Symptoms of dyspepsia

Symptoms of dyspepsia and their definition

Symptom	Definition
Pain localized in the epigastric region by the median line	The pains are subjectively perceived as unpleasant sensations, some patients can feel damage to tissues. Other symptoms may disturb the patient, but not be identified as pain. When questioning a patient, one must distinguish between pain and discomfort
Discomfort localized in the epigastric region along the median line	A subjective unpleasant sensation that is not interpreted by the patient as pain and in more detailed evaluation. May include the symptoms listed below
Early saturation	The feeling that the stomach is full immediately after the start of the meal, regardless of the amount of food taken, so that the meal can not be completed
Overflow	An unpleasant sensation of food delay in the stomach, it may or may not be related to food intake
Inflammation in the epigastric region	Feeling of raspiraniya in the epigastric region, it must be distinguished from a visible bloating
Nausea	Feeling of faintness and approaching vomiting

[1], [2], [3], [4]

Dyspeptic Syndrome

Dyspeptic syndrome is typical for acute food-borne infections, salmonellosis, escherichiosis, gastrointestinal forms of yersiniosis, rotavirus gastroenteritis and other viral diarrhea, the initial period of botulism, is possible in the pre-jaundiced period of viral hepatitis.

The syndrome of dyspepsia is also observed in various organic lesions and functional disorders of the gastrointestinal tract. In those cases when the symptoms of dyspepsia are caused by diseases such as peptic ulcer, gastroesophageal reflux disease, malignant tumors, cholelithiasis and chronic pancreatitis, it is customary to talk about the syndrome of organic dyspepsia. If, with a thorough examination of the patient, these diseases are not identified, it is legitimate to diagnose functional (non-ulcer) dyspepsia.

[5], [6], [7],

Stomach ache

Abdominal pain is one of the main symptoms of acute diarrheal infections. Localization and character of them depend on the primary localization and prevalence of the inflammatory process in the intestine. Acute enteritis is characterized by cramping pains throughout the abdomen. In acute colitis, cramping pains are localized in the iliac regions. In distal colitis (proctosigmoiditis), typical of a typical colitis variant of shigellosis, patients are concerned about pain in the left ileal region, palpable painful spasmodic sigmoid colon.

Differential diagnostics

In the differential diagnosis of pain, the most important is the recognition of acute surgical and gynecological pathology, in which the patient's stay in the infectious hospital and the delay in surgical intervention can irreparably affect the outcome of the disease. Under the guise of acute intestinal infections, acute appendicitis, cholecystitis, pancreatitis, intestinal obstruction, mesenteric vascular thrombosis, hollow organ perforation, abnormal ectopic pregnancy, tibial ovary cicatrix, pelvic peritonitis, ovarian apoplexy can occur.

Pain in the epigastric region, similar to those in the gastritic and gastroenteric variant of acute foodborne infections, is possible with myocardial infarction, most often when it is localized in the back wall of the left ventricle, with pneumonia, especially the lower lobe. Unlike the pain in the abdomen of another etiology in acute diarrheal infections, the pain is cramping, there is no clear local soreness and symptoms of irritation of the peritoneum.

[8], [9]

Vomiting

Vomiting in acute diarrheal infections is observed quite often. It can be single, repeated or multiple; scanty or plentiful ("vomiting full mouth"); eaten food, with bile, with blood. Vomiting in acute diarrheal infections occurs as a result of inflammatory changes in the mucosa, increased permeability of cell membranes due to the action of endotoxin-LPS of the pathogen and a significant discharge of fluid into the lumen of the upper gastrointestinal tract, reverse peristalsis. An important role in the development of vomiting is played by the intoxication syndrome, which is characteristic of most acute diarrheal infections. Vomiting due to intoxication is often noted in the initial period of infections not belonging to the group of acute diarrhea (mug, meningococcal infection, tropical malaria). Vomiting can 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 fungi, organophosphorus compounds and alcohol substitutes. The account of previous nausea and immediate relief after vomiting makes it possible to distinguish gastritis from cerebral genesis when these two traits are absent. Cerebral vomiting is characteristic for hypertensive crisis, subarachnoid hemorrhage, acute disturbance of cerebral circulation.

Diarrhea

Diarrhea is observed in most patients with acute diarrheal infections. More often than not, she becomes the first reason to see a doctor.

There are four types of diarrhea due to various pathogenetic mechanisms:

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

Each disease of the intestine is characterized by a particular type of diarrhea, and sometimes their combination.

[10], [11], [12], [13],

Secretory diarrhea

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

Hyperexudative diarrhea

The emergence of hyperexcudative diarrhea is due to the release of mucus and the swelling of blood plasma and serum proteins into the lumen of the intestine. This type of diarrhea is typical for inflammatory processes in the intestine, including shigellosis, campylobacteriosis. Salmonellosis and clostridiosis. Hyperexudative diarrhea is also possible with non-infectious diseases, in particular ulcerative colitis, Crohn's disease, lymphoma and intestinal carcinoma. Osmotic pressure of fecal masses is higher than the osmotic pressure of blood plasma. Faeces in patients with liquid, with an admixture of mucus, blood and pus.

Hyperosmolar diarrhea

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

Hyperosmolar diarrhea is observed in malabsorption syndrome, malabsorption of one or several nutrients in the small intestine and disturbance of metabolic processes. The basis for the development of malabsorption syndrome is considered not only morphological changes in the mucous membrane, but also functional disorders of enzyme systems, motor and transport mechanisms, as well as developing dysbacteriosis. Malabsorption is the pathogenetic basis of the development of diarrhea in rotavirus gastroenteritis. Hyperosmolar diarrhea is possible with the abuse of salt laxatives. Osmotic pressure of fecal masses is higher than the osmotic pressure of blood plasma. Feces in patients are plentiful, liquid, with an admixture of half-digested food.

Hyper- and hypokinetic diarrhea

This type of diarrhea occurs when there is a violation of transit of intestinal contents caused by increased or decreased intestinal motility. It is often observed in patients with irritable bowel syndrome, with neuroses and abuse of laxatives and antacids. Osmotic blood pressure corresponds to the osmotic pressure of the blood plasma. Faeces in patients are liquid or mushy, ungrowth.

Dehydratation

Dehydration (dehydration) is the most important syndrome that develops as a result of a gastrointestinal lesion in acute diarrheal infections due to loss of body fluid and salts during vomiting and diarrhea. Dehydration of various degrees occurs with the majority of acute intestinal infections. In adults, the isotonic type of dehydration develops. There is a transsudation of protein-poor isotonic fluid that can not be reabsorbed in the large intestine. The hemoconcentration increases. There is a loss not only of water, but also electrolytes Na ⁺, K ^-, CL ^-. Syndrome of dehydration in acute diarrheal infections often leads to metabolic acidosis, in severe cases - decompensated. Occasionally, with the prevalence of vomiting, metabolic alkalosis is possible.

IN AND. Pokrovsky (1978) proposed the classification of dehydration in terms of its severity. According to this classification, there are four degrees of dehydration: at grade I, weight loss does not exceed 3%, at grade II - 4-6%, at grade III - 7-9%, at grade IV - 10% or more. With pronounced dehydration, hypovolemic shock develops. The characteristic of the 2nd degree of dehydration corresponds to the I phase of shock (compensated), III degree - to the II phase of shock (subcompensated), IV degree - to the III phase of shock (decompensated).

[14], [15], [16]