Symptoms bring patients to the doctor. Quite often a diagnosis can be made just on a symptom or its combination with others. The doctor’s examination and tests merely go toward confirming the diagnosis. It is very important that a good account of the symptoms be noted and described, as this will help separate and identify the various conditions or illness, which can affect the digestive system.

– It is the commonest symptom when seeking a doctor. Where the pain is felt will often point to its origin: upper abdominal pain for the stomach, liver, pancreas and gallbladder; central (naval) pain for the small intestine; and lower abdomen pain for the large intestine. The character of the pain, whether it is cramping, acidic, constant, or sharp and sudden, may help suggest the mechanism involved with the pain. How severe it is & for how long it lasts are two useful features to note. Are there actions or medicines that help or worsen the pain? Does the pain move about? As there are other organs within the abdomen and pelvis, which are not part of the digestive system e.g. kidneys, uterus, ovaries etc., describing the pain and location accurately may often distinguish them apart.

– An important cause of vomiting is that of an obstruction to the passage of food anywhere along the digestive tract. Distension, pain and vomiting after eating or drinking would be an important combination to look for. Stale / old food and large quantities vomited are also highly suggestive of obstruction. Often in such cases, the vomiting provides some relief. Pain, severe nausea and anorexia can cause vomiting even without obstruction (e.g. diseases of the liver, gallstones, gastritis, gastroenteritis etc.). Vomiting tends to occur together with these symptoms and varies in amount. A common side effect of medications is vomiting. Other causes of vomiting not related to the digestive system include severe giddiness and even severe emotional distress (horror, revulsion).

– This describes the acid-type of discomfort or pain experienced in the chest caused by the back flow of gastric acid and juices from the stomach into the gullet, or esophagus. Positions such as lying flat and bending forward, and the act of burping are known to trigger this. Antacids may temporarily relieve heartburn. Other important symptoms to note would also include pain and food getting stuck during swallowing, as these may indicate the presence of ulcers, narrowing of the food passage or tumors.

– When gas accumulates in the digestive tract, it causes bloating and discomfort. Burping clears swallowed air (gobbling down food, fizzy drinks) while passing flatus rids the air formed in the large intestine caused by bacterial action on undigested food. Changes in the diet may contribute to this problem. Often, there is no actual increase in the amount of air even though bloating is sensed. Burping could also be a habit, a type of nervous tic. Air alone does not indicate a significant problem, unless symptoms of maldigestion or malabsorption (greasy diarrhoea, weight loss, vitamin deficiencies) or intestinal obstruction are also present(pain, vomiting, and constipation).

– This is said to occur when stools become loose or watery. The number of movements per day and the volume passed is important. Abdominal pain, bleeding (heavy versus staining), fever, distension, vomiting, & dizziness are also important when estimating dehydration (thirst, dizziness, lethargy, low blood pressure) or the presence of severe inflammation. Acute diarrhoea is most often caused by food poisoning or food/water borne infections whereas chronic diarrhoea (more than 3 weeks long) has other reasons beside infections. Dysentery describes bloody diarrhoeas, which are caused by certain invasive infections.

– This is usually defined as having less than 3 bowel movements a week. Often the stools are hard and patients complain of the need to strain and for frequent use of laxatives. Most chronic constipation comes from slow intestinal transit, lack of exercise, inadequate fluids and fibre, and it often afflicts women and the older individuals. It may also be the result of medication. Any recent onset or worsening of constipation, especially if accompanied by other alarm symptoms – bleeding, pain, fluctuating bowel habits, warrants further diagnostic tests.

– When the pigment bilirubin circulating in the blood increases, it colors the eyes yellow and the urine dark yellow or brown. It usually implies the presence of diseases affecting the liver or the gallbladder and bile ducts. Additional symptoms such as lethargy, nausea, anorexia, and abdominal swelling may point to the liver as the cause, and, when there is acute and severe pain the gallbladder and bile ducts are the likelier culprits. The common causes include hepatitis, liver cirrhosis, gallstones and liver cancer, bile duct cancer or pancreatic cancer. Severe and rapid destruction of red blood cells may also cause jaundice even when the liver and bile ducts are normal. In a few individuals, the liver is less efficient in removing bilirubin. This results in raised blood levels and mild jaundice in some. These people have a condition called Gilbert’s syndrome, which is not at all dangerous.

– Blood passed in the digestive tract is always regarded as abnormal. It appears fresh and bright red when the bleeding is lower most (rectum or anus). When bleeding occurs higher up – e.g. stomach, small intestines or at the start of the large intestine – it often mixes with stools causing stools to turn black, or, the blood and clots appear stale (darker, maroon coloured). Small quantities of blood in faeces may not be visible – “occult blood”— and can only be detected by the use of special tests. This form of bleeding is suspected in patients with unexplained anaemia. The commonest cause of painless, fresh, and sometimes heavy bleeding is haemorrhoids. When fresh bleeding is accompanied by pain in the anus, skin tears called anal fissures are likely. Diverticular disease, inflammatory bowel disease, and cancer of the colon & rectum, are other important causes of bleeding. Other lesser known causes include angiodyplasia (abnormal blood vessels), large colonic polyps, and ischaemic colitis (inadequate blood supply to the colon). Tests such as colonoscopy and barium enema are used to investigate and confirm the cause of bleeding in patients whenever it is felt that more important diseases, could lie deeper in the large intestine.