Introduction

Gastrointestinal (GI) diseases most often present with one or more of four
common classes of symptoms and signs: (1) abdominal or chest pain; (2)
altered ingestion of food (eg, resulting from nausea, vomiting, dysphagia
[difficulty swallowing], odynophagia [painful swallowing], or anorexia [lack
of appetite]); (3) altered bowel movements (ie, diarrhea or constipation); and
(4) GI tract bleeding, either occurring without warning or preceded by one or
more of the foregoing (Table 131). However, not all cases of a particular GI
disease present in the same way. For example, peptic ulcer disease, although
typically accompanied by abdominal pain, may be painless.

Table 131 Common Presentation of GI Disease.

Cardinal GI
Symptom or
Sign

Esophagus

Stomach

Intestines

Gallbladder

Pain

Achalasia,
reflux

Gastric ulcer

Duodenal ulcer Cholelithiasi

s

Gastric cancer Irritable bowel

syndrome
Diverticular
disease
Altered ingestion
Dysphagia

Achalasia,
reflux

Nausea,
vomiting

Achalasia,
reflux

Gastroparesis

Acute
gastroenteritis

Cholelithiasi
s

Cardinal GI
Symptom or
Sign

Esophagus

Stomach

Esophageal
cancer

Intestines

Gallbladder

Obstruction

Altered bowel movements

Constipation

Diverticular
disease
Diabetic
autonomic
neuropathy

Diarrhea
(including
steatorrhea)

Gastric
surgery,
dumping
syndrome

Gastroenteritis Cholelithiasi
s
Irritable bowel
syndrome
Inflammatory
bowel disease
Diabetic
autonomic
neuropathy

Bleeding
Hematemesis

Varices
Gastric ulcer
Duodenal ulcer
resulting from
portal
hypertension Mucosal
laceration (eg,
after violent

Cardinal GI
Symptom or
Sign

Esophagus

Stomach

Intestines

Gallbladder

retching)
Bloody stools
(including
melena, frank
blood, and
occult blood)

Varices

Gastric ulcer

Inflammatory
bowel disease
Duodenal ulcer
Diverticular
disease
Colon cancer
Gastroenteritis
Infarction

GI disease may be limited to the GI tract (eg, reflux esophagitis, peptic ulcer,
diverticular disease), be a manifestation of a systemic disorder (eg,
inflammatory bowel disease), or present as a systemic disease resulting from
a primary GI pathologic process (eg, vitamin deficiencies resulting from
malabsorption). Because different parts of the GI tract are specialized for
certain functions, the most prominent causes, consequences, and
manifestations of disease differ from one anatomic site to another.
Acutely, GI disease can be complicated by dehydration, sepsis, or bleeding or
by their consequences, such as shock. Dehydration can occur as a
consequence of even subtle alterations in fluid input or outflow because the
volume of fluid traversing the GI tract daily is enormous (see later
discussion). Sepsis can result from disruption of the barrier function against

pathogens in the environment, including bacteria resident in the colon. The

tendency for bleeding is a reflection of the tremendous vascularity of the GI
tract and the difficulty of applying pressure at the site of bleeding.
Chronically, GI disease can be complicated by malnutrition and deficiency
states. These occur because many primary GI diseases result in
malabsorption (failure to absorb one or more necessary nutrients in
ingested food).
GI tract disease can present as partial or complete obstruction (blockage of
movement of contents down the GI tract) caused by adhesions and
stenosis resulting from proliferation of connective tissue in response to
inflammation. The symptoms and signs of obstruction can range from mild
nausea, abdominal pain, and anorexia to projectile vomiting and rebound
tenderness. In severe cases, obstruction can result in perforation, infarction
and bleeding, hypotension, shock, sepsis, and death. The severity of
symptoms depends on the extent of obstruction, the degree to which the
obstruction compromises blood flow to the affected region, and the stage in
the natural history of the process at which the patient presents for medical
attention.

Checkpoint
1. What are the cardinal symptoms and signs of GI disease?
2. What are some acute systemic complications of primary GI disease?
3. What additional systemic manifestations can occur as a result of
chronic GI disease?