Symptoms of the gastrointestinal diseases

Abdominal pain
 
Dyspepsia
 
Motor disorders
- Dysphagia
- Pyrosis
- Vomiting
- Constipation and diarrhoea
 
Bleeding into GIT
- Melena
- Enterorrhagia
- Haematemesis

The most frequent manifestations of the GIT disorders are pain, dyspepsia, and motility.
 
Abdominal pain
 
is the most important symptom. It can be classified into:
 

	Somatic (parietal) pain - is caused by irritation of abdominal wall, peritoneum, root of the mesentery, and diaphragm. It is a sharp, marked, localised pain, often accompanied by reflex muscle contraction (défense musculaire). It is conducted by sensitive branches of spinal nerves.
	Visceral pain - is caused by irritation of inner organs (tension of organ capsule or muscle wall). The pain is dull, the worst one can describ, usually in medial line; its localisation does not correspond to position of organs. It is conducted by sympathetic nerves.
	Referred pain (shooting) - caused by a strong stimulus or anatomic damage of organs (passage of calculus, intestinal hernia). Pain shoots into places on the body surface, which are innervated from the same spinal roots as the affected organ. Typical direction of pain helps to determine its origin.

 
In abdominal pain the following can be assessed:
 

	Character - usually dull, compressive, stinging, and spastic.
	Localisation - of pain does not need to correspond to the position of the organ.
	Irradiation - has greater importance than localisation of pain, allows determination of the affected organ.

 
The most common directions of irradiation are:
 

	Upward from epigastrium: disorder of lower oesophagus, gastric cardia, and upper part of stomach (diagnostically need to differentiate stenocardia).
	Into the right subcostal area: gastroduodenal ulcer, biliary tract, the head of pancreas.
	Under the right shoulder blade: gall bladder disorder.
	Into the left subcostal area and under the left shoulder blade: body and cauda of pancreas, stomach, of colon cancer.
	In between shoulder blades: inflammation and ulcer of oesophagus, calculus in cystic duct, perforation of gastroduodenal ulcer.
	Into shoulder: affection of diaphragm and subdiaphragmatic area (subphrenic abscess, spleen infarction, perforation of gastroduodenal ulcer).
	Into groin: kidneys, ureters.

 
Duration - varies, usually characteristic for the type of disease. Spastic pain lasts seconds, minutes, even hours; irritation of the mucous membrane lasts days but also weeks.
 
Rhythm - here means changing of periods with and without pain.
 
"Colic" (colic pain) - is rhythmically recurring and repeatedly receding abdominal pain of various duration, caused by peristaltic of hollow organs (spasm and relaxation of smooth muscle tissue trying to overcome an obstacle in the passage)
 
(biliary - a calculus in the biliary duct, renal – a calculus in the ureter, intestinal - ileus, dyskinesia)
 
Triggering and relieving factors:
 

	Food intake - can improve or provoke pain (duodenal and gastric ulcer).
	Defecation - usually provokes pain in diseases of rectum (carcinoma, proctocolitis) and anal canal (fissure, haemorrhoids)
	Suitable position - usually brings relief in oesophageal reflux disease (elevation of the chest) or pancreas carcinoma ("on all fours")

 
Perception of the pain:
 
depends on the nature and extent of the impuls, as well as on the sensitivity threshold and patient’s interpretation of the sensation.
It is always necessary to take into account the possibility of extraabdominal origin of the pain. It can be radicular, associated with disorders of the abdominal wall, myalgia, myocardial infarction, and general symptoms of other diseases (e.g. decompensation of diabetes mellitus), toxic or infectious causes, and CNS disorders (tabes dorsalis).
 
Dyspepsia
 
is a term difficult to define. It is used for overall expression of GIT discomfort of functional or organic origin, particularly of extra-gastrointestinal character(metabolism, medications).
 
Upper (gastric) dyspepsia - represents:
 

	Nausea (a desire to vomit)
	Vomitting
	Burping
	Pyrosis (heartburn)

 
Lower (intestinal) - dyspepsia - the most common are:
 

	Defecation disorders
	Flatulence (flatus)
	Bloating (tympanites)

 
Dysphagia
 
describes feeling of solid bolus stuck in the digestive tube while swallowing. According to localisation we distinguish upper or lower type. The reason can be mainly carcinoma or oesophageal ulcer, oesophageal reflux disease, or spasms.
 
Paradox dysphagia represents troubles while swallowing some liquid. It usually has a functional character.
 
Pyrosis
 
is a stinging feeling behind the lower part of sternum related to reflux of gastric or duodenal content to oesophagus. Due to the nature of complaints it is necessary to exclude angina pectoris.
 
Vomiting
 
has a complex reflex character, it is caused by irritation of the vomiting centre.
 
The following types of vomiting are recognised according to its cause:
 

	Central vomiting - toxicity (acidosis, uraemia), medication (digoxin, morphine), psychogenic (repulsion), intracranial hypertension (vomiting without nausea)
	Peripheral vomiting - in gastroduodenal diseases, biliary diseases, but also in otogenic diseases and during pregnancy

 
Correct diagnosis of vomiting requires evaluation of the contexts of its origin and inspection of vomitus.
 

	Origin - dependence on food intake in context with the time and type of food.
	Appearance - colour, presence of food (fresh, semi-digested), and/or blood.
	Smell - sour indicates the presence of hydrochloric acid, faecal smell is connected with intestinal obstruction.

 
Constipation and diarrhoea
 
Constipation means difficulty in emptying of rigid stool.
 
Diarrhoea is characterised by emptying of runny or watery stools, more often than usual.
 
Patient's comments in both cases are very subjective; therefore they cannot be relied upon. The following should be evaluated number of stools, quantity, consistence, pathological admixture, and relation to food intake.
 
The urgent desire to empty the bowel (tenesmus) is also assessed.
 
Causes can be functional, infectious, or organic, they always require careful diagnoses because of possible presence of colorectal carcinoma.
 
Bleeding into GIT
 
Melena, enterorrhagia
 
Melena means leaving of runny stool of black colour, and tar appearance. It is caused by bleeding in upper part of the digestive tube (oesophagus, stomach, duodenum). Evaluating of black coloured stool can be made more difficult by previous intake of food containing animal blood, some medications (containing iron, bismuth, or charcoal).
 
Bleeding from lower part of GIT is manifested by enterorrhagia (blood is not semi-digested). The most common reason can be colorectal carcinoma, internal haemorrhoids, and idiopathic proctocolitis.
 
Haematemesis
 
represents vomiting of fresh or semi-digested blood. Colouring depends on bleeding intensity, speed of stomach emptying, and presence of hydrochloric acid. Slow emptying and effect of hydrochloric acid causes brown-black colouring, it looks like coffee grounds.
 
The source of bleeding are usually oesophageal varices, duodenal or gastric ulcers, haemorrhagic gastropathy, and tumours. Presence of blood admixture in repeated forcefull vomiting means high probability of Mallory-Weiss syndrome (laceration – rupture of mucous membrane of distal part of oesophagus).
 
Evaluation of haematemesis requires excluding other causes of bleeding (epistasis, haemoptysis), particularly confusion with consumed food (blackberry, beetroot) or some medications (charcoal).
 
Haematemesis may occur together with melena.