Category Archives: Internal Medicine

What are the symptoms and manifestations of proctitis?

Proctitis is inflammation limited to the distal 12–15 cm of the rectum. It may be acute or chronic, infectious, inflammatory, ischemic, or radiation-induced. Because the rectum stores stool just before defecation, even limited mucosal irritation produces prominent local symptoms that patients notice immediately.

Core rectal symptoms

Tenesmus: a persistent, often painful urge to defecate despite an empty rectum; may interrupt sleep.
Urgency: sudden, compelling need to reach a toilet; accidents occur if access is delayed.
Frequent, small-volume stools: 5–10 passages daily, each <50 g, sometimes only mucus or blood.
Rectal bleeding: bright red streaks on toilet paper, coating stool, or dripping into the pan; clots are rare unless ulcers are deep.
Mucus discharge: clear, white, or blood-tinged slime either with stool or spontaneously.

Associated discomfort

Burning or aching in the anal canal during and after defecation.
Feeling of incomplete evacuation or “blockage” leading to repeated straining.
Mild cramping in the suprapubic area; pain rarely localizes to the right or left iliac fossa because the inflamed segment is midline.

Systemic and variant clues

Low-grade fever and malaise: suggest bacterial or sexually acquired proctitis.
Nocturnal diarrhea: uncommon; if present, consider proximal extension (proctosigmoiditis).
Skin or oral lesions: concurrent psoriasis, erythema nodosum, or aphthae point toward inflammatory bowel disease.
History of anal-receptive intercourse, recent antibiotic use, or travel: guide microbiologic testing.

Specific context patterns

Radiation proctitis: bleeding 6–18 months after pelvic radiotherapy, often with rectal pain and spasm.
Ischemic proctitis: sudden bloody diarrhea in older adults with vascular risk factors; pain out of proportion to bleeding.
Diversion proctitis: mucus discharge and urgency months after colostomy formation in unused rectal stump.

Red-flag combinations
Continuous bleeding with orthostatic dizziness, passage of large clots or melena (implying proximal source), severe anal pain suggesting abscess or fistula, and weight loss >5 % within 4 weeks.

Summary table

Key symptom	Typical quality	When to suspect extension or complications
Tenesmus	Frequent false urges	Persistence >2 weeks despite topical therapy
Blood on paper	Bright red, scant	Clots or melena → colonoscopy
Mucus only	Clear or pink	Copious pus → culture for STI
Urgency	<5 min warning	Accidents, nocturnal awakening → evaluate proximal spread
Anal pain	Burning during stool	Throbbing, swelling → rule out abscess

What are the symptoms and manifestations of acute gastroenteritis?

Acute gastroenteritis is a sudden inflammation of the stomach and small intestine, most often infectious but sometimes toxin-mediated. It peaks within hours to a few days, resolves within a week in immunocompetent hosts, and ranges from mild discomfort to rapidly dehydrating illness. Recognizing its varied faces guides fluid replacement, diet adjustment, and decisions on medical review.

Cardinal gastrointestinal symptoms

Nausea: an uneasy urge to vomit, sometimes accompanied by hypersalivation.
Vomiting: initially gastric contents, later bile-stained fluid; repeated cycles every 30–60 min suggest viral or food-borne toxin origin.
Diarrhea: watery, occasionally rice-water or bloody; frequency >3 times per day, volume >200 g, lasting <14 days defines the acute window.
Cramping abdominal pain: periumbilical or upper-mid, colicky waves that ease briefly after stool or gas passage.
Hyperactive bowel sounds: audible gurgling or splashing without stethoscope during severe phases.

Systemic and dehydration clues

Low-grade fever 37.5–38.5 °C common in viral and bacterial cases; >39 °C raises suspicion for invasive pathogens.
Malaise, myalgia, headache: part of systemic inflammatory response.
Thirst, dry lips, reduced urine output: early dehydration.
Sunken eyes, delayed skin turgor (>2 s), orthostatic dizziness: moderate to severe fluid loss.
Irritability or lethargy in infants, absence of tears, and sunken anterior fontanel mark critical deficit.

Variant presentations by pathogen group

Viral (rotavirus, norovirus): vomiting precedes diarrhea, fever mild, symptoms resolve in 3–5 days; outbreaks in schools or cruise ships.
Pre-formed toxin (Staphylococcus aureus, Bacillus cereus): sudden onset within 6 h of food, intense vomiting, short duration 12–24 h.
Invasive bacteria (Salmonella, Shigella, Campylobacter): fever >38.5 °C, bloody stools, tenesmus, leukocytes on stool smear.
Cholera-like: profuse painless “rice-water” stools, rapid dehydration, risk of hypovolemic shock within hours.

Red-flag combinations demanding urgent care
Persistent vomiting preventing oral intake, bloody diarrhea with hemodynamic changes, high fever >39 °C with altered consciousness, severe abdominal rigidity or localized rebound, and oliguria despite rehydration efforts.

Summary table

Symptom complex	Typical cause	Home-care threshold
Watery diarrhea, mild fever	Viral	ORS 200 mL after each stool, solids when tolerated
Rice-water stools, no fever	Cholera	Seek care immediately; start ORS en route
Bloody stools, high fever	Invasive bacteria	Medical review for stool culture ± antibiotics
Vomiting every 30 min	Toxin	Small ice-chip sips; if >8 h no keep-down, visit ED
Sunken eyes, dizzy stand	Dehydration	If unable to drink or urine dark/scant, go to hospital

What are the symptoms and manifestations of upper gastrointestinal bleeding?

Upper gastrointestinal bleeding refers to hemorrhage originating from any site between the mouth and the ligament of Treitz. It ranges from trivial ooze noticed only on laboratory testing to catastrophic, life-threatening exsanguination. Rapid recognition of its varied presentations allows timely resuscitation and definitive hemostasis.

Key visual clues
• Hematemesis: vomiting fresh red blood or clots indicates active, usually arterial, bleeding; when gastric acid mixes with blood for minutes the appearance becomes “coffee-ground.”
• Melena: black, tarry, foul-smelling stool that sticks to the toilet bowl; at least 50 mL of blood in the upper tract is needed to produce this change.
• Nasogastric aspiration: bloody return confirms ongoing bleeding; clear bile-stained fluid makes a proximal source unlikely but does not exclude duodenal hemorrhage.
Volume-related symptoms
• Postural dizziness or syncope when standing: suggests ≥15 % circulating volume loss.
• Resting tachycardia (>100 beats/min) and orthostatic drop (>20 mmHg systolic) are early compensatory signs.
• Hypotension, cold clammy extremities, and delayed capillary refill mark hemorrhagic shock (>30 % loss).
• Oliguria and confusion follow if mean arterial pressure remains below 65 mmHg.
Subtle or chronic presentations
• Iron-deficiency anemia: fatigue, pallor, brittle nails, or pica in patients denying overt blood loss; may be the sole clue to a slowly bleeding gastric neoplasm.
• Occult positive fecal immunochemical test in an otherwise asymptomatic individual undergoing screening.
Associated features pointing to specific etiologies
• Epigastric pain relieved by food: peptic ulcer.
• Profuse retching followed by longitudinal mucosal tear: Mallory-Weiss syndrome.
• Severe hematemesis in a patient with cirrhosis, spider nevi, or ascites: variceal rupture.
• Projectile non-bilious vomiting in an infant: pyloric stenosis with mucosal erosion.
• Recent heavy aspirin, clopidogrel, or anticoagulant use: drug-induced erosive gastropathy.
Immediate red-flag combinations
Syncope plus coffee-ground emesis, hematemesis with systolic blood pressure <90 mmHg, or melena accompanied by rising creatinine and falling urine output mandate emergency activation of bleeding protocols.

Summary table

复制

Sign/Symptom	Typical volume loss	What to do next
Coffee-ground vomitus	100–300 mL	Urgent gastroscopy within 24 h
Fresh hematemesis with clots	>500 mL often	Large-bore IV, cross-match 4–6 units, consider ICU
Melena without shock	50–200 mL	Monitor vitals every 30 min, Hb at 6 h intervals
Orthostatic drop	≥15 %	Rapid crystalloid, consider transfusion trigger Hb <70 g/L
Syncope, hypotension, tachypnea	≥30 %	Activate massive transfusion protocol, airway protection

What are the symptoms and manifestations of irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by recurrent abdominal pain linked to altered bowel habits, without detectable structural or biochemical abnormalities. Symptoms fluctuate over years, often beginning in adolescence or early adulthood, and can significantly impair quality of life while sparing life expectancy.

Cardinal features

Abdominal pain or discomfort: crampy, aching, or sharp, usually located in the lower abdomen; episodes last minutes to hours and are relieved by defecation.
Change in bowel frequency: patients may experience >3 loose stools daily or <3 stools weekly; the pattern can alternate within the same individual.
Change in stool form: using the Bristol scale, types 6–7 (mushy/watery) during diarrhea spells and types 1–2 (hard/lumpy) during constipation spells are typical.
Sensation of incomplete evacuation: persistent urge after bowel movement, leading to repeated visits to the toilet.
Visible abdominal distension: objectively measured increase in girth by evening, often accompanied by tight clothing.

Subtypes based on predominant habit

IBS-D: >25 % of bowel movements loose and <25 % hard.
IBS-C: >25 % hard and <25 % loose.
IBS-M (mixed): both loose and hard stools >25 % of the time.
IBS-U: insufficient criteria for above categories.

Associated non-colonic symptoms

Upper GI: early satiety, nausea, epigastric burning overlapping with functional dyspepsia.
Genitourinary: frequent urination, urgency, dyspareunia.
Gynecologic: dysmenorrhea intensifying IBS pain mid-cycle.
Fatigue, headache, and sleep disturbances: independent of stool pattern.

Symptom triggers

Food: fatty meals, caffeine, sorbitol, onions, garlic, beans, wheat, milk (via either lactose or FODMAP effect).
Stress: examinations, job interviews, or personal conflicts can precipitate flares within hours.
Hormonal: many women report worsening perimenstrually.
Post-infectious: 10 % of acute gastroenteritis cases evolve into IBS through low-grade inflammation and altered microbiota.

Red flags that exclude IBS
Age >50 at first onset, nocturnal pain awakening from sleep, bloody stools, unintentional weight loss, anemia, elevated inflammatory markers, or family history of colorectal cancer, celiac disease, or inflammatory bowel disease—these mandate further investigation.
Daily-life impact
Symptoms often peak during working hours; fear of incontinence leads to avoidance of long commutes or social events, creating a cycle of anxiety and heightened gut sensitivity.

Summary table

Domain	Common presentation	Tip for patients
Pain	Lower-crampy, post-prandial	Heat pad, peppermint oil capsules
Stool	Alternating loose/hard, urgency	Keep 2-week diary to identify triggers
Bloating	Visible distension by evening	Reduce carbonated drinks, chew slowly
Non-gut	Tired, poor sleep, frequent urination	Regular exercise improves both gut and sleep
Alarm signs	Blood, night pain, weight loss	Seek immediate medical review

What are the symptoms and manifestations of Crohn’s disease?

Crohn’s disease is a chronic, relapsing inflammatory bowel disease that can involve any segment of the gastrointestinal tract from mouth to anus, but most commonly affects the terminal ileum and adjacent right colon. The clinical picture is highly variable, ranging from subtle, intermittent discomfort to severe, life-threatening complications. Recognizing the key symptoms early can shorten the delay to diagnosis and reduce long-term damage.

Core intestinal symptoms

Diarrhea: usually semiliquid, without visible blood in limited ileal disease; overt bloody diarrhea is more common when the colon is involved.
Abdominal pain: typically crampy or colicky, localized to the right lower quadrant; pain often precedes defecation and may temporarily improve after a bowel movement.
Weight loss: results from reduced oral intake (food fear), malabsorption, and chronic inflammation-driven hypercatabolism; unintentional loss >5 % within 3–6 months warrants evaluation.
Fatigue: disproportionate to sleep duration; correlates with anemia, micronutrient deficits, and systemic cytokine release.

Extraintestinal manifestations

Joints: peripheral arthritis (knees, ankles, wrists) that parallels bowel activity; axial involvement (sacroiliitis, ankylosing spondylitis) runs independently.
Skin: erythema nodosum (painful red nodules on shins), pyoderma gangrenosum (rapidly expanding ulcers).
Eyes: episcleritis (redness without visual loss), uveitis (photophobia, blurred vision—requires urgent ophthalmologic care).
Mouth: aphthous ulcers recurring every few weeks.
Hepatobiliary: primary sclerosing cholangitis (fatigue, pruritus, cholestatic liver tests), gallstones due to ileal bile-salt malabsorption.

Signs of penetrating or stricturing disease

Perianal tags, fissures, or fistulas: spontaneous drainage of serosanguinous or purulent fluid; may be the first clue in adolescents.
Palpable abdominal mass: inflamed ileal loop or phlegmon.
Subacute obstruction: post-prandial bloating, borborygmi, and colicky pain culminating in nausea—suggesting fibrostenotic narrowing.

Systemic and laboratory clues

Low-grade fever (37.5–38.5 °C) spikes during flares.
Normocytic or microcytic anemia, thrombocytosis, elevated CRP/ESR.
Vitamin B12 or vitamin D deficiency; low serum albumin reflects severe mucosal loss.

When to suspect Crohn’s in daily practice
Persistent right-sided abdominal discomfort plus diarrhea for >4 weeks, especially in young adults or smokers, should prompt ileocolonoscopy and small-bowel imaging. Conversely, isolated rectal bleeding with constipation is more typical of hemorrhoids or malignancy—age-appropriate cancer screening remains mandatory.
Course and red-flag evolution
Symptoms often wax and wane; however, sudden severe abdominal distension, obstipation, or continuous bleeding signals complications (perforation, abscess, or massive hemorrhage) and mandates emergency assessment.

Summary table

Organ system	Typical findings	Clues to severity
Gut	Loose stools, right-sided cramps, oral ulcers	Blood, nocturnal diarrhea, weight loss >10 %
Joints	Swelling, morning stiffness <30 min	Limitation of spine motion, hip pain
Skin	Tender nodules, enlarging ulcers	Ulcer diameter >2 cm, necrotic center
Eyes	Redness, photophobia	Visual blur, hypopyon
General	Fatigue, low-grade fever	Temperature >38.5 °C, orthostatic dizziness

Symptoms and Manifestations of Bile Reflux Gastritis

Bile reflux gastritis is a common form of chronic gastritis caused by the abnormal backflow of duodenal contents—especially bile—into the stomach, leading to mucosal inflammation and a range of upper-gastrointestinal complaints. The condition can markedly impair quality of life, and symptoms often overlap with those of acid-peptic disorders, making recognition important.

Typical symptoms

Epigastric burning or dull pain: usually steady, more intense when the stomach is empty or at night, and frequently exacerbated after fatty meals.
Nausea and bilious vomiting: vomitus is yellow-green, bitter-tasting and may contain food residue; attacks are common in the evening or around midnight.
Post-prandial fullness and early satiety: patients feel bloated soon after starting a meal, leading to reduced food intake.
Regurgitation and heart-burn: a sour or bitter fluid rises into the throat, sometimes accompanied by a retrosternal burning sensation.
Belching and excessive flatus: frequent belching does not relieve the discomfort and nocturnal flatulence is often reported.

Atypical or accompanying symptoms

Chest pain: a deep-seated discomfort behind the sternum that may radiate to the back, neck or jaw, occasionally misinterpreted as cardiac pain.
Chronic cough, hoarseness or oropharyngeal burning: caused by duodeno-gastro-oesophageal reflux reaching the larynx and airways.
Anorexia and modest weight loss: persistent nausea and fear of post-meal pain discourage adequate eating.
Fatigue and even anaemia: long-standing mucosal erosion can produce occult bleeding, ultimately leading to iron-deficiency anaemia.

Alarm features (prompt urgent evaluation)
Repeated haematemesis, melena, dysphagia, progressive unintentional weight loss, or anaemia suggest complications such as erosive oesophagitis, gastric ulcer or Barrett’s mucosa and require immediate endoscopy.

Symptom summary table

Category	Common manifestations	Timing / triggers	Clinical hints
Pain	Epigastric burning, dull ache	Empty stomach, night, high-fat meals	Relieved slightly by sitting up
Nausea & vomiting	Bilious vomitus, bitter taste	Evening, after overeating	Vomit is yellow-green, non-acidic
Dyspepsia	Fullness, early satiety, belching	During or right after meals	May mimic functional dyspepsia
Reflux	Heart-burn, regurgitation, chest pain	Supine position, bending	Distinguish from acid reflux
Systemic	Anorexia, weight loss, fatigue	Chronic course	Suggest mucosal damage ± bleeding

Symptoms and Manifestations of Fatty Liver

Fatty liver disease usually begins insidiously and progresses slowly. Most patients have no obvious discomfort in the early stage, and the condition is often discovered incidentally during physical examination or imaging for other reasons. When symptoms do appear, they are generally non-specific and easily overlooked.

Fatigue
The liver is an important organ for energy metabolism. When liver cells are filled with fat, their ability to synthesize glycogen and other energy substances decreases, resulting in insufficient energy supply and a persistent feeling of tiredness.
Discomfort or dull pain in the right upper abdomen
As fat accumulates, the liver enlarges and the tension of its capsule increases. The capsule is rich in nerve endings, so the stretching can cause vague distension, dull pain, or a dragging sensation under the right ribs.
Abdominal bloating and digestive upset
The liver secretes bile to help digest fats. When function is impaired, patients often experience early satiety, belching, or aversion to greasy foods; some complain of vague abdominal distension.
Nausea and poor appetite
These are more common in patients with fatty hepatitis. Inflammatory cytokines and delayed bile secretion can reduce appetite; occasionally mild nausea occurs, especially after a fatty meal.
Unintentional weight change
A minority of patients with severe steatosis lose weight because of markedly reduced food intake, while those with concurrent metabolic syndrome may continue to gain weight.
Signs of advanced liver damage
If fatty hepatitis or fibrosis progresses, the following may appear:

Itchy skin
Spider naevi on the chest or shoulders
Red palms
Lower-limb edema or ascites
Jaundice (yellowing of sclera and skin)
Splenomegaly and easy bruising

Because early fatty liver is almost silent, anyone with obesity, type 2 diabetes, dyslipidemia, or long-term alcohol use should have regular liver imaging and biochemical check-ups even in the absence of symptoms.

Stage / Finding	Common Manifestations
Early (simple steatosis)	Often asymptomatic; mild fatigue, vague right-upper-quadrant fullness
Moderate steatosis	Intermittent right-side discomfort after meals, easy tiring, dyspepsia
Fatty hepatitis (NASH/MASH)	Persistent fatigue, nausea, anorexia, possible low-grade fever
Fibrosis	Dull abdominal pain, decreased exercise tolerance, possible itching
Compensated cirrhosis	Spider naevi, red palms, palpable firm liver, mild platelet drop
Decompensated cirrhosis	Ascites, leg edema, jaundice, variceal bleeding, confusion

Symptoms and Manifestations of Alcoholic Liver Disease

Alcoholic liver disease (ALD) is a spectrum of liver injury caused by long-term excessive alcohol consumption. It progresses from simple steatosis to alcoholic hepatitis, fibrosis, and ultimately cirrhosis. Symptoms vary depending on the stage of liver damage.

In the early stage—alcoholic fatty liver—most patients have no obvious symptoms. Some may feel mild fatigue or a sense of heaviness in the right upper abdomen, and physical examination may reveal a slightly enlarged, soft liver without tenderness .

When the disease progresses to alcoholic hepatitis, symptoms become more prominent. Patients often develop jaundice, which is the yellowing of the skin and sclera due to bilirubin accumulation. Other common symptoms include loss of appetite, nausea, vomiting, low-grade fever, fatigue, and tenderness in the upper right quadrant of the abdomen. In severe cases, complications such as ascites (fluid buildup in the abdomen), hepatic encephalopathy (confusion or altered behavior due to toxin buildup), and even liver or kidney failure may occur .

In the cirrhotic stage, patients may present with signs of chronic liver disease and portal hypertension, such as spider angiomas, palmar erythema, gynecomastia, splenomegaly, ascites, and esophageal varices. Additional symptoms include weight loss, muscle wasting, and endocrine disturbances like testicular atrophy in men. Laboratory findings often show elevated AST and ALT levels (typically with an AST/ALT ratio ≥2), hyperbilirubinemia, prolonged prothrombin time, hypoalbuminemia, and thrombocytopenia .

Summary Table: Symptoms and Manifestations of Alcoholic Liver Disease by Stage

Stage	Common Symptoms	Physical Signs	Possible Complications
Alcoholic fatty liver	Often asymptomatic; mild fatigue	Slight hepatomegaly, soft liver	Reversible with abstinence
Alcoholic hepatitis	Jaundice, nausea, vomiting, fever, fatigue, anorexia	Tender hepatomegaly, low-grade fever	Ascites, encephalopathy, liver failure
Alcoholic cirrhosis	Weight loss, pruritus, bleeding tendency	Spider angiomas, ascites, splenomegaly, gynecomastia	Variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, liver cancer

Symptoms and Manifestations of Gastroptosis

Gastroptosis is a condition in which the stomach descends abnormally low within the abdominal cavity, often below the iliac crest when standing. It is more common in females and is frequently associated with a slender body habitus and reduced abdominal muscle tone. Symptoms are typically chronic and nonspecific, closely tied to meals and posture.

The most frequent complaint is a heavy, dragging sensation or dull ache in the upper abdomen that worsens after eating or prolonged standing. Pain is usually alleviated when the patient lies down. Early satiety, bloating, and visible distension of the lower abdomen are common. Nausea and occasional vomiting may follow large meals or sudden physical activity. A characteristic succussion splash may be heard on percussion or palpation, reflecting retained gastric fluid. Because the transverse colon often sags together with the stomach, chronic constipation is typical. Weight loss, fatigue, and neuro-psychiatric symptoms such as insomnia, dizziness, headache, or even orthostatic syncope can develop when the disorder is long-standing. Physical examination reveals a thin frame, weak abdominal muscles, and a concave upper abdominal profile with relative bulging below the umbilicus.

Key manifestation	Typical features	Aggravating / relieving factors
Abdominal pain or heaviness	Dull, dragging, upper-mid abdomen	Worse after meals or standing; better when supine
Bloating & early satiety	Sense of fullness, visible lower-abdominal swell	Large meals, activity; improved by rest
Nausea / vomiting	Occasional, usually post-prandial	Triggered by over-eating or sudden movement
Succussion splash	Sloshing sound on shaking or palpation	More evident after overnight fast
Constipation	Chronic, often intractable	Linked to colonic ptosis
Systemic / neuro symptoms	Weight loss, fatigue, dizziness, insomnia, syncope	Prolonged illness, anxiety about symptoms

Symptoms of Colitis

Symptoms of ColitisColitis refers to inflammation of the colon, which may be triggered by infection, ischemia, autoimmune reactions, or inflammatory bowel disease. Clinical presentation varies by cause and extent of inflammation, but several core symptoms are frequently observed.

Patients typically report cramping abdominal pain, most often localized to the lower quadrants. Diarrhea is nearly universal: stools may be watery, contain mucus, or be overtly bloody; frequency can range from a few episodes to more than twenty per day. Urgency and tenesmus are common, and nocturnal bowel movements frequently disrupt sleep. Rectal bleeding, sometimes occult, can lead to fatigue, pallor, and iron-deficiency anemia. Weight loss, low-grade fever, and anorexia develop when inflammation is extensive or persistent. Extraintestinal manifestations—such as joint pain, mouth ulcers, or skin lesions—may accompany active disease .

Major Symptom Groups	Typical Features
Pain & Cramping	Lower abdominal cramps, often preceding defecation
Diarrhea	Loose, mucoid, bloody stools; frequency ↑; nocturnal episodes
Rectal Complaints	Urgency, tenesmus, visible bleeding
Systemic Signs	Fatigue, low-grade fever, unintended weight loss
Complications	Anemia, dehydration, extraintestinal joint/skin/eye involvement

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Category Archives: Internal Medicine

What are the symptoms and manifestations of proctitis?

What are the symptoms and manifestations of acute gastroenteritis?

What are the symptoms and manifestations of upper gastrointestinal bleeding?

What are the symptoms and manifestations of irritable bowel syndrome?

What are the symptoms and manifestations of Crohn’s disease?

Symptoms and Manifestations of Bile Reflux Gastritis

Symptoms and Manifestations of Fatty Liver

Symptoms and Manifestations of Gastroptosis

Symptoms of Colitis

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