Semiology of The Intestine

Semiology of the intestine
Disease history
Onset: recent, sudden: intestinal occlusion, intestinal perforation,
intestinal infarction, acute appendicitis
Insidious onset: tumors, chronic enterocolitis
Evolution - proggressive: cancer
Local symptoms
1. Intestinal pain
2. Intestinal transit disorders
3. Intestinal gas content disorders
4. Intestinal hemorrhage
Local symptoms
1. Intestinal pain
Intestinal colic: apendicular, occlusion, perforation
Characteristics: - intense pain
- caused by muscle spasms or distensy
- calming down at pressure

- intermitent
Local symptoms
1. Intestinal pain
- appendicular colic
- intestinal occlusion
- intestinal perforation
- Vascular pain
- rectal tenesma
- defecation pain
- acute enterocolitis
Local symptoms
2. Intestinal transit disorders
- diarrhea
- constipation; - ileus (dynamic or mechanic)
Local symptoms
3. Intestine gas content disorders
- meteorism:  gas content of the intestine with fullness feeling
- flatulence: frequent and repeated gas elimination through the
anus
4. Intestinal hemorrhage
Objective exam
II. Local
Inspection a) abdomen volume alterations: total, localized
bulging, abdominal excavation
b) peristaltic movements
Objective exam
II. Local
Palpation a) superficial: muscular contraction, cutaneous
hyperestesia, “damp cloth” feeling
b) profound: - mesenteric, apendicular, sigmoidian
spots
- “colic chord”
- cecum (relaxed)
- împăstarea
- hard formation
c) digital rectal exam

Paraclinical exploration in intestine disorders

1. Coprological exam
- macroscopic
- biochemical
- microscopic
- bacteriological
DIARRHEIC SYNDROME
Diarrheic syndrome
Definition:  frequency of daily evacuation  3 times/day
 weight  200 g/24 ore
, abnormal stool consistency
*the simultaneous presence of all features is not necessary
Diarrheic syndrome
Pathogenetic mechanisms
1. Osmotic diarrhea
2. Secretory diarrhea
3. Diarrhea through enterocitar alterations or damage and
inflammation
4. Diarrhea through motility disorders
Osmotic diarrhea
*active osmotic substance in the intestine

*2 types of substances: unmetabolizable/metabolizable by
the bacterial flora
Osmotic diarrhea
Cause:
- ingestion of substances containing divalent ions (Mg
sulfate, magnezia usta, iron concotions, sodium sulfate)
- sorbitol, manitol,
- lactulose
- sugar deficiency
- pilorum suppression: piloroplasty
Secretory diarrhea
* Disturbance of the water and electrolyte transport

mechanisms: stimulation of chlorine and bicarbonate
secretion; inhibition of sodium and chlorine absorbtion
Secretory diarrhea
Cause:
a) exogen: - laxative (fenolftalein, antrachinone, ricinoleic acid,
bisacodyl)
- medicamente: diuretics, antiarrhythmics
(quinidine), prostaglandyne, aminophylline, colinergics
- toxic substances: arsene, organo-phosphorics,
mushroom poisoning – Amanita falloides, caffeine,
methylxantine (tea, coffee, cola), alcohol, bacterial toxines:
staph. aureus
Secretory diarrhea
Cause:
b) endogen:
- microbial enterotoxines: E. coli, Yersinia
enterocolitica
- endogen detergents: billiary acids
- hormone producing tumors: VIP, gastrine,
serotonine, prostaglandine
c) idiopathic
Diarrhea through enterocitar
alterations or damage and
inflammation
*inflammatory diarrhea
*caused by absorption disorders, electrolithical secretion,
inflammation mediators, vascular damage.
Diarrhea through enterocitar
alterations or damage and
inflammation
Cause:
a) Light/moderate inflammation: infectious (bacterial, viral,
parasitary), cytostatics, radiotherapy, food allergies, auto-
immune (microscopic colitis)
b) Moderate/severe inflammation: infection (Shigella, Salmonella),
auto-immune (Crohn’s dis., ulcerative colitis), through
hypersensibility mechanism (coeliac disease)
Diarrhea through motility
disorders
*hyper-motility
*hypo-motility
Diarrheic syndrome
1. acute:
- 3 stools/day, deformed
- < 2-3 weeks
- ± fever
2. chronic:
- > 3 weeks
- clinical: steatorrhea, watery, inflammatory
Diarrheic syndrome
Paraclinical exploration
- coprologic exam
- abdominal Rx on empty stomach or Ba passage
- endoscopy (colonoscopy, gastroduodenoscopy)
- doudenal, jejunal, colonic mucosa biopsy
- loading tests
- pancreas and hepato-billiary exploration
Recto-sigmoid syndrome
Definition:
- tenesma
- recto-sigmoid colic
- defecation pain
- constipation/diarrhea
- pathological elements in stool
Cause:
- rectitis, anitis, recto-sigmoiditis
- anal, perianal fissure,
- perianal abscess,
- complicated hemorrhoids
- tumors
Diagnosis, etiological
* symptoms + exam (anal inspection, rectal digital exam) + stool
exam (pathological elements) + Recto-sigmoidoscopy
Constipation syndrome
Definition: < 3 stools/week

low quantity
increased consistency
± sensation of incomplete evacuation
duration> 3 months without the use of laxatives
Etiology
- usual constipation (primary, idiopathic)
- secondary symptomatic constipation
Habitual constipation (constipation "disease", functional - class

Rome II)
Pathophysiology:
-hypotonia
- Hypertonia
- defecation disorders
Favoring factors: female gender, inactivity, irregular defecation

programme, reduced water and fiber consumption, multiple
births, age, consumption of medicines
Secondary constipation
- organic obstructive lesions (mechanical): tumor,

inflammatory stenosis, ischemic stenosis, compression,
metabolic and endocrine diseases
- reflex (abdominal departure point)

Inferior digestive hemorrhage (IDH)
Definition: DH in the small intestine, colon, rectum and anus
Clinical:
- melena
- Rectoragy (Haematochezia)
Clinical picture
a) Rectoragy (20% from the upper digestive tract)
- Bright red with clots (rectum)
- Brown-red (right colon, transverse)
b) Melena
- Small intestine
- Proximal colon
(slow transit, microbial flora action)
Cause:
-Hemorrhoids
-Anal fissures
-Diverticulosis
-Polyps
-Rectal or colon cancer
-Crohn's Disease
- Haemorrhagic rectocolitis
-Infectious colitis
Diagnostic exploration in HDI
- rectal digital exam
- Colonoscopy, biopsy, histological ex
- Anuscopy / rectosigmoidoscopy
- barytic enema (irigography)

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Semiology of the intestine

Semiology of the intestine

- calming down at pressure

c) digital rectal exam

Paraclinical exploration in intestine disorders

*active osmotic substance in the intestine

* Disturbance of the water and electrolyte transport

Definition: < 3 stools/week

Habitual constipation (constipation "disease", functional - class

Favoring factors: female gender, inactivity, irregular defecation

- organic obstructive lesions (mechanical): tumor,

- reflex (abdominal departure point)

Definition: DH in the small intestine, colon, rectum and anus

Diagnostic exploration in HDI

- rectal digital exam

- Colonoscopy, biopsy, histological ex

- barytic enema (irigography)

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