Presenting problems in gastrointestinal disease

Dysphagia

Dysphagia 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 Web

Achalasia

Malignant stricture

Peptic stricture

Dyspepsia

Dyspepsia 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.

Causes of Dyspepsia Upper GI disorders: Other 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

Causes of Dyspepsia Systemic disease: Drugs: Others: Renal failure Hypercalcemia Drugs: NSAIDs Iron & potassium supplements Corticosteroids Digoxin Others: Alcohol Psychological e.g. anxiety, depression

Alarm Features in Dyspepsia Weight loss Anemia Vomiting Hematemesis and/or malena Dysphagia Palpable abdominal mass

Dyspepsia Are there “alarm features”? Endoscopy No Yes > 55 years Test for H pylori Negative Positive Treat Symptomatically or Consider other diagnosis H pylori eradication Symptoms resolve persist follow up

Vomiting

Synchronous contraction Relaxation of the lower of the diaphragm, intercostal muscles, & abdominal muscles Relaxation of the lower Esophageal sphincter Increases intra-abdominal pressure Forcible ejection of Gastric contents

Causes of Vomiting Infections: Drugs: Gastroduodenal disease: Gastroenteritis Hepatitis Urinary tract infection Drugs: NSAIDs Antibiotics Opiates Digoxin Cytotoxic drugs Gastroduodenal disease: Chronic peptic ulcer disease (± gastric outlet obstruction) Gastric cancer Gastroparesis e.g. diabetes, scleroderma, drugs

Causes of Vomiting Acute abdominal disorders: CNS disorders: Appendicitis Cholecystitis Pancreatitis Intestinal obstruction CNS disorders: Vestibular neuritis Migraine Meningitis Raised intracranial pressure Metabolic: Diabetic ketoacidosis Uremia Addison’s disease. Others: Any severe pain e.g. myocardial infarction. Psychogenic Alcoholism pregnancy

Vomiting-Symptoms 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

Vomiting-signs 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