SYMPTOMS & SIGNS IN GIT PROBLEMS • Dear Viewers • Greetings from “ Surgical Educator” • I am uploading a PPT presentation on symptoms and signs in GI problems • What are the questions you have to ask the patients for each problem in GIT is explained • How to examine and elicit various signs in abdomen is also explained • I hope this PPT presentation will be very useful to you • You can watch all my surgery teaching videocasts in the following links • surgicaleducator.blogspot.com youtube.com/c/surgicaleducator

1. SYMPTOMS & SIGNS
IN GI PROBLEMS
(History & Physical)
Dr.B.SELVARAJ MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical college
Melaka 75150 Malaysia

2. SYMPTOMS IN GI
PROBLEMS
(History Taking)
Dr.B.SELVARAJ MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical college
Melaka 75150 Malaysia

3. SYMPTOMS IN GI
PROBLEMS
• Pain abdomen
• Difficulty in swallowing- Dysphagia
• Vomiting
• Heartburn- Retrosternal pain- Pyrosis
• Indigestion
• Change in bowel habits-Constipation/Diarrhea
• Loss of appetite/ Loss of weight

4. SYMPTOMS IN GI
PROBLEMS
PAIN ABDOMENBasic questions you would ask in Abdominal pain
• When did the pain start?
• Where is it, show me?
• Have you ever had it before?
• Did it come on suddenly or
gradually?
• Does it go anywhere else? Show me.
• How bad is it, worst you have ever
had, severe, very severe, mild,
moderate, just an ache (do not use
x/10 unless you define 10)?
• Is it the same all the time?
• Have you had time completely free of
pain since it started?
• Is it constant or comes in waves?
• Is it getting worse?
• What makes it better, e.g. lying
still/painkillers?
• What makes it worse, e.g. moving
about?
• Have you got any other symptoms with
it, give examples,
e.g. vomiting/fever

5. SYMPTOMS IN GI
PROBLEMS
Difficulty in Swallowing-
Dysphagia
Basic questions you would ask in Dysphagia
• How long have you had the problem?
• Describe what it is like?
• Have you had it before?
• Did it come on gradually or suddenly?
• Is it becoming worse?
• Do you have difficulty with solids and/
or liquids?
• Which came first?
• Does the food seem to stick. Show me
where?
• Have you been vomiting, what, etc.
(see below)?
• How is your appetite?
• Have you lost weight?
• Plus, all the other GI protocol
questions
• Plus, do you feel anything else wrong
with you at present.

6. SYMPTOMS IN GI
PROBLEMS
VOMITINGBasic questions you would ask in Vomiting
• When did the vomiting start?
• What do you vomit?
• Is it food/water/bile/greeny
stuff/acid/blood?
• If food, is it food you have just eaten
or old food?
• If it is blood, how do you know?
Amount, color, clots, coffee grounds.
• How often do you vomit?
• Do you feel sick (nauseated) all the
time?
• Does anything bring the vomiting on
(worse)?
• Does anything make it better?
• Does it shoot out with great force
(projectile)?
• Any coughing or choking?

7. SYMPTOMS IN GI
PROBLEMS
Heartburn- Retrosternal Pain-
Pyrosis
Basic questions you would ask in Retrosternal Pain
• Describe it to me .
• How long have you had it?
• Have you had it before this episode?
• Did it come on gradually or suddenly?
• Is it becoming worse?
• What makes it worse (e.g. lying down
in bed, bending over, certain types of
food and drink-spicy food/
alcohol/coffee)?
• What makes it better ( sleeping, sitting
up, avoiding certain drinks or food,
medications)?
• Do you get any acid reflux-acid or
water coming into your mouth, describe
this please (distinguish acid reflux and
water-brash).
• Do you have any difficulty swallowing?
Describe.
• Do you have any pain behind the chest
bone? Describe.
• Do you vomit?
• Do you have indigestion?
• Have you put on weight recently?

8. SYMPTOMS IN GI
PROBLEMS
INDIGESTIONBasic questions you would ask in Indigestion
• Do you have any indigestion, if says 'yes'?
• Ask what do you mean by this, if says 'no; ask: do
you have any discomfort or pain in your tummy
after eating?
• Where is the discomfort, show me (pointing sign
of DU)?
• When do you get it-before meals/ after meals?
• Does it wake you at night (DU), what do you do
about it, e.g. get up have some milk and a biscuit
(DU)?
• How often do you get it, e.g. every day?
• Have you had it before?
• Have you seen your GP about it or been
investigated in hospital (e.g. endoscopy)?
• What did they say was wrong with you?
• What makes the indigestion worse/better?
• Have you been vomiting any blood?
• How is your appetite; have you lost
weight?
• Do you take any medications for it
(define)?
• Are you taking aspirin/NSAIDs/ steroids/
herbal medications?

9. SYMPTOMS IN GI
PROBLEMS
Altered Bowel HabitsBasic questions you would ask in Altered Bowel Habits
• Has your bowel habit changed
recently?
• If patient does not appear to
understand-Explain.
• Have you developed diarrhea or
constipation recently (means different
things to different people)?
• Define their normal bowel habit.
• Define what it has changed to, e.g.
normal is x 1 per day now is x 3 per day.
• If has diarrhea-define content, color,
offensive, blood/floats (see set of
questions below).
• If has constipation-is it constipation or
incomplete evacuation? or even tenesmus
(see below set of questions)?
• Have you passed any blood or slime?
Define both.
• Have you had any abdominal pain or
weight loss?
• On any drugs ( e.g. antibiotic)?

10. SYMPTOMS IN GI
PROBLEMS
Altered Bowel HabitsBasic questions you would ask in Diarrhea
• Frequency of defecation (>x3 =
abnormal).
• Recent or present for long time.
• Solid/liquid/mixed. Bulky may be
steatorrhea.
• Color: Black (melena), red (blood),
pale (steatorrhea,obstructive jaundice),
silver (because of mixture of melena
and fatty stool in tropical sprue,
carcinoma (Ca) of ampulla of Vater).
• Pus or mucus.
• Smell-very offensive, may be
infective/melena.
• Floats/ difficult to flush away, may be
steatorrhea.
• Any other symptoms, e.g. vomiting.
• Been abroad recently.
• Anyone else in family with it
(gastroenteritis).
• NB: Some gastroenterologists divide by
physiological cause into secretory, osmotic,
exudative, malabsorption (not very useful
in practice).

11. SYMPTOMS IN GI
PROBLEMS
Altered Bowel Habits
Basic questions you would ask in Constipation
• What do you mean by constipation-
infrequent bowel action or very hard
motion or difficulty in evacuation?
• Is this a new symptom or long
standing?
• If recent, define 'change': Normal
bowel habit versus old bowel habit.
• Any blood or mucus?
• Incomplete emptying-have to go
again-is a symptom of pelvic floor
descent or rectal cancer- Tenesmus
• Any incontinence-overflow or
otherwise?
• Painful almost continuous urge to
defecate is tenesmus (rectal equivalent of
urinary strangury) indicates inflammation
or tumor involving anal sphincters.
• Other GI symptoms, e.g. abdominal
pain/distension.
• On any drugs, e.g. codeine.
• Alternating diarrhea + constipation,
some say symptom of tumor but more
likely irritable bowel syndrome (large
bowel tumor is more often change from
normal to more frequent).

12. SYMPTOMS IN GI
PROBLEMS
Loss of Appetite/Loss of Weight
Basic questions you would ask in Loss of appetite/ Loss of Weight
• When did this happen, did it start
same time as other GI symptoms?
• Loss of appetite (anorexia) +
weight loss = Suspicious of
malignancy.
• Increase in appetite, may suggest
hypermetabolic state, e.g.
thyrotoxicosis
• When did it start?
• How much (in kg over weeks) if patient
not sure, ask about loose clothes?
• Why do you think lost weight-may say
on diet? - intentional or unintentional
• Are there other symptoms-may need
full review of systems, e.g. fever/thirst?
LOSS OF APPETITE LOSS OF WEIGHT

13. SIGNS IN GI PROBLEMS
(PHYSICAL EXAMINATION)
Dr.B.SELVARAJ MS;Mch;FICS;
Professor of Surgery
Melaka Manipal Medical college
Melaka 75150 Malaysia

14. SIGNS IN GI PROBLEMS
FACE:
Jaundice
Lemon yellow (uremia, CA
cecum,pernicious anemia)
Weight loss ( temporalis muscles, cheeks )-
cachexia
Dehydration
Distress (pain)
Pale (anemia/pain)
Flushed (temperature)
EYES:
Yellow sclera
Pale mucous membranes
Kayser-Fleischer rings (Wilson's disease)
MOUTH:
Angular stomatitis (B12 deficiency, Fe deficiency)
Pigmentation (Peutz-Jeghers syndrome)
Ulcers (Crohn's disease)
HANDS:
Finger nails leukonychia (low protein)
Koilonychia (Fe deficiency)
Clubbing (UC/Cirrhosis)
PALMS:
Pale creases (anemia)
Palmar erythema (liver failure)
Liver flap (liver failure)
ARMS:
Scratch marks ( obstructive jaundice)

15. SIGNS IN GI PROBLEMS
NECK:
Enlarged lymph nodes (supraclavicular-
CA stomach)
LEGS:
Superficial thrombophlebitis
(Pancreatic CA)
AXILLA:
Acanthosis Nigricans (Ca stomach)
Irish nodes ( Ca stomach)
CHEST:
Spider nevi (liver failure)
Gynecomastia (liver failure)
ABDOMEN: Inspection:
No movement with respiration (peritonitis)
Jaundiced
Distended ( obstruction, ascites)
Weight loss (malignancy)
Scars (previous surgery)
Fistula ( Crohn's)
Everted umbilicus (ascites)
Mass ( tumor, abscess)
Visible peristalsis (intestinal obstruction)
Pulsatile Swelling- Expansile/transmitted
Enlarged veins + caput medusa (liver disease)
Cullen's/Grey Turner's sign(pancreatitis)
Erythema ab igne (pain/hotwater bottle use)
Sister Joseph's nodule(transcelomic spread of tumor)
Cellulitis ( abscess-diverticulardisease/tumor)

16. SIGNS IN GI PROBLEMS
PALPATION:
Tenderness/guarding/rebound
(inflammation)
Rigidity- Perforative perotonitis
Mass (tumor)
ORGANOMEGALY:
Liver (primary CA/metastases)
Tender+ enlarged (hepatitis)
Small + hard (cirrhosis)
Spleen-enlarged
(portal hypertension)
ANORECTAL EXAM:
Fistula (Crohn's)
Fissure (Crohn's)
Abscess (IBD)
Anal cancer
Rectal prolapse
Prolapsed haemorrhoids
DRE:
Tumor/polyp felt
Blood on finger (tumor/lBD)
Pus/mucus (IBD)
Black motion (melena)
pale motion ( obstructive jaundice/
steatorrhea)