Haemetemesis

• Peptic ulcer
• Gastritis (inflammation of the stomach)
• Gastric erosions (breakdown of tissue lining the stomach)
• Mallory-Weiss Syndrome (tear in the esophagus due to forceful vomiting)
• Cirrhosis (scarring of the liver)
• Gastric varices (enlarged veins in the stomach)

• Esophageal varices (enlarged veins in the esophagus)
• Portal hypertension (high blood pressure in the portal vein)
• Chronic Viral Hepatitis
• Gastroenteritis
• Alcoholism
• Aspirin
• Benign tumors of the stomach or esophagus
• History of smoking

Definition:

Flatulence means releasing the gas from digestive system through anus.

• Beans and lentils
• Dairy products containing lactose
• Fructose and sorbitol, which are found in some fruits and are also used as sweeteners

1. Lactose intolerance
2. Irritable bowel syndrome
3. Celiac disease
4. Food allergy or intolerance?
5. Dumping syndrome
6. GERD — Gastro esophageal reflux disease
7. Peptic ulcer
8. Gastroparesis

Definition:

Nausea: Nausea is sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It occasionally precedes vomiting. A person can suffer nausea without vomiting.

Vomiting: Vomiting is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting consists of phase of nausea followed by hypersalivation, pallor, sweating and hyperventilation.

• Migrain
• Motion sickness
• Morning sickness
• Alcoholism
• Dizziness
• Meningitis
• Food poisoning
• Brain tumor
• Intestinal obstruction
• GERD— Gastro esophageal reflux disease

• Depression
• Appendicitis
• Diabetic ketoacidosis
• Cholecystitis
• Ear infection
• Anxiety disorder
• General anaesthesia
• Pancreatitis
• Hydrocephalus
• Heart failure
• Chemotherapy

There may be various causes for abdominal pain. Abdominal pain requires investigations for certain diagnosis. It points to internal organ which is affected, according to which we can come to final diagnosis. Upper abdominal pain Causes

• Duodenal / Gastric ulcer
• Acute Gastritis
• Acute Hepatitis
• Oesophagitis
• Acute pancreatitis

• Gallbladder disease
• Duodenal ulcer
• Pneumonia/Pleurisy
• Subphrenic abscess
• Kidney disease

• Pneumonia
• Splenic infarct
• Acute pyelonephritis
• Subphrenic abscess

• Early appendicitis
• SBP
• Acute gastritis
• Acute pancreatitis

• Acute Appendicitis
• Acute urinary retention
• UTI / Cystitis
• PID
• Ectopic pregnancy
• Diverticulitis

• Diverticulitis
• Constipation
• Left ureteric colic
• IBD - UC
• PID
• Colonic obstruction
• Ectopic rupture

• Acute urinary retention
• UTI / Cystitis
• PID
• Ectopic pregnancy
• Diverticulitis

Severe Generalised Abdominal Pain

Definition- Pain that isn't focused in one specific area of abdomen is referred to as generalised abdominal pain. Following disease require urgent attention and may require emergency surgery.

Causes

•       Intestinal Perforation
•       Acute pancreatitis
•       Intestinal Obstruction
•       Mesenteric Ischemia

Maintenance antisecretory acid therapies (PPI’s) are used in many patients, particularly those with gastroesophageal reflux disease (GERD). With the long-term use of any medication, drug safety becomes an important issue. Acid (HCl) is normally secreted into the gastric lumen, where it serves to both digest dietary protein and maintain a sterile environment by removing ingested bacterias. Proton pump inhibitors (PPIs) are strong acid suppressants, and thus long term usage has raised several issues which shall be discussed in this article.

The three main concerns regarding the long-term usage of proton pump inhibitors (PPIs) include:

1. Risk of infectious complications – including Pneumonias, Cl difficile diarrhoeas
2. Malabsorption of Iron, Vitamin B12, Magnesium and Metabolic bone disease
3. Hypergastrinemia, Gastric carcinoids and Atrophic Gastritis

Other concerns include acute interstitial nephritis (kidney disease) and drug interactions particularly reducing the effect of Clopidogrel, which is used in coronary stented patients to reduce the risk of stent blockage.

What is Indigestion? Sensation of fullness / heaviness or discomfort in upper abdomen. Indigestion may include Heartburn, upper abdominal pain, Bloating, Feeling of distension and Nausea. It may preset as burning pain in upper abdomen especially after eating or drinking. Causes of Indigestion Indigestion is often associated with other medical conditions or problems such as: Disease conditions related to Gastro intestinal tract:

• Stomach infection and food poisoning.
• GERD (Gastro Esophageal Reflux Disease)
• Oesophagitis (Inflammation of food pipe) or Gastritis (Inflammation of stomach)
• Ulcers in stomach or early part of small intestine.
• Pancreatitis or gall bladder stone.
• Irritable bowel syndrome (IBS)
• Hiatus hernia or Gastoparesis.

• Thyroid disease
• Diabetes (Gastroparesis)
• Food allergies
• Depression

• Pregnancy
• Obesity

• Long term use of Non steroidal pain killers. (Aspirin)
• Steroids
• Antibiotics
• Narcotic drugs

• Faulty eating habits/ Fast Food
• Inadequate knowledge
• No exercise
• Stress & Smoking (Tobacco)
• Harmful use of Alcohol

What is Heartburn? Heartburn is a burning sensation/pain in neck, behind the chest bone and upper central part of abdomen usually after food, and relieved by itself after some time. Commonly presents with/after burping, bending or after lying down. You notice a burning sensation in your chest that may start in your upper abdomen and radiate to your neck and leave sour taste in your mouth especially when you lying down (symptom worse at night). Cause Burning pain/sensation is due to reflux of stomach content (Acidic) into the food pipe (esophagus). What is reflux? When acid or bile from stomach regurgitates in to mouth causing burning sensation in chest and sour/bitter taste in mouth it is called reflux. Causes of Heartburn Heartburn is common symptom in some condition in which abdominal pressure is increases results into reflux of stomach content into food pipe, for example Pregnancy and obesity. Some common food and drink that we eat or drink i.e. Acidic juices (grapefruit, orange, and pineapple), acidic foods (tomatoes, grapefruit, and oranges) and carbonated beverages (Soda), May increase acid secretion in stomach and cause heartburn. Over consumption of Alcohol or caffeine (Coffee or chocolates) often cause Heartburn. Smoking and consumption of fatty food affect function of food pipe valve and cause reflux and results in Heartburn. A disease called Hiatus hernia where a portion of the stomach lies within the chest instead of the in abdomen, cause reflux and heartburn. Diseases and complication related to Heartburn Heartburn is a symptom of a common medical condition called Gastro esophageal reflux disease (GERD). It also commonly present with Hiatus hernia. If left neglected over long periods of time it may lead to other more serious conditions such as Barrett's esophagus (Pre cancerous condition) or esophageal cancer.