IT 2 - SIGNS AND SYMPTOMS OF GIT DISORDERS.ppt

8/18/2019 IT 2 - SIGNS AND SYMPTOMS OF GIT DISORDERS.ppt

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SIGNS AND SYMPTOMS OF GITSIGNS AND SYMPTOMS OF GITDISORDERSDISORDERS

Vidi Orba Busro

DEPARTEMENT OF INTERNAL MEDICINEDEPARTEMENT OF INTERNAL MEDICINEDIVISION OF GASTROENTERO-DIVISION OF GASTROENTERO-

HEPATOLOGYHEPATOLOGYFK UNSRIFK UNSRI


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DEFINITIONDEFINITION

S !"#o! $ Sub%&'#i(& da#a o) "a#i&*#+sS !"#o! $ Sub%&'#i(& da#a o) "a#i&*#+s'o!",ai*#s 'o!",ai*#s

S !"#o! is # & !os# i!"or#a*# # i*. i*S !"#o! is # & !os# i!"or#a*# # i*. i*dir&'#i*. or .uidi*. a dia.*os#i' /0123dir&'#i*. or .uidi*. a dia.*os#i' /0123Si.* $ Ob%&'#i(& da#a o) " si'a,Si.* $ Ob%&'#i(& da#a o) " si'a,

)i*di*.s )i*di*.s

R&))&r&*'&s$ Ada!+s P si'a, D4R&))&r&*'&s$ Ada!+s P si'a, D4 Harisso*Harisso*

Si.*s 5S !"#o!sSi.*s 5S !"#o!s


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Dia.*os#i' Pro'&dur&Dia.*os#i' Pro'&dur&

SOAPSOAPSS Sub%&'#i(& /id&*#i# 6 s !"#o!s6Sub%&'#i(& /id&*#i# 6 s !"#o!s6

',i*i'a, is#or 6 .&*i's3 ',i*i'a, is#or 6 .&*i's3OO Ob%&'#i(& /si.*s6 ,abora#or 6Ob%&'#i(& /si.*s6 ,abora#or 6

radio,o.i'6 '3 radio,o.i'6 '3

A A Ass&s!&*# /dia.*os#i' 5 DD3 Ass&s!&*# /dia.*os#i' 5 DD3PP P,a**i*. /#r&a#!&*#6 su""or#i*.P,a**i*. /#r&a#!&*#6 su""or#i*.

&4a!i*a#io*3&4a!i*a#io*3


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Basi' o) S !"#o!s a*d Si.*sBasi' o) S !"#o!s a*d Si.*s

A*a#o!i'a, A*a#o!i'a,- #o"o.ra"- #o"o.ra"- (as'u,ari7a#io* a*d i**&r(a#io*- (as'u,ari7a#io* a*d i**&r(a#io*P sio,o.i'a,P sio,o.i'a,

- or.a* )u*'#io*- or.a* )u*'#io*- !abo,is!- !abo,is!


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TOPOGRAPHY TOPOGRAPHY

Abdominal regionsAbdominal regions nine regions systemnine regions system ororfourfour regions systemregions system

RHC LHCEPI

RL LL

RI LI

UMB

SP


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Or.a* Fu*'#io*Or.a* Fu*'#io*

Eso" a.usEso" a.us- s8a,,o8i*.- s8a,,o8i*.

Gas#&r 5 Duod&*u!Gas#&r 5 Duod&*u!- di.&s#i(& a*d absorb#io*- di.&s#i(& a*d absorb#io*Li(&r Li(&r - a*abo,is! a*d 'a#abo,is!- a*abo,is! a*d 'a#abo,is!

- do4i)i'a#io*- do4i)i'a#io*- &ri#ro"o&sis &4#ra!&du,,ar - &ri#ro"o&sis &4#ra!&du,,ar - bi,& s&'rio*- bi,& s&'rio*


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Pa*'r&as- or!o*& s&'rio*- &*7 !& s&'rio*

Co,o*- r&absorb#io*- )a&'a, )or!a#io*R&'#a,- )a&'a, r&s&r(oar


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Symptoms

1.1. Abdominal PainAbdominal Pain


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1.1. Abdominal PainAbdominal Pain - the most ommon symptom- the most ommon symptom - lo ation! type! ont. or intermitten!- lo ation! type! ont. or intermitten!

spread! referredspread! referred - lo ation depend on topography- lo ation depend on topography

- due to " G#T !T$G! Gyn! %S&! ' &(- due to " G#T !T$G! Gyn! %S&! ' &( - intermittent pain related to luminar- intermittent pain related to luminar

organorgan) oli *) oli *

- referred pain depend on inner+asion- referred pain depend on inner+asion


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Types of abdominal pain Types of abdominal pain- epigastri pain- epigastri pain gastroduodenitis!gastroduodenitis!

pan reatitis! #nferior %! left li+erpan reatitis! #nferior %! left li+erab ess! hepati disorders! lymphoma!ab ess! hepati disorders! lymphoma!aneurisma aortaaneurisma aorta

- ,iliary oli- ,iliary oli pain from the rightpain from the righthypo hondrial spread to right bahypo hondrial spread to right bashouldershoulder gallstone ' &, stonegallstone ' &, stone


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- Renal oli- Renal oli pain from ba &(Apain from ba &(A spread to right ilia regionspread to right ilia region

obstru ti+e uropathyobstru ti+e uropathy- Right hypo hondrial pain- Right hypo hondrial pain hepatihepati

disorders! gall disorders! pleuritis!disorders! gall disorders! pleuritis!

T$G disorders! and olon disorders T$G disorders! and olon disorders


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- /eft hypo hondrial Pain- /eft hypo hondrial Pain gastritis!gastritis!pseudo yst pan reas! olon disorderspseudo yst pan reas! olon disorders

T$G disorders! pleuritis! and spleen T$G disorders! pleuritis! and spleen disordersdisorders- $mbili al pain- $mbili al pain gastritis! enteritis! gastritis! enteritis!

olitis! aneurisma aorta! trombosis of olitis! aneurisma aorta! trombosis of

mesenteri arterymesenteri artery- Right ' /eft /umbal pain- Right ' /eft /umbal pain olonolondisorders ! T$G disorders! psoas ab essdisorders ! T$G disorders! psoas ab ess


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- Right #lia pain- Right #lia pain appendi itis!appendi itis!olon disorders! psoas ab ess! P# !olon disorders! psoas ab ess! P# !

o+ary yst! ileitis term.! T$G dis.o+ary yst! ileitis term.! T$G dis.- /eft #lia pain- /eft #lia pain olon disorders!olon disorders!

psoas ab ess! P# ! o+ary yst! T$Gpsoas ab ess! P# ! o+ary yst! T$G

disordersdisorders


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- Suprapubi pain- Suprapubi pain ystitis ' bladderystitis ' bladderstone! gynae ologi disorders!stone! gynae ologi disorders!

prostatprostatdisorders! olo-re tal disordersdisorders! olo-re tal disorders

- 0hole abdomen pain- 0hole abdomen pain peritonitis!peritonitis!

mus le pain! gastroenteritis! olitismus le pain! gastroenteritis! olitis


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9: Abdo!i*a, Dis#&*#io*

ue to" gas! uid! mass!ue to" gas! uid! mass!organomegaliorganomegali0ith or 2ithout pain 30ith or 2ithout pain 3A ute! re urent! or hroni 3A ute! re urent! or hroni 3,o2el or mi turia alteration 3,o2el or mi turia alteration 3Organ in+ol+ed" G#T! T$G! HeartOrgan in+ol+ed" G#T! T$G! Heart


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;: D s" a.ia

i4 ulty s2allo2ingi4 ulty s2allo2ingue to pain! obstru tion! abn. peristalsiue to pain! obstru tion! abn. peristalsi

or impaired re e5 )ner+e*or impaired re e5 )ner+e*Organ in+ol+edOrgan in+ol+ed esophagus oresophagus ororopharyn5oropharyn5

%ost ommon ase" Stri ture esophagu%ost ommon ase" Stri ture esophagu malignan y! G6R ! multiple s lerosismalignan y! G6R ! multiple s lerosis


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4. Odinophagia4. Odinophagia

Pain of s2allo2ingPain of s2allo2ingOrgan in+ol+edOrgan in+ol+ed esophagusesophagus

ue to in ammation pro essue to in ammation pro ess


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5. Heartburn5. Heartburn

,urn sensation on the front hest,urn sensation on the front hestue to re u5 esofagitisue to re u5 esofagitis

7 angina pe toris! inter ostal7 angina pe toris! inter ostalneuralgia! pulmonary problem!neuralgia! pulmonary problem!psy hosomatipsy hosomati

&onfounding fa tor" asthma!&onfounding fa tor" asthma!dyspepsia! no ardio+as ular risdyspepsia! no ardio+as ular risfa tor! obesityfa tor! obesity


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6. Hiccup or Singultus6. Hiccup or Singultus

#n+oluntary spasmodi ontra tion#n+oluntary spasmodi ontra tionof the diaphragm follo2ed byof the diaphragm follo2ed by

sudden losure of glottissudden losure of glottisue to in rease of intra ranialue to in rease of intra ranial

pressure! abdominal distention!pressure! abdominal distention!

gastri dilatation or in ammation!gastri dilatation or in ammation!and renal failure! de rease serumand renal failure! de rease serumle+els of arbondio5idele+els of arbondio5ide


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7. Vomitus &7. Vomitus &

RegurgitationRegurgitationRe u5 of gastri ontentsRe u5 of gastri ontents

The di8eren e The di8eren e 2ith or 2ithout2ith or 2ithoutontra tionontra tion

#n+ol+ed +agal me hanism#n+ol+ed +agal me hanism9on spe i:9on spe i: all of G#T disordersall of G#T disorders


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8. Bloating8. Bloating

;ull sensation of stoma h;ull sensation of stoma hue to in ammation! gastriue to in ammation! gastri

emptying disorders! gastri mass!emptying disorders! gastri mass!#n rease of gastri pressure!#n rease of gastri pressure!in rease of gas produ tion! full orin rease of gas produ tion! full or

partial obstru tionpartial obstru tion


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. Hematemesis. Hematemesis

,leeding of upper G#T )lig. treit


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!". #elena!". #elena

,la bloody stool from upper G#T,la bloody stool from upper G#T,la olor is due to o5idation of,la olor is due to o5idation ofHbHb&aused and organ in+ol+ed&aused and organ in+ol+edsimilar to hematemesissimilar to hematemesis/ife threatening symptom/ife threatening symptom


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!!. $iarrhea!!. $iarrhea

0aterry stool more than = 57day0aterry stool more than = 57dayA ute or hroni 3 ) > 2ee s *A ute or hroni 3 ) > 2ee s *

ue to reabsorbtion impairmentue to reabsorbtion impairment)osmoti ! to5in!et * or)osmoti ! to5in!et * orhyperperistaltihyperperistalti

)hyperthyroid*)hyperthyroid*Organ in+ol+edOrgan in+ol+ed #ntestinal and#ntestinal and

olore talolore tal


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!%. onstipation!%. onstipation

9o defe ation more than = days9o defe ation more than = daysue to obstru tion!ue to obstru tion!

hypoperistalti ! in ammation!hypoperistalti ! in ammation!medi ationmedi ationOrgan in+ol+edOrgan in+ol+ed &olore tal&olore tal


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!'. Hematosche(ia!'. Hematosche(ia

;resh red bloody stool;resh red bloody stoolue to lo2er G#Tue to lo2er G#T

Haemorhoid is the most ommonHaemorhoid is the most ommonause of hematos he


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SignsSigns

;rom physi al :ndings;rom physi al :ndings%ost ommon in hepatobilliary%ost ommon in hepatobilliarydisordersdisordersGeneral " +ital signGeneral " +ital signSpe i: " inspe tion! palpation!Spe i: " inspe tion! palpation!

per usion! and aus ultationper usion! and aus ultationGentleGentleRight side of patientsRight side of patients


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!. #ental hange!. #ental hange

%ost ommon in end stage of%ost ommon in end stage ofirrhosis or se+ere hepatiirrhosis or se+ere hepati

disordersdisorders&alled as en ephalopathy hepati&alled as en ephalopathy hepati

ue to false neurotransmitterue to false neurotransmitter

)aromati amino a ids! ammonia*)aromati amino a ids! ammonia*Sometimes a ompanied bySometimes a ompanied by

apping tremorapping tremor


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%. )cteric or *aundice%. )cteric or *aundice

A yello2 dis oloration of the s in! mu ousA yello2 dis oloration of the s in! mu ousmembranes! or s lera of the eyesmembranes! or s lera of the eyes

Signs of e5 essi+e le+els of on?ugated orSigns of e5 essi+e le+els of on?ugated orun on?ugated bilirubin in the bloodun on?ugated bilirubin in the blood

Type " Prehepati ! Hepati ! and Type " Prehepati ! Hepati ! andPosthepatiPosthepati

&ommonly a ompanied by pruritus&ommonly a ompanied by pruritusbe ause bile pigment damage sensorybe ause bile pigment damage sensoryner+e )hepati or posthepati ?aundi e*ner+e )hepati or posthepati ?aundi e*


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)+teri+ )+teri+


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jaundice


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Tea dar olored urine! lay olored stools Tea dar olored urine! lay olored stoolsal2ays a oppany obstru ti+e oral2ays a oppany obstru ti+e orposthepati ?aundi eposthepati ?aundi ePrehepati ?aundi ePrehepati ?aundi e hemolysishemolysisHepati ?aundi eHepati ?aundi e hepati disorders!hepati disorders!

ongesti+e li+er )heart*! systemiongesti+e li+er )heart*! systemiin ammation )sepsis! lupus*! malignan y!in ammation )sepsis! lupus*! malignan y!and drugsand drugsPosthepati ?aundi ePosthepati ?aundi e &, stone!&, stone!malignan y of billiary system! lymphomamalignan y of billiary system! lymphoma


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'. ,-necomastia'. ,-necomastia

O uring only in malesO uring only in males#n reased breast si


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4. Spider4. Spider

e/i01ngiomae/i01ngiomaA :ery red +as ular lession 2ithA :ery red +as ular lession 2ithan ele+ated entral body and aan ele+ated entral body and a

surrounding ushsurrounding ush%ost ommon in fa e! ne ! and%ost ommon in fa e! ne ! and

hesthest

Related 2ith irrhosis andRelated 2ith irrhosis andhyperestrogenemia )pregnan y*hyperestrogenemia )pregnan y*


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5. 2almar 3r-thema5. 2almar 3r-thema

/o al +asodilatation along palmar/o al +asodilatation along palmarsideside

%ost ommon in irrhosis%ost ommon in irrhosis%e hanism is un no2n%e hanism is un no2n


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6. 1scites6. 1scites

A umulation of uid in abdominal a+ityA umulation of uid in abdominal a+ityue to de rease of osmoti pressureue to de rease of osmoti pressure

)hypoalbumin* or in rease of hydro-stati)hypoalbumin* or in rease of hydro-statipressure )portal hypertension*pressure )portal hypertension*SignsSigns shifting dullness! undulationshifting dullness! undulation9onspe i: sign9onspe i: sign

%ost ommon in irrhosis! gynae ologi%ost ommon in irrhosis! gynae ologidis.! se+ere diseases! peritonealdis.! se+ere diseases! peritonealtuber ulous! renal and heart problemtuber ulous! renal and heart problem


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Ascites

as'i#&s a''u!u,a#io* o) ),uid i* # & abdo!i*a, 'a(i#


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7. #eteorismus7. #eteorismus

A umulation of gas in abdominalA umulation of gas in abdominala+itya+ity

Hypersonor per usionHypersonor per usion,o2el sound 3 %etali sound 3,o2el sound 3 %etali sound 3Pain 3 ;latus 3 ,o2el Habit 3Pain 3 ;latus 3 ,o2el Habit 3

ue to ele trolyte imbalan e! drug!ue to ele trolyte imbalan e! drug!in ammation! total or partialin ammation! total or partialobstru ti+eobstru ti+e


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8. 2ain palpation8. 2ain palpation

epend on tophographiepend on tophographi Types" %urphy@s sign! /ud2ig@s Types" %urphy@s sign! /ud2ig@ssign! &(A per ussion pain!sign! &(A per ussion pain!epigastri pain! % ,urtney@sepigastri pain! % ,urtney@spain! defanse mus ular!pain! defanse mus ular!

suprapubi painsuprapubi pain


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. Hepatomegal-. Hepatomegal-

Hepati enlargement more thanHepati enlargement more thannormal ) ho2 the border3*normal ) ho2 the border3*

&on:rmed by palpation! per ussion!&on:rmed by palpation! per ussion!and sonographiand sonographi

ue to systemi or hepatiue to systemi or hepati

problemsproblems#mportant things#mportant things si


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,i(&r &*,ar.&!&*#6 "or#a, "&r#&*sio*


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LIVER SPAN

PERCUSSION

PALPATION

PERCUSSION

SCRATCH TEST

NL < =9-=; CM

MCL

9-; CM DURINGINSPIRATION ANDE>PIRATION

COPD

LIVER SPAN MAY VARY BET?EENOBSERVERS DEPENDING UPON?HERE THE MCL IS DETERMINED

@AMA = 9 =$= -= 0


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PALPATION

FLE> KNEES AND HIPS IF POSSIBLE

BEGIN LO? ON ABDOMINAL ?ALL AND MOVE HAND CEPHALAD6 HAVEPATIENT TAKE A DEEP BREATH

NOTE CONSISTENCY /NODULES6 SMOOTH3 AND CONTOUR IF THELIVER EDGE IS FELT

NOTE IF THERE IS ANY PAIN ?ITH PALPATION

AUSCULTATEMOSBY+S GUIDE TO THE PHYSICAL E>AMINATION6 ; RD ED: =


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!". Splenomegal-!". Splenomegal-

6nlargement of spleen more than6nlargement of spleen more thannormal )ho2 the border3*normal )ho2 the border3*

ue to infe tion! trauma! portalue to infe tion! trauma! portalhypertension! neoplasti !hypertension! neoplasti !hematologi disordershematologi disorders

&on:rmed by palpation and&on:rmed by palpation andsonographsonograph


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!!. #ass palpation!!. #ass palpation

epend on topographi )similar toepend on topographi )similar toabdominal pain*abdominal pain*

#mportant things#mportant things si


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!%. lapping remor!%. lapping remor

Patognomonis sign ofPatognomonis sign ofen ephalopathy hepatien ephalopathy hepati

Tremor of 2rist ?oint after full Tremor of 2rist ?oint after fulle5tensione5tension


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!'. 2itting 3dema!'. 2itting 3dema

A umulation of uid in sub utisA umulation of uid in sub utisespe ially in plantar pedisespe ially in plantar pedis

ue to hepati ! renal! heart!ue to hepati ! renal! heart!malnutrition! blood +essel! andmalnutrition! blood +essel! andsystemi in ammationsystemi in ammation


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ase Simulationase Simulation

A young lady! married! => yo!A young lady! married! => yo!ame to hospital 2ith hiefame to hospital 2ith hief

omplaint of epigastri painomplaint of epigastri painlo ali


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This lady ha+e a fe+er sin e 1 This lady ha+e a fe+er sin e 12ee s ago! abdominal distention2ee s ago! abdominal distention

in epigastri ! +omitus! history ofin epigastri ! +omitus! history ofbloody diarhea! no history ofbloody diarhea! no history ofdyspepsia beforedyspepsia before

0hat e5aminations should you0hat e5aminations should youperform to this patients3perform to this patients3


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;rom e5amination! there are;rom e5amination! there arei teri ! pain and palpable mass ini teri ! pain and palpable mass in

epigastri ! dar tea olor urine! noepigastri ! dar tea olor urine! noley- olor stool! no defanseley- olor stool! no defanse

mus ularmus ular

0hat 2or ing diagnosti and0hat 2or ing diagnosti anddi8erential diagnosti are possibledi8erential diagnosti are possiblein this patient3in this patient3


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The 2or ing dignosti in this patient is The 2or ing dignosti in this patient isleft lobe hepati ab essleft lobe hepati ab ess

The di8erential diagnosti are The di8erential diagnosti arepan reati neoplasm! gastri mass!pan reati neoplasm! gastri mass!pseudo yst of pan reas! left lobepseudo yst of pan reas! left lobehepatoma! olon mass! lymphoma!hepatoma! olon mass! lymphoma!aorti aneurism.aorti aneurism.0hat are ne5t e5aminations you0hat are ne5t e5aminations yousuggested to on:rm a diagnosti 3suggested to on:rm a diagnosti 30hat is the treatment 30hat is the treatment 3


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IT 2 - SIGNS AND SYMPTOMS OF GIT DISORDERS.ppt