Let’s discuss some common gastrointestinal symptoms a patient may present with when their chief complaint is abdominal pain. This list is not comprehensive but includes common symptoms that will help you focus your history questions.
The acronym OLD CARTS can be used to obtain a history of present illness (HPI) as part of the exam’s subjective portion; OLD CARTS stands for onset, location, duration, character, alleviating factors, radiation, temporal patterns, and symptoms associated. Let’s focus on the S—the last letter in the acronym—which represents symptoms associated with the presentation of abdominal pain. But first, let’s do a quick review of the three anatomical sections of the gastrointestinal (GI) system.
What are the three anatomical sections of the GI system?
The GI system, also known as the digestive system or alimentary canal, is an organ system responsible for the transportation, digestion, and absorption of food and nutrients. It contains hollow, viscus organs including the mouth, esophagus, stomach, small intestine, large intestine, and solid organs such as the liver, gallbladder, and pancreas.
When trying to identify the cause of abdominal symptoms, it’s useful to remember the anatomical origin of the intestines. The GI tract is divided into three broad anatomical sections that are formed during embryonic development:
The foregut spans from the mouth to the second portion of the duodenum. The midgut spans from the distal aspect of the second portion of the duodenum to the proximal two-thirds of the transverse colon. Finally, the hindgut spans from the distal third of the transverse colon to the proximal two-thirds of the rectum.
Which GI symptoms are associated with the foregut?
There are seven gastrointestinal symptoms that can be considered foregut symptoms:
- Early satiety
Reflux is often associated with heartburn while dysphagia is a difficulty with swallowing.
Hematemesis is the vomiting of blood, usually from a source in the upper GI tract. It’s important that hematemesis is not confused with hemoptysis, which is the coughing up of blood. Hemoptysis is often from a source in the respiratory tract.
Early satiety involves feeling full quickly after eating a small amount of food.
Singultus (also known as hiccupping) is the sound made by the rapid closure of the glottis due to a reflex spasm of the diaphragm. It is often a symptom of indigestion.
Which GI symptoms are associated with the midgut?
There are three gastrointestinal symptoms that can be considered midgut symptoms:
- Loss of appetite
Which GI symptoms are associated with the hindgut?
There are five gastrointestinal symptoms that can be considered hindgut symptoms:
Constipation is commonly defined as fewer than three bowel movements per week, whereas obstipation is the inability to pass stool or gas. On the other hand, melena is the passage of dark or tarry stools. It is commonly caused by bleeding from an upper GI source, but can be due to bleeding anywhere in the GI tract.
The passage of bright red blood from the rectum, also known as hematochezia, is similar to melena because it can stem from anywhere in the GI tract. In fact, the most common cause of a lower GI bleed is from an upper GI source.
What about GI symptoms that are not easily localized?
There are eight other common gastrointestinal symptoms that don’t easily fall into an anatomical category:
- Weight loss (unintentional)
- Weight gain (unintentional)
Malaise refers to a lack of well-being or an overall feeling of discomfort. Icterus (e.g., jaundice) involves yellowing of the skin or sclera. Icterus is also referred to as scleral icterus. Edema and bloating may be associated with pain.
It is also extremely helpful to ask if the patient experiences any other associated symptoms and when the gastrointestinal symptoms occur—before, after, or during the pain. There are several other symptoms that the patient may complain of when they experience abdominal pain. Often, these coexist with a chief complaint of abdominal pain. These symptoms can stem from other systems such as the urological and gynecological systems.
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