human-digestive-system GIT HISTORY AND COMMON SYMPTOMS Clinical Sessions 2011 safe_image med-logo 50276_82989623131_8357482_n Afonso Sequeira 3rd year - General Medicine systematic, scientific and easy PRESENT COMPLAINT patient-demander-docteur_~x16844906 COMMON SYMPTOMS lAnorexia and weight loss lDysphagia lHeartburn lDyspepsia lNausea and vomiting lHaematemesis lAbdominal pain lWind lAbdominal distension lAltered bowel habit lRectal bleeding lJaundice COMMON SYMPTOMS of git system are listed above ANOREXIA AND WEIGHT LOSS lAnorexia: loss of appetite lWeight loss: energy expenditure exceeds calorie intake stomach-ache “Do you still enjoy your meals?” CAUSES: lDM type 1 lHyperthyroidism lMalabsorption lDiuretic therapy lSevere burns magnifying_glass It is common in many upper GIT and liver diseases including malignancy. But it doesn specifically indicate git disease Anorexia nervosa achalasia-indications-picture DYSPHAGIA lDifficulty swallowing “Does food (or drink) stick when you swallow?” CAUSES: lOral –Ulcers –Mouth infections lNeurological –Stroke –Bulbar palsy lNeuromuscular –Achalasia –Myasthenia gravis lMechanical –Oesophageal cancer l magnifying_glass Dysphagia is dfficulty swallowing and should always be investigated Achalasia – when the lower oesophageal sphincter fails to relax normally, leads to progressive oesophageal dilatation above the sphincter. Odynophagia is pain on swallowing (ulceration, inflamation, candidiasis) HEARTBURN lHot burning, retrosternal discomfort lRadiates upwards heartburn-disease Heartburn Is the principal symptom of gastro-oesophageal reflux disease. Accompanied by acid reflux due to regurgitation producing a sour taste in the mouth. Differential diagnosis to differentiate from heart infarct. DYSPEPSIA lPain or discomfort centred in the upper abdomen CAUSES: lGastro-oesophageal reflux disease lPeptic ulcer disease lFunctional dyspepsia indigestion AKA Indigestion. Peptic-ulcer disease Pain is worse in an empty stomach and is eased by eating. NAUSEA AND VOMITING lNausea: sensation of feeling sick lVomiting: expulsion of gastric contents via mouth. CAUSES: lDyspepsia lPeptic ulcers lGastric outlet/ pylorus obstruction lGastroenteritis lCholecystitis lRaised intracranial pressure clam-chowder-z MCj04244540000[1] Associated with pallor, sweating and hyperventilation Gastric outlet obstruction Projectile vomiting of non-bile stained contents Pylorus obstruction Bile stained Other causes: -drugs -bulimia 18145 HAEMATEMESIS lVomiting blood lAbove g-o sphincter (oesophageal varices) lBelow g-o sphincter (Mallory-Weiss tear) l CAUSES: lGastric ulcer lOesophagitis, gastritis lOesophagic, gastric cancer lNSAIDS l The blood can be fresh and red or dark resembling coffee grounds. Mallory-Weiss tear -Mucosal lacerations - gastroesophageal junction - occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear may bleed . Drugs – ask patients about NSAIDS, aspirin, drugs and alchol magnifying_glass stomach-ache-t14815 ABDOMINAL PAIN Stomach-Pain-Causes Access its characteristics! (site, timing, severity, what makes it worse and what makes it better) lVisceral abdominal pain: distension of hollow organs, smooth muscle contraction (deep poorly localized) lSomatic pain: irritation of parietal peritoneum l Hindgut – pain localizes to suprapubic area Midgut – pain localizes to periumbilical area Foregut – pain localizes to epigastric area Experienced as Pain in various GIT diseases is well documented with details FG - stomach, pancreas, liver, bil MG – small intestine HG – colonic pain Radiation of pain usually indicates peritoneal inflammation WIND lRepeated belching, excessive flatus, abdominal distension lBorborygmi: bowel sounds, movement of fluid and gas along the intestine Bad-smell magnifying_glass Ask the patient to describe what is being experienced. Borborygmi Audible bowel sounds ABDOMINAL DISTENSION lFactors (the 5 Fs) –FAT –FLATUS –FAECES –FLUID –FOETUS Consider –Excessive alcohol consumption –Obstruction –Obstruction, constipation –Ascites –Date of last menstrual period Obesity, wind, faeces, fluid in peritoneal cavity, pregnancy Causes of ascites: -Hepatic cirrhosis with portal hypertension -Right heart failure -Intra-abdominal malignancy diarrhea ALTERED BOWEL HABIT l3x each day to 1x every 3 days is considered normal lConstipation: infrequent passage of hard stools –Impaired mobility –Physical obstruction lDiarrhoea: frequent passage of loose stools –Impaired water absorption magnifying_glass Ask for change in stool consistency, increased frequency of defecation, urgency, etc Normal evacuation/ bowel movement frequency Impaired mobility  irritable bowel syndrome Physical obstruction  colorectal cancer Diarrhoea Increased water content RECTAL BLEEDING lFresh rectal bleeding –Haemorrhoids –Anal fissure –Colorectal cancer –IBD – lMelaena: blood loss in upper GIT tract gi21 understandinghemorrhoidsbasics-hemorrhoids IBD – inflammatory bowel disease Melaena Black, tarry stools with a characteristic odour JAUNDICE lYellow discoloration of the skin, sclerae and mucous membrames (> 50 μmol/L) lHyperbilirubinaemia –Prehepatic (haemolysis, Gillbert’s syndrome) +Ubg –Hepatocellular (viral hepatitis, drugs, cirrhosis) –Obstructive (drugs, gallstones, cancer) +UnBil – 70 micro mol/l to be noticed in skin Bilir – breakdown product of Hb PAST HISTORY lSimilar problem might suggest diagnosis lPrevious abdominal surgery k3490913 lOTCs lAspirin and NSAIDs lOpioids lAntibiotics Lets move on now to … OTCs – herbal mixtures, ‘alternative’/ home made remedies Aspirin and NSAIDs - dyspepsia, gastric erosion, ulcers Opioids – nausea, vomiting, constipation Atbs FAMILY HISTORY lColorectal cancer in a < 50 years old, first degree patient lIBD lCrohn’s disease lUlcerative colitis l+ve family history in most of GIT diseases is not helpful l l 12465913522002067962family Inflammatory bowel disease .. Because they are very common SOCIAL HISTORY drinking-alcohol101 coping-with-stress food-photo cigarettes many picture photo lots bunch lDietary history lAlcohol consumption lSmoking lStress lSpecific risk factors l l l Diets lacking in fruit, vegetables, and fibre increase COLONIC CANCER CANCER and VENTRICULAR DISEASE Ask for Alcohol consumption units Smoking Increase the incidence of Crohns Reduce incidence of ulcerative colitis Stress – work, home circumstances Foreign travel – diarrhoea Since it can be related to amoebiasis Clinical Sessions 2011 safe_image med-logo 50276_82989623131_8357482_n Afonso Sequeira 3rd year - General Medicine med107 click-here-green