Digestive Diseases
GASTROENTEROLOGIST
A physician that
specializes in
disorders and
diseases of the
digestive system
REVIEW
Small intestine –
where digestion is
completed and
absorption occurs
Here you have the
addition of enzymes
from pancreas and
bile from
liver/gallbladder
Absorption
Absorption occurs when:
1. Carbohydrates are
converted to glucose
2. Proteins broken down
to amino acids
3. Fats changed to fatty
acids and glycerol
GASTROENTERITIS
Inflammation of mucus
membrane lining of
stomach and intestine
Common causes –
virus
Symptoms – diarrhea
and vomiting for 24 –
36 hours
Complication dehydration
REVIEW
Regulation of H2O balance
by absorbing large quantities
back into bloodstream
Also absorbs Vitamin B
complex and K
Bacterial action on
undigested food –
decomposed products
excreted through colon –
bacteria form moderate
amounts of B complex and
Vitamin K
FECES
Is undigested semi-solid
consisting of bacteria, waste
products, mucous and
cellulose
Defecation – when lg
intestine fills, defecation
reflex triggered – colon and
rectal muscles contract while
internal sphincter relaxes
E-Coli live in lg intestine and
feed on undigested fiber in
fecal material to help reduce
amount of feces produced.
1/3 of feces excreted is
made up of E-Coli bacteria
DIARRHEA
Loose, watery, frequent bowel
movements when feces pass
along colon too rapidly and not
enough water is absorbed
Caused by infection, poor diet,
nervousness, toxic substances
or irritants in food
When the lg. Intestine is
irritated and inflamed, the
intestinal mucosa secretes
large amounts of water and
electrolytes in addition to
mucus.
CONSTIPATION
Slow movement of
feces through the
large intestine
Feces become dry
and hard because of
the increased fluid
absorption during its
extended time in the
large intestine
CONSTIPATION
If passage of feces
through lg intestine is
prolonged beyond 5
days, the feces lose
volume and become
more solid
Causes include
irregular defecation
patterns, intestinal
blockages, tumors,
and diverticulitis
CONSTIPATION
Treatment includes
diet with cereals,
fruits, vegetables,
(roughage), drinking
plenty of fluids,
exercise, and
avoiding tension
Colon removed from
a man that did not
have a bowel
movement for 30
days.
HEMORRHOIDS or PILES
Enlarged or inflamed veins
(varicose veins) that
protrude from the anal lining
Cause – excessive straining
during defecation or
childbirth
Rx – remove pressure that
causes the condition or in
severe cases they can be
removed surgically
FLATULENCE
Gas formation
(flatus) is from 1-3
pints per day
It passes through
the rectum at least
14 times a day
Bacteria in the large
intestine produce
the gases (methane
– CH4
COLITIS (Irritable
Bowel Syndrome)
Any inflammatory condition of
the lg intestine
Cause unknown – may be result
of emotional stress or an
autoimmune disease such as
ulcerative colitis
Symptoms – alternating
episodes of constipation or
diarrhea and abdominal cramps
Rx – high fiber diet, relaxation,
and antispasmodic drugs. If
these don’t work – affected part
can be surgically removed.
DIVERTICULOSIS
Little sacs (diverticuli) develop
in wall of colon
Most people over the age of
50 who eat low fiber foods
have this
When the sacs become
inflamed = DIVERTICULITIS
Symptoms – abdominal pain
and swelling, diarrhea,
constipation,gas, and rectal
bleeding
APPENDICITIS
Inflammation of the appendix that
usually occurs because of
obstruction of the appendix
If it ruptures, bacteria from
appendix can spread to the
peritoneal cavity causing
PERITONITIS
Symptoms – acute pain in RLQ,
loss of appetite, nausea,
vomiting, and mild fever
Rx – surgical removal
COLORECTAL CANCER
2nd leading cause of death from
cancer in the United States
Occurs most frequently after age 50
and even more frequently after the
age of 70
Risk factors – family history,
inflammatory bowel disease,
intestinal polyps, high saturated-fat
intake diet, and increasing age
Symptoms – fecal blood, a change
in bowel habits, decrease in stool
diameter, weight loss, fatigue, and
onset of abdominal pain
COLONOSCOPY
Early detection for colon
cancer is critical – need
a colonoscopy after age
50
Colonscope (flexible
viewing tube) is passed
through the anus into the
colon
Can take pictures and
obtain tissue samples
HEMOCCULT SLIDE
Stool slide specimen to look
for hidden (occult) blood
Hemoccult annual
screening tests can reduce
the risk of death from CRC
by up to 33%
In the privacy of their home,
they collect a small amount
of stool specimen on 3
different days and return
the test card to your doctor
or laboratory
COLON CANCER
Rx – surgical resection
May also require a
COLOSTOMY –
opening in abdomen,
healthy bowel brought
to skin after cancer
removed
Pouch worn to collect
waist
CIRRHOSIS
Chronic progressive
disease of the liver
Normal tissue is replaced
by fibrous connective
tissue
Symptoms – nausea,
anorexia, gray-white
stools, weakness, and
pain
CIRRHOSIS
Causes – hepatitis, chronic
alcohol abuse,
malnutrition, or infection
75% caused by excessive
alcohol consumption
Rx – Remove cause and
put on high protein diet.
Liver transplant may be
needed for extensive
damage
CIRRHOSIS OF THE LIVER
Ascites is an abnormal accumulation of fluid
containing large amounts of protein and
electrolytes – detectable when more than 500
ml of fluid has accumulated
Is a complication of cirrhosis
Rx – diet therapy and diuretic therapy
CIRRHOSIS
Jaundice – yellow
color of skin and
sclera when bile
pigment gets in
bloodstream
Best place to assess
for jaundice is the
hard palate
Is a symptom of liver
disease and biliary
obstruction
HEPATITIS A
Known as infectious
hepatitis
Cause – virus
Spread through
contaminated food
and water
Occurs commonly in
young people
HEPATITIS A
Symptoms – Makes you feel like you have the
flu – tired, sick to your stomach, fever,
anorexia, diarrhea, dark yellow urine (tea
colored), gray stools, and jaundice
Rx – Bedrest and no alcohol
Can protect yourself by getting a Hepatitis A
Vaccine. Also always wash your hands after
using the bathroom and drink bottled water
when you are in another country
HEPATITIS B
(Serum Hepatitis
Caused by virus found in the blood
Transmitted by blood transfusion or
being stuck with contaminated
needles (drug addicts)
Can block the flow of blood through
the liver, thus causing it to back up
into the hepatic portal circulation.
This causes portal hypertension
and to relieve the pressure – new
veins that connect to the systemic
veins are formed.
HEPATITIS B
Health care workers
at risk and should
be vaccinated
Use standard
precautions for
prevention
CHOLELITHIASIS
Condition of gallstones
Gallstones are solid clumps of
material (mostly cholesterol)
Can block the bile duct causing
pain and digestive disorders
Small ones may pass on their
own, large ones surgically
removed
Surgical removal of gallbladder CHOLECYSTECTOMY
CHOLECYSTITIS
(Gallbladder Inflammation
Often seen with gallstones
Risk factors for gallstone
formation –severely obese
people because the liver
produces higher level of
cholesterol and also
people who have a
significant weight loss in a
short amount of time
LAPAROSCOPIC
CHOLECYSTECTOMY
Most common method of
cholecystectomy
Small abdominal incisions
allow insertion of surgical
instruments and small video
camera
Surgeon performs procedure
by watching monitor and
manipulating instruments
Stomach muscles are not cut,
healing is quicker
LAPAROSCOPIC
CHOLECYSTECTOMY
ULCERS
Craterlike sore or lesion
that forms in the mucosal
lining of the stomach
1 in 10 people in the US will
suffer from an ulcer
Gastric ulcers in the
stomach and duodenal
ulcers in the duocenum
Cause – H. pylori (bacteria)
is primary cause – burrows
through the mucosa and
impairs the lining’s ability to
produce protective mucus
ULCERS
Lifestyle factors that contribute:
Cigarette smoking
Alcohol
Stress
Certain Drugs
Symptoms – burning pain in
abdomen, between meals and early
morning, may be relieved by eating
or taking antacid
ULCERS
Diagnosis -X-ray and presence
of H.pylori (bacteria)
The bacteria is diagnosed by
biopsy, breath, or blood
antibody tests
If not treated, these lesions
may result in hemorrhage,
perforation, widespread
infection, scarring, and other
serious medical complications
Rx – H2 blockers (drugs) that
block release of histamine
PANCREAS REVIEW
Lies behind stomach
Both endocrine and
exocrine gland
Pancreatic juice is the
most important
digestive juice
It contains enzymes
that digest all three
major kinds of foods
Pancreatic juice
contains sodium
bicarbonate, an
alkaline substance
that neutralizes the
hydrochloric acid
Pancreatic juice
enters the
duodenum in the
same place bile
enters
PANCREATITIS
Inflammation of pancreas
Acute pancreatitis usually
results from blockage of the
common bile duct – pancratic
enzymes “back up” and digests
it.
In some cases of stomach
inflammation from excess
alcohol consumption or in
gallbladder disease, irritation
may extend to the pancreas
and cause abnormal activation
of the pancreatic enzymes
½ of cases are fatal
PYLORIC STENOSIS
Normally stomach contents
are moved through the pyloric
sphincter within about 2 to 6
hours after eating
Narrowing of pyloric sphincter,
often found in infants- more
common in boys
Symptoms – projectile
vomiting
Treatment – surgery to modify
the muscle to food can pass
from the stomach into the
duodenum
GASTROESOPHAGEAL
REFLUX DISEASE (GERD)
Cardiac sphincter is weak and
relaxes inappropriately
Esophagus is irritated by acid
that comes up from the stomach
Also called “Acid Reflux”
Some people feel nothing
Symptoms – heartburn pain, a
bitter taste in your mouth,
coughing at night, hoarseness in
the morning, or worsening
asthma
Stomach acid in the esophagus
can cause ulcers, stenosis, and
cancer
GERD
Dietary habits that improve
GERD
1. Eat small portions
2. Avoid onions, chocolate,
peppermint, high-fat or spicy
foods, citrus fruits, garlic,
and tomatoes
Avoid drinking citrus juices,
alcohol, coffee, tea, soft
drinks, and other caffeinated
and carbonated drinks
Avoid eating or drinking for 3
hours before going to bed
GERD
Lifestyle habits that improve
GERD
1. Lose weight if overweight
2. Stop smoking
3. Avoid wearing tight fitting
clothing or belts
4. Avoid lying down or prolonged
bending over, especially after
eating
5. Avoid straining and
constipation
6. Elevate the HOB 6 to 8 inches
7. Avoid stress
GERD
Additional treatments:
1. Over-the-counter antacids or nonprescription-strength acid-blocking
medications called H2 receptor antagonists
such as Tagamet, Zantac, or Pepcid
2. Severe cases require surgery
HIATAL HERNIA
When stomach protrudes
above diaphragm through
esophageal opening
More common in people
over 50
GERD is a symptom for
hiatal hernia
TO BE CONTINUED
Hepatitis part 1
Hepatitis A-fecal contamination of food
or water ( improper food handling,raw
shellfish,)
Hepatitis B- sexual contact blood
transfusions or needle sticks
Hepatitis C –blood contact and dirty
neeles( Tattoo parlors)Low incidence of
this kind
Hepatitis part 2
1. Hepatitis E-mainly in Asia,
Mexico,India and Africa. Also thru
feces contaminated foods.Pregnant
women often die with this form
2. Hepatitis F-Nonexistent in the
US.In Far East only.It is non A,non
B and non C types, so its called F
3. Hepatitis G- Not infectious,doesn’t cause
sickness. Found in a MD in Chicago.Rx:rest