Approach to Patient With Gastrointestinal System

8/11/2019 Approach to Patient With Gastrointestinal System

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Marshell Tendean, MD, DPCP


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Understand gastrointestinal anatomy andphysiology.

To know common gastrointestinal hepatology

diseases. Recognize common gastrointestinal- hepatology

symptoms. Know approach to gastrointestinal-hepatology

disease. Ancilary procedures related to gastrointestinal-

hepatology dicipline. Dyspepsia.


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Anatomy : Is an organ complex with distincfunction comprising from mouth to anus.

Function : Assimilating nutrient

Eliminating waste


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Mouth : mechanically processed, mixed withsalivary.

Esophagus : propels the bolus into stomach.

Stomach : Mechanical digestion : mixing process

Ezymatic digestion : pepsin, acid intrinsic factor.

Small intestine : absorption of nutrient(macro/micronutrient, vitamins, fat)

Colon : water absorption and preparation ofwaste


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Impaired digestion and absorption Altered secretion

Altered gut transit Immune dysregulation Impaired gut blood flow Neoplastic degeneration


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Abdominal pain Heart burn

Nausea and vomiting Altered bowel habit Gi bleeding Obstructive jaundice


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Including GI disease and extraintestinal

conditions the genitourinary tract,

abdominal wall, thorax, or (spine). Most common cause functional dyspepsia. Pain source :

Visceral pain generally is midline in location and

vague in character.

While parietal pain is localized and precisely

described.


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Causes :

Common inflammatory diseases with pain.

Other intraabdominal causes of pain includegallstone disease and pancreatitis.

Noninflammatory visceral sources include

mesenteric ischemia, neoplasia and constipation.


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Heartburn, a burning substernal sensation. Classically, heartburn is felt to result from

excess gastroesophageal reflux of acid. Some cases exhibit normal esophageal acid

exposure and may result from reflux ofnonacidic material or heightenedsensitivity of esophageal mucosal nerves


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Nausea and vomiting are caused by GI diseases,medications, toxins, acute and chronic infection,endocrine disorders, labyrinthine conditions, andcentral nervous system disease.

The best-characterized GI etiologies relate tomechanical obstruction of the upper gut; however,disorders of propulsion including gastroparesis andintestinal pseudoobstruction also elicit prominent

symptoms. Nausea and vomiting also are commonly reported

by patients with irritable bowel syndrome andfunctional disorders of the upper gut.


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Constipation is reported as infrequent defecation, straining withdefecation, passage of hard stools, or a sense of incomplete fecalevacuation.

Causes of constipation include obstruction, motor disorders of thecolon, medications, and endocrine diseases such as

hypothyroidism and hyperparathyroidism. Diarrhea is reported as frequent defecation, passage of loose or

watery stools, fecal urgency, or a similar sense of incompleteevacuation. The differential diagnosis of diarrhea is broad and includes infections,

inflammatory causes, malabsorption, and medications.

Irritable bowel syndrome produces constipation, diarrhea, or analternating bowel pattern.

Fecal mucus is common in irritable bowel syndrome, while puscharacterizes inflammatory disease.

Steatorrhea develops with malabsorption.


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Most commonly, upper GI bleeding presents withmelena or hematemesis, whereas lower GI bleedingproduces passage of bright red or maroon stools.

Chronic slow GI bleeding may present with iron

deficiency anemia. The most common upper GI causesof bleeding are ulcer disease, gastroduodenitis, andesophagitis.

The most prevalent lower GI sources of hemorrhageinclude : Hemorrhoids, anal fissures, diverticula, ischemic colitis, and

arteriovenous malformations. Other causes include neoplasm, inflammatory bowel

disease, infectious colitis, drug-induced colitis, and othervascular lesions.


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Appear if bilirubin level >3 mg/l. Jaundice results from prehepatic,

intrahepatic, or posthepatic disease. Posthepatic causes of jaundice include biliary

diseases such as choledocholithiasis, acutecholangitis, primary sclerosing cholangitis,

other strictures, and neoplasm andpancreatic disorders, such as acute andchronic pancreatitis, stricture, andmalignancy.


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Abdominal pain :

Organic

Non Organic Tumor of the GI tract IBD Diarrhoea Absorbtion disorder GI Bleeding (upper lower).


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Hepatitis (acute or Chronic) Liver abcess

Liver malignancy Gall stones. Billiary malignancy Pancreatitis (acute or chronic) Pancreatic malignancy Liver cirrhosis


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Good history Accurate physical examination

Proper diagnostics: Invasive.

Non invasive.

IAPP


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Invasive : Biopsy (ultrasound, CT-scan guided). Endoscopy. ERCP. EUS. Cholangiography. Angiography

Non invasive : Laboratory examination :

Imaging procedure : Conventional

USG

CT scan

MRI

Nuclear


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Group of disease hallmarked as pain or upsetupper in the epigastrium.

Organic (Known pathology) Ulcer disease

Polyp

Gastritis Malignancy

Functional (no known pathology)


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Recognized as the presence of alarm symptoms.

Age > 45 yo

Hematemesis melena

Weight loss

Early satiety

Vomiting

Anemia. Ulcer disease :

Duodenal (Hpylori related)

Gastric (malignancy or drug related)


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Functional dyspepsia : Ulcer type

Dysmotility type

Mixed type

Defined as the Rome III criteria. Entertained if there were no anatomic

lession.


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Diagnostics :

USG

Barrium meal Endoscopy of the Upper Abdomen (Esophago-

gastro- duedunoscopy)


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Treatment :

Antacid

Sukralfat Anti spasmodic

H2R blocker

PPI


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Approach to Patient With Gastrointestinal System