Makindo Medical Notes

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).