disorders of the gastrointestinal...
TRANSCRIPT
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