1. Presenting problems in gastrointestinal disease

2. Dysphagia

3. Dysphagia It is defined as difficulty in swallowing
It must be distinguished from:
Globus sensation
Odynophagia.

5. All esophageal dysphagia need endoscopy .
Esophagitis & stricture could be caused by eosinophilic esophagitis & drugs e.g bisphosphonates

6. Mys

7. Systemic sclerosis

8. Sideropenic Web

9. Achalasia

10. Malignant stricture

11. Peptic stricture

12. Dyspepsia

13. 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.

14. 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

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

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

17. 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

18. Vomiting

19. 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

20. 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

21. 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

22. 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

23. 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