3_2024_MAJOR_MANIFESTATIONS_OF_GASTROINTESTINAL_DISEASES_1.pptx

lectur about major manifestations of gastroentestinal system

1. MAJOR MANIFESTATIONS OF GASTROINTESTINAL DISEASES DR JABBAR JASIM

2. 2 Dysphagia: difficult swallowing Odynophagia: painful swallowing. Aphagia: can not swallow. Heart burn. Non cardiac chest pain. Regurgitation. Aerophagia: eructation. Hematemesis. Melena. BLACK tarry stool Hematochesia : fresh bleeding per rectum. Dyspepsia: abnormal digestion. Anorexia. Flatulence. Alteration in bowel habits. Diarrhea or constipation Bleeding per rectum. Abdominal pain. Nausea and vomiting

3. 3 CAUSES OF HALITOSIS 1- POOR ORAL HYGIENE. 2- ANXIETY WHEN HALITOSIS IS MORE IMAGINARY THAN REAL. 3- ESOPHAGEAL STRICTURE. 4- PULMONARY SEPSIS. 5- GASTRIC OUTLET OBSTRUCTION. 6- INTESTINAL GASTRIC FISTULA. GINGIVAL SWELLING HEREDITARY DRUGS PREGNANCY SCURVY LEUKEMIA WEGENERS GRANULOMA

4. CAUSES OF XEROSTOMIA ( DRY MOUTH ) 1- Sjogren's syndrome. 2- Drugs ( e.g. antimuscarinic, antiparkinsonian, antihistamine, lithium) 3- radiotherapy 4- Psychogenic causes. 5- Dehydration, shock and renal Failure. 6- D.M 4

5. Nausea and Vomiting : Nausea is a feeling of wanting to vomit. Vomiting is the expulsion of gastric contents through the mouth. Vomiting passes by three phases: nausea , retching then vomiting . Itis associated with many gastrointestinal disorders. If it is not associated with pain, it is usually due to non gastrointestinal disorders. Vomiting is highly integrated & complex reflex involving both autonomic & somatic neural pathways.

6. Synchronous contraction of the diaphragm, intercostal muscles, & abdominal muscles Increases intra-abdominal pressure Relaxation of the lower Esophageal sphincter Forcible ejection of Gastric contents

7. Vomiting is usually associated with : Nausea Retching Salivation Anorexia Or dyspepsia You must distinguish between: True vomiting & regurgitation Acute & chronic vomiting. You must ask about: Abdominal pain Fever Diarrhea Relationship to food Drug ingestion Headache Vertigo Weight loss

8. Causes of vomiting: Intra-abdominal Extra-abdominal Metabolic/ medications Obstructing disorders: byloric , small bowel, colonic....etc. Enteric infections: viral, bacterial. Inflammatory diseases: cholecystitis, pancreatitis, Appendicitis, hepatitis. impaired motor function: gastroparesis, functional dyspepsia, GERD. Biliary colic. Abdominal irradiation. Cardiopulmonary disease: myocardial infarction, cardiomyopathy. Labyrinthine disease: motion sickness, labyrinthitis Intracerebral disorders: increased intra-cranial tension, Neurobehavioural & psychiatric illnesses : anorexia nervosa, bulimia, depression Postoperative vomiting. Drugs: cancer chemotherapy, antibiotics, digoxin, contraceptives, cardiac antiarrhythmics. Metabolic disease: uremia, ketoacidosis, para-thyroid disease, adrenal insufficiency. Toxins: ethanol. Pregnancy: morning sickness, hyper-emesis gravidarum.

9. Complications: Dehydration, malnutrition, dental caries. Metabolic alkalosis, hypokalemia. Aspiration pneumonitis. Hematemesis from mucosal tear (Mallory-Weiss syndrome). Rupture esophagus ( Boerhaave’s syndrome). Treatment: 1. Treatment of the specific cause. 2. Antiemetic medications. Metoclopramide 10 mg /8 hours Ondansetron

10. Diarrhea: Definition: Change of normal bowel habits in the form of: Increase in frequency. Increase in amount. Decrease in consistency. Feces exceeding 200 g per day when dietary fiber content is low is considered diarrhea. Acute diarrhoea This is extremely common and is usually caused by faecal –oral transmission of bacteria or their toxins, viruses or parasites Infective diarrhoea is usually short-lived and patients who present with a history of diarrhoea lasting more than 10 days rarely have an infective cause. A variety of drugs, including antibiotics, cytotoxic drugs, PPIs and NSAIDs, may be responsible. . Chronic or relapsing diarrhoea The most common cause is irritable bowel syndrome. which can present with increased frequency of defecation and loose, watery or pellety stools. Diarrhoea rarely occurs at night and is most severe before and after breakfast. At other times, the patient is constipated and there are other characteristic symptoms of irritable bowel syndrome. The stool often contains mucus but never blood, and 24-hour stool volume is less than 200 g. Chronic diarrhoea can be categorised as being caused by disease of the colon or small bowel, or to malabsorption

11. Clinical presentation, examination of the stool, routine blood tests and imaging reveal a diagnosis in many cases. A series of negative investigations usually implies irritable bowel syndrome but some patients clearly have organic disease and need more extensive investigations.

12. Constipation: Definition: Presence of 2 or more of the following: Infrequent Stools < 3/week. Hard Stools >1/4 times of defecation. Incomplete Evacuation >1/4 times of defecation. Straining in >1/4 times of defecation. Manual maneuvers as digital evacuation and support of pelvic floor >1/4 times of defecation

13. Dyspepsia Definition .. ( indigestion ) is a collective term for any symptoms thought to originate from the upper GIT. Although symptoms often correlate poorly with the underlying diagnosis, a careful history is important to: Elicit symptoms classical of specific disorders like peptic ulcer. Detect alarm features requiring urgent investigation Detect atypical symptoms more suggestive of other disorders e.g. myocardial ischemia. Early satiation, postprandial fullness, epigastric pain, and epigastric burning are the cardinal dyspeptic symptoms Dyspepsia occurs in one-fourth of the adult population and accounts for 3% of general medical office visits Etiology: A. Functional or "non ulcer" dyspepsia: This is the most common cause of chronic dyspepsia. Patients have no structural abnormality. Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying or impaired accommodation to food, or psychosocial stressors. While benign, the symptoms may be chronic and difficult to treat. B. Gastrointestinal luminal diseases Peptic ulcer disease is present in15-25% of patients with dyspepsia. Gastroesophageal reflux disease is present in up to 20% of patients with dyspepsia. Gastric cancer is identified in 1% but is rare in persons under age 45. Helicobacter pylori chronic gastritis as acause of dyspepsia remains controversial H pylori eradication treatment seldom helps.

14. - Other causes include gastroparesis (especially in diabetes mellitus), lactose intolerance or malabsorptive conditions, and parasitic infection (Giardia, Strongyloides ). C. Biliary tract disease The abrupt onset of epigastric or right upper quadrant pain due to cholelithiasis or choledocholithiasis should be readily distinguished from dyspepsia. D. Pancreatic disease Pancreatic carcinoma, chronic pancreatitis. E. Food or drug intolerance Acute, self-limited "indigestion" may be caused by overeating, eating too quickly, eating high-fat foods, eating during stressful situations, or drinking too much alcohol or coffee. Many medications cause dyspepsia, including aspirin, NSAIDs, antibiotics (metronidazole, macrolides), corticosteroids, digoxin, theophylline, iron, and narcotics. F. Other conditions Diabetes, thyroid disease, renal insufficiency, myocardial ischemia, intra-abdominal malignancy, gastric volvulus or para-esophageal hernia, and pregnancy are sometimes accompanied by dyspepsia.

15. Causes of Dyspepsia Upper GI disorders : Peptic ulcer disease Acute gastritis Gallstones Motility e.g. esophageal spasm Functional (non-ulcer dyspepsia & IBS) Other GI disorders: Pancreatic disease (cancer, chronic pancreatitis) Hepatic disease (hepatitis, metastases) Colonic carcinoma Systemic disease: Renal failure Hypercalcemia Drugs: NSAIDs Iron & potassium supplements Corticosteroids Digoxin Others: Alcohol Psychological e.g. anxiety, depression

16. Alarms features of dyspepsia Weight loss Anemia Vomiting Hematemesis and/or Malena Dysphagia Palpable abdominal mass

17. Abdominal pain: Abdominal pain is one of the most important and common presenting symptom. Abdominal pain can be induced by one of the following mechanisms: Stretch of muscle fiber of hollow viscus (biliary colic) or organ Capsule (congested liver). Ischemia or inflammation with release of mediators which irritate nerve endings (pancreatitis, cholecystitis). Entrapment of nerve fibers by neoplasm or fibrotic process. Parietal peritoneal inflammation whether localized or generalized. Extra-abdominal e.g. referred (pneumonia) or metabolic (diabetic ketoacidosis, porphyria). According to the origin of pain: Esophageal pain: Pain is usually retrosternal, Gastric and duodenal pain: Pain is usually epigastric like in peptic ulcer disease or functional dyspepsia. Its relation to meals is a very important symptom. Epigastric pain is often dull in character or may be sharp and severe as in pancreatic pain which may be epigastric or left hypochondrial and radiates to the back or left shoulder. Small intestinal: Pain is usually peri-umbilical while right iliac fossa pain is often from the caecum or appendix.

18. Lower abdominal pain may be colonic or rectal and in females may be also due to gynecological causes. Biliary or hepatic pain: Pain is right hypochondrial and may radiate to right shoulder or infrascapular . Renal pain: Pain is felt in renal angles and if ureteric it can radiates to upper medial thigh or scrotum in males. Left iliac fossa pain: It can be due to IBS, diverticulitis or left sided colitis.

19. Medical Causes of acute abdomen Referred pain: Pneumonia & pleurisy Myocardial infarction Renal: Pelviureteric colic Acute pyelonephritis Metabolic: Diabetic ketoacidosis Lead poisoning Familial Mediterranean fever Hematological: Henoch- Schénlein purpura Sickle cell crisis Polycythaemia vera Paroxysmal nocturnal haemoglobinaemia Porphyria Vascular: Embolic Abdominal angina (atherosclerosis) Vasculitis Sites of referred pain

20. Management of acute abdominal pain