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Symptoms of dyspepsia

, medical expert
Last reviewed: 04.07.2025
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Symptoms included in dyspepsia syndrome and their definition

Symptom

Definition

Pain localized in the epigastric region along the midline

Pain is subjectively perceived as an unpleasant sensation, some patients may feel as if tissue is damaged. Other symptoms may bother the patient, but not be defined by him as pain. When questioning the patient, it is necessary to distinguish pain from a feeling of discomfort

Discomfort localized in the epigastric region along the midline

A subjectively unpleasant sensation that is not interpreted by the patient as pain and, upon closer examination, may include the symptoms listed below.

Early saturation

A feeling of fullness in the stomach immediately after starting a meal, regardless of the amount of food consumed, resulting in the meal not being completed

Overflow

An unpleasant feeling of food retention in the stomach, which may or may not be related to food intake

Bloating in the epigastric region

A feeling of distension in the epigastric region, which must be distinguished from visible bloating

Nausea

Feeling sick and about to vomit

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Dyspeptic syndrome

Dyspeptic syndrome is characteristic of acute food poisoning, salmonellosis, escherichiosis, gastrointestinal forms of yersiniosis, rotavirus gastroenteritis and other viral diarrhea, the initial period of botulism, and is possible in the pre-icteric period of viral hepatitis.

Dyspepsia syndrome is also observed in various organic lesions and functional disorders of the gastrointestinal tract. In cases where dyspepsia symptoms are caused by diseases such as peptic ulcer, gastroesophageal reflux disease, malignant tumors, cholelithiasis and chronic pancreatitis, it is customary to speak of organic dyspepsia syndrome. If, upon careful examination of the patient, the above diseases are not detected, it is legitimate to make a diagnosis of functional (non-ulcer) dyspepsia.

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Stomach ache

Abdominal pain is one of the main symptoms of acute diarrheal infections. Their localization and nature depend on the predominant localization and prevalence of the inflammatory process in the intestine. Acute enteritis is characterized by cramping pain throughout the abdomen. In acute colitis, the pain is cramping, localized in the iliac regions. In distal colitis (proctosigmoiditis), characteristic of the typical colitic variant of shigellosis, patients are bothered by pain in the left iliac region, and a painful spasmodic sigmoid colon is palpated.

Differential diagnostics

In differential diagnostics of pain syndrome, the most important is the recognition of acute surgical and gynecological pathology, in which the patient's stay in an infectious hospital and delay in surgical intervention can irreparably affect the outcome of the disease. Acute appendicitis, cholecystitis, pancreatitis, intestinal obstruction, thrombosis of the mesenteric vessels, perforation of a hollow organ, disrupted ectopic pregnancy, torsion of the ovarian cyst pedicle, pelvic peritonitis, ovarian apoplexy can occur under the guise of acute intestinal infections.

Pain in the epigastric region, similar to that in gastritis and gastroenteritis variants of acute food toxic infections, is possible in myocardial infarction, most often when it is localized in the area of the posterior wall of the left ventricle, in pneumonia, especially lower lobe. Unlike abdominal pain of other etiologies, in acute diarrheal infections the pain is cramping, there is no clear local soreness and symptoms of peritoneal irritation.

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Vomit

Vomiting in acute diarrheal infections is observed quite often. It can be single, repeated or multiple; scanty or profuse ("vomiting with a full mouth"); with eaten food, with bile, with blood. Vomiting in acute diarrheal infections occurs as a result of inflammatory changes in the mucous membrane, increased permeability of cell membranes due to the action of the endotoxin-LPS of the pathogen and significant release of fluid into the lumen of the upper gastrointestinal tract, reverse peristalsis. Intoxication syndrome, characteristic of most acute diarrheal infections, plays a major role in the development of vomiting. Vomiting due to intoxication is often noted in the initial period of infections that do not belong to the group of acute diarrheal infections (erysipelas, meningococcal infection, tropical malaria). Vomiting may be a symptom of acute surgical and gynecological diseases, toxicosis of the first half of pregnancy, decompensation of diabetes mellitus, withdrawal syndrome in patients with chronic alcoholism and drug addiction, poisoning with salts of heavy metals, poisonous mushrooms, organophosphorus compounds and alcohol substitutes. Taking into account the preceding nausea and immediate relief after vomiting allows us to distinguish its gastritis genesis from cerebral, when these two signs are absent. Cerebral vomiting is characteristic of a hypertensive crisis, subarachnoid hemorrhage, acute cerebrovascular accident.

Diarrhea

Diarrhea is observed in most patients with acute diarrheal infections. Most often, it becomes the first reason for visiting a doctor.

There are four known types of diarrhea, caused by different pathogenetic mechanisms:

  • secretory;
  • hyperexudative;
  • hyperosmolar:
  • hyper- and hypokinetic.

Each intestinal disease is characterized by one or another type of diarrhea, and sometimes a combination of them.

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Secretory diarrhea

The basis for the development of secretory diarrhea is increased secretion of sodium and water into the intestinal lumen. Less often, it is caused by a decrease in the absorption capacity of the intestine. An example of secretory diarrhea is diarrhea in cholera. Exotoxin (cholerogen) penetrates through receptor zones into enterocytes and activates adenylate cyclase, which promotes increased synthesis of cyclic adenosine monophosphate (cAMP). This leads to increased secretion of electrolytes and water into the intestinal lumen by enterocytes. A certain role is given to prostaglandins, which stimulate the synthesis of cAMP. In addition to cholera, secretory diarrhea is also observed in other acute diarrheal infections - salmonellosis, escherichiosis, klebsiella. It can also occur in diseases of a non-infectious nature: terminal ileitis. postcholecystectomy syndrome, damage to the pancreas (so-called pancreatic cholera), villous adenoma of the rectum. In secretory diarrhea, the osmotic pressure of feces is lower than the osmotic pressure of blood plasma. The feces of patients are watery, abundant, sometimes green.

Hyperexudative diarrhea

The occurrence of hyperexudative diarrhea is caused by the secretion of mucus and the oozing of blood plasma and serum proteins into the intestinal lumen. This type of diarrhea is characteristic of inflammatory processes in the intestine, including shigellosis, campylobacteriosis, salmonellosis and clostridiosis. Hyperexudative diarrhea is also possible with non-infectious diseases, in particular with ulcerative colitis, Crohn's disease, lymphoma and intestinal carcinoma. The osmotic pressure of feces is higher than the osmotic pressure of blood plasma. Feces in patients are liquid, with an admixture of mucus, blood and pus.

Hyperosmolar diarrhea

This type of diarrhea is possible with some acute diarrheal infections due to impaired absorption in the small intestine.

Hyperosmolar diarrhea is observed in malabsorption syndrome, impaired absorption of one or more nutrients in the small intestine and metabolic disorders. The basis for the development of malabsorption syndrome is considered to be not only morphological changes in the mucous membrane, but also functional disorders of enzyme systems, motility and transport mechanisms, as well as developing dysbacteriosis. Malabsorption is the pathogenetic basis for the development of diarrhea in rotavirus gastroenteritis. Hyperosmolar diarrhea is possible with the abuse of saline laxatives. The osmotic pressure of feces is higher than the osmotic pressure of blood plasma. Feces in patients are abundant, liquid, with an admixture of semi-digested food.

Hyper- and hypokinetic diarrhea

This type of diarrhea occurs when intestinal transit is disrupted due to increased or decreased intestinal motility. It is often observed in patients with irritable bowel syndrome, neuroses, and abuse of laxatives and antacids. The osmotic pressure of feces corresponds to the osmotic pressure of blood plasma. Feces in patients are liquid or mushy, not abundant.

Dehydration

Dehydration is a major syndrome that develops as a result of damage to the gastrointestinal tract in acute diarrheal infections, caused by the loss of fluid and salts by the body during vomiting and diarrhea. Dehydration of varying degrees occurs in most acute intestinal infections. In adults, an isotonic type of dehydration develops. Transudation of protein-poor isotonic fluid occurs, which cannot be reabsorbed in the large intestine. Hemoconcentration increases. Not only water is lost, but also electrolytes Na +, K -, CL -. Dehydration syndrome in acute diarrheal infections often leads to metabolic acidosis, in severe cases - decompensated. Rarely, with a predominance of vomiting, metabolic alkalosis is possible.

V.I. Pokrovsky (1978) proposed a classification of dehydration by its severity. According to this classification, four degrees of dehydration are distinguished: at degree I, the loss of body weight does not exceed 3%, at degree II - 4-6%, at degree III - 7-9%, at degree IV - 10% or more. With severe dehydration, hypovolemic shock develops. The characteristics of degree II dehydration correspond to phase I shock (compensated), degree III - to phase II shock (subcompensated), degree IV - to phase III shock (decompensated).

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