Related Subjects:
|Upper Gastrointestinal Bleed
|Oesophageal Variceal Bleeding
|Dieulafoy Lesion
|Mallory-Weiss Tear
|Gastric Cancer
|Peptic Ulcer Disease
|Oesophagogastroduodenoscopy (OGD/EGD)
|Hereditary Haemorrhagic Telangiectasia
|Hypovolaemic or Haemorrhagic Shock
🚨 Red flags in GI symptoms: dysphagia, unplanned weight loss ⚖️, anorexia 🍽️, haematemesis 💉, melaena 🪠, older age 👴, failure to respond to therapy, chronicity, or long-term drug use 💊.
🥤 Dysphagia
- Difficulty swallowing - distinguish gastroenterological (oesophageal, food “sticking”) vs neurological (oral/pharyngeal phase) causes.
- Gastro causes:
- Achalasia ⚡ (young, regurgitation of undigested food, solids & liquids held up at LOS).
- Malignancy 🦠 - progressive, first solids then liquids.
- Oesophageal stricture 🔄 - often post-GORD.
- Oesophageal spasm 💥 - painful, normal endoscopy but seen on barium swallow.
- Dysmotility (elderly, reflux association).
- Globus hystericus 😟 (“lump in throat” sensation, often anxiety).
- Hiatus hernia.
- Oesophagitis 🔥 (painful swallowing).
- Pharyngeal pouch 🛍️ - regurgitation of undigested food.
- Neuro causes: stroke 🧠, MND, myasthenia gravis, Parkinson’s disease.
🔥 Odynophagia (Painful Swallowing)
- Common: oesophagitis, candidiasis 🍄, CMV, corrosive injury.
- Linked to drugs (bisphosphonates), malignancy, spasm.
🤢 Dyspepsia
- Symptoms: bloating, fullness, nausea, belching, “wind.”
- Causes: inferior MI (if acute ⚠️), GORD, PUD, oesophagitis, stomach cancer, functional dyspepsia.
⚖️ Weight Loss
- Reduced intake: anorexia, dyspepsia, nausea (drugs 💊, brain tumours 🧠), ENT issues, stroke, infection, psychiatric (anorexia, depression, dementia).
- Normal intake but loss: cancer 🦠, hyperthyroidism 🔥, IBD (Crohn’s/UC), rheumatoid arthritis.
💩 Altered Bowel Habit
- Distinguish frequency ↑ vs diarrhoea.
- Causes of frequency: hyperthyroidism 🔥, anxiety 😟, IBS.
💦 Diarrhoea (>200g stool/24h)
- Acute: infective 🌡️, antibiotic-related (C. diff), food poisoning 🍗, UC flare.
- Chronic: Crohn’s, UC, laxatives, colorectal tumour/polyp, coeliac disease.
🧈 Steatorrhoea
- Pale, offensive, greasy stools - fat malabsorption.
- Causes: small bowel disease, pancreatic disease 🫛, biliary disease. Often with ADEK vitamin deficiency.
🚫 Constipation
- Causes: Hirschsprung’s (children 👶), atonic colon, IBS, ageing, opioids 💊, hypothyroidism 🌀, dehydration 💧, immobility, diverticular disease, left-sided tumour, Parkinson’s.
🪠 Tenesmus
- Feeling of incomplete rectal emptying after defecation.
- Seen in IBS, rectal tumours.
🟡 Jaundice
- Cholestatic: dark urine ☕, pale stools 🪣, RUQ pain → gallstones.
- Painless jaundice + weight loss: pancreatic cancer 🚨.
- Drug-induced: e.g., hepatotoxic medications.
- Viral hepatitis risks: HAV (seafood 🐟, cigarette distaste), HBV (IVDU 💉, sexual), HCV (IVDU, transfusion pre-1990).
- Leptospirosis 🌊 (canoeing, water sports).
- Alcohol 🍺 - alcoholic liver disease.
- Other: haemolysis, Gilbert’s syndrome (benign, fasting-related).
💉 Haematemesis
- Bright red = upper GI bleed. Not all dark/black is blood (could be bile).
- Causes: PUD, gastric erosions, Mallory-Weiss tear, oesophagitis, duodenitis, varices ⚠️, gastric/oesophageal cancer, angiodysplasia, HHT, aorto-duodenal fistula.
🪠 Melaena
- Dark, tarry stools from upper GI bleeding (same causes as haematemesis).
