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.
Pain is stimulated mainly by the stretching of smooth muscle or organ capsules. Severe acute abdominal pain can .be due to a large number of gastrointestinal conditions, and normally presents as an emergency. An ‘acuteabdomen’ can occasionally be due to referred pain from the chest, as in pneumonia, or to metabolic causes, such as diabetic ketoacidosis. In patients with abdominal pain the following should be ascertained:
• The site, intensity, character, duration and frequency of the pain
• The aggravating and relieving factors
• Associated symptoms, including non-gastrointestinal symptoms Localized abdominal pain with tenderness can very rarely arise from the abdominal wall itself. The cause is unknown, but may possibly be due to nerve entrapment; a local anaesthetic injection may help.
Upper abdominal pain
PIGASTRIC PAIN. This is very common, often a dull ache, but can be sharp and severe. Its relationship to food intake should be ascertained. It is a common feature of peptic ulcer disease, but it can be caused by a variety of upper gastrointestinal diseases.
RIGHT HYPOCHONDRIAL PAIN is usually from the gallbladder or biliary tract (see p. 281). Hepatic congestion, e.g. in hepatitis, and sometimes peptic ulcer can present with pain in the right hypochondrium. Chronic, often persistent, pain in the right hypochondrium is a frequent symptom in healthy females suffering from functional bowel disease. This chronic pain is not due to gallbladder disease.
Lower abdominal pain Pain in the left iliac fossa is usually colonic in origin. It is most commonly associated with functional bowel disease. In females, lower abdominal pain occurs in a number of gynaecological disorders and the differentiation from gastrointestinal disease is often difficult.
Persistent pain in the right iliac fossa over a long period is not due to chronic appendicitis.
PROCTALGIA. Proctalgia is a severe pain deep in the rectum that comes on suddenly but lasts only for a short time. It is not due to organic disease.
Abdominal distension or bloating is a common complaint often erroneously attributed to wind. In the absence of physical signs, the symptom is due to functional bowel disease.
This is due to anorexia (loss of appetite) and is a frequent accompaniment of all gastrointestinal disease. Anorexia is also common in systemic disease and may be seen in psychiatric disorders, particularly anorexia nervosa. Anorexia often accompanies carcinoma but it is a late symptom and not of diagnostic help. Weight loss with a normal or increased dietary intake occurs with hyperthyroidism. Malabsorption is never so severe as to cause weight loss without anorexia. Weight loss should be assessed objectively as patients often ‘think’ they have lost weight. For a discussion of appetite. Rectal bleeding Bright red blood on the toilet paper on wiping the anus is a common symptom of piles. There are many other causes.