Disorders of gastrointestinal tract

,hepatobiliary system and pancrease

 Symptoms
• Abdominal pain
– Visceral-midline and vague e.g in gastroenteritis
– Parietal pain-localised precisely eg acute appendictis
• Heartburn-burning substernal feeling eg in peptic ulcer
disease
• Nausea and vomiting-from GIT,medication,endocrine
causes,CNS
• Altered bowel movements
– Constipation-infrequent,straining,hard stool eg in
obstrction,motility disorders etc
– Diarrhoea-loose watery stools eg in infections,inflamamtory
bowel disturbances ,malabsorption
• GIT bleeding
– Upper GIT –vomiting blood(haematemesis) or
passing black stool(melena) in peptic ulcer
disease,esophagitis,varices
– Lower GIT bleeding presents with fresh bright
red(haematochyzia) or maroon stool eg in
haemorrhoids,anal fissure,malignancy etc
– N/B brisk upper GI bleedin might give
haematochzia and slow ascending colon bleeds
might give melena stool
• Jaundice-yellowness of eyes due to accumulation of
bilirubin/bile products in liver disease eg hepatitis or
extrahepatic like haemolysis biliary obstruction etc
• Other symptoms
– Dysphagia-difficult swallowing in esophageal tumor
– Odynophagia-painful swallowing in esopheal
ulcers,esophagitis
– Unexplained chest pain in reflux etc
– Weigthloss,anorexia,fatigue-malabsorption,GIT
malignancy,chronic pancreatitis
– Fever-gastroenteritis,inflamamtory bowel disorder
 examination
• Dehydration-water loss from vomiting,diarrhoea
• Jaundice-sclera in hepatitis
• Lymph node-virchows node-left supraclavicular
due to GI malignancy
• Angular cheilitis/stomatitis-iron deficiency
• Digital rectal examination-haemorrhoids,tumor
impacted stool etc
• Stigmata of chronic liver disease-duputyren
contracture,spider naevi etc
• Inspection of the abdomen
– Distended-ascites,intestinal obstruction etc
– Visible blood vessels in portal hypertension
– Visible peristalsis in obstruction
• Palpation
– Tenderness,rebound tenderness,guarding and rigidity in
peritonitis,appendicitis
– Palpable organs eg spleen,liver,tumors
– Percussion
• Shifting dullness and fluid thrill in ascites
– Auscultation
• Increased bowel sounds in obstrruction or absent in ileus
 investigations
• Iron deficiency anemia in inflammatory bowel disease(IBD),tumors
etc
• Vitamin B12 deficienc induced macrocytic anemia
malabsoption,chronic atrophic gastritis
• Elevated WBC,CRP,ESR in IBD,infective diarrhoea etc
• Renal function test-renal dysfunction from GI water loss
• Liver function test-abnormal enzymes and bilirubin
• Hormone profile e.g throid,VIP,cortisol etc
• Stool occult blood in GI malignacy,
• Stool microscopy and culture in diarrhoea
• Fecal fat in malabsoprtion
• Pancreatic enzymes in pancreatitis
• Helicobacter pylori and salmonella antigen
• Endoscopy-direct visualization of
lumen,biopsy and treatment eg band ligation
of varices,injection of bleeding ulcers etc
– Esophagoduodenoscopy(OGD)-
Esophagus,stomach and duodenum.used in
PUD,tumors of stomach,esophagus,bleeding
– Colonoscopy-colon and distal ileum.suspected
tumor,bleeding etc
– Capsule or push enteroscopy in elusive GI
bleeding eg in small intesine
• Ascitic fluid analysis-ascitic fluid serum albumin gradient
• Radiological investigations
– Abdominal ultrasound- liver,pancrease,gallbladder and biliary
tree
– CT SCAN-as above but also stomach,intestine
– MRI-mostly used in hepatopancreatobiliary imaging(MRCP)
– Endoscopic retrograde pancreatography-biliary obstruction eg
stones,tumors,cholangitis etc
– Barium swallow-esophageal strictures,rings
– Angiography-mesenteric ischemia etc
• Histopathology-tissue diagnosis e.g after endoscopy