (+back pain)
- gallstones (+RUQ pain)
Peri-umbilical pain (midgut) = true colicky pain
- small bowel: pain every ~2-3min
- large bowel: pain every ~10-15min
Small bowel obstruction e.g. appendicitis = early vomiting, abdominal distension, AXR shows central distended loops
Suprapubic pain (hindgut) e.g. sigmoid volvulus
What is dyspepsia? Give some examples of causes. How is it treated?
Chronic or recurrent upper abdominal pain/bloating/discomfort/nausea etc. (inexact)
Causes (debatable):
- chronic peptic ulcer disease
- gastro-oesophageal reflux disease (GORD)
- malignancy
- functional/non-ulcer disease (diagnosis of exclusion)
Treatment:
- empirical acid suppression
- non-invasive H. pylori testing/eradication
- early endoscopy
What is anorexia? Give some examples of causes.
Loss of appetite
Causes:
- subjectively unpleasant food/surroundings
- anxiety/anger/fear
- psychological e.g. anorexia nervosa
- GI cancer
- chemotherapy/antibiotics
- pregnancy
- depression
- endocrine disorders
What is cachexia?
Weakness/wasting of body due to chronic illness
note: 5%+ unintentional weight loss should be investigated
What is nausea? Give some examples of causes.
Subjective sensation of the need to vomit
Vomiting centre affected by:
- peripheral pain receptors
- histamine
- distension/irritation
- vestibular system (labyrinthia of ear)
- emetic drugs
Causes:
- food poisoning (Staph., Salmonella, E. coli)
- gastroenteritis (Norovirus)
- cholecystitis
- appendicitis
- hepatitis
- pancreatitis
- intestinal obstruction
- pain
What is constipation? Give some examples of causes.
Infrequent bowel movements/difficulty during defecation/incomplete bowel evacuation
note: infrequent is usually <3/week but any change in bowel habit is more important than the exact number
Causes:
- diet
- medication e.g. opioid analgesics, tricyclics
- dehydration
- immobility
- neurological disease e.g. stroke
- diabetes
- colorectal stricture
What is diarrhoea? Give some examples of the different types and causes.
Increased frequency/decreased consistency of bowel movements
note: “true diarrhoea” = increased stool weight (note hyperdefecation or incontinence)
- secretory (infection)
- osmotic (lactose intolerance)
- exudative (colitis, cancer)
- malabsorption (reduced pancreatic enzymes & bile salts)
- abnormal motility (IBS, thyrotoxicosis)
What is dysphagia? What can it be caused by?
Difficulty swallowing
note: odynophagia = painful swallowing e.g. peptic ulcerations, oesophageal candidiasis, oesophagitis, cancer
Neurological —> difficulty initiating swallow due to deficits in control of muscles of tongue, pharynx, larynx (harder to swallow fluid than bolus)
- cerebrovascular accident which has damaged corticobulbar tracts
- Bulbar palsy = bilateral problem with cranial nerve
- pseudobulbar palsy = problem in cortical parts of brain
- achalasia = failure to relax lower oesophageal sphincter due to problems with inhibitory neurones
Anatomical —> food sticking in oesophagus
- foreign body
- goitre
- stricture (benign = peptic ulcer, malignant = carcinoma)
Give some examples of causes of bleeding in the top of the GI tract.
Haematemesis
Acute/chronic peptic ulcer disease
Mallory-Weiss tear = mucosal lacerations at GOJ/cardia of stomach caused by a sudden increase in intra-gastric pressure/gastric prolapse into oesophagus
e.g. vomiting, coughing, straining
Oesophageal/gastric varices
Erosive oesophagitis
Gastric/oesophageal cancer
Give some examples of causes of bleeding from the bottom of the GI tract.
Angiodysplasia (vascular malformation in gut)
Diverticular disease
Colonic carcinoma
Haemorrhoids/anal fissure
Irritable bowel syndrome
Massive upper GI bleed
note: haematochezia = bloody stool
rectorrhagia = expulsion of bright red blood without stool
What are the causes of abdominal distension?
Fat
Fluid (ascites e.g. liver failure, portal hypertension, cancer)
Faeces
Flatus (aerophagia or incomplete digestion)
Foetus
How can the appearance of blood in the stool differ, and why?
Bleeding in upper GI is oxidised during its passage through the gut
—> foul-smelling tarry black stool - MELAENA
Bleeding in lower GI/massive upper GI bleeding passes through the gut too quickly to be digested - fresh blood
What investigations should be performed to identify the cause of dysphagia?
Barium swallow/endoscopy for oesophageal dysplasia
Videofluoroscopic swallow for oropharyngeal dysplasia (allows real-time evaluation of all phases of swallow by following movement of barium sulfate using fluoroscope) - more useful for neurological cause
What is gastro-oesophageal reflux disease?
Stomach acid/content flows back into the oesophagus and irritates the lining of the oesophagus (“heartburn”)
What is classical pernicious anaemia? What is it caused by? How is it treated?
B12 deficiency causing defective production of RBCs
Normal:
Vit. B12 binds to intrinsic factor (produced by parietal cells in stomach) during gastric emptying
Intrinsic factor actively transported into blood in the terminal ileum
Binds to transcobalamin II in the liver (3yr storage supply)
Abnormal:
- autoimmune disorder causing atrophy of gastric mucosa (loss of parietal cells -> intrinsic factor deficiency)
- terminal ileum removed
- vit. B12 deficiency
S&S (advanced disease): polyneuropathies
- peripheral nerves -> symmetrical paraesthesiae
- subacute combined degeneration: loss of proprioception, delusions, dementia, ataxia, optic atrophy, paraplegia etc.
Treatment: oral/injected B12
