Disorders of the

Gastrointestinal System

History taking

Physical examination

Special techniques for diagnosis

Anatomic and functional

consideration

GI tract extends: mouth→ anus

Assimilation of nutrients

Elimination of waste

Stomach: pepsin, gastric acid, secrete

intrinsic factor for vitmin B12 absorption

Small intestine: absorptive function, villous

architecture

Pancratice juice, bile→ facilitate digestion

Colon: dehydrates the stool

Symptoms of GI diseases

Abdominal pain

Heartburn

Nausea and vomiting

Altered bowel habits

GI bleeding

Jaundice

Dysphagia

Anorexia

Weight loss

Extraintestinal symptoms

Abdominal Pain

Appendicitis

Gallstone disease

Pancreatitis

Diverticulitis

Peptic ulcer disease

Esophagitis

GI obstruction

IBD: inflammatory bowel disease

Functional bowel disorder

Vascular disease

Nausea and Vomiting

Medications

GI obstruction

Functinal bowel disorder

Enteric infection

Pregnancy

Endocrine disease

CNS disease

Diarrhea

Infection

Poorly absorbed sugars

IBD

Microscopic colitis

Functional bowel disorder

Celiac disease

Pancreatic insufficiency

Hyperthyroidism

Ischemia

Endocrine tumor

GI Bleeding

Peptic ulcer disease

Esophagitis

Varices

Vascular lesions

Neoplasm

Diverticula

Hemorrhoids

IBD

Infectious colitis

Obstructive Jaundice

Bile duct stones

Cholangiocarcinoma

Cholangitis

Sclerosing cholangitis

Ampullary stenosis

Ampullary carcinoma

Pancreatitis

Pancreatic tumor

Evaluation of the patient with GI

disease

Careful history taking

Physical examination

History taking

Symptom timing

Symptoms of short duration→ acute

Long-standing symptoms→ chronic

Symptoms worsened by meal ingestion

Symtoms relived by eating

Obstructive symptoms with prior abdominal

surgery→ adhesions

Loose stools after gastrectomy→ dumping

syndrome

Physical examination

Abnormal vital signs→ acute intervention

Fever→ inflammation, neoplasm

Orthostasis→ significant blood loss, dehydration, sepsis

Eye, skin→ jaundice

Acute coronary syndrome→ abdominal pain, nausea

Rectal examination→ blood, neoplasm

Palpable inflammatory mass→ acute appendicitis

Physical examination 2

Inspection of the abdomen→ tumor, ascites, distension from obstruction

Ecchymosis→ severe pancreatitis

Loss of bowel sounds on auscultation→ ileus, intestinal obstruction

Percussion→ liver size

Percussion→ shifting dullness from ascites

Palpation→ hepatosplenomegaly, neoplastic masses

Peritonitis→abdominal pain, involuntary guarding, rigidity

Tools for patient evaluation

Laboratory

Radiographic

Functional tests

Upper and lower endoscopy

Examination of luminal contents

Histopathologic examination

Laboratory

Iron-deficiency anemia→ GI bleeding

Vitamin B12 deficiency← gastric, small intestinal disease

Leukocytosis, sedimentation rate↑→ inflammation

Severe vomiting or diarrhea→ electrolyte disturbances, BUN↑

Liver enzymes↑→ liver disease

Pancreatic enzymes↑→ pancreas disease

Nausea young women→ pregnancy testing

Laboratory 2

Celiac disease→ serologies tests

Tumor markers: CEA, CA 19-9, α-

fetoprotein

Ascitic fluid analysis

Urine samples→ carcinoid

Luminal Contents

Stool samples

Duodenal aspirates

Fecal fat→ malabsorption

Gastric acid

Pancreatic juice

Endoscopy

Upper endoscopy=

Esophagogastroduodenoscopy

Colonoscopy

ERCP= Endoscopic Retrograde

Cholangiopancreatography

Endoscopic Ultrasound

Capsule endoscopy

Radiography/Nuclear Medicine

Oral and rectal barium contrast agents

Barium swallow

Small-bowel contrast radiology

Contrast enema

Ultrasound

CT

CT colonography

MRI→ pancreatobiliary ducts

Angiography

Biliary scintigraphy

Gallium scintigraphy→ intraabdominal abscesses

Histopathology

Gut mucosal biopsies

Deep rectal biopsy→ amyloidosis

Liver biopsy→ chronic

viral/autoimmune hepatitis

CT/ultrasound directed biopsy

Functional Testing

Esophageal manometry

Breath test for Helicobacter pylori