Dyspepsia and gastro-oesophageal reflux disease (GORD) are common conditions, affecting around 28% of the population.They cause significant impairment of quality of life (1)
Colorectal cancer
With reference to symptoms of digestive problems:
Dyspepsia:
Abdominal pain:
Vomiting:
Vomiting is a symptoms that may signify different pathologies based on the age of a patient. For example vomiting in a neonate may due to a cause such as feeding problems (including overfeeding) or systemic infection. If a mother has had a home delivery and requests a visit for her 3 day old baby then what other causes of the vomiting should be considered?
In adult presenting to the GP surgery with persistent vomiting, what metabolic causes of vomting should be considered?
In addition the GP should also consider possible neurological causes. Vomiting may occur with vestibular dysfunction such as benign positional vertigo and Meniere's disease. Vomiting may also be a feature of raised intracranial pressure. What other neurological causes might be considered?
Haematemesis:
Haematemesis is the vomiting of blood. This condition occurs when there is bleeding in the oesophagus, stomach or duodenum, i.e. bleeding proximal to the duodenal-jejunal junction
Ehlers-Danlos syndrome is a rare syndrome that may initially present with an episode of haematemesis. What is Ehlers-Danlos syndrome?
What mineral supplement taken in accidental overdose (e.g. by an infant) could result in an acute presentation with haemetemesis?
Melaena:
Melaena is the passage of black, tarry stools. The stools have a characteristic and offensive smell due to the presence of blood that has been digested by intestinal enzymes and bacteria. The degradation of the blood also accounts for the dark colouration. It usually implies a bleed at some point early in the gastrointestinal system proximal to the splenic flexure of the colon (usually the oesophagus, stomach or duodenum).
Rectal Bleeding:
Causes of rectal bleeding include haemorrhoids, diverticular disease, colonic polyps and carcinoma. A review of the causes of rectal bleeding is available on GPN
An unsual cause of rectal bleeding is a bleeding Meckel's diverticulum - what is this? GPN reference
Colonic angiodysplasia may be a cause of rectal bleeding in the elderly. What is colonic angiodysplasia and how may it be treated?
Tenesmus:
Tenesmus is an intense, painful but fruitless desire to defaecate. It may be continuous or recurrent. The rectum feels full, but when the patient tries to pass a stool, nothing appears, or a little blood and mucus is passed.
In the context of a symptom of tenesmus, what is the likely diagnosis?
Jaundice:
A 35 year old man was noted to have yellow sclera by the practice nurse during his new patient medical. She tested his urine sample and the sample was negative for urine bilirubin.
Is the cause of this gentelman's jaundice prehepatic, hepatic or posthepatic?
This gentleman has no history of ongoing medical problems and says that he is otherwise well. He notes that his father and brother also intermittently have episodes of "yellow eyes".
What is the likely diagnosis and how is this relevant to the family history ?
This patient was seen by the GP the following week and was noted to have a mild splenomegaly. A set of screening blood tests revealed a normocytic anaemia. A blood smear was reported to have increased number of reticulocytes. This gentleman notes that his father has a history of "something wrong with his blood" and gallstones.
Constipation:
A 62 year old man comes into the GP surgery with a history of a change in bowel habit in the last 2 months. He has now opens his bowels every other day when before he had opened his bowels once per day. He is otherwise well and has had no weight loss. He has no past history of bowel disease. Clinical examination was unremarkable.
Diarrhoea:
A 62 year old man comes into the GP surgery with a history of a change in bowel habit in the last 2 months. He has now opens his bowels three to four times per day when before he had opened his bowels once per day. He is otherwise well and has had no weight loss. He has no past history of bowel disease. Clinical examination was unremarkable.
Dysphagia:
The causes of dysphagia should be considered in terms of oesophageal causes and systemic causes. Some systemic causes of dysphagia include:
What lesions outside the oesophageal lumen might cause dysphagia?
What is odynophagia?
Dysphagia is a symptom that should prompt urgent referral. The urgent referral guidance for suspected upper GI cancer is GPN reference
Reference:
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