Approach to the

Patient with
Gastrointestinal
Disease
MAO
Medicine 4
FUNCTION
• assimilation of nutrients

• elimination of waste.
Impaired Digestion and Absorption

• Zollinger Ellison Syndrome

• Lactase deficiency
• Biliary Obstruction
• Pancreatic Cancer
Altered Secretion

• Zollinger Ellison syndrome

• G cell hyperplasia
• Retained antrum syndrome
• Pernicious anemia
• Inflammatory and Infectious Small –
Intestinal and colonic disease
Altered Gut Transit

• Mechanical obstruction
• Retardation of Propulsion
• Achalasia
• Gastroparesis
• Intestinal Pseudo-obstruction
• Disorder of Rapid Propulsion
Impaired Gut Blood Flow

• Intestinal and colonic ischemia

Neoplastic Degeneration

• Colon Cancer
• Gastric Cancer
• Small-Intestinal Neoplasms
• Anal Cancer
• Pancreatic and Biliary Cancer
• Hepatocellular Carcinoma
 AFFECTED VISCERAL PAIN PARIETAL PAIN REFERRED PAIN
ORGAN
Appendix Periumbilical area RLQ RLQ

Distal colon Hypogastrium and left Over affected area LLQ and back (rare)
flank for descending
colon

Gallbladder Middle epigastrium RUQ Right subscapular

area
Ovaries, Fallopian Hypogastrium and Over affected area Inner thighs
tubes and uterus groin

Pancrea Middle epigastrium Middle epigastrium Back and Left

and LUQ and LUQ shoulder
Proximal Colon Periumbilical area Over affected ste RLQ and back (rare)
and R flank for
Ascending colon

Small Intestines Periumbilical area Iver affected sute Midback (rare)

Stomach Middle Epigastrium Middle epigastrium Shoulders

and LUQ
Ureters Costovertebral angle Over affected site Groin: scrotum in
HISTORY

• DURATION
• WORSENED OR RELIEVED AFTER A
MEAL?
• CHARACTERIZE THE PAIN
HISTORY

• ASK OPEN QUESTIONS

• DURATION
• WORSENED OR RELIEVED AFTER A
MEAL?
• CHARACTERIZE THE PAIN
PHYSICAL EXAMINATION

• ASK OPEN QUESTIONS

• DURATION
• WORSENED OR RELIEVED AFTER A
MEAL?
• CHARACTERIZE THE PAIN
PHYSICAL EXAMINATION
Tools for Patient Evaluation
• Laboratory
• Luminal Contents
• Endoscopy
• Radiographic / Nuclear Medicine
• Histopathology
Tools for Patient Evaluation
• Laboratory
• Luminal Contents
• Endoscopy
• Radiographic / Nuclear Medicine
• Histopathology
TREATMENT
• OVER THE COUNTER AGENTS
• PRESCRIPTION DRUGS
• ALTERNATIVE THERAPIES
• Interventional endoscopy or radiology
• surgery