Digestive Diseases

1. Digestive Diseases Introduction to Human Diseases Chapter 10

2. Gastrointestinal System Anatomy • Oropharynx • Esophagus • Stomach • Small intestine • Large intestine • Rectum • Other digestive organs: liver, gall bladder, pancreas

3. Stomatitis • Inflammation of the oral mucosa • Etiology: • Herpetic stomatitis (cold sores, HSV 1) • Aphthous stomatitis (canker sores) • Temporary immunosuppression involve in both • S/S: painful blisters or ulcers • Treatment: topical anesthetics & rinses, antiviral meds for herpes (1 day of meds)

4. Gastroesophageal Reflux Disease(GERD) • Backup (reflux) of gastric & duodenal contents (food & acid) past the incompetent lower esophageal sphincter into the esophagus • More GERD in people over 40 YOA • Stats: • 7% of US population have daily heartburn • 20-40% with heartburn have GERD

5. GERD • Usually involves the following: • Functional/mechanical problem with LES • Certain foods, meds, hormones • Coffee, etoh, b-or Ca channel blockers, nitrates, progesterone • Obesity (contributing factor)

6. GERD • S/S: • Heartburn, regurgitation, dysphagia, cough, chest pain, wheezing • Treatment: • Antacids, H2 blockers, PPI, prokinetic agents • 80% GERD is controlled with meds, 20% need surgery • Other issues: • 50% GERD get esophagitis • 8-15% GERD have Barrett’s esophagus (stricture)

7. Gastritis • Acute or chronic inflammation & erosion of the gastric mucosa • Etiology: idiopathic frequently, may be due to foods, meds, alcohol, caffeine • S/S: epigastric pain, nausea & vomiting, belching, full feeling in epigastrium • Treatment: avoidance of irritants, H2 blockers or antacids

8. Gastroenteritis • Inflammation of the stomach & small intestine • Some types: traveler’s diarrhea, food poisoning • Etiology: commonly infectious (viral, bacterial, protozoal, parasitic), also meds and toxins • Diagnosis: history, stool culture for bacteria or stool exam for parasites • Treatment: varies with etiology • Meds for parasitic, helminthic, protozoal • Antiemetics, sometimes antidiarrheals • Avoids of fatty or dairy foods, increased fluid intake

9. Hiatal Hernia • Protrusion of part of the stomach through the diaphragmatic opening into the thorax • Types: • Sliding (most common) GE jct + stomach slide upwards into thorax • Paraesophageal (rolling) GE jct remains fixed • More common in: women, obesity, trauma,older age • Etiology: unknown • Suspected: high intra-abdominal pressure or weakness of gastroesophageal junction, trauma

10. Hiatal Hernia (HH) • S/S: • 50% asymptomatic • Heartburn, chest pain, dysphagia, reflux • Diagnosis: • CXR, endoscopy • Treatment: • Diet, meds for reflux, change in activities, surgery

11. Peptic Ulcers • Well-defined lesion (ulcers) in the mucosa of the lower esophagus, stomach, pylorus, or duodenum • Etiology: • Gastric acid hypersecretion conditions, Helicobacter pylori infection, mucosal damage from aspirin, NSAID’s, alcohol, tobacco • More common in: • Middle-aged and older males, smokers, alcohol and NSAID users, Type A blood type (gastric) and type O blood type (duodenal)

12. Peptic Ulcers • S/S: heartburn, epigastric pain, nausea, vomiting, GI bleeding, symptoms within/about 2 hours post-prandial • Diagnosis: endoscopy • Treatment: • H. pylori: antibiotics, bismuth • Same as reflux, also possible endoscopic surgery (cautery) or routine surgical resection

13. Infantile Colic • Paroxysmal abdominal pain or cramping • First 3 months of life • Etiology: • Excessive fermentation & gas production, overeating, air swallowing, rapid feeding, inadequate burping • S/S: crying, drawing up legs • Diagnostics: Rule of Three’s (1st 3 months of life, crying 3 hrs/day, 3 days/week, at least 3 weeks.) • Treatment: calming child, feeding techniques, etc.

14. Lower GI Tract Diseases • Celiac Disease/ Gluten Induced Enteropathy • Malabsorption due to immunologic reaction to part of gluten (wheat), gluten intolerance, and mucosal damage to intestine • Inherited, female to male = 2 to 1 • S/S: abdominal distention, diarrhea (large, greasy, grey-yellow), poor absorption of B12 & folate, weight loss,

15. Celiac Disease • Testing: small intestinal biopsy (villi destruction) and improvement on gluten-free diet • Treatment: • Dietary avoidance of wheat products, supplements if needed of folate, etc.

16. Irritable Bowel Syndrome • GI symptom complex with no known organic cause: • Alternating constipation & diarrhea • Some change in colon motility • A diagnosis of exclusion • Most frequent GI disorder in US • Etiology: unknown • Disorder of adults

17. IBS • Treatment: • Variable, avoidance of foods or other factors that provoke episodes • No single successful treatment

18. Crohn’s Disease/ Regional Enteritis • Chronic inflammatory disease of unknown etiology that primarily involves the ileum • Transmural thickening of bowel wall • Patchy or segmental areas of this • Thickening of wall, narrowing of lumen • S/S: abdominal pain, diarrhea, anorexia & weight loss, anal or other fissures, fistulas

19. Crohn’s Disease • Diagnosis • Colonoscopy & biopsy • Treatment: • Immunosuppressives, anti-inflammatories, surgery (colectomy, ileostomy)

20. Ulcerative Colitis • Inflammation & ulceration of the colon, beginning in rectum or sigmoid and extending proximally • Only mucosa is involved • Uniform involvement of the area, no segments or patches of healthy tissue • Etiology, diagnostic test, treatment: like Crohn’s Disease

21. Diverticular Disease • Diverticulosis • Outpouching of colonic mucosa that bulge through wall into peritoneum • Diverticulitis • Infection of diverticuli • Etiology: obstruction of diverticuli by matter (particulate material in stool, fecalith, etc) and subsequent infection

22. Diverticular Disease • S/S • LLQ pain, fever, nausea, diarrhea • Diagnostics • Blood tests nondiagnostic, CT scan • Treatment • Dietary changes (high fiber), antibiotics for flare-up, surgery if needed

23. Acute Appendicitis • Inflammation & infection of appendix, often due to obstruction by fecalith • S/S: RLQ pain (McBurney’s Point), anorexia, low-grade fever, nausea, possible peritonitis if rupture occurs • Treatment: appendectomy

24. Hemorrhoids • Dilated, tortuous veins of anus or rectum • Internal or external • S/S: itching, bleeding, pain • Etiology: high intraabdominal pressure conditions • Treatment: antiinflammatories, hemorrhoidectomy

25. Abdominal Hernias • Protrusion of an internal organ through an abnormal opening in the abdominal wall • Umbilical (ventral), femoral, or inguinal (most common type) • Etiology: congenital or acquired weakness in part of abdominal wall • Lifting, pregnancy, obesity = predispositions • S/S: visible or palpable bulge is most common, sometimes pain, nausea, vomiting

26. Hernias • Incarcerated vs. strangulated hernia • Treatment: Surgery (herniorraphy)

27. Colorectal Cancer • Adenocarcinoma almost always • Disease of adults (over 40 YOA) • Risk factors: • High meat, low fiber diets, IBS, polyposis • S/S: often asymptomatic, occult lower GI bleeding, change in bowel habits • Diagnosis: sigmoidoscopy or colonoscopy and biopsy, routine screening after age 50

28. Colorectal Cancer • Treatment: • Surgery if early • Chemotherapy/radiation if mets

29. Diarrhea • Frequent passage of feces, often increased in volume and fluidity • Is this itself a disease? • Sign or symptom? • Etiology: numerous • Testing: stool cultures, examination for WBC, RBC, parasites, etc

30. Helminths • Worms living as parasites in human GI tract • Types: • Roundworms • Ingestion of larvae deposited by dogs/cats • Usually children ingest dirt • Pinworms • Egg deposition around anus • Nocturnal pruritis

31. Pancreatitis • Inflammation of pancreas • Autodigestion due to leaking pancreatic digestive enzymes • Acute or chronic • Mild or life-threatening • Etiology: associated with alcoholism, biliary disease, trauma, severe hyperlipidemias

32. Pancreatitis • S/S: • Upper abdominal pain, vomiting • Diagnosis: blood tests helpful • Treatment: IV hydration, treatment of vomiting, no oral foods (GI rest)

33. Biliary Diseases • Cholelithiasis • Gallstones, mostly cholesterol in US • Mostly middle-ages or older females • May are asymptomatic • Cholecystitis • Inflammation of GB wall • Often occurs due to obstruction of cystic duct by gallstone

34. Biliary Diseases • S/S: • Severe RUQ pain, often spasmic, nausea, vomiting, intolerance of fatty foods • Diagnosis: ultrasound, blood tests • Treatment: • If mild: dietary avoidance • If severe: laparoscopic cholecystectomy

35. Cirrhosis • Chronic, irreversible degenerative liver disease, like scarring with regrowth of abnormal liver cells • Due to repeated trauma of many etiologies: • Toxins, infections, metabolic, circulatory • Liver failure (hepatic insufficiency) often occurs

36. Cirrhosis • Etiologies: • Alcoholic is most common etiology • Also biliary diseases, hemochromotosis, idiopathic • S/S: jaundice, firm, enlarged palpable liver, weight loss, pruritis, increased bleeding,ascites, edema of legs and abd wall, esophageal varices

37. Hepatitis • Acute viral etiology is most common • Hepatitis A: infectious hepatitis • Hepatitis B: via human secretions or feces • Hepatitis C: less common, often becomes chronic, quiescent for decades • Hepatitis D: delta hepatitis • Hepatitis E: rare in US, feces-contaminated water • Hepatitis G: blood-borne illness

38. Hepatitis • Diagnosis: blood testing for antibodies and antigens, liver function tests • S/S: RUQ pain, nausea, fatigue, jaundice, loss of appetite, fever • Treatment: • Usually supportive, immunoglobulin

39. Pancreatic Cancer • Usually adenocarcinoma • Often head of the pancreas • Geriatric disease (60-70 YOA) • Remains asymptomatic until late • Great majority of patients have advanced disease at time of diagnosis