Semiología Aparato Digestivo PDF

# SEMIOLOGÍA APARATO DIGESTIVO ## ANAMNESIS ### FILIACIÓN * **EDAD:** - In childhood and adolescence, inflammatory processes are predominant. - In adults and elderly people, neoplasias are predominant. * **SEX:** - In males, the following are more common: - Neoplasms of lip, tongu...

# SEMIOLOGÍA APARATO DIGESTIVO ## ANAMNESIS ### FILIACIÓN * **EDAD:** - In childhood and adolescence, inflammatory processes are predominant. - In adults and elderly people, neoplasias are predominant. * **SEX:** - In males, the following are more common: - Neoplasms of lip, tongue, esophagus, and stomach - Gastritis - Gastric or duodenal ulcer - Intrahepatic obstructive jaundice - Crohn's disease - In females, neoplasms are more common: - Gallstones - Gallbladder neoplasia - Extrahepatic obstructive jaundice - Dyspeptic dystonia - Constipation * **OCCUPATION:** - **Porcelain or glass making (handling lead or lead salts):** Acute and chronic gastroenteritis, acute hepatitis, and episodes of colic. - **Thermometer, barometer, and fulminate making (mercury handling):** Cholera-like gastroenteritis. - **Shepherds (contact with cattle and dogs):** Hydatid cyst. - **Truck and taxi drivers (sitting for long hours):** Hemorrhoids. - **Occupations with great responsibility and psychological stress (company managers, officials, etc.):** Peptic gastroduodenal ulcers, irritable bowel, and ulcerative colitis, ### ANTECEDENTES PERSONALES GENERALES * **HOUSING:** No access to water supply and sewage system: Parasitism, gastrointestinal infections, hepatitis, etc. * **DIET:** Abundant, spicy, or overly seasoned food, without a set schedule: Dyspepsia and gastritis. ### ANTECEDENTES FAMILIARES * Familial predisposition for cancer and duodenal ulcer ### ANTECEDENTES PATOLÓGICOS * **Diseases of the digestive system:** Stomach cancer, gastroduodenal ulcer, colitis. * **Secondary digestive disease to other organic processes:** Uremia due to renal failure: Anorexia, vomiting, and epigastralgia. ### HABITOS NOCIVOS: * **Alcohol**: Dyspepsia, Gastritis * **Tobacco**: Neoplasias ## ENFERMEDAD ACTUAL - PRINCIPAL SYMPTOMS ### Nausea Nausea is an unpleasant sensation of unease in the stomach, accompanied by neurovegetative manifestations, sweating, salivation, and tachypnea, which may occur alone or accompanied by vomiting. * Nausea on an empty stomach is observed in acute gastritis, after a dinner with a lot of chili and seasonings, and accompanied by excess alcohol consumption. * Nausea can also be observed in chronic gastritis of habitual drinkers and smokers. * It manifests in ascariasis, disappearing with food intake. * It manifests in hypotonic or atonic stomachs. * Postprandial nausea is common in hypotonic or atonic stomachs. * Nausea also occurs in gastric cancer. ### Vomiting Vomiting is a reflex act resulting in the expulsion of gastric contents through the mouth. * Vomiting may be preceded and accompanied by nausea, except for cerebral vomiting, which appears abruptly and explosively. * Depending on its composition, vomiting may be: - **Alimentary vomiting:** It is the most common and composed of undigested food. - **Mucous vomiting:** Gastric mucus floats in gastric juice and is characterized by adhering to the walls. It is a sign of gastritis. - **Watery vomiting:** It is composed of pure gastric juice. It is usually abundant, clear in appearance, not very thick, and acid in taste. It is characteristic of gastroduodenal ulcers with pyloric obstruction. - **Bile vomiting:** It appears in duodenal reflux and is composed of bile. It has a bitter taste and yellowish or greenish color. It is common in liver and gallbladder affections, duodenal stenosis, acute pancreatitis, and intestinal obstruction. - **Porraceous vomiting:** Greenish dark, slightly fetid in color, it results from a mixture of gastric contents, duodenum, small intestine, and bile. It appears in acute peritonitis, acute dilatation of the stomach, and high-level intestinal obstruction. - **Feculent vomiting:** It is dark brown, diarrheic in appearance, and with a fecal smell. It appears in low-level intestinal obstruction and gastrocolic fistulas due to ulcerated gastric cancer. ### Diarrhea Diarrhea is the passage of loose or liquid feces more than three times a day. Acute diarrhea usually lasts one or two days. Persistent diarrhea is considered chronic if it lasts more than two weeks. * Diarrhea can be infectious and non-infectious. * Infectious diarrhea is usually seen in environments with poor hygienic and sanitary conditions, without access to clean water for drinking, cooking, or washing. It is caused by various bacteria, parasites, and viruses. * The most common causes of non-infectious diarrhea are food intolerance (lactose intolerance, fructose intolerance), Irritable bowel syndrome, inflammatory bowel disease, hyperthyroidism, and the effects of certain drugs. ### Hematemesis Hematemesis is fresh, undigested blood vomiting, usually abundant, coming from the stomach, duodenum, or esophagus (Upper Gastrointestinal bleeding). The most common causes are gastric or duodenal ulcer and esophageal varices due to portal hypertension. ### Melena Melena is the passage of dark, tarry, foul-smelling stools. It is formed by digested blood in the stomach and intestines. It indicates upper gastrointestinal bleeding due to gastroduodenal ulcers, cirrhosis, or rupture of esophageal varices. ### Jaundice Jaundice is a yellowish coloration of the skin and mucous membranes due to an increase in bilirubin concentration in the blood. * In some cases, jaundice may be accompanied by choluria (very dark urine due to bilirubin) and acolia (very light-colored feces because of the absence of bilirubin derivatives). * Jaundice can be caused by an increased red blood cell destruction rate (hemolysis), liver diseases (acute and chronic hepatitis, cirrhosis), and biliary obstruction (gallstones and tumors in the biliary system or pancreas). ### Acute abdominal pain Acute abdominal pain is a severe pain that appears in a matter of hours or days. It can be found in various conditions such as: * Aortic abdominal aneurysm * Appendicitis * Cholecystitis * Diverticulitis * Intestinal obstruction * Pancreatitis * Peritonitis ## PHYSICO-ABDOMINAL EXAMINATION ### INSPECTION * **Overall modifications of abdominal shape and volume:** - **General or global:** - **Protrusion:** - **Obesity:** Due to the excessive thickness of the abdominal wall, with a certain degree of flatulence. - **Ascites:** Fluid accumulates inside the peritoneum. - **Peritoneal hydatidosis:** Multiple hydatid cysts in the peritoneum, with significant fluid accumulation. - **Acute peritonitis:** Usually associated with peritoneal exudate. - **Pneumoperitoneum:** Gas present outside of the intestines inside the abdomen. - **Meteorism:** Accumulated gas in the intestines. - **Visceral tumors:** As they grow, they cause abdominal protrusion. - **Depression or indentation:** - **General or global:** The abdomen appears flattened in general, as if it were a board (flat abdomen), and in some cases, it becomes indented or hollowed out (bathtub abdomen). - **Prolonged starvation, with emaciation (wasting syndrome) and dehydration.** - **Marked contraction of abdominal muscles.** - **Partial or regional:** Localized deformations that originate in the abdominal organs or wall. They are not symmetrical, therefore inspection helps to locate the cause. - **Parietal:** - **Hernias:** Depending on their location, they can be umbilical, inguinal, and epigastric hernias. - **Diastasis of rectus abdominis:** It appears as a vertical elongation at the sides of the midline. - **Postoperative eventration:** Hernias that appear in the scar of an abdominal surgical procedure. - **Parieto-abdominal tumors:** Fibromas, angioma, sarcoma, etc. - **Visceral:** - **Stomach:** Distension due to pyloric obstruction. - **Intestine:** Constriction of the intestinal tract, with visible peristalsis. It occurs in intestinal obstruction. - **Gallbladder:** Inflammation becomes visible when the gallbladder increases in size. - **Pancreas:** Expansion of the pancreas can be observed between the xiphoid process and the navel. * **Skin alterations:** - **Color:** The color of the abdominal skin can change in general diseases. - **Yellowish (jaundice), pale (anemia), or bronze (cirrhosis).** - **Appearance:** - **Tense, smooth, and shiny:** It occurs in distended abdomens (ascites, meteorism, large tumors, etc.) * **Umbilical cicatrix:** - **Position:** In pathological situations, the umbilical cicatrix is displaced. For example, a liver or spleen tumor displaces it down. - **Shape and size:** - **Obesity:** It gets deeper. - **Increased abdominal contents:** It expands and flattens. * **Venous network:** In portal hypertension, the dilated surrounding veins are visible, constituting collateral circulation. ### AUSCULTATION * **Auscultation is performed with the patient lying on their back, with shallow breaths.** * **Use of stethoscope and auscultate each of the 9 areas of the abdomen in an organized manner.** * **Auscultate normal abdominal sounds.** * **Sounds are intensified and more frequent during diarrhea.** * **Sounds are weaker and less frequent during flatulence, paralytic ileus, and peritoneal reactions, such as appendicitis, and intestinal perforation.** * **In intestinal obstruction, sounds are increased above the obstruction and reduced below it.** ### PALPATION * **Palpation is the most important method.** * **It requires discipline and practice.** * **It is done in two stages:** - **Superficial palpation:** Gently and smoothly, explore the surface and then the abdominal tension. - **Abdominal surface:** Gently and smoothly, glide your hand along the abdominal surface. It is often useful to close your eyes to pay more attention to the examination. - **Abdominal tension:** It is done by placing your hand on the abdomen without applying pressure, and make small movements with the tips of your fingers. - **Deep palpation:** It is used to directly explore the abdominal organs, and check for tenderness.