Alimentary Symptoms

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Disorders of the alimentary tract may present with a wide range of symptoms including painful mouth, difficulty in swallowing (dysphagia), nausea and vomiting, abdominal pain, heartburn, indigestion (dyspepsia), toss of appetite (anorexia), weight loss, abdominal distension, alLered bowel habit, rectal bleeding and jaundice (Table 5.1). Sometimes, alimentary disease is suggested only by the occurrence of a secondary feature such as anaemia. Occasionally palienls may conceal important symptoms such as rectal bleeding

TABLE 5.2 Common causes of a painful mouth

Idiopathic

Recurrent aphthous mouth ulcers

Infections

Candidiasis Dental sepsis

Herpes simplex virus (HSV1) Coxsackie A virus, herpangina, hand-foot-mouth disease Vincents angina (ulcerative gingivitis) Glandular fever

Miscellaneous

Trauma from teeth/dentures Leukoplakia, carcinoma

Associated with systemic disorder

Drug allergies, e.g. sulphonamides, gold, cytotoxics Iron, folate, vitamin Bl2 deficiency Leucopenia, acute leukaemia Reiter's syndrome, Behcet's disease Crohn's disease, ulcerative colitis, coeliac disease

Associated with skin disorder

Lichen planus, erythema multiforme Pemphigoid, pemphigus vulgaris

because of embarrassment, a belief that the cause is trivial or fear of serious illness. The clinician should not only listen carefully to the patient's presenting complaints but also enquire systematically about the other principal symptoms of abdominal disease. It is important to remember that alimentary symptoms may develop in response to emotional distress.

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