The digestive system is made up of the gastro-intestinal tract which is a continuous tract from mouth to rectum. It consists of mouth, oesophagus, stomach, small intestine, large intestine and rectum. It also has 3 accessory organs which take products from the circulation surrounding the GIT to the liver where it is filtered and excreted in the form of bile back into the GIT.
Food is broken down by the stomach and absorbed by the intestines.
Substances pass through the intestine walls into the circulation which goes via the liver back to the heart. Bile is created when the liver filters this supply of blood. It is then stored in the gallbladder to be excreted into the intestines later. The sphincter of oddi governs when this bile is excreted. The pancreas uses the same duct as the bile does to excrete digestive enzymes into the intestines. It also excretes hormones; this will be covered in the endocrine system section.
Physical Examination
In each examination one must always begin by observing the patient. Look at the creases on their palm for pink lines, if these are pale it can indicate poor peripheral circulation or anaemia. If the palm is particularly red it may indicate liver failure. If the patient has yellow skin this is jaundice and may indicate liver problems such as cirrhosis and liver failure. You may also notice spider naevi which will indicate the same things but is usually ignored by physicians unless there are at least 5 of them on the body. Then look at the nails for Terry’s nail (a sign of liver cirrhosis), clubbing (a sign of irritable bowel diseases) and splinter haemorrhaging. Then move to the face looking at the patient sclera (pull down the eyes for this) if it is particularly pale this may indicate anaemia as will ankylosing stomatitis in the corners of the mouth. Yellow conjunctivae also indicates cirrhosis and jaundice. Look at the patients mouth for ulcers (may indicate crohn’s disease), healthy teeth (bad dentures will make digestion harder) and fillings (possible cause of mercury poisoning).
Before beginning ask the patient if they need to wee or are on their period or pregnant if a woman. Ask the patient to lay back on the bed and pull their shirt up to either their bra line (if a woman) or just high enough so the entire abdomen is uncovered this may involve rolling the trousers down over the hips. Usually one would palpate, percuss then auscultate but in the case of the abdominal examination this occurs in reverse due to not wanting to move the contents of the bowel or cause unnecessary pain. Firstly observe the abdomen for striae (child bearing, cushing’s syndrome or steroids can cause this), distension caused by the 6 f’s (fat, flatus, faeces, foetus, fluid, fibroids), scars (perhaps from an appendectomy), and look across the abdomen surface to observe a healthy abdominal aortic pulsation. Then listen to the abdomen for normal bowel movements. Percuss the 9 areas listening for the dullness of a bolus or a sign of pathology. Then lightly palpate to locate any areas of tenderness. Deeply palpate the same areas to feel for masses which may be the source of pain. Then move on to finding the accessory organs.
Firstly, percuss for the liver from the hip upwards as this is where the liver will expand to when enlarged. Then palpate for the liver. A healthy liver should sit about the ribs and be very difficult to feel. An unhealthy one may be hard and enlarged and usually painful. This indicates hepatitis, cirrhosis and liver failure.
Secondly, percuss diagonally from the belly button to the spleen as this is where it will expand to. Then ask the patient to breathe in and percuss then ask them to breathe out and percuss again. There should be no change in tympany. If there is the spleen may be enlarged (splenomegaly).
Lastly, palpate for the kidneys by placing your hands over them and then on their in breathe push down briskly to the back of the patient and try to grab the kidney. When they breathe out it should slip away from your hand. (This is very difficult and usually uncomfortable for the patient).
Shifting dullness is a special test for ascites. One must have the patient lie supine (flat) and percuss outwards from the belly button outwards and towards the feet as if they were sun rays. Listen for when the sound changes, this is the current level of fluid (inaudible in a normal person usually). Then have them turn to one side to the fluid settles on one side then percuss again from the bottom up (from one side of the body to the other). In a healthy person the level of fluid won’t have changed much but in someone with ascites it would change and the higher it is the more fluid there is. You would usually be able to observe distension in these patients.
Digestive System Pathologies
Irritable bowel syndrome is a collection of symptoms which have been identified to occur frequently without any known organic cause. It can be characterised by diarrhoea or constipation alike.
Crohns disease (IBD) is a form of irritable bowel disease. This has similar symptoms as irritable bowel syndrome but the pain is usually localised to the area which is ulcerated. The ulcers can occur at any point in the gastro intestinal tract from mouth to rectum. However, ulcers that occur in the stomach are usually called peptic (meaning stomach) ulcers.
Diverticulitis (IBD) is another form of irritable bowel disease. It is characterised by many diverticular which have become inflamed. Before this occurs you can have diverticular disease (multiple diverticular or diverticulosis) without any symptoms or problems caused by it.
Hiatal hernia occurs when a defect in the diaphragm allows the stomach to push up past it. This has almost identical symptoms to GERD and usually is only diagnosed accidently when a barium swallow test is done.
Gastric reflux (GERD) is when gastric juices from the stomach make its way back up the oesophagus which causes a burning sensation as it goes.
Appendicitis is inflammation of the appendix, the exact cause is unknown but it can cause severe pain and as the function of the appendix is unknown (or has none depending who you talk to) it is usually removed (appendectomy) to treat the pain.
Cancers of the GIT make up 20% of all cancers diagnosed and should therefore always be ruled out when treating someone with GIT complaints.
Cirrhosis of the liver occurs after serious hepatic cells die (necrosis). Then they can not perform their function and give rise to symptoms like jaundice, spider naevi, abdominal distension, itching, nosebleeds, fluid in the lungs, mental changes, dry skin and liver enlargement (hepatomegaly).
Heptatits is inflammation of the liver, in this case cell death occurs due to an organic cause, usually an infection. This gives rise to similar symptoms as cirrhosis.
Gall stones are formed cholesterol and if large enough are operated on but often they are passed naturally but painfully by the patient whilst weeing.
Pancreatitis is inflammation of the pancreas which usually occurs as a result of gall stones as well. They are usually caught in the common bile duct or just before the sphincter of oddi in this case.
Cholecystitis is inflammation of the gall bladder usually occurring when gall stones get caught in the cystic duct.
Candida albicans is a fungus which always lives in our guts but if we change the environment in our gut by eating too much sugar, taking oral contraceptives, taking recreational drugs or antibiotics we disturb the balance of micro flora and give candida a chance to proliferate. When this happens it can cause gas, bloating, indigestion, mental confusion, heart burn, nausea, constipation or diarrhoea, mood swings, sugar cravings, depression, fatigue, pre-menstrual syndrome and low immunity.
Giardia is a parasite. It lives in the small intestine and causes symptoms of diarrhoea, fatigue, excessive gas, abdominal pain, bloating, nausea, low appetite, possibly vomiting and weight loss.
Herbs for the Digestive System
Plantago psyllium; this acts as a bulking agent for those with diarrhoea.
Althea officinalis: this is a mucilaginous herb which coats the digestive tract and soothes it in the case of IBS and IBD
Glycyrrhiza glabra; this too is mucilagenous
Chamomilla recutita; this herb helps promote good gut bacteria after having had a serious viral infection e.g. giardia
Curcuma longa; this also helps promote good bacteria in the gut.
Cinamommum zeylanicum; almost all the spices from India help with ailments such as wind, gut dysbiosis.
Zingiber officinalis; this helps the GIT through the promotion of serotonin in the gut
Silybum marianum; this herb helps liver cells regenerate faster, this is known as a liver tonic
Taraxacum officinalis radix; this is a liver tonic as well
Calendula officinalis; this is not specific to the GIT but it promotes healing of tissue and can be helpful in cases of IBD
Nice post. Well what can I say is that these is an interesting and very informative topic on gut ailments
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