| Upper Gastrointestinal Bleed
| Oesophageal Variceal Bleeding
| Dieulafoy Lesion
| Mallory-Weiss Tear
| Gastric Cancer
| Peptic Ulcer Disease
| Oesophagogastroduodenoscopy (OGD/EGD)
| Hereditary Haemorrhagic Telangiectasia
|Hypovolaemic or Haemorrhagic Shock
Red flags are Dysphagia, Unplanned weight loss, Anorexia, Haematemesis and/or Melaena, Older patient, Lack of response to therapy, Chronic symptoms, On Chronic therapy
- This is "difficulty swallowing" Differentiate from neurological causes.
- Gastroenterology problems with swallowing are usually with oesophageal phase of swallowing with food sticking or being regurgitated rather than the oral and pharyngeal.
- Achalasia - a young patient, regurgitates undigested food soon after swallowing. Food (liquid and solids) held up at the lower oesophageal sphincter
- Malignancy - progressive dysphagia to solids rather than fluids
- Oesophageal Stricture - often a history of GORD.
- Oesophageal spasm - pain
- Oesophageal dysmotility - GORD symptoms, older patient. Normal endoscopy. Spasm may be seen on Barium swallow.
- Globus hystericus - lump in the throat. Anxious patient. ENT referral. Reassurance
- Hiatus hernia
- Oesophagitis - pain
- Pharyngeal pouch - regurgitation
- Stroke - Bulbar/pseudobulbar
- Motor neuron disease
- Myasthenia gravis
- Parkinson's disease
Odynophagia - pain swallowing
- Causes include Oesophageal inflammation, Oesophageal Candida, CMV, Chemical oesophagitis
- Bisphosphonates, Oesophagitis, Malignancy - oesophageal tumour, Oesophageal spasm
- A rather loose term meaning abdominal pain, fullness in the stomach, with nausea, belching, wind.
- Causes include inferior MI if acute, GORD, Peptic ulcer disease, Oesophagitis, Stomach cancer, Non-ulcer Dyspepsia
- Due to reduce calorie intake - Loss of appetite, Dyspepsia, Nausea - drugs, brain tumour, ENT problems
- Motor neurone disease, stroke
- Infection, Dysphagia, Psychiatric, Anorexia, Depression/Anxiety, Dementia
- Despite normal calorie intake - Cancer must always be considered, Hyperthyroidism, Inflammatory disease - Crohn's disease / UC, Rheumatoid etc...
Altered Bowel habit
- Increased bowel frequency (be sure to understand the difference between increased frequency and diarrhoea)
- Causes of Increased Stool frequency - Hyperthyroid, Anxiety, Irritable bowel syndrome
Diarrhoea defined as stool weight > 200g/24 hrs
- Acute onset diarrhoea - Infective, Antibiotic related Clostridioides difficile, Foodborne illness, Flare-up of Ulcerative colitis.
- Subacute/Chronic Diarrhoea - Ulcerative colitis, Crohn's disease, Laxative overuse, Colorectal tumour or polyps, Coeliac disease
- Passing of pale, offensive smelling greasy stools due to problems with fat digestion or their uptake.
- Causes - Small bowel disease, Pancreatic disease, Biliary disease, Malabsorption of fat-soluble vitamins ADEK often accompanies fat malabsorption
- Causes - Hirschsprung's disease (in a child) dilated atonic colon, Irritable bowel syndrome, Ageing, Codeine and other opiates, Hypothyroid, Dehydration, Immobility, Diverticular disease, Left-sided Colorectal tumour, Parkinson's disease.
- Feeling of incomplete rectal emptying post defecation
- Seen with Irritable bowel syndrome, Rectal tumour
- Dark urine / Pale stools - cholestatic - ask about RUQ pain suggesting gallstones
- Painless abdomen, weight loss - Pancreatic tumour
- New medications
- Food intake - seafood, distaste for cigarettes etc. Hepatitis A
- IV drug use/Sexual contacts-HBV
- IV drug abuse, transfusions- HCV
- Canoeing, watersports - Leptospirosis
- Alcohol intake
- Haemolysis causes mild jaundice
- Gilbert's syndrome - benign cause. Worse with starvation. Familial.
- All that is dark and black is not blood. It may be bile. Bright red blood is a useful sign.
- Causes - Duodenal ulcer, Gastric ulcer, Gastric erosions, Mallory-Weiss tear, Oesophagitis, Duodenitis, Oesophageal varices, Gastric/Oesophageal cancer, Angiodysplasia, Hereditary haemorrhagic telangiectasia, Aorto-duodenal fistula