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The classic history of esophageal rupture is one of severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock develop rapidly thereafter. [6] Physical examination is usually not helpful, particularly early in the course.
Unlike rumination, gastroparesis causes vomiting (in contrast to regurgitation) of food, which is not being digested further, from the stomach. This vomiting occurs several hours after a meal is ingested, preceded by nausea and retching, and has the bitter or sour taste typical of vomit. [4]
Iron-deficiency anemia is mainly caused by blood loss, such as may occur during menses or gastrointestinal hemorrhage.This often results in a depapilled, atrophic glossitis, giving the tongue a bald and shiny appearance, along with pallor (paleness) of the lips and other mucous membranes a tendency towards recurrent oral ulceration, [6] and cheilosis (swelling of the lips). [7]
People who are capable of "handsfree purging", or the induction of vomiting by the willful opening of the esophageal sphincter in a manner similar to belching, while contracting the stomach muscles, do not have Russell's sign. People who use a fork, spoon, or foreign object to stimulate the gag reflex may not display Russell's sign.
As the mouth and nasal cavity are connected via the back of the throat, particularly forceful vomiting, or producing large quantities of vomit may result in material being ejected through the nostrils in addition to the mouth. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days.
Esophagitis can be asymptomatic; or can cause epigastric and/or substernal burning pain, especially when lying down or straining; and can make swallowing difficult . The most common cause of esophagitis is the reverse flow of acid from the stomach into the lower esophagus: gastroesophageal reflux disease (GERD).
As many as 39% of the children had resolution of symptoms immediately or within weeks of the diagnosis. Vomiting had resolved at the time of follow-up in 61% of the sample. Many children, including those in the remitted group, continued to have somatic symptoms such as headaches (in 42%) and abdominal pain (in 37%). [18]
However, upper central abdominal pain is the most common symptom; the pain may be dull, vague, burning, aching, gnawing, sore, or sharp. [13] Pain is usually located in the upper central portion of the abdomen, [14] but it may occur anywhere from the upper left portion of the abdomen around to the back.