Major Symptoms and Signs of Digestive Tract Disorders

G.R.Jeloudar MD

DYSPHAGIA Difficulty in swallowing is termed dysphagia Odynophagia : Painful swallowing Globus :sensation of something stuck in the

throat without a clear etiology Oropharyngeal dysphagia : transfer of the

food bolus from the mouth to the esophagus is impaired (also termed transfer dysphagia)

Neurologic and muscular disorders

The most serious complication is life-threatening

aspiration

Oropharyngeal dysphagia

Oropharyngeal problem is usually part of a more generalized neurologic or muscular problem (botulism, diphtheria, neuromuscular disease)

Painful oral lesions, such as acute viral stomatitis or trauma

If nasal air passage is seriously obstructed causes severe distress when suckling

Esophageal dysphagia

Esophageal dysphagia :difficulty in transporting the food bolus down the esophagus

Can result from neuromuscular disorders or

mechanical obstruction

Achalasia is an esophageal motility disorder

After surgical repair of tracheoesophageal fistula

or achalasia

Collagen vascular disorders

Esophageal dysphagia

Mechanical obstruction :

Intrinsic : stricture, web, tumor

Extrinsic :vascular rings, mediastinal lesions,

vertebral abnormalities

Structural defects typically cause more problems in swallowing solids than liquids

An esophageal stricture secondary to esophagitis occasionally has dysphagia as the first manifestation

Esophageal foreign body

stricture secondary to a caustic ingestion

REGURGITATION

Effortless movement of stomach contents into the esophagus and mouth

Not associated with distress

Hungry immediately after an episode

An incompetent or immature LES

A developmental process, and resolves with maturity

Regurgitation should be differentiated from vomiting

VOMITING

Highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching

Obstruction of the GI tract

Nonobstructive lesions of the digestive tract (pancreas, liver, or biliary tree)

CNS or metabolic derangements

Cyclic vomiting (2 or more periods of intense nausea and unremitting vomiting or retching lasting hours to days and return to usual state of health lasting weeks to months)

DIARRHEA

Excessive loss of fluid and electrolyte in the stool

Acute diarrhea :sudden onset of excessively loose stools of> 10 ml/kg/day in infants and >200 g/24 hr in older children, which lasts <14 days

chronic or persistent diarrhea :>14 days

The greatest volume of intestinal water is absorbed in the small bowel; the colon concentrates intestinal contents

The small intestine of an adult can absorb 10-11 L/day

Colon absorbs approximately 0.5 L

Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea

Dysentery (small volume,frequent bloody stools with mucus, tenesmus, and urgency) is the predominant symptom of colitis

Pathogenesis of diarrhea

Secretory diarrhea :occurs when the intestinal epithelial cell solute transport system is in an active state of secretion caused by (cholera toxin ,fatty acids and bile salts ) binding intracellular accumulation of (cAMP) or (cGMP)

Secretory diarrhea is usually of large volume and persists even with fasting

Osmotic diarrhea :occurs after ingestion of a poorly absorbed solute(magnesium, phosphate, lactulose, or sorbitol) or one that is not well absorbed because of a disorder of the small bowel (lactose with lactase deficiency or glucose with rota virus diarrhea)

This form of diarrhea is usually of lesser volume than a secretory diarrhea and stops with fasting

Motility disorders :can be associated with rapid or delayed transit and are not generally associated with large-volume diarrhea

Slow motility can be associated with bacterial overgrowth leading to diarrhea

CONSTIPATION

A hard stool passed with difficulty every 3rd day should be treated as constipation

True constipation in the neonatal period is most likely secondary to Hirschsprung disease, intestinal pseudo-obstruction, or hypothyroidism

ABDOMINAL PAIN

Organic

Nonorganic (functional)

In skin and muscle, A fibers mediate sharp localized pain; C fibers from viscera, peritoneum, and muscle transmit poorly localized, dull pain

Pain that suggests a potentially serious organic etiology is associated with :age <5 yr; fever; weight loss; bile or blood-stained emesis; jaundice;hepatosplenomegaly; back or flank pain or pain in a location other than the umbilicus; awakening from sleep in pain; referred pain to shoulder, groin or back; elevated ESR, WBC, or CRP; anemia; edema; or a strong family history of inflammatory bowel disease (IBD) or celiac disease

Visceral pain

Dull and aching

Experienced in the dermatome from which the affected organ receives innervations

Painful stimuli originating in the liver, pancreas, biliary tree, stomach, or upper bowel are felt in the epigastrium

pain from the distal small bowel, cecum, appendix,or proximal colon is felt at the umbilicus

pain from the distal large bowel, urinary tract, or pelvic organs is usually suprapubic

Somatic pain is intense and is usually well localized.

GASTROINTESTINAL HEMORRHAGE

Hematemesis :Bleeding that originates in the esophagus, stomach, or duodenum

Coffee grounds : When blood exposed to gastric or intestinal juices, quickly darkens

Hematochezia : red or maroon blood in stools, signifies either a distal bleeding site or massive hemorrhage above the distal ileum

Melena : moderate to mild bleeding from sites above the distal ileum tends to cause blackened stools of tarry consistency

Erosive damage to the mucosa of the GI tract is the most common cause of bleeding

Prolapse gastropathy producing subepithelial hemorrhage

Mallory-Weiss lesions secondary to mucosal tears associated with emesis are causes of upper intestinal bleeds

Upper intestinal bleeding is evaluated with an EGD

Evaluation of the small intestine is facilitated by capsule endoscopy

Lower GI bleeding is investigated with a colonoscopy

Brisk intestinal bleeding of unknown location, a tagged red blood cell (RBC) scan is helpful in locating the site of the bleeding

GI hemorrhage can produce hypotension and tachycardia but rarely causes GI symptoms

Brisk duodenal or gastric bleeding can lead to nausea, vomiting, or diarrhea