SIGNS AND SYMPTOMS OF GIT

DISORDERS

M. JUFRI MAKMUR
 DEFINITION

• Symptom : Subjective data of patient’s

complaints
• Symptom is the most important thing in directing or
guiding a diagnostic (60%)
• Sign : Objective data of physical
findings
• Refferences: Adam’s Physical Dx
Harisson
Signs &Symptoms
 Diagnostic Procedure

• SOAP
S  Subjective (identity, symptoms,
clinical history, genetics)
O  Objective (signs, laboratory,
radiologic, etc)
A  Assesment (diagnostic & DD)
P  Planning (treatment, supporting
examination)
 Basic of Symptoms and Signs

• Anatomical
- topography
- vascularization
• Physiological
- organ function
- metabolism
 TOPOGRAPHY
Abdominal regions
RHC EPI LHC
nine regions system
RL LL
UMB
RI LI

SP
 Organ Function

• Esophagus
- swallowing
• Gaster & Duodenum
- digestive and absorbtion
• Liver
- anabolism and catabolism
- detoxification
- eritropoesis extramedullar
- bile secretion
• Pancreas
- hormone secretion
- enzyme secretion
• Colon
- reabsorbtion
- faecal formation
• Rectal
- faecal reservoar
 SYMTOMPS
• 1. Abdominal pain
• 2. Abdominal distension
• 3. Dysphagia
• 4. Odinophagia
• 5. Hiccup or Singultus
• 6. Vomitus & Regurgitasion
• 7. Bloating
• 8. Hematemesis
• 9. Melena
• 10. Diarhea
• 11. Constipation
• 12. Hematochezia
 1. Abdominal pain

- the most common symptom

- location, type, cont. or intermitten, spread, referred
- location depend on topographyc
- due to : GIT ,TUG, Gyn, MSC, & CV
- intermittent pain related to luminar organ (colic)
- referred pain depend on innervasion
• Types of abdominal pain:
- epigastric pain  gastroduodenitis,
pancreatitis, Inferior MCI, left liver
abcess, hepatic disorders, lymphoma,
aneurisma aorta
- Biliary colic  pain from the right
hypochondrial spread to right back
shoulder  gallstone & CBD stone
- Renal colic  pain from back CVA spread to
right iliac region obstructive uropathy
- Right hypochondrial pain  hepatic disorders,
gall disorders, pleuritis, TUG disorders, and
colon disorders
- Left hypochondrial Pain  gastritis,
pseudocyst pancreas, colon disorders
TUG disorders, pleuritis, and spleen
disorders
- Umbilical pain  gastritis, enteritis,
colitis, aneurisma aorta, trombosis of mesenteric
artery
- Right & Left Lumbal pain  colon disorders ,
TUG disorders, psoas abcess
- Right Iliac pain  appendicitis, colon
disorders, psoas abcess, PID, ovary cyst,
ileitis term., TUG dis.
- Left Iliac pain  colon disorders, psoas
abcess, PID, ovary cyst, TUG disorders
- Suprapubic pain  cystitis & bladder
stone, gynaecologic disorders, prostat
disorders, colo-rectal disorders
- Whole abdomen pain  peritonitis,
muscle pain, gastroenteritis, colitis
 2. Abdominal Distention

• Due to: gas, fluid, mass, organomegali

• With or without pain ?
• Acute, recurent, or chronic ?
• Bowel or micturia alteration ?
• Organ involved: GIT, TUG, Heart
 3. Dysphagia

• Difficulty swallowing
• Due to pain, obstruction, abn. peristalsis, or
impaired reflex (nerve)
• Organ involved  esophagus or oropharynx
• Most common case: Stricture esophagus,
malignancy, GERD, multiple sclerosis
 4. Odinophagia
• Pain of swallowing
• Organ involved  esophagus
• Due to inflammation process
 5. Hiccup or Singultus

• Involuntary spasmodic contraction of the

diaphragm followed by sudden closure of
glottis
• Due to increase of intracranial pressure,
abdominal distention, gastric dilatation or
inflammation, and renal failure, decrease
serum levels of carbondioxide
 6. Vomitus & Regurgitation
• Reflux of gastric contents
• The difference  with or without contraction
• Involved vagal mechanism
• Non specific  all of GIT disorders
 7. Bloating

• Full sensation of stomach

• Due to inflammation, gastric emptying
disorders, gastric mass, Increase of gastric
pressure, increase of gas production, full or
partial obstruction
 8. Hematemesis
• Bleeding of upper GIT (lig. treitz)
• Due to variceal rupture, ulcer, erotion, mass
• Organ involved  esophagus, stomach, &
duodenum
• Life threatening symptoms
 9. Melena
• Black bloody stool from upper GIT
• Black color is due to oxidation of Hb
• Caused and organ involved similar to
hematemesis
• Life threatening symptom
 10. Diarrhea
• Waterry stool more than 3 x/day
• Acute or chronic ? ( 2 weeks )
• Due to reabsorbtion impairment (osmotic,
toxin,etc) or hyperperistaltic (hyperthyroid)
• Organ involved  Intestinal and colorectal
 11. Constipation
• No defecation more than 3 days
• Due to obstruction, hypoperistaltic,
inflammation, medication
• Organ involved  Colorectal
 12. Hematoschezia
• Fresh red bloody stool
• Due to lower GIT
• Haemorhoid is the most common cause of
hematoschezia
• Acute,reccurent, or chronic ?
• Bowel habit alteration ?
 Signs
• From physical findings
• Most common in hepatobilliary disorders
• General : vital sign
• Specific : inspection, palpation, percusion, and
auscultation
• Gentle
• Right side of patients
 1. Mental Change
• Most common in end stage of cirrhosis or
severe hepatic disorders
• Called as encephalopathy hepatic
• Due to false neurotransmitter (aromatic amino
acids, ammonia)
• Sometimes accompanied by flapping tremor
 2. Icteric or Jaundice
• A yellow discoloration of the skin, mucous
membranes, or sclera of the eyes
• Signs of excessive levels of conjugated or
unconjugated bilirubin in the blood
• Type : Prehepatic, Hepatic, and Posthepatic
• Commonly accompanied by pruritus because
bile pigment damage sensory nerve (hepatic
or posthepatic jaundice)
• Tea dark colored urine, clay colored stools always
accoppany obstructive or posthepatic jaundice
• Prehepatic jaundice  hemolysis
• Hepatic jaundice  hepatic disorders, congestive
liver (heart), systemic inflammation (sepsis,
lupus), malignancy, and drugs
• Posthepatic jaundice  CBD stone, malignancy
of billiary system, lymphoma
jaundice
 3. Gynecomastia
• Occuring only in males
• Increased breast size due to excessive mammary
gland development
• Most common in cirrhosis
• Failure to inactivate circulating estrogen
 4. Spider Nevi/Angioma
• A fiery red vascular lession with an elevated
central body and a surrounding flush
• Most common in face, neck, and chest
• Related with cirrhosis and hyperestrogenemia
(pregnancy)
 5. Palmar Erythema
• Local vasodilatation along palmar side
• Most common in cirrhosis
• Mechanism is unknown
 6. Ascites
• Accumulation of fluid in abdominal cavity
• Due to decrease of osmotic pressure
(hypoalbumin) or increase of hydro-static
pressure (portal hypertension)
• Signs  shifting dullness, undulation
• Nonspecific sign
• Most common in cirrhosis, gynaecologic dis.,
severe diseases, peritoneal tuberculous, renal
and heart problem
Ascites

ascites accumulation of fluid in the abdominal cavity

 7. Meteorismus

• Accumulation of gas in abdominal cavity

• Hypersonor percusion
• Bowel sound ? Metalic sound ?
• Pain ? Flatus ? Bowel Habit ?
• Due to electrolyte imbalance, drug,
inflammation, total or partial obstructive
 8. Pain palpation
• Depend on tophographic
• Types: Murphy’s sign, Ludwig’s sign, CVA
percussion pain, epigastric pain, Mc Burtney’s
pain, defanse muscular, suprapubic pain
 9. Hepatomegaly
• Hepatic enlargement subcostal
• Confirmed by palpation, percussion, and
sonographic
• Due to systemic or hepatic problems
• Important things  size, consistency, and
pain
liver enlargement, portal hypertension
 LIVER SPAN

MCL

PERCUSSION

NL < 12-13 CM
2-3 CM DURING
PALPATION INSPIRATION AND
PERCUSSION EXPIRATION

SCRATCH TEST COPD

LIVER SPAN MAY VARY BETWEEN

OBSERVERS DEPENDING UPON
WHERE THE MCL IS DETERMINED

JAMA 1994;271:1859-1865
 PALPATION

FLEX KNEES AND HIPS IF POSSIBLE

BEGIN LOW ON ABDOMINAL WALL AND MOVE HAND CEPHALAD, HAVE
PATIENT TAKE A DEEP BREATH
NOTE CONSISTENCY (NODULES, SMOOTH) AND CONTOUR IF THE LIVER
EDGE IS FELT
NOTE IF THERE IS ANY PAIN WITH PALPATION
AUSCULTATE MOSBY’S GUIDE TO THE PHYSICAL EXAMINATION, 3RD ED. 1995
 10. Splenomegaly
• Enlargement of spleen below of arcus costae
• Due to infection, trauma, portal hypertension,
neoplastic, hematologic disorders
• Confirmed by palpation and sonograph
 11. Mass palpation

• Depend on topographic (similar to abdominal

pain)
• Important things  size, consistency,
mobility, and pain
• Confirmed by sonograph, radiograph, and
endoscopy
 12. Flapping Tremor
• Patognomonis sign of encephalopathy hepatic
• Tremor of wrist joint after full extension
 13. Pitting Edema

• Accumulation of fluid in subcutis especially in

plantar pedis
• Due to hepatic, renal, heart, malnutrition,
blood vessel, and systemic inflammation
 Case Simulation
• A young lady, married, 32 yo, came to hospital with
chief complaint of epigastric pain localized
• What questions should you ask to this patient?
• This lady have a fever since 1 weeks ago, abdominal
distention in epigastric, vomitus, history of bloody
diarhea, no history of dyspepsia before
• What examinations should you perform to this
patients?
• From examination, there are icteric, pain and
palpable mass in epigastric, dark tea color urine, no
cley-color stool, no defanse muscular
• What working diagnostic and differential diagnostic
are possible in this patient?
• The working dignostic in this patient is left
lobe hepatic abcess
• The differential diagnostic are pancreatic
neoplasm, gastric mass, pseudocyst of
pancreas, left lobe hepatoma, colon mass,
lymphoma, aortic aneurism.
• What are next examinations you suggested to
confirm a diagnostic ?
• What is the treatment ?
SEKIAN