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Cause of 1. Malaena, 2. Jaundice, 3. Haematemesis, 4. Abdominal swelling, 5. Vomiting,6. Diarrhoea, 7.
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I now have comprehensive data from the textbooks. Here is a full, well-structured answer covering all 7 symptoms:
Causes of Key GI Symptoms
1. Melaena (Malaena)
Melaena is black, tarry stool caused by digested blood, indicating bleeding proximal to the ligament of Treitz (upper GI tract). The black colour results from haemoglobin being converted to haematin by intestinal enzymes and bacteria.
Causes:
- Peptic ulcer disease (most common) — gastric or duodenal ulcer
- Oesophageal varices (portal hypertension/cirrhosis)
- Mallory-Weiss tear — mucosal laceration at the gastro-oesophageal junction
- Erosive gastritis / oesophagitis
- Gastric carcinoma
- Meckel's diverticulum — ectopic gastric mucosa causes peptic ulceration
- Angiodysplasia of the upper GI tract
- Aorto-enteric fistula
- Swallowed blood (epistaxis, haemoptysis)
- Blood from proximal small bowel (e.g., duodenal carcinoma, radiation injury)
— Grainger & Allison's Diagnostic Radiology
2. Jaundice
Jaundice (icterus) is yellow discolouration of skin, sclerae and mucous membranes from elevated bilirubin. It is classified into three pathophysiological categories:
Pre-hepatic (Unconjugated hyperbilirubinaemia)
- Haemolytic anaemias (sickle cell disease, hereditary spherocytosis, G6PD deficiency, autoimmune haemolysis)
- Ineffective erythropoiesis
- Resorption of large haematoma
Hepatic (Hepatocellular)
- Viral hepatitis (A, B, C, D, E)
- Alcoholic hepatitis / cirrhosis
- Non-alcoholic fatty liver disease (NAFLD/NASH)
- Drug-induced liver injury (paracetamol, isoniazid, statins)
- Autoimmune hepatitis
- Wilson's disease, haemochromatosis
- Leptospirosis (Weil's disease)
- Sepsis / shock liver
- Liver metastases or primary hepatocellular carcinoma
- Breast milk jaundice / physiological jaundice (neonates)
Post-hepatic (Obstructive / Cholestatic — Conjugated hyperbilirubinaemia)
- Choledocholithiasis (gallstone in common bile duct)
- Carcinoma of the head of pancreas
- Cholangiocarcinoma
- Primary sclerosing cholangitis (PSC)
- Primary biliary cholangitis (PBC)
- Parasitic infestation (e.g., Ascaris, liver flukes)
- Post-operative biliary stricture
- External compression by lymph nodes
— Harper's Illustrated Biochemistry, Tintinalli's Emergency Medicine, Goldman-Cecil Medicine
3. Haematemesis
Haematemesis is vomiting of blood (bright red or coffee-ground), indicating haemorrhage from the upper GI tract (oesophagus, stomach, duodenum — proximal to the ligament of Treitz).
Causes:
- Peptic ulcer disease (most common — ~50% of cases)
- Oesophageal varices (portal hypertension)
- Mallory-Weiss tear
- Erosive gastritis / oesophagitis (NSAIDs, alcohol, H. pylori)
- Gastric carcinoma
- Dieulafoy's lesion (large aberrant submucosal artery)
- Angiodysplasia
- Aorto-enteric fistula (rare, life-threatening)
- Haemobilia (blood from biliary tract)
- Oesophageal carcinoma
- Coagulation disorders / anticoagulant therapy
— Grainger & Allison's Diagnostic Radiology
4. Abdominal Swelling
Abdominal swelling/distension is classically remembered by the "5 F's": Fat, Fluid, Flatus, Faeces, Foetus — with a 6th sometimes added: Fibroids/tumour.
Generalised Swelling
| Category | Examples |
|---|---|
| Fluid (Ascites) | Cirrhosis with portal hypertension, malignancy (ovarian, gastric, colonic, pancreatic, breast), heart failure, nephrotic syndrome, peritoneal TB, Budd-Chiari syndrome, pancreatitis |
| Fat (Obesity) | Central obesity |
| Flatus (Gas) | Bowel obstruction (small or large), ileus, pseudo-obstruction (Ogilvie's), severe constipation |
| Faeces | Constipation, megacolon |
| Foetus | Pregnancy |
Localised Swelling
- Hepatomegaly (right hypochondrium) — liver disease, right heart failure, haematological malignancy
- Splenomegaly (left hypochondrium) — portal hypertension, haematological causes, infection
- Ovarian cyst or uterine fibroids (pelvic/suprapubic)
- Abdominal aortic aneurysm
- Retroperitoneal mass or lymphadenopathy
- Tumours (gastric, colonic, pancreatic, renal)
- Bladder retention (suprapubic)
— Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Goldman-Cecil Medicine
5. Vomiting
Principal Causes of Nausea and Vomiting:
Abdominal / GI
- Mechanical obstruction: gastric outlet obstruction, small bowel obstruction (SBO)
- Motility disorders: gastroparesis, functional dyspepsia, chronic intestinal pseudo-obstruction
- Acute appendicitis, acute cholecystitis, acute pancreatitis
- Acute hepatitis, acute mesenteric ischaemia
- Crohn's disease, peptic ulcer disease
- Peritonitis / peritoneal carcinomatosis
- Gastric volvulus, diaphragmatic hernia
Drugs
- NSAIDs, aspirin, opioids/narcotics
- Cancer chemotherapy (cisplatin, methotrexate, 5-FU)
- Digoxin, antiarrhythmics, antibiotics (erythromycin, tetracycline)
- Oral contraceptives, theophylline, anticonvulsants, levodopa
Infectious
- Acute gastroenteritis (viral — norovirus, rotavirus; bacterial — Salmonella, Staphylococcus)
- Systemic / non-GI infections (UTI, meningitis)
Metabolic & Endocrine
- Diabetic ketoacidosis (DKA)
- Uraemia (renal failure)
- Addison's disease, hypercalcaemia, hyperthyroidism
- Hyponatraemia, hypoparathyroidism
- Pregnancy (hyperemesis gravidarum)
Nervous System
- Raised intracranial pressure (tumour, haemorrhage, abscess, hydrocephalus)
- Migraine
- Labyrinthine disorders (labyrinthitis, Ménière's disease, motion sickness)
- Meningitis, seizure disorders
Other
- Anxiety / depression
- Cannabinoid hyperemesis syndrome
- Cyclic vomiting syndrome
- Post-operative vomiting
— Sleisenger and Fordtran's Gastrointestinal and Liver Disease
6. Diarrhoea
Diarrhoea is defined as >3 loose or watery stools per day, or stool weight >200g/day. Classified as acute (<2 weeks) or chronic (>4 weeks), and by mechanism:
By Mechanism
| Type | Mechanism | Examples |
|---|---|---|
| Osmotic | Non-absorbable solutes draw water into lumen | Lactase deficiency, lactulose, Mg²⁺ antacids, sorbitol |
| Secretory | Active ion secretion; persists with fasting | Cholera, VIPoma, bile acid malabsorption, carcinoid |
| Inflammatory / Exudative | Mucosal damage | IBD (Crohn's, UC), Clostridium difficile, invasive bacteria |
| Motility-related | Rapid transit | Hyperthyroidism, IBS, post-vagotomy, diabetic autonomic neuropathy |
| Malabsorptive | Fat/nutrient malabsorption → steatorrhoea | Coeliac disease, chronic pancreatitis, bacterial overgrowth, Whipple's disease |
By Cause
Acute diarrhoea:
- Infective gastroenteritis — viral (norovirus, rotavirus), bacterial (E. coli, Salmonella, Shigella, Campylobacter, Vibrio cholerae), parasitic (Giardia, Entamoeba, Cryptosporidium)
- Drug-induced (antibiotics, laxatives, NSAIDs, metformin)
- Food poisoning, traveller's diarrhoea
Chronic diarrhoea:
- Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
- Coeliac disease
- Irritable bowel syndrome (IBS)
- Microscopic colitis, colorectal carcinoma
- Bile acid malabsorption
- Chronic pancreatitis / pancreatic exocrine insufficiency
- Endocrine: hyperthyroidism, Addison's disease, carcinoid, VIPoma, Zollinger-Ellison syndrome
- HIV/AIDS-related enteropathy
— Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Tietz Textbook of Laboratory Medicine
7. Dysphagia
Dysphagia is difficulty in swallowing. Classified as oropharyngeal (transfer dysphagia) or oesophageal.
Oropharyngeal Dysphagia
Neuromuscular (~80% of cases):
- Stroke (most common)
- Parkinson's disease
- Motor neurone disease (ALS/MND)
- Multiple sclerosis
- Myasthenia gravis
- Muscular dystrophy, polymyositis/dermatomyositis
- Post-polio syndrome, CNS tumours
- Thyroid dysfunction
Structural:
- Pharyngeal/oesophageal carcinoma
- Zenker's diverticulum
- Cervical osteophytes
- Pharyngeal infections
- Proximal oesophageal web
- Thyromegaly, prior surgery or radiotherapy
Oesophageal Dysphagia
Motility (Neuromuscular) Disorders:
- Achalasia (prototypical — dysphagia to solids and liquids)
- Distal oesophageal spasm
- Hypercontractile (jackhammer) oesophagus
- Scleroderma / systemic sclerosis
- Chagas disease, reflux-related dysmotility
Structural (Mechanical) — typically solids > liquids:
- Carcinoma of the oesophagus or gastric cardia
- Peptic stricture (GORD-related)
- Schatzki ring (lower oesophageal ring) — episodic, non-progressive
- Eosinophilic oesophagitis
- Medication-induced stricture (bisphosphonates, tetracycline)
- Oesophageal webs (Plummer-Vinson syndrome)
- Benign tumours, diverticula, foreign body
Extrinsic Compression:
- Mediastinal mass (lymphoma, lung tumour)
- Vascular compression (dysphagia lusoria — aberrant subclavian artery)
- Spinal osteophytes
— Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Yamada's Textbook of Gastroenterology, Rosen's Emergency Medicine
Quick Clinical Tip: Dysphagia to solids only → suspect mechanical obstruction. Dysphagia to both solids and liquids from onset → suspect motility disorder (achalasia). Progressive dysphagia with weight loss is a red-flag for malignancy until proven otherwise.
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