Y Heart Burn It is a burning pain or discomfort in retrosternal area, that usually occurs after meals The patient may experience a sour taste coming up into his mouth It is particularly associated with gastroesophageal reflux disease Mechanism: regurgitation of gastric contents into the oesophagus Aggravating factors: ▪ Stooping, bending or lying supine ▪ Fatty meals, coffee, alcohol, chocolates Relieving factors: antacids, anti-ulcer drugs Causes of heartburn: gastroesophageal reflux disease (GERD), acute gastritis, oesophagitis, pregnancy Causes of GERD: obesity (increased intra-abdominal pressure which overwhels lower oesophageal sphinctor) , lower oesophageal sphincter pressure (leads to inappropriate lower oesophageal sphinctor), decreased oesophageal peristalsis, gastric acid hypersecretion, delayed gastric emptying, overeating, certain foods (cafeine, fatty, or spicy foods), hiatus hernia (protrusion (herniation) of the cardia and/or fundus into the thorax).
Melaena is the passage of altered blood PR. A melaena stool is black and tarry and has a characteristic smell. The blood is degraded by hydrochloric acid and intestinal enzymes high in the gastrointestinal tract. Melaena is unlikely to occur if bleeding comes from lower than the jejunum, although occasionally melaena may result from a bleeding Meckel’s diverticulum. CAUSES SWALLOWED BLOOD • Epistaxis • Haemoptysis OESOPHAGUS • Reflux oesophagitis • Oesophageal varices • Oesophageal carcinoma STOMACH • Peptic ulceration • Acute gastric erosions • Mallory–Weiss syndrome • Carcinoma • Leiomyoma (gastro-intestinal stromal tumour – GIST) • Hereditary haemorrhagic telangiectasia • Vascular malformations DUODENUM • Peptic ulceration • Duodenal diverticulae • Aortoduodenal fistulae • Invasive pancreatic tumours • Haemobilia SMALL INTESTINE • Leiomyoma (gastro-intestinal stromal tumour – GIST) • Meckel’s diverticulum BLEEDING DISORDERS • Liver disease-associated Thrombocytopenia • Haemophilia DRUGS • Anticoagulants • Aspirin • NSAIDs • Steroids OTHERS • Uraemia • Connective tissue disorders
Hiccup (hiccough)
Hiccup:
▪ It is a spasmodic contractions of diaphragm
▪ Results in spasmodic breathing with the glottis is closed
▪ Accompanied by a characteristic sound (hic)
Usually it is a self-limited benign condition, lasting for a few minutes,
but may be intractable (lasting for weeks or even months), and may
indicate serious conditions
Causes of hiccup include gastric irritations, aerophagy, carbonated
drinks, rapid eating, spicy foods, renal failure, alcohol, stroke, multiple
sclerosis, brain tumours