major symptoms and signs of digestive tract disorders g.r.jeloudar md
TRANSCRIPT
Major Symptoms and Signs of Digestive Tract Disorders
G.R.Jeloudar MD
DYSPHAGIA Difficulty in swallowing is termed dysphagia Odynophagia : Painful swallowing Globus :sensation of something stuck in the
throat without a clear etiology Oropharyngeal dysphagia : transfer of the
food bolus from the mouth to the esophagus is impaired (also termed transfer dysphagia)
Neurologic and muscular disorders
The most serious complication is life-threatening
aspiration
Oropharyngeal dysphagia
Oropharyngeal problem is usually part of a more generalized neurologic or muscular problem (botulism, diphtheria, neuromuscular disease)
Painful oral lesions, such as acute viral stomatitis or trauma
If nasal air passage is seriously obstructed causes severe distress when suckling
Esophageal dysphagia
Esophageal dysphagia :difficulty in transporting the food bolus down the esophagus
Can result from neuromuscular disorders or
mechanical obstruction
Achalasia is an esophageal motility disorder
After surgical repair of tracheoesophageal fistula
or achalasia
Collagen vascular disorders
Esophageal dysphagia
Mechanical obstruction :
Intrinsic : stricture, web, tumor
Extrinsic :vascular rings, mediastinal lesions,
vertebral abnormalities
Structural defects typically cause more problems in swallowing solids than liquids
An esophageal stricture secondary to esophagitis occasionally has dysphagia as the first manifestation
Esophageal foreign body
stricture secondary to a caustic ingestion
REGURGITATION
Effortless movement of stomach contents into the esophagus and mouth
Not associated with distress
Hungry immediately after an episode
An incompetent or immature LES
A developmental process, and resolves with maturity
Regurgitation should be differentiated from vomiting
VOMITING
Highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching
Obstruction of the GI tract
Nonobstructive lesions of the digestive tract (pancreas, liver, or biliary tree)
CNS or metabolic derangements
Cyclic vomiting (2 or more periods of intense nausea and unremitting vomiting or retching lasting hours to days and return to usual state of health lasting weeks to months)
DIARRHEA
Excessive loss of fluid and electrolyte in the stool
Acute diarrhea :sudden onset of excessively loose stools of> 10 ml/kg/day in infants and >200 g/24 hr in older children, which lasts <14 days
chronic or persistent diarrhea :>14 days
The greatest volume of intestinal water is absorbed in the small bowel; the colon concentrates intestinal contents
The small intestine of an adult can absorb 10-11 L/day
Colon absorbs approximately 0.5 L
Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea
Dysentery (small volume,frequent bloody stools with mucus, tenesmus, and urgency) is the predominant symptom of colitis
Pathogenesis of diarrhea
Secretory diarrhea :occurs when the intestinal epithelial cell solute transport system is in an active state of secretion caused by (cholera toxin ,fatty acids and bile salts ) binding intracellular accumulation of (cAMP) or (cGMP)
Secretory diarrhea is usually of large volume and persists even with fasting
Osmotic diarrhea :occurs after ingestion of a poorly absorbed solute(magnesium, phosphate, lactulose, or sorbitol) or one that is not well absorbed because of a disorder of the small bowel (lactose with lactase deficiency or glucose with rota virus diarrhea)
This form of diarrhea is usually of lesser volume than a secretory diarrhea and stops with fasting
Motility disorders :can be associated with rapid or delayed transit and are not generally associated with large-volume diarrhea
Slow motility can be associated with bacterial overgrowth leading to diarrhea
CONSTIPATION
A hard stool passed with difficulty every 3rd day should be treated as constipation
True constipation in the neonatal period is most likely secondary to Hirschsprung disease, intestinal pseudo-obstruction, or hypothyroidism
ABDOMINAL PAIN
Organic
Nonorganic (functional)
In skin and muscle, A fibers mediate sharp localized pain; C fibers from viscera, peritoneum, and muscle transmit poorly localized, dull pain
Pain that suggests a potentially serious organic etiology is associated with :age <5 yr; fever; weight loss; bile or blood-stained emesis; jaundice;hepatosplenomegaly; back or flank pain or pain in a location other than the umbilicus; awakening from sleep in pain; referred pain to shoulder, groin or back; elevated ESR, WBC, or CRP; anemia; edema; or a strong family history of inflammatory bowel disease (IBD) or celiac disease
Visceral pain
Dull and aching
Experienced in the dermatome from which the affected organ receives innervations
Painful stimuli originating in the liver, pancreas, biliary tree, stomach, or upper bowel are felt in the epigastrium
pain from the distal small bowel, cecum, appendix,or proximal colon is felt at the umbilicus
pain from the distal large bowel, urinary tract, or pelvic organs is usually suprapubic
Somatic pain is intense and is usually well localized.
GASTROINTESTINAL HEMORRHAGE
Hematemesis :Bleeding that originates in the esophagus, stomach, or duodenum
Coffee grounds : When blood exposed to gastric or intestinal juices, quickly darkens
Hematochezia : red or maroon blood in stools, signifies either a distal bleeding site or massive hemorrhage above the distal ileum
Melena : moderate to mild bleeding from sites above the distal ileum tends to cause blackened stools of tarry consistency
Erosive damage to the mucosa of the GI tract is the most common cause of bleeding
Prolapse gastropathy producing subepithelial hemorrhage
Mallory-Weiss lesions secondary to mucosal tears associated with emesis are causes of upper intestinal bleeds
Upper intestinal bleeding is evaluated with an EGD
Evaluation of the small intestine is facilitated by capsule endoscopy
Lower GI bleeding is investigated with a colonoscopy
Brisk intestinal bleeding of unknown location, a tagged red blood cell (RBC) scan is helpful in locating the site of the bleeding
GI hemorrhage can produce hypotension and tachycardia but rarely causes GI symptoms
Brisk duodenal or gastric bleeding can lead to nausea, vomiting, or diarrhea