UNIT 20 THE GASTROINTESTINAL SYSTEM

PROFESSIONAL ENGLISH IN USE MEDICINE

UNIT 20

THE GASTROINTESTINAL SYSTEM

A.       Examination of the abdomen

Here is an extract from a textbook description of how to examine the abdomen.

Note if the abdomen is distended by fluid or gas. The presence of fluid can be confirmed by demonstrating shifting dullness; percuss or tap, first with the patient lying supine – flat on their back; then ask the patient to lie on one side and percuss again. If fluid is present, the dull note heard on percussion moves. Palpate each region, feeling for tenderness – pain when touched, or masses – palpable enlargement of tissue. Note also any guarding or rigidity, shown by contraction of the abdominal muscles. Guarding may be due to tenderness or anxiety and can be reduced if the patient is persuaded to relax. Rigidity, however, is constant and is due to peritoneal irritation. Rebound tenderness is pain when the palpating hand is suddenly removed. It is a sign of priorities. Listen for bowel sounds.

B.        The faeces

There are several words for the faeces

Doctors sometimes say

There was blood in the stools.

Have you passed black stools?

Patients sometimes say

My motions have been very loose lately.

Bowel movement is used to refer to defecation:

Have your bowels moved today?

Have you had a bowel movement today?

Bowel habit is a medical expression meaning the pattern of defecation.

Have you noticed any change of bowel habit?

How often do you open your bowels?

Are you going to the toilet more often than normal?

Change in bowel habit could be constipation – hard, infrequent stools, or diarrhoea – frequent soft or liquid stools.

Normal stools are brown in colour, and semi-solid, or formed. The consistency, or degree of hardness and softness, can be shown on a scale. 

 

The colour can be vary from black, due to altered blood as in melaena, to yellow, grey or even white. Melaena stools are often described as tarry – like tar, the black sticky substance that used in road making. The stools may be red when fresh blood is present. Blood that can only be detected with special tests is called faecal occult blood (FOB). When there is a high fat content, the stools are pale, and sometimes described as clay-coloured. Stools that are large in volume are described as bulky, a bad small described as foul or offensive.

EXERCISES

20.1.      Complete the table with words from B opposite and related forms

Case 14

Physical examination revealed a thin girl with slight pallor, she was not obviously dehydrated. The temperature was 380C. pulse 100/min, blood pressure 110/80 mmHg. Examination of the rest of the cardiovascular and respiratory system was normal. The abdomen was not 1 _________. There was generalized 2 _________, which was most marked in the right lower 3 _________ and was associated with 4 _________ but not 5 _________. There was rebound 6 _________ and no 7 _________were felt. 8 _________ sounds were reduced.

20.2       Match the descriptions of the stools (1-6) with the conditions most likely to cause them (a-f), using your medical knowledge. Look at B opposite to help you.

Type of stools		Condition
1	loose, bloody	a	gastric ulcer
2	loose, pale, bulky	b	irritable bowel syndrome
3	clay-coloured	c	ulcerative colitis
4	black, tarry	d	cholera
5	small, hard	e	coeliac disease
6	clear, watery with mucus	f	obstructive jaundice

20.3       Match the features (1-7) TO HE DOCTOR’S QUESTIONS (a-g). Look at B opposite to help you.

1	blood	a	How often do you open your bowels?
2	bowel habit	b	Are you going to the toilet more often than normal?
3	change in bowel habit	c	Are the motions hard or loose?
4	bulk	d	Do the motions have an unusual smell?
5	colour	e	What about the appearance of the stools?
6	consistency	f	Have you passed black stools?
7	offensiveness	g	Is the size or the amount of the stool normal?

ANSWER KEY