4. Gastroenterology

4.1. Syndromes for diseases of the esophagus, stomach and gut

1. Dysphagia Syndrome

Violation of the passage of food through the esophagus: from the oropharynx to the upper

esophagus (oropharyngeal dysphagia), transport of the food lump through the esophagus

(esophageal dysphagia)

SYMPTOMS:

1. Difficulty in the passage of solid or liquid food

1. Regurgitation, often at night (symptom of a wet pillow).

2. Vomiting without previous nausea, unchanged, undigested food, without impurities of gastric juice (the result of secondary expansion of the esophagus).

3. Drooling.

4. Bad breath.

5. Pain, feeling of fullness along the esophagus, behind the sternum.

1. functional (paroxysmal)

2. organic (constant, progressive) dysphagia Functional Dysphagia:

REASONS for functional dysphagia:

Damage to the swallowing center, vagus and glossopharyngeal nerve, tongue paralysis, oropharyngeal anesthesia, decreased salivation, damage to the muscles of the pharynx and esophagus, cardiac achalasia in the early stages.

SYMPTOMS:

• transient nature of violations

• connection with psychoemotional factors

• often provoked by excitement, hasty food

• sensation of a ―lump in the throat" or behind the sternum

2. the passage of solid and liquid food is equally difficult, sometimes, liquid food is more difficult than dense

2. general condition changes little

5. eliminated by sedatives and antispasmodics. Organic Dysphagia:

REASONS for Organic Dysphagia:

Inflammatory diseases and strictures of the esophagus, tumors, diverticulums of the esophagus, cardia achalasia in the later stages.

SYMPTOMS:

1. the constant and progressive nature of violations.

2. The difficulty of passing first only solid, and then gruel and liquid foods.

3. general condition:

a) with cicatricial narrowing of the esophagus (burn, esophagitis, achalasia of the cardia) changes little or slowly.

b) with cancer of the esophagus rapidly worsens58

Pic 4.1 Organic esophageal stenosis

2. Gastroduodenal pain syndrome

CAUSES:

Diseases of the stomach and duodenum. More often with peptic ulcer, chronic gastritis, duodenitis.

SYMPTOMS:

Epigastric pain. Often there is a seasonality of exacerbation: in spring and autumn.

Early pain: occur a few minutes later or within the first hour after eating. Sometimes, there is a fear of eating (cytophobia). Characterize the defeat of the cardial and fundal sections of the stomach.

Late pains: occur 1.5 to 2 hours after eating, on an empty stomach, at night, often accompanied by hypersecretion. Characterize the defeat of the pyloric stomach and duodenum. The pain is stopped by eating, antacids, antisecretory drugs.

At the height of the pain, there may be vomiting, which brings relief.

Percussion tenderness is a symptom of Mendel. This symptom is detected by abrupt percussion with a finger bent at right angles to the symmetrical sections of the epigastric region. Accordingly, the localization of ulcers with such percussion sometimes appears local, limited soreness, soreness is more pronounced on inspiration. Mendel’s symptom usually indicates that the ulcer is not limited to the mucous membrane, but is localized within the walls of the stomach or duodenum with the development of perivisceritis.