1. Introduction to Gastrointestinal System Dr.Yasir M Khayyat Assistant Professor, Consultant Gastroenterologist

2. GI History Physical Examination Specific Investigations

3. Upper GI symptoms Abd PainDysphagiaHalithosis Nausea Vomiting Heartburn Regurgitation Hematemesis and Melena Lower GI Symptoms Hematochezia Constipation Diarrhea Abdominal pain Bloating

4. Basic principles: Introduce yourself Know what system or disease type you are evaluating Write down Be brief and focused

5. Abdominal Pain Analysis SiteSeverityPattern PPT and reliving factors Radiation

6. Differential Diagnosis of Abdominal Pain by site Think also of non Abdominal organs Heart Lungs Spine Aorta

7. Diarrhea: Loose stool,frequent bowel motion,irritablity,feeling of incomplete evacuation Classified according to the duration : ( less than 3 weeks  Acute, More than 3 weeks  Chronic) Acute diarrhea is mainly infections or just the new onset of a chronic diarrhea. Ask about nocturnal diarrhea ( functional vs inflammatory) Ask the patient if this is different from his previous bowel habit ususally.

8. Infectious: Viral Bacterial Parasitic Protozoal Secretory : Osmotic : Medications Factiious Inflammatory Diarrhea Mechanisms

9. Constipation: Infrequent defecation, hard stool, painful defecation, straining Normally accepted 3 motions/week Note the type of constipation associated with acute surgical cause( Intestinal obstruction) vomiting-abdominal distension-constipation-abdominal pain. Ask the patient if this is different from his previous bowel habit ususally.

10. Weight loss: Loss of 5 pounds or 10 pounds within 6 months. Usually ask for appetite + weight loss and present the history accordingly. It is usually a manifestation of malignancy,so do not overlook it.

12. GI bleeding: Hematemesis,Melena = UGIB,usually a medical emergency,originates when there is passage of 100 ml of blood Hematochezia means fresh blood per rectum on or off the stool,usually located to the colon vs. sigmoid colon. If it is associated with hemodynamic instability it means significant UGIB

13. Physical Examination General Look Orientation Hands and Extremities Chest Trunk Abdomen ( Inspection, palpation, percussion, auscultation) Lower limbs Specific Examination for Chronic Liver disease.

14. Investigations in GI diseases Blood workStool Analysis Radiological work up Endoscopy CBC, Electrolytes, ESR,LFT,Liver related, Autoimmune Stool analysis,Microbiology, Culture Abdominal US CT Abdomen contrast MRI,MRCP Upper Endoscopy Colonoscopy ERCP

15. Important medical Emergencies in GI: Upper GI bleeding Lower GI bleeding Portal Hypertension Complications ( hepatic Encephalopathy, Ascites, SBP, HRS) Toxic megacolon in severe ulcerative colitis