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Semiology of the GI tract
Dr Salem Khoury
CSII
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Semiology of the GI tract
• Dysphagia: Difficulty in swallowing:
• Description
• location
• timing
• intermittency
• persistency
• progression
• solid, liquid
• Odynophagia: Pain on swallowing
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Semiology of the GI tract
• Heartburn:Retrosternal burning sensation • precipitating causes:food, alcohol, drugs,position
• Beching:Aerophagia• Gastroparesis
• Bloating:Abdominal distention,• Relation to food:milk , vegetables …
• Relation to stools , gaz
•
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Semiology of the GI tract
• Dyspepsia:Discomfort centerd in the upper abdomen
• Nausea:Chronicity,relation to food,vertigo
• Vomiting:Chronicity,relation to food,contents(bile , blood,indigested food)
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Semiology of the GI tract
• Abdominal Pain
Visceral pain:Poorly located,poorly described
Parietal pain:more sever ,localized
Reffered pain:Same spinal segment
Description,Localisation
Severity ,chronicity
Sudden,gradual
Aggravating factors
Relieving factors
Associated symptoms
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Semiology of the GI tract
• Constipation: DefinitionFrequencyQuality of stoolsColorPresence of blood
• Obstipation: No gaz-No stools: Intestinal obstruction
• Diarrhea: DefinitionFrequencyColorBlood , mucus ,greasy
Chronicity ,night diarrhea
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ABDOMINAL PAIN
• Location
• Work-up
• Acute pain syndromes
• Chronic pain syndromes
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Epigastric Pain
•PUD
•GERD
•MI
•AAA- abdominal aortic aneurysm
•Pancreatic pain
•Gallbladder and common bile duct
obstruction
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Right Upper Quadrant Pain
•Acute Cholecystitis and Biliary Colic
•Acute Hepatitis or Abscess
•Hepatomegaly due to CHF
•Perforated Duodenal Ulcer
•Herpes Zoster
•Myocardial Ischemia
•Right Lower Lobe Pneumonia
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Left Upper Quadrant Pain
•Acute Pancreatitis
•Gastric ulcer
•Gastritis
•Splenic enlargement, rupture or infarction
•Myocardial ischemia
• Left lower lobe pneumonia
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Right lower Quadrant Pain
•Appendicitis
•Regional Enteritis
•Small bowel obstruction
• Leaking Aneurysm
•Ruptured Ectopic Pregnancy
•PID
•Twisted Ovarian Cyst
•Ureteral Calculi
•Hernia
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Left Lower Quadrant Pain
•Diverticulitis
• Leaking Aneurysm
•Ruptured Ectopic pregnancy
•PID
•Twisted Ovarian Cyst
•Ureteral Calculi
•Hernia
•Regional Enteritis
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Periumbilical Pain
•Disease of transverse colon
•Gastroenteritis
•Small bowel pain
•Appendicitis
•Early bowel obstruction
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PELVIC PAIN
• Ectopic pregnancy
• PID
• UTI
• Ovarian cysts
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CHRONIC PAIN SYNDROMES
• Irritable bowel syndrome
• Chronic pancreatitis
• Diverticulosis
• Gastroesophageal reflux disease (GERD)
• Inflammatory bowel disease
• Duodenal ulcer
• Gastric ulcer
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Diffuse Pain
•Generalized peritonitis
•Acute Pancreatitis
•Sickle Cell Crisis
•Mesenteric Thrombosis
•Gastroenteritis
•Metabolic disturbances
•Dissecting or Rupturing Aneurysm
• Intestinal Obstruction
•Psychogenic illness
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Referred Pain
• Pneumonia (lower lobes)
• Inferior myocardial infarction
• Pulmonary infarction
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TYPES OF ABDOMINAL PAIN
• Visceral
– originates in abdominal organs covered by
peritoneum
• Colic
– crampy pain
• Parietal
– from irritation of parietal peritoneum
• Referred
– produced by pathology in one location felt at another
location
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ORGANIC VERSUS FUNCTIONAL PAINHISTORY ORGANIC FUNCTIONAL
Pain character Acute, persistent pain Less likely to change
increasing in intensity
Pain localization Sharply localized Various locations
Pain in relation to sleep Awakens at night No affect
Pain in relation to Further away At umbilicus
umbilicus
Associated symptoms Fever, anorexia, Headache, dizziness,
vomiting, wt loss, multiple system com-
anemia, elevated ESR plaints
Psychological stress None reported Present
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WORK-UP OF ABDOMINAL
PAINHISTORY
• Onset
• Qualitative description
• Intensity
• Frequency
• Location - Does it go anywhere (referred)?
• Duration
• Aggravating and relieving factors
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WORK-UP
PHYSICAL EXAMINATION
• Inspection
• Auscultation
• Percussion
• Palpation
• Guarding - rebound tenderness
• Rectal exam
• Pelvic exam
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WORK-UP
LABORATORY TESTS
• U/A
• CBC
• Additional depending on rule outs
– amylase, lipase, LFT’s
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WORK-UP
DIAGNOSTIC STUDIES
• Plain X-rays (flat plate)
• Contrast studies - barium (upper and lower
GI series)
• Ultrasound
• CT scanning
• Endoscopy
• Sigmoidoscopy, colonoscopy
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Common Acute Pain
Syndromes• Appendicitis
• Acute diverticulitis
• Cholecystitis
• Pancreatitis
• Perforation of an ulcer
• Intestinal obstruction
• Ruptured AAA
• Pelvic disorders