REASONS: gastritis, gastric and duodenal ulcer, cholecystitis, biliary dyskinesia, gallstone disease, pancreatitis, hepatitis, cirrhosis of the liver, colitis, enteritis, tumors of the gastrointestinal tract, pancreas, dysbacteriosis, etc. It arises as a result of a violation of gastric and intestinal digestion, a disorder of the motor-evacuation function of the gastrointestinal tract, dysbiosis, etc.
SIGNS:
impaired appetite;
Bad taste in the mouth;
Belching - throwing the contents of the stomach into the oral cavity (which is associated with insufficiency of the sphincter of the cardia). When the gaseous contents of the stomach get in, they speak of ―belching with air‖, if it contains food particles - ―belching with food‖, and with
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the formation of organic acids as a result of fermentation - ―belching with rancid oil‖.
Heartburn - severe burning behind the sternum, which is associated with the ingestion of the contents of the stomach into the esophagus as a result of insufficiency of the cardiac sphincter;
Nausea - occurs more often with diseases with reduced secretory function of the stomach, and is also associated with the intake of certain foods (fats);
Vomiting - associated with increased tone of the vagus nerve, which is accompanied by severe secretory and motor disorders of the gastrointestinal tract. Its nature, the content of vomit and its quantity are of diagnostic value;
Constipation occurs as a result of reflex dyskinesia of the intestine, due to an increase in the tone of the vagus nerve, nutritional features, restriction of motor activity, medications, hypersecretion;
Diarrhea - is the result of a decrease in the acid-forming function of the stomach, pancreatic disease, a consequence of secondary vitamin deficiency, motor, inflammatory and functional intestinal diseases.
Flatulence - increased flatulence in the intestines.
Dyspepsia, depending on the prevalence of dysfunction of a particular digestive organ, is schematically divided into clinical forms - gastric, intestinal, pancreatic and liver.
Gastric dyspepsia.
Symptom complex, including symptoms: a feeling of fullness, heaviness in the epigastrium, belching, heartburn, nausea, vomiting. Possible mechanisms: secretory insufficiency [function, impaired motility of the upper gastrointestinal tract.
Intestinal dyspepsia:
maldigestion - a violation of digestion in the small intestine;
malabsorption - malabsorption.
The symptom complex including symptoms: flatulence, rumbling and abdominal pain, constipation, diarrhea (see. Fermentative dyspepsia, putrefied dyspepsia). It is a sign of inflammation of the intestinal wall, impaired intestinal motility, insufficiency of a number of enzymes: enterokinase, sucrase, phosphatase, etc. It occurs in diseases of the intestine.
Fermentative dyspepsia (in violation of the digestion of carbohydrates).
Symptom complex, including symptoms: severe flatulence, cramping pains, diarrhea, worsening after a meal rich in carbohydrates, characteristic changes in the coprogram. A type of intestinal dyspepsia. It is observed with prolonged adherence to a carbohydrate diet.
Putrid dyspepsia (in violation of protein digestion).
Symptom complex, including symptoms: moderate flatulence, persistent abdominal pain, diarrhea, alternating with constipation, worsening after eating a protein-rich meal, characteristic changes in the coprogram. A type of intestinal dyspepsia. It is observed with prolonged adherence to a protein diet.
Malabsorption syndrome
REASONS: primary (hereditary deficiency of individual digestive enzymes)
Secondary (due to dysfunction and diseases of the stomach, intestines, digestive organs, endocrine and other systems, exposure to toxic, medicinal substances)
Symptom complex that develops due to lack of absorption of many food ingredients (proteins,
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carbohydrates, vitamins, trace elements). Symptoms: diarrhea, weight loss, up to cachexia, hypoproteinemic edema, creatorrhea, steatorrhea, amylorrhea, neuritis, hair loss. Syndromes: asthenic, polyhypovitaminosis, anemic.
Functional disorders of the intestine, not associated with organic diseases.
Causes:
Frequent stressful situations
Excessive bacterial growth
Poor nutrition
Alcohol abuse
Intestinal infections Clinical options.
Spastic-colitic option
With a predominance of diarrhea
With a predominance of constipation
The main clinical signs:
1 Abdominal pain - localized near the navel or lower abdomen. They have various intensities, from slightly aching to very pronounced intestinal colic. As a rule, pain decreases or disappears after defecation or exhaustion of gases. An important hallmark is the absence of pain and other symptoms at night.
2 Violation of the stool is expressed in the appearance of diarrhea or constipation. Diarrhea often occurs suddenly after eating, sometimes in the morning. Characteristic is the absence of polyfecalia (the amount of feces is less than 200 g per day, with constipation it resembles sheep). Feces often contain mucus. Many patients have a feeling of incomplete bowel movement after defecation.
Flatulence - one of the characteristic signs, usually intensifies in the evening. As a rule, bloating increases before defecation and decreases after it. Quite often, flatulence is local in nature.
Laboratory and instrumental studies:
- Coprogram: a large number of mucus or mucous membranes and tapes in which eosinophils are sometimes found under microscopy.
- Endoscopic - no changes are detected.
- An X-ray examination may reveal signs of dyskinesia asymmetric and uneven contractions of the colon, the alternation of spastically reduced and enlarged sections of the intestine.
The following types of abdominal pain are distinguished:
spastic;
due to flatulence;
mesenteric;
due to ganglionitis;
rectal colic;
mixed character.
Intestinal colic - due to spasm or distension of the small or large intestine, are paroxysmal in nature, and localized over the site of spasm.
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Pain due to flatulence - usually of a constant nature, is associated with bloating of the intestine with gases, and decreases after exhaustion of gases and bowel movements.
Mesenteric pain is caused by the development of non-specific mesadenitis. These pains are permanent, not associated with food, do not stop with anticholinergics, antispasmodics, do not disappear after defecation and exhaustion of gases. The pains are located along the mesentery of the small intestine.
Pain due to ganglionitis. In chronic enteritis, the involvement of the ganglia of the autonomic nervous system in the pathological process is possible. In this case, the pains have a peculiar burning character, they are constant, do not decrease after defecation and gas discharge, as well as after the use of antispasmodics.
Rectal colic, or the so-called tenesmus - they are manifested by frequent and painful urges to defecate with a feeling of convulsive contraction of the intestine and sphincter. Defecation does not occur, sometimes lumps of mucus (rectal spitting) are secreted.
Mixed pains are caused by a combination of causes that cause abdominal pain. Most often, this is a combination of spastic pain and pain caused by flatulence.
With a prolonged course of chronic colitis, asthenoneurotic syndrome develops. Patients complain of weakness, fatigue, headache, decreased performance, irritability, excessive sweating, and poor sleep.
REASONS: cholelithiasis, biliary dyskinesia.
SYMPTOMS:
Paroxysmal pain in the right hypochondrium - severe, colicky for a few minutes to 2-6 hours, often radiating to the right hypochondrium, to the right shoulder blade, shoulder, lumbar region, neck. It occurs 3-4 hours after a plentiful meal (fried, fatty, spicy foods), physical influences, "shaking rides", etc.
Nausea and vomiting (with duodenal contents mixed with bile), bitterness in the mouth.
The patient is very anxious: rushing about in bed, looking for a comfortable position, not finding him; fever is possible.
Enlarged, painful gall bladder. Skin hypersthesia and pain symptoms of the projection point of the gallbladder, epigastric region, phrenicus - symptom, etc. The abdomen is soft, with peritoneal irritation - tension of the anterior abdominal wall in the right hypochondrium. There may be signs of subhepatic jaundice.
"Bubble" symptoms reveal the interest of the gallbladder in the pathological process. The gallbladder point (Kera point) corresponds to the projection of such on the surface of the abdomen, located at the intersection of the outer edge of the right rectus abdominis muscle with the right costal arch.
Mackenzie symptom - hypersensitivity of the skin in the right hypochondrium;
Zakharyin's symptom; pain when pressed or beaten at the point of the gallbladder;
symptom of Musse-Georgievsky (soreness between the legs of the right m. Sternocleidomastoideus) - a right-sided phrenicus-symptom;
Obraztsova-Murphy symptom - pain at the height of inspiration during palpation of the gallbladder zone - ―the breath is interrupted by pain‖. It is carried out in a prone position and sitting. In this case, a grimace of pain may appear on the patient's face;
Kera symptom - pain in the right hypochondrium in the gallbladder area on inspiration;
Vasilenko’s symptom - the occurrence of pain when applying abrupt strokes with the fingertips on the inspiration below the right costal arch;
Ortner-Grekov symptom - the appearance of pain when the right rib arch is striking with the edge of the palm of the hand (the pain appears due to shaking of the inflamed gall bladder);
Zakharyin-Ged skin hypertension zones - extensive zones of severe soreness and hypersensitivity at the lower angle of the right scapula and in the region of 9-11 intercostal spaces.
REASONS: obstruction of the hepatic and common bile duct from the inside (stones, tumor, parasites), tumors of the large duodenal nipple, pancreas, gall bladder, cyst and chronic inflammation of the pancreas, lymphogranulomatosis, postoperative narrowing of the common bile duct, atresia of the bile duct.
SYMPTOMS:
The pain in the right hypochondrium is often colicky, itchy, intense jaundice, neurosthenic complaints - general weakness, fatigue, irritability, headache, insomnia, sometimes progressive worsening and intense jaundice with a greenish skin tone.
The liver is painless, enlarged, significantly densified, the gall bladder is sometimes enlarged (cm Courvoisier-Terrier), often pain at the point of its projection. Bradycardia The spleen is not enlarged.
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Urine - dark, with bright yellow foam, bilirubinuria, lack of urobilin.
Feces discolored (acholic) - grayish-white, clay, no stercobilin.
Blood - hyperbilirubinemia, mainly associated (direct) bilirubin. An increase in the activity of alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGT), an increase in the content of bile acids, copper, cholesterol, and transaminases are usually negative for 4-8 weeks.
X-ray or ultrasound examination - signs of gallstone disease, cancer of the head of the pancreas, cancer of the Vater's nipple.
Symptom of Courvoisier-Terrier - a large and painless gall bladder is palpated, which is due to the complete closure of the common bile duct (usually tumor origin) and the accumulation of bile in the bladder.