Major Manifestations of GIT Disease

Dysphagia

Dysphagia It is defined as difficulty in swallowing It must distinguished from: Globus sensation Odynophagia.

See Next Slide Dysphagia Esophageal Oropharyngeal Endoscopy Difficulty initiating swallow ± chocking or aspiration Food “sticking” after Swallowing, regurgitation Oropharyngeal Esophageal Videofluorscopic Swallowing assessment & neurological investigation Liquid worse than solids Solids worse than liquids Barium Swallow Uncoordinated Peristalsis or aspiration Neurological Disease Bulbar palsy Pseudobulbar Myasthenia gravis Endoscopy & biopsy See Next Slide

See Previous Slide Esophageal Dysphagia Endoscopy & biopsy Dysmotility Liquid worse than solids Solids worse than liquids Endoscopy & biopsy See Previous Slide Dysmotility Esophagitis Stricture Manometry Achalasia Non-specific motiliy disorder Peptic Candidiasis Malignant Benign Ca of esophagus Ca stomach Extrinsic compression Fibrous ring

Myasthenia

Systemic sclerosis

Achalasia

Sideropenic Web

Malignant stricture

Peptic stricture

Dyspepsia

Dyspepsia Dyspepsia (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.

Causes of Dyspepsia Upper GI disorders: Other 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

Causes of Dyspepsia Systemic disease: Drugs: Others: Renal failure Hypercalcemia Drugs: NSAIDs Iron & potassium supplements Corticosteroids Digoxin Others: Alcohol Psychological e.g. anxiety, depression

Alarm Features in Dyspepsia Weight loss Anemia Vomiting Hematemesis and/or malena Dysphagia Palpable abdominal mass

Dyspepsia Are there “alarm features”? Endoscopy No Yes > 55 years Test for H pylori Negative Positive Treat Symptomatically or Consider other diagnosis H pylori eradication Symptoms resolve persist follow up

Vomiting

Vomiting Vomiting is highly integrated & complex reflex involving both autonomic & somatic neural pathways.

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

Causes of Vomiting Infections: Drugs: Gastroduodenal disease: Gastroenteritis Hepatitis Urinary tract infection Drugs: NSAIDs Antibiotics Opiates Digoxin Cytotoxic drugs Gastroduodenal disease: Chronic peptic ulcer disease (± gastric outlet obstruction) Gastric cancer Gastroparesis e.g. diabetes, scleroderma, drugs

Causes of Vomiting Acute abdominal disorders: CNS disorders: Appendicitis Cholecystitis Pancreatitis Intestinal obstruction CNS disorders: Vestibular neuritis Migraine Meningitis Raised intracranial pressure Metabolic: Diabetic ketoacidosis Uremia Addison’s disease. Others: Any severe pain e.g. myocardial infarction. Psychogenic Alcoholism pregnancy

Vomiting-Symptoms 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

Vomiting-signs Examination may reveal: Signs of dehydration, fever & infection. Evidence of abdominal mass Evidence of peritonitis Evidence of intestinal obstruction Neurological signs including: Papilledema Nystagmus Photophobia Neck stiffness. Other findings suggestive of: Alcoholism Pregnancy or Bulimia