Gastrointestinal (GI) diseases most often present with one or more
of four common classes of symptoms and signs: (1) abdominal or chest
pain; (2) altered ingestion of food (eg, resulting from nausea,
vomiting, dysphagia [difficulty swallowing], odynophagia [painful
swallowing], or anorexia [lack of
appetite]); (3) altered bowel movements (ie, diarrhea or
constipation); and (4) GI tract bleeding, either occurring without warning
or preceded by one or more of the foregoing (Table 13–1).
However, not all cases of a particular GI disease present in the
same way. For example, peptic ulcer disease, although typically
accompanied by abdominal pain, may be painless.
Table 13–1 Common Presentation of GI Disease. |Favorite Table|Download (.pdf)
Table 13–1 Common Presentation of GI Disease.
|Cardinal GI Symptom or Sign||Esophagus||Stomach||Intestines||Gallbladder|
|Pain||Achalasia, reflux||Gastric ulcer||Duodenal ulcer||Cholelithiasis|
|Gastric cancer||Irritable bowel syndrome|
|Nausea, vomiting||Achalasia, reflux||Gastroparesis||Acute gastroenteritis||Cholelithiasis|
|Altered bowel movements|
|Diabetic autonomic neuropathy|
|Diarrhea (including steatorrhea)||Gastric surgery, dumping syndrome||Gastroenteritis||Cholelithiasis|
|Irritable bowel syndrome|
|Inflammatory bowel disease|
|Diabetic autonomic neuropathy|
|Hematemesis||Varices resulting from portal hypertension||Gastric ulcer||Duodenal ulcer|
|Mucosal laceration (eg, after violent retching)|
|Bloody stools (including melena, frank blood,
and occult blood)||Varices||Gastric ulcer||Inflammatory bowel disease|
GI disease may be limited to the GI tract (eg, reflux esophagitis,
peptic ulcer, diverticular disease), be a manifestation of a systemic
disorder (eg, inflammatory bowel disease), or present as a systemic
disease resulting from a primary GI pathologic process (eg, vitamin
deficiencies resulting from malabsorption). Because different parts
of the GI tract are specialized for certain functions, the most
prominent causes, consequences, and manifestations of disease differ
from one anatomic site to another.
Acutely, GI disease can be complicated by dehydration, sepsis,
or bleeding or by their consequences, such as shock. Dehydration can
occur as a consequence of even subtle alterations in fluid input
or outflow because the volume of fluid traversing the GI tract daily
is enormous (see later discussion). Sepsis can result
from disruption of the barrier function against pathogens in the
environment, including bacteria resident in the colon. The tendency
for bleeding is a reflection of the tremendous vascularity
of the GI tract and the difficulty of applying pressure at the site
Chronically, GI disease can be complicated by malnutrition and
deficiency states. These occur because many primary GI diseases
result in malabsorption (failure to absorb one or more
necessary nutrients in ingested food).
GI tract disease can present as partial or complete obstruction (blockage
of movement of contents down the GI tract) caused by adhesions and stenosis resulting
from proliferation of connective tissue in response to inflammation.
The symptoms and signs of obstruction can range from mild nausea, abdominal ...