Essential GI system revision: Learn common symptoms like dysphagia, reflux, and abdominal pain. Classify diseases with VINDICATE and recognize critical red
GI System — Revision Notes Disease Classification (VINDICATE) V — Vascular Ischemic colitis, mesenteric ischemia, angiodysplasia, esophageal varices, hemorrhoids I — Infection / Inflammation Gastroenteritis (viral/bacterial/parasitic), C. diff, IBD (Crohn's, UC), appendicitis, pancreatitis N — Neoplastic Colorectal Ca, gastric adenocarcinoma, HCC, pancreatic Ca, esophageal carcinoma D — Degenerative / Deficiency Achalasia, gastroparesis, celiac disease, pernicious anemia (B12 deficiency) I — Iatrogenic / Intoxication NSAID-induced ulcers, antibiotic-associated diarrhea, alcohol-related liver disease, toxic megacolon C — Congenital Hirschsprung's disease, Meckel's diverticulum, pyloric stenosis, malrotation A — Autoimmune / Allergic Autoimmune hepatitis, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) T — Traumatic Mallory-Weiss tears, bowel perforation, foreign body ingestion E — Endocrine / Metabolic Diabetic gastroparesis, paralytic ileus from electrolyte imbalance, exocrine pancreatic insufficiency --- GI Symptoms Upper GI: dysphagia, odynophagia, heartburn, reflux, indigestion, haematemesis, vomiting Lower GI: constipation, diarrhoea, rectal bleeding, melaena, flatulence Systemic: anorexia, weight loss, jaundice, pruritus, abdominal pain, abdominal distension --- Red Flag Symptoms Raise suspicion for malignancy — especially in patients 55 years or with symptoms of <3 months duration. Dysphagia New-onset dyspepsia lasting weeks New-onset abdominal pain lasting weeks Change in bowel habit — diarrhoea, constipation, or sense of incomplete evacuation Rectal bleeding Weight loss / loss of appetite New iron deficiency anaemia in men or non-menstruating women Diarrhoea that wakes the patient at night --- Dysphagia Difficulty swallowing — ranges from awareness of something sticking to complete inability to swallow. Can indicate oesophageal cancer or cancer of the gastric cardia/fundus. Oropharyngeal dysphagia Difficulty transferring food from mouth to pharynx. Features: choking, nasal regurgitation, drooling, dysphonia, aspiration pneumonia. Neurogenic dysphagia (stroke, MND, myotonic dystrophy) is typically worse with liquids than solids. Investigation: video fluoroscopy / modified barium swallow Oesophageal dysphagia — Motility disorder Examples: achalasia, oesophageal spasm, scleroderma Key feature: dysphagia to both solids AND liquids Investigation: oesophageal manometry Oesophageal dysphagia — Mechanical disorder Examples: stricture, ring, web, diverticulum, cancer Key feature: dysphagia to solids ONLY. Progressive dysphagia + weight loss = suspect malignancy Investigation: OGD (oesophagogastroduodenoscopy) --- Odynophagia Painful swallowing from inflammation of the oropharynx or proximal oesophagus. May occur with or without dysphagia. Most common cause: oesophageal candidiasis. Other cause: CMV oesophagitis. --- Heartburn & Reflux Heartburn — burning sensation in chest/neck from acid refluxing into the oesophagus (GERD). Worse when lying supine or bending. Aggravated by alcohol, fatty/spicy foods, and certain medications (e.g. bisphosphonates). Reflux — regurgitation of non-acid fluid or bile into the mouth, causing bitter taste and retrosternal discomfort. Suggests GERD, but not all GERD patients have reflux symptoms. --- Vomiting Forceful expulsion of gastric contents. Mechanism: synchronous contraction of the diaphragm, intercostal and abdominal muscles raises intra-abdominal pressure + relaxation of the lower oesophageal sphincter. Sequence: nausea → hypersalivation, pallor, sweating, hyperventilation → retching → expulsion GI vomiting: associated with abdominal discomfort Non-GI vomiting (raised ICP, metabolic): not associated with food or abdominal discomfort --- Haematemesis Vomiting blood from an upper GI source. Bright red blood — brisk bleed (e.g. large vessel in gastric/duodenal ulcer); often accompanied by melaena Coffee-ground vomitus — old blood oxidised by gastric acid; dark, granular appearance --- Melaena Black, tarry stool — the 5 S's: schwartz (black), sticky, smelly, shiny, stool Caused by digestion of blood. Usually indicates upper GI bleeding. Rarely from small bowel (proximal to ileocaecal valve) or right colon. --- Abdominal Pain Characterise using SOCRATES — Site, Onset, Character, Radiation, Timing, Exacerbating/relieving factors, Associated symptoms. Pancreatic pain — radiates through to the back, relieved by leaning forward Ureteric colic — radiates from loin to groin (ipsilateral side) Can be caused by systemic disease: DKA, porphyria, lead poisoning Referred pain — pain felt at a site distant from the actual source, due to convergence of sensory nerve pathways as they travel to the brain. --- Abdominal Distension — The 5 F's Fat, Fluid (ascites), Foetus, Flatus, Faeces Symmetrical distension — ascites or obesity Common causes of ascites: decompensated liver cirrhosis, congestive heart failure, nephrotic syndrome, abdominal malignancy Asymmetrical dist