Symptoms of GI System

Dr. Hina latif

Assistant professor
West medical ward
Symptoms of GI system:
Common GI symptoms:
Abdominal pain
Diarrhea
Upper GI bleed
Dysphagia
Odynophagia
Dyspepsia
Vomiting
Jaundice
Case 1
A 45 year old banker who has been a smoker & consumed
alcohol almost daily for past 15 – 20 years has been having
central abdominal pain for past 7 years.

Pain is severe & occurs in intermittent attacks, often in the

mid or left upper abdomen and occasionally radiating in a
band like fashion or localized to the mid back. The pain may
occur either after meals or independent of meals, but it is not
fleeting or transient and tends to last at least several hours.
 He has diarrhea for past 3 years passing 7-8 large volume
stools daily which are foul smelling and sticky. He
describes a weight loss of 12 Kg over 3 years

 He was diagnosed as diabetic 4 years ago and is using 24

units of premix insulin injections twice daily.

 Frequency and severity as well as duration of attacks is

increasing and he has multiple visits to emergency room
receiving analgesics, antispasmodics, H2 Blockers, PPI’s
and getting partial relief.
 GPE exhibits a pale looking man having decreased
subcutaneous fat, temporal wasting, sunken supraclavicular
fossa, and other physical signs of malnutrition.

 In an attempt to relieve his abdominal pain he assumes a

characteristic position ( lying on the left side, flexing the
spine and drawing the knees up toward the chest).
Abdominal Pain
Acute Pain in Upper Abdomen
Esophagitis, Hiatus Hernia
Acute Coronary Syndrome
Gastritis, GU, DU
Gall Stones & Cholecystitis
Pancreatitis
Gastric Carcinoma
Acute Central Abdominal Pain
Small Bowel Obstruction
Crohn’s Disease
Mesenteric artery occlusion
Abdominal aortic Dissection
Abdominal Pain
Acute lateral Abdominal & flank pain
Pyelonephritis
Renal Calculus
Ureteric Calculus
Appendicitis
Salpingitis

Acute lower central Abdominal (hypogastric pain)

Infective or Inflammatory Colitis
Large Bowel Obstruction
Cystitis
Pelvic Inflammatory disease
Pelvic Endometriosis
Ectopic Pregnancy
Case 2
A 33 years old male lecturer visited medical OPD with 06
months history of loose motions, malaise, low grade fever
and abdominal pain.

Stools are 5 – 7 per day, small, mucoid and blood stained. The
amount of blood has increased over past 2 weeks and now his
defecation is painful.

Abdominal pain is dull, diffuse and griping.

His temperature is mostly 99o F and rising to 100o F in evenings.

He has lost 6 kg weight over 6 months.

Diarrhoea:
Acute diarrhoea: lasting less than 2 weeks duration..
Commonly by invasive n non-invasive pathogens and
their enterotoxins

Chronic diarrhoea: for more than 4 weeks..commonly

due to infections, IBS, drugs, malignancies etc.
Large bowel or small bowel diarrhea???
Diarrhea
Acute diarrhea fever & vomiting.
Clostridium difficle, Rota & Norvalk viruses, Toxin food poisoning, Bacillus Cereus,
Clostridium Perfringens, Vibrio Para hemolyticus, Botulism, Salmonella Typhimurium.

Acute diarrhea with blood + mucus (dysentery).

Shigella, Campylobacter, Enteroinvasive & Enterohemorrhagic type 0157 E-coli,
Entamoeba histolytica.

Recurrent diarrhea with blood + mucus.

Chron’s disease, Ulcerative colitis, Colonic CA, Colorectal CA, Diverticular disease .
Diarrhea

Watery diarrhea.
Traveller’s diarrhea, Enterotoxigenic E-coli, Vibrio Cholera, Rota & Norwalk viruses.

Recurrent diarrhea with no blood in stools or fever

(IBS ,HIV, Malabsorption, Drug Induced, Spurious, Diabetic autonomic nueropathy,
Thyrotoxicosis,
Carcinoid).
Change in Bowel Habit

Diet Change
Drug Induced
Depression
Immobility
Colonic Carcinoma
Cerebral or spinal cord lesions
Metabolic & Endocrine
Hypothyroidism, Hyperthyroidism, Hypokalemia, Hypercalcemia .
Case:3
A 32 years old housewife presents in OPD with c/o
recurrent epigastric pain, She often notices that stools she
passes are blackish and shiny. Yesterday she had a large
vomitus that contained fresh blood in it.
On inquiry she admits frequent usage of NSAIDs for her
longstanding backache and headache.
She never had jaundice in past and was transfused 2 pints
of blood 6 months ago when she had LSCS for her 5 th
childbirth.
O/E she has marked pallor.
Hematemesis & Malena

Bleeding duodenal Ulcer

Gastric Erosions (NSAIDs, Stress Ulcers).
Esophageal varices
Gastric Ulcer
Mallory Weiss tear
Gastric CA
Esophageal CA
Corrosive ingestion
Meckel’s diverticulum
Angiodysplasia
Bleeding disorders & Anticoagulants.
Bleeding per rectum

Bleeding Hemorrhoids
Anal Fissure
Diverticulitis
CA Rectum
CA Colon
Inflammatory bowel disease
Meckel’s diverticulum
Massive Upper GI bleed
Intussusception
Trauma
Tenesmus & Anorectal pain.

Tenesmus
Proctitis
Rectal tumor
Tumor of descending colon
Pelvic inflammatory disease

• Anorectal Pain
Anal fissure
Hemorrhoids
Perianal Abscess
Proctitis
Prostatis
Proctalgia Fugax (Coccydynia).
Vomiting.

Vomiting with weight loss

Vomiting without weight loss
Vomiting within hours of food intake
Vomiting unrelated to food intake
a. With abdominal pain & fever
b. With abdominal pain but NO fever
Non-Metabolic & Metabolic
c. Without abdominal pain but with headache
d. Vomiting alone.
Vomiting
With Weight Loss
Esophageal CA
Gastric CA
Achalasia
Esophageal stricture

Small gut tumor e.g. lymphoma

Without Weight Loss

Pharyngeal pouch
Achalasia
Esophagitis & ulceration
Vomiting

Shortly after food intake

Gastritis
Peptic ulcer disease
Gastric outlet obstruction
CA, lymphoma, chronic scarring, pyloric stenosis

Small gut obstruction

Acute cholecystitis
Acute pancreatitis
Vomiting Unrelated to food intake
But with fever and Abdominal pain
 Gastroenteritis
 Food poisoning
 UTI
 Acute Appendicitis
 Mesenteric adenitis
 Acute hepatitis A, B or E
 Toxic shock syndrome
 Pneumonia lower lobe
 PID
 HUS
 Malaria
Vomiting Unrelated to food intake
With Abdominal Pain and NO FEVER
Non-Metabolic cause
Large gut obstruction (Malignancy, Strangulated Hernia)
Mesenteric artery occlusion
Intussusception
Ectopic pregnancy, Miscarriage
Renal Calculi / Colic
Acute Inferior MI
CCF with liver congestion
Metabolic Causes
Drugs e.g. Digoxin
DKA
Hypercalcemia
Acute Intermittent Porphyria
Lead poisoning
Phaeochromocytoma
Vomiting with Headache
 Migraine
 Raised Intracranial pressure
 Meningitis
 Hemorrhagic Stroke
 Severe Hypertension
 Epilepsy
 Glaucoma
 Addison’s disease
Vomiting Alone
 Gastroenteritis
 Sliding hiatus hernia
 Acute viral labyrinthitis
 Meniere’s disease
 Pregnancy
 Anaphylaxis
 Renal failure
 Addison’s disease
 Drugs

(antibiotics, cytotoxics, overdosage, alcohol)

Case:4
61 yr old male with no prior co-morbids, presented
with c/o dysphagia initially for solids for last 8
months. Initially he was tolerating soup but for last
1 month , it took him 2 hr to finish one bowl of
soup. He also c/o sticking of food which he had to
forcefully swallow.
There was also h/o vomiting ; which contained
whitish partially digested food material.
He has lost 10 kg of his weight.
Barium swallow was done which showed dilated
esophagus with shouldering and narrowed lower end.
Dysphagia
For Solid foods that Stick
Esophageal Stricture
CA Esophagus
CA Gastric Cardia
External Esophageal Compmression

• For Solid foods (which don’t stick) > fluids

Pharyngeal Pouch
Xerostomia
Post-cricoid web (Plumer-Vincet or Peterson Kelly Syndrome)
Globus Hystericus
Dysphagia

Dysphagia for Fluids > Solids

 Myasthenia Gravis
 Pseudobulbar Palsy
 Bulbar Palsy
 Motor Neuron Disease
 Scleroderma
 Achalasia Progressive
 Diffuse Esophageal Spasm
Odynophagia

 Viral pharyngitis
 Acute follicular tonsillitis
 Candidiasis
 Agranulocytosis
 Meningococcal meningitis
Case:5

A 26 year old primigravida presents with 2 weeks h/o

nausea, vomiting, anorexia and noticed yellowness of
sclera and skin.
O/E
Jaundiced with tender hepatomegaly

? diagnosis
Jaundice

D/D
 Carotinemia
 Pre-hepatic Jaundice (Jaundice + Anemia)
 Hepatic Jaundice (Enzyme defects, Normal Stool & Urine color)
 Hepatocellular Jaundice (Normal stool & Dark urine)
 Obstructive Jaundice (Pale stool & Dark urine)
Jaundice

Pre-hepatic/ hemolytic
Hereditary hemolytic anemia
Acquired hemolytic anemia
Septicaemic hemolysis
Malaria
• Hepatic due to enzyme defects
Gilbert’s Syndrome
Crigler-Najjar Syndrome type I and II
Jaundice

Hepatocellular

 Acute Viral Hepatitis A, E, B and C

 Alcoholic
 Drug Induced
 Primary Hepatoma
 Infectious Mononucleous
 Right heart failure
Jaundice
Obstructive and Cholestatic

 CBD stone
 CA head of Pancreas
 Sclerosing Cholangitis
 Primary biliary cirrhosis
 Drug Induced
 Alcoholic
 Pregnancy
 Dubin- Johnson syndrome
Thank you