7. Patient Presentations Related to the Gastrointestinal System and Nutritional Health

Patient presentations span all relevant age categories, special populations, and varied clinical settings.

The guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

abdominal conditions, acute or chronic – distention, trauma (blunt or penetrating, splenic rupture/splenomegaly); abdominal aortic aneurysm; abdominal wall hernias; pulsatile masses • abdominal pain, acute or chronic (localized and diffuse/generalized); radiating to extra-abdominal location; infection (e.g., peritonitis, gastroenteritis, appendicitis, mesenteric adenitis); sickle cell crises; mesenteric ischemia • anorectal conditions, including fissures, pain, hemorrhoids, pruritus ani, encopresis/stool incontinence • ascites due to liver disease (e.g., cirrhosis, portal hypertension), malignancy, heart failure, renal failure • bleeding, lower or upper gastrointestinal; overt gastrointestinal; in stool (e.g., occult, melena, hematochezia) • bowel conditions, acute, chronic, or inflammatory – constipation, flatus, obstruction, intussusception, volvulus, obstipation, ischemic bowel; inflammatory bowel disease (Crohn disease, ulcerative colitis); fecal impaction; adhesions; diverticulitis, diverticulosis; ileus, meconium ileus; gastroparesis; infantile colic; Meckel diverticulum • dental disease and conditions – abscess, gingival abnormalities, periodontal disease • diabetes-related conditions (e.g., gastroparesis, ketoacidosis) • eating disorders – bulimia, anorexia (including anorexia due to drugs); metabolic disorders, mood disorders; laxative abuse • esophageal and pharyngeal disorders – epiglottitis, esophagitis, oropharyngeal or esophageal dysphagia, retropharyngeal abscess, hernia, stricture, varices, Mallory-Weiss syndrome, Boerhaave sign, Barrett esophagus • feeding and nutrition – feeding tubes, total parenteral nutrition • gallbladder conditions – cholecystitis, cholelitihiasis, cholestasis • gastroesophageal disorders – foreign body (e.g., ingested food boluses and non-food items such as bones, fruit pits, broken teeth, dental appliances); gastroesophageal reflux disease; gastritis; peptic ulcer disease, Helicobacter pylori infection • gastrointestinal disorders – parasites (e.g., helminths and protozoa), polyps, stomas • Henoch-Schönlein purpura • hernias, direct and indirect – inguinal, abdominal wall, hiatal, esophageal • Kawasaki disease • lesions, gastrointestinal, including erosions, blisters, white lesions, neoplasms • liver conditions, including fatty liver; hepatitis; jaundice, infection-induced (e.g., bacterial, parasitic, viral) or neonatal (prehepatic [physiologic or pathologic], hepatic, or posthepatic hyperbilirubinemia); hepatomegaly; masses; iron storage disorder (hemochromatosis) • malabsorption conditions, acute and chronic – diarrhea; celiac diseases; immune or enzyme deficiency (e.g., lactase, disaccharidase); steatorrhea; short-bowel syndrome • mouth disorders (e.g., mucous membrane disorders, such as oral ulcers); tongue abnormalities • muscle strain, abdominal • nausea and vomiting – due to drugs/toxins/poisoning, food allergy, infections; hyperemesis gravidarum; pediatric vomiting; hematemesis; irritable bowel syndrome; pyloric stenosis; other systemic cause (e.g., uremia, central nervous system and psychiatric conditions) • pancreatitis • tumors, including primary and secondary gastrointestinal and abdominal organ malignancies

CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

PHYSICAL EXAM FINDINGS
abdominal and inguinal palpation, rigidity, tenderness • abdominal auscultation, bowel sounds • abdominal percussion • asterixis • Cullen sign • fluid thrill or wave • Grey Turner sign • Murphy sign • peritoneal signs • puddle maneuver • shifting dullness

LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
alkaline phosphatase levels • amylase levels • bilirubin levels, total serum and conjugated • carcinoembryonic antigen levels • Clostridium difficile testing • CT scanning • fluoroscopy • Helicobacter pylori stool antigen or breath tests • lipase levels • liver enzyme levels • magnetic resonance imaging • nuclear medicine imaging • radiography • serum ascites-albumin gradient • stool culture • stool for ova and parasites • tissue transglutaminase antibody or antimicrobial antibody levels • ultrasonography • viral hepatitis panels