7. Patient Presentations Related to the Gastrointestinal System and Nutritional Health
Patient presentations span all relevant age categories, special populations, and varied clinical settings.
7.1 |
Jaundice |
7.2 |
Ascites |
7.3 |
Anorexia |
7.4 |
Nausea, Vomiting, and Hematemesis |
7.5 |
Disorders of Bowel Frequency and Evacuation |
7.6 |
Abdominal Pain |
7.7 |
Abdominal, Gastrointestinal, and GI tract Masses, Cancers, and Organomegaly |
7.8 |
Melena/Hematochezia/Anorectal Rectal Bleeding and Pain |
7.9 |
Heartburn and Reflux |
7.10 |
Oropharyngeal and Dental Pain and Lesions |
7.11 |
Issues of Weight |
7.12 |
Abdominal Trauma |
7.13 |
Dysphagia and Odynophagia |
7.14 |
Foreign Body in Gastrointestinal Tract |
7.15 |
Abdominal Wall Abnormalities |
7.16 |
Physical Exam Findings Related to the Gastrointestinal System and Nutritional Health |
7.17 |
Laboratory Test Findings and Diagnostic Imaging Related to the Gastrointestinal System and Nutritional Health |
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 (eg, peritonitis, gastroenteritis, appendicitis, mesenteric adenitis); sickle cell crises; mesenteric ischemia • anorectal conditions, including fissures, pain, hemorrhoids, pruritis ani, encopresis/stool incontinence • ascites due to liver disease (eg, cirrhosis, portal hypertension), malignancy, congestive heart failure, renal failure • bleeding, lower or upper gastrointestinal; overt gastrointestinal; in stool (eg, occult, melena, hematochezia) • bowel conditions, acute or chronic – constipation, flatus, obstruction, intussusception, volvulus, obstipation, ischemic bowel; fecal impaction; adhesions; diverticulitis, diverticulosis; ileus, meconium ileus; gastroparesis; infantile colic; Meckel diverticulum • dental disease and conditions – abscess, gingival abnormalities, periodontal disease • diabetesrelated conditions (eg, 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 tear, Barrett esophagus • feeding and nutrition – feeding tubes, total parenteral nutrition • gallbladder conditions – cholecystitis, cholelitihiasis, cholestasis • gastroesophageal disorders – foreign body (eg, 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 • gastrointestinal disorders – parasites (eg, 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 (eg, 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 (eg, lactase, disaccharidase); steatorrhea; short-bowel syndrome • mouth disorders (eg, 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; with hematemesis from irritable bowel syndrome, pyloric stenosis, or other systemic cause (eg, 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 • amylase • bilirubin, total serum and conjugated • carcinoembryonic antigen level • Clostridium difficile testing • computed tomography imaging • elevated liver enzymes • fluoroscopy • Helicobacter pylori stool antigen or breath tests • lipase • magnetic resonance imaging • nuclear imaging • radiography • serum ascites-albumin gradient • sonography • stool culture • stool for ova and parasites • tissue transglutaminase antibodies, antimicrobial antibodies • viral hepatitis panels