Category Archives: Gastroenterology

The pharynx and oesophagus

STRUCTURE The oesophagus is a muscular tube, approximately 25 em long, connecting the pharynx to the stomach. The muscle coat has two layers-an outer longitudinal layer and an inner circular layer of fibres. In the upper portion both muscle layers are striated. They gradually change to smooth muscle in the lower oesophagus, where they are continuous with the muscle layer of the stomach. The oesophagus is line

The salivary glands

Xerostomia Xerostomia means dryness of the mouth. Causes include: • Psychogenic-anxiety • Pyrexia • Drugs-anticholinergics, antihistamines, and tricyclic and related antidepressants • Sjogren’s syndrome • Diabetic ketoacidosis and dehydration The sensation of excess salivation (ptyalism) is chiefly psychogenic. It occurs before vomiting and with lesions of the mouth. Bacterial and viral infectio

Common mouth lesions

Ulceration Infective HERPES SIMPLEX VIRUS type I, or rarely type 2, presents with fever and widespread confluent painful oral ulcers. After spontaneous resolution, the virus remains latent and recurs as herpes labialis (cold sores). HAND, FOOT AND MOUTH DISEASE due to Coxsackie A virus produces mouth vesicles, usually in children. No treatment is required. Herpes zoster involving the fifth cranial nerve can

The mouth

Mastication of the food takes place in the mouth. The nfood then passes into the pharynx. Problems in the mouth are extremely common and although they may be trivial they can produce severe symptoms. Poor dental hygiene is often a factor. A bad taste in the mouth and offensive breath (halitosis), particularly if only noticed by the patient, are psychogenic symptoms. Patients with gastric outflow obstruction r


Radiology and endoscopy are the principal investigations. These are usually preceded by routine haematology and biochemistry. Plain X-rays Plain X-rays of the abdomen are chiefly used in the investigation of acute abdomen (see p. 233). Areas of calcification can be seen in chronic pancreatitis. Routine abdominal X-rays are of little use in the management of most gastrointestinal disease. Barium contrast stud

Clinical examination

A general examination is performed, with particular emphasis on the examination of all lymph nodes and noting the presence of anaemia or jaundice. Detailed examination of the gastrointestinal tract starts with the mouth and tongue before examining the abdomen. Examination of the abdomen (Acute abdomen, Liver disease,) Inspection The organs found in a normal abdomen are shown in  a normal CT scan. Organs som


Steatorrhoea is the passage of pale, bulky stools that contain fat, sometimes float in the lavatory pan and are difficult to flush away. These stools float because of the increased air content. Normally people with steatorrhoea complain of diarrhoea, but occasionally they may pass only one motion per day. Abdominal pain Pain is stimulated mainly by the stretching of smooth muscle or organ capsules. Severe acu

Common symptoms

Dysphagia Dysphagia is difficulty in swallowing Incidence (approximate) of cancers at various sites of the gastrointestinal tract. Heartburn Heartburn is a retrosternal or epigastric burning sensation that spreads upwards to the throat. Dyspepsia and indigestion These are terms often used by lay people to describe any symptom, e.g. nausea, heartburn, acidity, pain or distension, that occurs as a result of eatin


Gastrointestinal disease is a major cause of ill-health worldwide. In developing countries infection and malnutrition are common. For example, over a billion people are infested with roundworms and hookworms, and amoebiasis affects over 10% of the world’s population. Poor hygiene and malnutrition allows the spread of infective organisms and many infections could be prevented by improved sanitation and