(BQ) Part 2 book "Davidson's essentials of medicine" has contents: Gastrointestinal and nutritional disorders, liver and biliary tract disease, blood disease, neurological disease, skin disease, laboratory reference ranges, interpreting key investigations,. and other contents. | Gastrointestinal and nutritional disorders 12 Diseases of the GI tract are a major cause of morbidity and mortality. Approximately 10% of all GP consultations in the UK are for indigestion, and 1 in 14 is for diarrhoea. Infective diarrhoea and malabsorption are responsible for much ill health and many deaths in the developing world. PRESENTING PROBLEMS IN GASTROINTESTINAL DISEASE Dysphagia Dysphagia means difficulty in swallowing, as distinct from globus sensation (a ‘lump’ in the throat without organic cause) and odynophagia (pain during swallowing). Oropharyngeal dysphagia results from neuromuscular dysfunction that affects swallowing, causing choking, nasal regurgitation or tracheal aspiration. Drooling, dysarthria, hoarseness and other neurological signs may be present. Oesophageal causes include benign or malignant strictures and oesophageal dysmotility. Patients complain of food ‘sticking’ after swallowing, although swallowing of liquids is normal until stric tures become extreme. Endoscopy is preferred to facilitate biopsy and dilatation of stric tures. Videofluoroscopic barium swallow will detect most motility disorders. Oesophageal manometry is occasionally required. Dyspepsia Dyspepsia (‘indigestion’) may arise from within or outside the gut (Box ). Heartburn and other ‘reflux’ symptoms are separate and are considered elsewhere. Although symptoms correlate poorly with diagnosis, careful history may reveal classical symptoms of peptic ulcer, ‘alarm’ features requiring urgent investigation (Box ) or symptoms of other disorders. Dyspepsia affects up to 80% of the population at some time, often with no abnormality on inves tigation, especially in younger patients. Examination may reveal anaemia, weight loss, lymphadenopathy, abdominal masses or liver disease. Patients with ‘alarm’ symptoms, G A S T R O I N T E S T I N A L A N D N U T R I T I O N A L D I S O R D E R S • 12 CLINICAL EXAMINATION OF THE GASTROINTESTINAL TRACT Head and neck .
