Disorders Of Gi Tract

DISORDERS OF GI TRACT

Regardless of the cause and type of a disease Gastrointestinal (GI )pathologies have the following presenting features;

• Abdominal pain
• GI bleeding
• Diarrhoea
• Steatorrhea
• Constipation
• Nausea
• Vomiting
• Dysphagia
• Odynophagia
• Gastroesophageal reflux
• Anorexia

Weight loss

Abdominal pain

Pain originates from tissue injury, distention, contraction, inflammation, and direct chemical injury.Visceral pain is often poorly localized and loosely corresponds to the spinal segment that innervates the involved viscus.

• Somatoparietal pain arises from noxious stimulation of the parietal peritoneum.
• Diarrhoea

An increased number or fluidity of stools is usually due to an excess of water in stool.

Most people have experienced loose stools for a day or two (e.g. viral gastroenteritis), but other causes, such as inflammatory bowel disease, can be chronic and cause intermittent symptoms for a patient's entire lifetime.

Disorders Of Gi Tract

Diarrhoea results from either an increase in secretion or decrease in absorption or both.It is classified as : secretory or osmotic diarrhoea Bloody diarrhoea occurs with mucosal inflammation or erosions or ulcerations secondary to infectious, inflammatory, or ischemic entero-colitis.

• Blood in the stool always implies an underlying organic abnormality.

Constipation

It is characterised by difficult in passage of stool.It occurs most commonly in elderly and often used to describe more than one symptom, including:

• Infrequent stools
• A sense of incomplete evacuation

Abdominal bloating or discomfort

Treatment plans vary, but the simplest and most common starting point is to increase the patient's daily fibre and fluid intake.

Nausea and Vomiting

Nausea and vomiting may be manifestations of GI diseases or primary non-GI diseases and may lead to fluid and electrolyte imbalances, nutritional deficiencies, aspiration pneumonia and oesophageal rupture Nausea is the unpleasant sensation of the desire to vomit Retching, is coordinated voluntary muscle activity of the abdomen and chest without discharge of stomach contents into the mouth.

Vomiting, or the act of emesis, occurs as gastric contents are forcefully ejected out of the mouth Nausea and vomiting may be acute, such as with acute obstruction, inflammation, or ischemia, other acute infections, medication, pregnancy or head trauma.

Disorders Of Gi Tract

Nausea and vomiting that are chronic in nature are usually associated with pregnancy, medications, and motility disorders such as diabetic, gastroparesis, partial obstruction, intracranial disease, psychogenic disorders, or an underlying metabolic or endocrine disturbance.

Dysphagia

Is the sensation of solids or liquids not passing from the mouth into the stomach.It is a common symptom and can be divided into: oropharyngeal dysphagia and oesophageal dysphagia.

• Oesophageal dysphagia is caused by either :
• Motility disorder, such as achalasia, diffuse oesophageal spasm, or scleroderma.

Mechanical obstruction, such as a benign stricture, ring, or neoplasm.

Gastroesophageal Reflux Disease (GERD)

The terms heartburn, acid regurgitation, sour stomach, and bitter taste are all used to describe GERD symptoms.Reflux occurs when the oesophageal epithelium is exposed to gastric secretions.

Some degree of gastric reflux is considered normal, but symptoms occur when the mucosa's tolerance to acid is exceeded.

In addition to the typical symptoms of heartburn or chest pain, extra-oesophageal manifestations of GERD include laryngitis, asthma, and chronic cough GERD develops when acidic gastric contents reflux into the oesophagus and remain there long enough to overcome the resistance of the oesophageal epithelium.

Heartburn

Is typically a burning pain or discomfort that rises up the retro sternum arises from dyspepsia.Dyspepsia refers to persistent or recurrent epigastric pain or meal-related upper abdominal discomfort that may be characterized by early satiation or postprandial fullness Anorexia and Early Satiety

Anorexia is loss of the desire to eat and is a major symptom in many GI and non-GI diseases, including central nervous system, systemic, and psychological disorders.

• Common causes include;
• Delayed gastric emptying such as occurs in long-term diabetes mellitus
• Decreased gastric distention secondary to gastric malignancy

Gastric outlet obstruction caused by peptic ulcer disease

GI bleeding

• GI bleeding can be either acute or chronic, and it can be massive or occult.
• Upper GI bleeding may be manifested as Hematemesis(vomiting blood)
• Lower GI bleeding may be manifested as;
• 1.Melena (black stool)
• 2.Haematochezia (Blood in stool)

Esophageal varices also lead to upper GI bleeding The two most common causes of acute lower GI bleeding are diverticulosis and arterio-venous malformations.

Occult bleeding is defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generally by routine faecal occult blood testing or the presence of iron deficiency anaemia.

GI motility disorders

Intestinal obstruction

Is a blockage that keeps food or liquid from passing through either small intestine or large intestine.

• There are two main causes of intestinal obstruction,which are;

1.Mechanical obstruction

This may be due to extrinsic or intrinsic blockage factors such as Adhesions(Post abd surgery pt),volvulus (twisting of either ceacum or sigmoid colon),intussusception in pediatric patients and fecal impaction.

• 2.Paralytic ileus

This occurs when the muscle of the intestine are paralyzed,preventing peristalsis

Hernia

• Is a defect occurred on a membranous tissue or cavity.It can be congenital or acquired.
• There are three types of hernia,which are;
• 1.Reducible hernia
• 2.Incarcerated hernia
• 3.Strangulated hernia

Other forms of hernia are hiatus,inguinal,

Jaundice

Is a yellowish discolouration of eye or skin caused by excessive bilirubin(hyperbilirubinemia).Bilirubin is a nitrogenous waste produced after death of red blood cells and is filterd by liver.There are two types of jaundice,which are;

1.Obstructive jaundice,

Caused by blockage of biliary tree that lead to poor supply of bile.Bile is stored within Gall bladder 2.Non-obstrucutive jaundice,

Caused by poor production of bile due to liver parenchyma diseases