Gastrointestinal Disease
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GASTROINTESTINAL SYMPTOMS AND SIGNS!
Stomatitis and Burning Mouth Sensation!
Stomatitis = inflammation of mouth from any cause e.g. ill-fitting dentures. !
Angular stomatitis = inflammation of corners of mouth. !
‘Burning mouth syndrome’: burning sensation with clinically normal oral mucosa; more common in middle-aged and
elderly-females; probably psychogenic in origin. !
- Hallitosis (bad breath) = common syptoms; due to poor oral hygiene/ anxiety/ rare causes e.g. oesophageal stricture
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and pulmonary sepsis.!
Dyspepsia and Indigestion!
Indigestion: common; 80% population suffer this at some time. !
Dyspepsia: term used to describe many upper abdo symptoms e.g. nausea, heartburn, acidity, pain or discomfort, wind,
fullness, belching !
Features of dyspepsia that are suggestive of serious disease e.g. cancer (aka ALARM SYMPTOMS) = dysphagia, weight
loss, vomiting, anorexia, haematemesis, meleana: patents with these symptoms have a higher possibility of significant
!
GI pathology, and should be investigated. !
Nausea and Vomiting
Nausea: feeling of wanting to vomit (often associated with hypersalivation, pallor, sweating); often precedes
vomiting.
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Retching: strong involuntary effort to vomit, associated with abdominal muscle contraction but without
expulsion of gastric contents.
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Vomiting: expulsion of gastric contents through the mouth
Many GI and non-GI conditions are associated with vomiting. Vomiting is controlled by complex reClex involving
central neural control centres, located in the later reticular formation of the medulla, which are stimulated in
chemoreceptor trigger zones in Cloor of 4th ventricle and also by vagal afferents from the gut.
Central zones are directly stimulated by toxins, drugs, motion sickness, metabolic disturbances.
Raised intracranial pressure has direct effect on vomiting centre —> vomiting.
Local GI causes of vomiting: luminal toxins, inClammation, mechanical obstruction.
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Causes of Vomiting
Any GI disease Diabetic Ketoacidosis Psychogenic Pregnancy
Infections: viruses CNS disease: raised ICP, Drugs: antibiotics, Metabolic: uraemia and
(influenza, norovirus), vestibular disturbance chemotherapy, digoxin, hypercalcaemia
bacterial (pertussis, e.g. motion sickness, immuno-suppressives
urinary infection) migraine (e.g. aza), levodopa, Reflex: MI or biliary
opiates colic
Alcohol excess
!
Faeculent vomit Suggests lower intestinal obstruction/ presence of gastrocolic fistula
Haematemesis Vomiting fresh/ altered blood (“coffee ground”)
Early-AM N&V Seen in pregnancy, alcohol dependence and some metabolic disorders
Persistent nausea Often stress related; not due to GI disease
GASTRO SIOBHAN PAGE 1
!
!
GASTROINTESTINAL SYMPTOMS AND SIGNS!
Stomatitis and Burning Mouth Sensation!
Stomatitis = inflammation of mouth from any cause e.g. ill-fitting dentures. !
Angular stomatitis = inflammation of corners of mouth. !
‘Burning mouth syndrome’: burning sensation with clinically normal oral mucosa; more common in middle-aged and
elderly-females; probably psychogenic in origin. !
- Hallitosis (bad breath) = common syptoms; due to poor oral hygiene/ anxiety/ rare causes e.g. oesophageal stricture
!
and pulmonary sepsis.!
Dyspepsia and Indigestion!
Indigestion: common; 80% population suffer this at some time. !
Dyspepsia: term used to describe many upper abdo symptoms e.g. nausea, heartburn, acidity, pain or discomfort, wind,
fullness, belching !
Features of dyspepsia that are suggestive of serious disease e.g. cancer (aka ALARM SYMPTOMS) = dysphagia, weight
loss, vomiting, anorexia, haematemesis, meleana: patents with these symptoms have a higher possibility of significant
!
GI pathology, and should be investigated. !
Nausea and Vomiting
Nausea: feeling of wanting to vomit (often associated with hypersalivation, pallor, sweating); often precedes
vomiting.
!
Retching: strong involuntary effort to vomit, associated with abdominal muscle contraction but without
expulsion of gastric contents.
!
Vomiting: expulsion of gastric contents through the mouth
Many GI and non-GI conditions are associated with vomiting. Vomiting is controlled by complex reClex involving
central neural control centres, located in the later reticular formation of the medulla, which are stimulated in
chemoreceptor trigger zones in Cloor of 4th ventricle and also by vagal afferents from the gut.
Central zones are directly stimulated by toxins, drugs, motion sickness, metabolic disturbances.
Raised intracranial pressure has direct effect on vomiting centre —> vomiting.
Local GI causes of vomiting: luminal toxins, inClammation, mechanical obstruction.
!
Causes of Vomiting
Any GI disease Diabetic Ketoacidosis Psychogenic Pregnancy
Infections: viruses CNS disease: raised ICP, Drugs: antibiotics, Metabolic: uraemia and
(influenza, norovirus), vestibular disturbance chemotherapy, digoxin, hypercalcaemia
bacterial (pertussis, e.g. motion sickness, immuno-suppressives
urinary infection) migraine (e.g. aza), levodopa, Reflex: MI or biliary
opiates colic
Alcohol excess
!
Faeculent vomit Suggests lower intestinal obstruction/ presence of gastrocolic fistula
Haematemesis Vomiting fresh/ altered blood (“coffee ground”)
Early-AM N&V Seen in pregnancy, alcohol dependence and some metabolic disorders
Persistent nausea Often stress related; not due to GI disease
GASTRO SIOBHAN PAGE 1
