SYMPTOMS, SIGNS AND

GASTROENTEROLOGY EXAMINATION
Approach to the patient with gastrointestinal
disorders  CARDINAL SYMPTOMS:
• Heartburn
• Problems of swallowing • Gas / flatulence
– Odynophagia • Diarrhea
– Dysphagia • Constipation
• Chest pain • Abdominal pain
• Hiccups • Weight loss
• Nausea & Vomiting • Occult or overt
• Dyspepsia gastrointestinal bleeding
 HEARTBURN (Pyrosis)
• Common symptom

• Defined
• Feeling of substernal burning that radiates toward the neck from the
epigastrium

• Caused by : regurgitation of gastric acidic

• Occurs 1 hours of meals or within 2 hours of reclining

• Precipitated by :
• foods
• manuevers that increase intraabdominal pressure (straining at stool,
exercise, etc)
• Cigarettes / smoking
 Motility disorders

ACID
Intragastric pressure
anti reflux barrier
REFLUX
 ODYNOPHAGIA
• Pain with swallowing

• Dull retrosternal pain or a severe, sharp sensation

• Associated with
• Severe erosive disease
• Infectious esophagitis resulting from Candida, herpes, and CMV
• Immunocompromised patients
 CHEST PAIN
• Recurrent chest pain resembling angina
pectoris

• Cardiac disease must excluded

• Esophageal causes of chest pain include:

• acid reflux
• esophageal motility disorders
• abnormal visceral nociception
• esophageal distention
 DYSPHAGIA
• Sensation of impaired passage of food from
the mouth to the stomach

• Distingueshed with odynophagia and globus

(a sensation of a lump in the throat)

• Result from an abnormality at each stage of

the swallowing process:
– oropharyngeal stage
– esophageal stage
• Signs :
• No abnormality in the physical examination for the
esophageal causes

• Diagnostic studies :
• Upper endoscopy : direct visualization
• Barium esophagography : mechanical lesions
• Esophageal monometry
 HICCUPS
• Sudden contraction of the diaphragm inspiratory
muscles that is terminated with an abrupt
closure of the glottis

• Etiology :
• Gastric distention
• Sudden temperature changes
• Alcohol ingestion
• Smoking
• Emotional stress
 NAUSEA & VOMITING
• Nausea
• feeling sick to the stomach that may be followed by vomiting

• Vomiting
• forceful expulsion of gastric contents through a relaxed upper
esophageal sphincter and open mouth
 DYSPEPSIA
• A variety of complaints including :
• epigastric pain
• Bloating
• Fullness
• Hearburn
• nausea
• early satiety

• Etiology :
– Functional dyspepsia
– Anatomi abnormality
• Peptic ulcer disease
• Reflux esophagitis
 ALARM SYMPTOMS
• Weight loss
• Persistent vomiting
• Dysphagia
• Anemia
• Bleeding
• Diagnostic studies
• Upper Endoscopy
• Ultrasonography
• Computed Tomography Scan
• Magnetic Resonance Imaging
 DIARRHEA
• Range in severity from an acute, self-limited
annoyance to a severe, life threatening illness

• Define
• increased liquidity or decreased consistency of stools
 Acute Diarrhea
• Non inflammatory diarrhea
• Watery, nonbloody diarrhea associated with periumbilical cramps,
bloating, nausea, or vomiting  a small bowel enteritis

• Inflammatory diarrhea
• Fever and bloody diarrhea (dysentery)

• Enteric Fever
• A severe systemic illness manifested initially by prolonged high
fevers, prostration, confusion, respiratory symptoms
 Chronic Diarrhea
• Osmotic diarrhea
• Malabsorptive conditions
• Secretory diarrhea
• Inflammatory conditions
• Motility disorders
 CONSTIPATION
• Perception of abnormal bowel movements
that may include straining, hard stools,
decreased frequency and a feeling of
incomplete evacuation

• Etiology (variety of reasons) :

– Abnormal motor function of the large intestine
– Abnormalities of the muscular structures of the
anorectum
 WEIGHT LOSS
• Involuntary decrease in body weight at least 5% in a 6
month period  requires clinical evaluation

• Numerous causes :
– Decreased caloric intake
• Anorexia : malignant, psychiatric, CKD
• Swallowing disorders
• Abnormal taste
• Postprandial pain
– Increased metabolic rate : COPD, CHF, Hiperthyroidism
– Decreased caloric absorption : intestinal malabsorption
 DIAGNOSTIC STUDIES
• Stool analysis
• Laboratory tests
– Routine tests
– Specific laboratory tests
• Colonoscopy or Flexible sigmoidoscopy with
mucosal biopsy
• Imaging studies
 ABDOMINAL PAIN
• One of the most common symptoms

• Origin of pain :
• Clinical history
• Physical findings
• Laboratory value
• Radiographic examination
• Sudden onset (within seconds to minutes)
• Perforated peptic ulcer
• Ruptured aortic aneurysm
• Rupture abscess or hematoma

• Rapidly progressive (within 1-2 hours)

• Biliary colic, cholecystitis
• Acute pancreatitis

• Gradual onset (over number of hours)

• Appendicitis
• IBD
DIAGNOSTIC STUDIES
• Plain radiographs
• Ultrasonography