Makindo Medical Notes.com

Related Subjects: |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

Dysphagia

• 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.

Gastrointestinal Causes

• 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

Neurological Causes

• 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

Dyspepsia

• 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

Weight loss

• 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

Steatorrhoea

• 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

Constipation

• 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.

Tenesmus

• Feeling of incomplete rectal emptying post defecation
• Seen with Irritable bowel syndrome, Rectal tumour

Jaundice

• 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.

Haematemesis

• 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

Melaena

• As for Haematemesis