Digestive System Semiology: Signs, Symptoms, and Diseases

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Digestive System and Diseases

• The digestive system consists of the esophagus, stomach, small intestine, large intestine, pancreas, liver, and gallbladder.
• Digestive disease is an umbrella term for health issues in any of these organs.

Signs and Symptoms of Digestive Diseases

• Abdominal pain
• Vomiting
• Diarrhea
• Constipation
• Gastrointestinal hemorrhage
• Enlargement of the spleen
• Enlargement of the liver
• Jaundice

Common Digestive Diseases

• Acid Reflux (GERD)
  • Symptoms: bloating, excessive gas, alternating between diarrhea and constipation, mucus in bowel movements
• Gallstones
  • Symptoms: dark urine, clay-colored bowel movements, nausea, vomiting, pancreatitis, diarrhea, right-side pain
• Peptic Ulcers
  • Symptoms: heartburn, stomach pain, blood in bowel movements, vomiting, blood in vomit
• Irritable Bowel Syndrome (IBS)
  • Symptoms: bloating, excessive gas, alternating between diarrhea and constipation, mucus in bowel movements
• Crohn's Disease
  • Symptoms: abdominal cramping, immediate need to use the bathroom, frequent diarrhea, fever, blood in stool, weight loss/loss of appetite
• Diverticulitis
  • Symptoms: abdominal pain, tenderness, fever, constipation, nausea, and vomiting

Abdominal Pain

• Types: acute and chronic
• Causes: gastro-intestinal infections, urinary tract and reproductive organs infections, kidney stone disease, peritonitis, and other infections
• Characteristics: site of the pain, radiation, character of the pain, exacerbating and relieving factors, associated symptoms

Vomiting

• Definition: the sudden ejection of the matter from the stomach with the active involvement of the contraction of the diaphragm and the abdominal muscles
• Types: nausea, regurgitation, rumination, and vomiting
• Causes: infection, inflammatory bowel disease, celiac disease, acute appendicitis, food allergies and intolerances, enzyme deficiencies, and irritable bowel syndrome
• Medical history: character and circumstances of the occurrence, pathological admixtures, other patient's diseases, taken medication, associated symptoms

Constipation

• Definition: defecating less than 3 times a week or defecating more often, but with straining to go
• Causes: anorectal malformations, congenital defects of the rectum innervation, metabolic disorders, collagenosis, side effects of taken medicines, heavy metal poisoning

Diarrhea

• Definition: change of the texture of the stool to runny or loose and/or increase of the frequency of defecation
• Causes: infection, inflammatory bowel disease, celiac disease, acute appendicitis, food allergies and intolerances, enzyme deficiencies, and irritable bowel syndrome
• Medical history: number and texture of the stools, duration of the symptoms, pathological admixtures, influence of the food on the symptoms, epidemiological inquiry, associated symptoms

Gastrointestinal Bleeding

• Definition: bleeding from the upper or lower gastrointestinal tract
• Causes: varices, esophagitis and gastritis, Mallory-Weiss tear, ulcers, vascular malformations, inflammatory bowel diseases, anal fissures, colitis, hemorrhoids, and rectal varices
• Medical history: duration of the symptoms, how the stool/vomit looks like, dietary history, taken medication, associated symptoms

Enlarged Spleen (Splenomegaly)

• Definition: an increase in the size of the spleen
• Causes: infections, hematologic diseases, malignancy, Langerhans cell histiocytosis, storage and metabolic diseases, autoimmune diseases, and circulatory disorders in the portal or the splenic vein
• Medical history: presence of an acute infection, chronic diarrhea, hyperbilirubinemia/jaundice/anaemia in the medical history, epidemiological inquiries, risky sexual behaviour, injuries, co-existing diseases and the history of surgeries, family history

Enlarged Liver (Hepatomegaly)

• Definition: an increase in the size of the liver
• Causes: inflammatory changes, drug-induced liver damage, cancer, storage and metabolic diseases, and congestive changes in the circulation
• Medical history: presence of an acute infection, chronic diarrhea, hyperbilirubinemia/jaundice/anaemia in the medical history, epidemiological inquiries, risky sexual behaviour, injuries, co-existing diseases and the history of surgeries, family history

Jaundice

• Definition: a yellowish discoloration of the skin and mucous membranes
• Causes: inflammatory changes, drug-induced liver damage, cancer, storage and metabolic diseases, and congestive changes in the circulation
• Medical history: time of onset and the rate of acceleration, associated symptoms, In infants: mother's blood type, medicines taken during pregnancy, breastfeeding### Abnormalities of Stool and Gas
• Frank blood: red blood in stool, usually from lesions in rectum or anal canal
• Occult blood: small, hidden amounts of blood in stool, detectable with stool test, may be caused by small bleeding ulcers
• Melena: dark-colored, tarry stool, may result from significant bleeding in upper digestive tract

Gas

• Causes:
  • Swallowed air, such as from drinking from a straw
  • Bacterial action on food
  • Foods or alterations in motility
• Effects:
  • Eructation
  • Borborygmus
  • Abdominal distention and pain
  • Flatus

Constipation

• Definition: less frequent bowel movements than normal
• Characteristics:
  • Small, hard stools
  • Acute or chronic problem
  • May be caused by decreased peristalsis, leading to increased time for reabsorption of fluid
  • Periods of constipation may alternate with periods of diarrhea
• Chronic constipation may cause:
  • Hemorrhoids
  • Anal fissures
  • Diverticulitis

Causes of Constipation

• Weakness of smooth muscle due to age or illness
• Inadequate dietary fiber
• Inadequate fluid intake
• Failure to respond to defecation reflex
• Immobility
• Neurological disorders
• Certain medications (opiates, antacids, iron)
• Obstructions caused by tumors or strictures

Fluid and Electrolyte Imbalances

• Dehydration and hypovolemia are common complications of digestive tract disorders
• Electrolytes lost in vomiting and diarrhea
• Acid-base imbalances:
  • Metabolic alkalosis: results from loss of hydrochloric acid with vomiting
  • Metabolic acidosis: severe vomiting causes a change to metabolic acidosis due to loss of bicarbonate from duodenal secretions

Pain: Visceral Pain

• Burning sensation: inflammation and ulceration in upper digestive tract
• Dull, aching pain: typical result of stretching of liver capsule
• Cramping or diffuse pain: inflammation, distention, or stretching of intestines
• Colicky, severe pain: recurrent smooth muscle spasms or contraction, often caused by severe inflammation or obstruction

Pain: Somatic Pain

• Somatic pain receptors directly linked to spinal nerves
• May cause reflex spasm of overlying abdominal muscles
• Steady, intense, often well-localized abdominal pain
• Involvement or inflammation of parietal peritoneum
• Rebound tenderness: identified over area of inflammation when pressure is released

Pain: Referred Pain

• Common phenomenon
• Pain is perceived at a site different from the origin
• Results when visceral and somatic nerves converge at one spinal cord level
• May assist or delay diagnosis, depending on the problem

Malnutrition

• May be limited to a specific nutrient or general
• Causes of limited malnutrition:
  • Vitamin B12 deficiency
  • Iron deficiency
• Causes of generalized malnutrition:
  • Chronic anorexia, vomiting, diarrhea
  • Chronic inflammatory bowel disorders
  • Cancer treatments
  • Wasting syndrome
  • Lack of available nutrients

Basic Diagnostic Tests

• Radiography: may use contrast medium
• Ultrasound: may show unusual masses
• Computed tomography (CT): may use radioactive tracers, useful for liver and pancreatic abnormalities
• Magnetic resonance imaging (MRI): useful for liver and pancreatic abnormalities

Therapies and Prevention

• Dietary modifications:
  • Example: gluten-free diet for celiac disease
  • Reduced intake of alcohol and coffee
  • Increased fiber and fluid intake
• Stress reduction techniques: stress impairs immune function and tissue healing
• Drugs: various medications are available, including antacids, antiemetics, laxatives or enemas, antidiarrheals, sulfasalazine, clarithromycin or azithromycin, sucralfate, anticholinergic drugs, histamine 2 antagonists, and proton pump inhibitors