APPROACH TO A PATIENT WITH GASTROINTESTINAL DISEASE

INTRODUCTION

• Extends from the mouth to the anus.

• Other associated organs: the liver, pancreas, gallbladder

• Many functions: digestion, absorption, and excretion. As well as endocrine functions, growth factor and cytokine production

• In developing countries most pathologies are infectious

SYMPTOMS OF GASTROINTESTINAL DISEASE

1. MOUTH• Stomatitis

• Halitosis

2. OESOPHAGUS• Dysphagia and odynophagia

3. STOMACH• Dyspepsia/ indigestion : heartburn, reflux, flatulence, belching

• Vomiting

VOMITING

• Nausea

• Projectile or not

• Quantity and frequency

• timing

• Colour• Blood- haematemesis (red, coffee ground)

• Bilous (green)

• Faeculent (brown)

• CHANGE IN BOWEL HABITS• Constipation or diarrhea

1. CONSTIPATION• Two or more of the following for 12weeks

i. Infrequent passage of stools (<3/week)

ii. Straining >25% of time

iii. Passage of hard stools

iv. Incomplete evacuation and sensation of anorectal blockage

2. DIARRHOEA• No uniformly accepted definition

• Increased fluidity, frequency or quantity of stool

• Typesi. Osmotic diarrhea

ii. Secretory diarrhea

iii. Inflammatory diarrhea

iv. Abnormal motility

• Can be acute or chronic

• Real or factitious

OTHER SYMPTOMS

• Abdominal pain

• Abdominal distention

• Weight loss

• Haematemesis

• Rectal bleeding

• Melena

• jaundice

GENERAL SIGNS

• Fluffy hair

• Jaundice

• Palor

• Parotid fullness

• Oral ulcers, stomatitis, glossitis, gum swelling, breath

• Lymph nodes

• Wasting

• Skin changes: scratch marks, wrinkling, palmar erytherma

• Nail changes: clubbing, leukonycia

• Gynaecomastia

• Loss of hair: axillary and change in pubic hair pattern

• Spider nevi

EXAMINATION OF THE ABDOMEN

• INSPECTION• Distention: 5 Fs

• Scarification marks

• Anterior abdominal wall vessels

• Hernia orifices

• PALPATION• Tenderness

• Masses and organs

• PERCUSSION• Masses and organs

• Ascities

• AUSCULTATION• Bowel sounds

• Bruits

• Succussion splash

THE EXAMINATION OF THE ABDOMEN IS NOT COMPLETE WITHOUT• Digital rectal examination

• Vaginal examination

• Examination of the genital

INVESTIGATIONS

• IMAGING• Abdominal USS• Abdominal Xray

• Plain• Barium swallow• Barium swallow and follow through• Barium enema

• Endoscopy• Oesophagoduodenoscopy• Colonoscopy• Proctoscopy• Sigmoidoscopy• Endoscopic USS• Endoscopic retrograde cholangiopancreatography

• CT Scan• MRI

• STOOL• Microscopy – ova, trophozoites, helminths, blood

• Microbiology• Stool specific antigen – H.pylori

• Biochemistry• Stool pH

• Feacal fat

• Feacal elastase

• BLOOD• Full blood count

• Hepatitis virus tests- HBV, HCV

• Liver function tests• Bilirubin

• Prothrombin time

• Protein and albumin

• Liver biochemistry• Transaminases – ALT, AST

• Alkaline phosphatase

• Glutaryl transpeptidase

• OTHER SPECIFIC TESTS• Schillings test

• Hydrogen breath test

• D-xylose test

• Urea breath test

• BIOPSIES• Liver biopsy

• others