15. Symptoms of the Gastro-Intestinal System

8/13/2019 15. Symptoms of the Gastro-Intestinal System

1/28

SYMPTOMS OF

THE GASTROINTESTINAL

SYSTEM

Dr. Anna

-

Maria Andronescu

May 2009


2/28

COMMON SYMPTOMS of the GASTROINTESTINAL SYSTEM

GENERAL

SYMPTOM DEFINITION

ANOREXIA Loss or lack of APETITE

WEIGTH LOSS

ABDOMINAL PAIN

ABDOMINAL DI STENSION


3/28

UPPER GASTROINTESTINAL

SYMPTOM DEFINITION

XEROSTOMIA Dry mouth

WATER BRUSH Sudden appearance of excessive saliva in the mouth

DYSGEUSIA Altered taste sensation

DYSPHAGIA Difficulty swallowing

GLOBUS Sensation of a lump in the throat

ODYNOPHAGIA Pain on swallowing

HEARTBURN Burning retrosternal discomfort radiating upward

FLATULENCE Belching

DYSPEPSIA Indigestion

EARLY SATIETY Premature fullness on eating

NAUSEA Feeling sick

HAEMATEMESIS Vomiting fresh or altered blood

HICCUPS


4/28

UPPER GASTROINTESTINAL

SYMPTOM DEFINITION

WIND Excessive/offensive flatus, or bloating/distension

ALTERED BOWEL

HABIT

DIARRHOEA Abnormally soft stools and/or frequent defecation

CONSTIPATION Abnormally firm stools and/or infrequent defecation

STEATORRHEA Fatty stools, pale, greasy difficult to flush away

HAEMATOCHEZIA Rectal bleeding

MELAENA Black tarry stools


5/28

HEPATOBILLIARY

SYMPTOM DEFINITION

JAUNDICE

(ICTERUS) Yellow discoloration of skin and mucosae

ITCH

(PRURI TUS) Generalized itchiness


6/28

ABDOMINAL PAIN

THE SEVEN ATTRIBUTES OF A SYMPTOM

1. Location.

2. Radiation (Referral of pain)

3. Quality

4. Severity

5. Timing and Setting in which it occurs.

6. Remitting or exacerbating factors.

7. Associated manifestations.


7/28

ABDOMINAL PAINlocation

EPIGASTRIC pain


8/28


RIGHT UPPER QUADRANT pain


9/28


LEFT UPPER QUADRANT pain


10/28


PERIUMBILICAL pain


11/28


pain in the FLANKS

i


12/28

ABDOMINAL PAINlocationLOWER ABDOMEN pain


13/28

ABDOMINAL PAIN- radiation

SECONDARY SITE

= RADIATION

= REFERRAL

= PROJECTION of paindue to

shared sensory innervation of various parts of the body

the nature/location/evolution of the organ/process itself


14/28



15/28



16/28



17/28

ABDOMINAL PAIN - quality

I. BRIGHT pain

II. DULL pain

III. UNDIFFERENTIATED pain


18/28

ABDOMINAL PAIN - quality

I. BRIGHT pain"hot, "burning, "sharp, "knifelike, "stabbing, "sour, "sore

- Usually in the upper abdomen- of mucosal in origin

- signs of inflammatory disease

II. DULL pain

"dull" "squeezing" "cramping" "colicky "like something too big

or " li ke something moving around."

- origin in muscular walls of the gut, in solid masses

- Obstructive diseases, intestinal ischemia or enlarged organs

III. UNDIFFERENTIATED pain = ACHINGpains

- Originating from Solid organs

- Pain referred to the abdomen from the chest

- Pain of abdominal wall origin


19/28

ABDOMINAL PAIN - SEVERITY

Highly subjective

Assess the impact on the patient life

Underestimated in specific circumstances (elders, diabetes)

Not useful in appreciating the correct magnitude of the

causative lesion


20/28

The CRONOLOGY of the ABDOMINAL PAIN

Onset of the Pain:

date and circumstances can suggest the cause

character and location at the onset can differ from the present ones and may

reflect the evolution and possible complications of the causative process

rapid onset of the an abdominal pain:

perforation of a hollow viscus, a ruptured abdominal aortic aneurysm

mesenteric infarction, torsion of an organ

slower onset and progression (hours or days): inflammatory disorders

h

C O O OG

f h A O A A


21/28

The CRONOLOGY of the ABDOMINAL PAIN

The Progress of Abdominal Pain

not often truly constantbut characterized by exacerbations and remissions

commonest constant abdominal pain:

pancreatic carcinoma,

chestoriginating pain,

dissecting aortic aneurism

colicky pain: origin from hollow structuresbowel, uterus

biliary and renal colic are misnamed (hours not minutes in duration)

particular patterns of progression suggestive of a specific cause:

silent interval: perforation of un ulcer

appendicitis: changes in character and location of pain

` small bowel obstruction: changing from colic to persistent pain


22/28

ABDOMINAL PAIN

ti / li i f t


23/28

ABDOMINAL PAINaggravating/relieving factors

AGGRAVATING FACTORS of abdominal pain

Eating and drinking:

stomach, pancreas, biliary tract, small intestine, colon

Certain foods/drinks:

coffee, alcohol, hot spicy foods, fruit juices: gastritis, duodenal ulcer

high quantity of fiber-reach foods: partial small bowel obstruction

Aspirin, nonsteroidal anti-inflammatory drugs, erythromycin

inflammatory disease of the upper gut

Defecation: obstructive disease of the distal colon

Coughing, sneezing, deep breathing, straining with defecation:

abdominal wall pain, under diaphragmatic organs

Restlessness:pancreatitis

ABDOMINAL PAIN

ti / li i f t


24/28

ABDOMINAL PAINaggravating/relieving factors

RELIEVING FACTORS of abdominal pain

Eating and drinking milk products:

gastritis and uncomplicated duodenal ulcer

Antacids: gastritis, gastric ulcer

Defecation: lower left quadrant pain

Specific body position

ABDOMINAL PAIN

i t d if t ti


25/28

ABDOMINAL PAINassociated manifestations

1. WEIGHT LOSS

2. NAUSEA AND VOMITING3. ALTERATION IN BOWEL HABIT

4. BLOOD IN STOOLS

5. JAUNDICE6. BLOATING

ABDOMINAL PAIN

i t d if t ti


26/28


1. WEIGHT LOSS

due to reduce caloric intake, caloric loss or malignancyextreme in: pancreatic cancer, intestinal ischemia

2. NAUSEA AND VOMITING

establish a temporal relationship to pain

more common in:gastric, small-intestinal disease, solid organs and peritoneum

rare in: esophageal and colonic disease

particularly associated with distension of the gut

hepatitis, pancreatitis (due to rapid enlargement)

ABDOMINAL PAIN

i t d if t ti


27/28


3. ALTERATION IN BOWEL HABIT

DIARRHEA: partial/intermittent obstruction of the small intestine/colo

CONSTIPATION: ileus, neoplasm of the distal bowel, diverticulitis,

irritable bowel syndrome

4. BLOOD IN STOOLmucosal lesion: neoplastic or inflammatory

bleeding can be intermittent

ABDOMINAL PAIN

i t d if t ti


28/28


5. JAUNDICE

usually assoc. with biliary or pancreatic pain

exception: hemolysis, Gilbert sd.

6. BLOATING

obstruction of the gut

ileus

Documents

15. Symptoms of the Gastro-Intestinal System