What are the common presentations of abdominal disorders?
- Abdominal pain
What is meant by dyspepsia?
- Upper abdominal pain and bloating
- Chronic or recurrent pain or discomfort in the upper abdomen
What are the causes of dyspepsia?
- Chronic peptic ulcer disease
- Functional / non-ulcer
Some debate over this
What % of dyspepsia is functional / non-ulcer?
What is meant by functional / non-ulcer dyspepsia?
No functional problem found to account for symptoms
When is dyspepsia classified as functional?
When there is 3 months of dyspepsia with no structural causes found
What is the course of treatment for dyspepsia?
- Empirical acid suppression
- Non invasive H-pylori testing/eradication
- Early endoscopy
How common is abdominal pain?
Very common, 2% of all hospital admissions
What must be taken into consideration when a patient presents with abdominal pain?
That there are many causes, and it can be misleading, so we must therefore adopt a sensible approach
Is abdominal pain related to the small bowel intra- or extra-peritoneal?
Why is it important to question what embryological division abdominal pain related to the small bowel belongs to?
Because intra-peritoneal structures refer pain to shared areas of the abdominal wall
Where does the foregut refer pain to?
Up to the 2nd part of the duodenum to the epigastric area
Where does the midgut refer pain to?
Up to the distal third of the transverse colon to the peri-umbilical area
Where does the hindgut refer pain to?
What may cause foregut pain?
What kind of foregut pain is produced when caused by ulcers
Where does epigastric pain caused by ulcers commonly occur?
In the first part of the duodenum or lesser curve of the stomach
Where does pancreatitis cause pain?
- Epigastric pain
- Back pain (retroperitoneal structure)
Where do gallstones cause pain?
- Epigastric pain
- Can also get right upper quadrant (RUQ) pain
What is gallstones pain sometimes referred to as?
Why is referring to gallstones pain as colicky a slight misnomer?
Because the pain is fairly constant
What is midgut pain sometimes referred to as?
'Real' colicky pain
At what frequency is colicky pain in the small bowel?
Every 2-3 minutes
At what frequency is colicky pain in the large bowel?
Every 10-15 minutes
What are the symptoms of a small bowel obstruction?
- Abdominal distention
What may be shown on an x-ray of a small bowel obstruction?
- Central abdominal distended loops
- Circular folds extending the full width of the bowel lumen
What is the classic midgut pain scenario?
What may cause hindgut pain?
What % of intestinal obstructions are due to sigmoid volvuluses?
What happens in a sigmoid volvulus?
Twists in on itself or its mesentery, causing a bowel obstruction and interruption to blood supply
What is the result of a bowel obstruction in a sigmoid volvulus?
What is the result of the interuption to the blood supply in a sigmoid volvulus?
What is anorexia?
Loss of appetite
What may cause anorexia?
- Subjectively unpleasant food or surroundings
- Symptom of a physical disorder
- Symptom of a psychological disorder
What physical disorders may anorexia be a symptom of?
- Cancer (in particular, of the GI tract)
- Certain antibiotics
- Endocrine disorders
At what point should weight loss be investigated?
More than 5% intentional weight loss
What is nausea?
The subjective sensation of the need to vomit
Where is the vomiting centre?
In the medulla
What sources of information feed into the vomiting centre?
- Labyrinths (in the inner ear)
- Cerebral cortex
- Peripheral pain receptors
- Chemo- and baroreceptors
- Emetic drugs
Describe the passage of information from the labyrinths to the vomiting centre?
- Labyrinths to vestibular, via acetylcholine
- Vestibular to vomiting centre, via acetylcholine
What neurotransmitter is responsible for communication between peripheral pain receptors and the vomiting centre?
What may trigger chemo- and baroreceptors to stimulate the vomiting centre?
Distension or irritation
How do substances such as emetic drugs, dopamine and 5-HT communicate with the vomiting centre?
Via the chemoreceptor trigger zone (CTZ)
Where does the CTZ lie?
At the base of the 4th ventricle
What are the common causes of vomiting?
- Food poisoning
- Viral hepatitis
- Intestinal blockage
What microorganisms can cause food poisoning?
What causes viral gastroenteritis?
When is someone classified as having constipation?
When they defecate less than 3 times a week (varies)
What is more important to consider than the frequency of defication?
Changes in bowel habits
What are the potentila causes of constipation?
What medication can cause constipation?
- Opiod analgesics
What diseases can cause constipation?
- Neurological, e.g. stroke
- Colorectal stricture
What is functional constipation?
When there is no reason for constipation
What is a possible cause for functional constipation in paediatrics?
What is classified to be diarrhoea?
- More stools
- Change in consistancy
Different for individuals
What is required to make a diagnosis of diarrhoea?
A good history
What are the categories of diarrhoea?
- Abnormal intestinal motility
What causes secretory diarrhoea?
What causes osmotic diarrhoea?
What causes abnormal intestinal motility diarrhoea?
What causes exudative diarrhoea?
What causes malabsorption diarrhoea?
Pancreatic enzyme/bile salt deficiency
What is dysphagia?
Difficulty swallowing (both solids and liquids)
What should dysphagia be differentiated from?
What is odynophagia?
What are the broad categories of dysphagia?
- Difficulty initating swallowing
- Food sticking in oesophagus
What is the cause of difficulty initating swallowing?
What is the cause of food sticking in the oesphagus?
What are the broad categories of GI bleeding?
- From the top
- From the bottom
What can cause bleeding from the top of the GI tract?
- Acute or chronic peptic ulcer
- Mallory-Weiss tear
- Oesophagea or gastric varices
- Erosive oesophagitis
- Gastric or oesophageal cancer
What is a Mallory-Weiss tear?
A tear in the oesophagus from repetitive retching
What can cause bleeding from the bottom of the GI tract?
- Diverticular disease
- Colonic carcinoma
- Haemorrhoids or anal fissure
- Inflammatory bowel disease
- Massive upper GI bleed
What is angiodysplasia?
Vascular malformation of the gut blood vessels
What cau cause a massive upper GI bleed?
Draw a diagram illustrating the portal venous system
What can cause abdominal distention?
What is ascites?
Abnormal amounts of fluid collecting in the peritoneal cavity
What can cause ascites?
- Liver failure
- Portal hypertension
What can cause flatus?
- Gas production in gut (especially if digestion has been incomplete)
What is aerophagia?
What should be looked for during a GI practical examination?