History of Past Gastrointestinal Diseases

The history of past gastrointestinal diseases encompasses disorders of the esophagus, stomach, pancreas, gall bladder, and biliary tract, as well as jaundice. Among the esophageal diseases, gastroesophageal reflux disease consists of reflux of gastric contents through an incompetent lower esophageal sphincter causing symptoms. It may be associated with esophageal inflammation and, in a minority of patients, bleeding and stricture formation. An esophageal stricture is a fibrotic narrowing generally of its lower end as a consequence of injury, usually from reflux esophagitis. Tumors of the esophagus, both extrinsic and intrinsic, can produce narrowing of the esophageal lumen, leading to symptoms that closely mimic those of benign stricture. Motor disorders of the esophagus are a group of disorders characterized by motor dysfunction, some being primary esophageal diseases such as achalasia, diffuse spasm, and presbyesophagus, while others reflect esophageal manifestations secondary to other diseases. A peptic ulcer is a sharply demarcated denuded area involving the mucosa, submucosa, and muscularis mucosa. It occurs commonly in the stomach and duodenum. Pain is the characteristic symptom. Pancreatitis, inflammation of the pancreas, is classified as acute, acute recurrent (relapsing), chronic relapsing, and chronic (exocrine pancreatic insufficiency). The most common disease of the gallbladder is associated with the presence of gallstones, with subsequent inflammation (cholecystitis). Cholecystitis can be acute or chronic. Stones in the common bile duct (choledocholithisis) or hepatic ducts may produce jaundice and/or biliary sepsis (cholangitis). Jaundice (icterus) is a yellow discoloration of the skin, sclera, and mucous membranes caused by the deposition of bilirubin. It is clinically apparent when the serum bilirubin is in the range of 2 to 3 mg/dl. It results from abnormalities in bilirubin metabolism. Depending on the site of interference, hyperbilirubinemia can be unconjugated (indirect), conjugated (direct), or combined.