Chapter 5

1. Chapter 5 The Digestive System: Pathology

2. Pathology • Oral Cavity • Canker Sores (AKA Aphthous Ulcers) • Grey-white pits with a red border • Often associated with stress, certain foods, fever • Dry Mouth (AKA Xerostomia) • Absence of or diminished amount of saliva

3. Pathology • Cold Sores (AKA Herpes labialis) • Blisters on the lips or face caused by HSV-1 • Most adults are infected, but only some experience the exacerbation

4. Pathology • Cleft Lip / Palate • AKA harelip • Congenital defect where the lip or the palate or both fail to close properly and result in a fissure • If left can cause difficulty in eating or speaking • Can be surgically corrected

5. Pathology • Teeth • Bruxism • Clenching or grinding of teeth • Associated with tension or stress • Caries • Tooth decay • Infectious disease that destroys the enamel and dentin • May eventually expose the pulp and become infected

6. Pathology • Dental Plaque • Soft deposit of bacteria that builds up on teeth • Major cause of caries and periodontal disease • Calculus • AKA tartar • Hardened dental plaque that irritates the surrounding tissues • Gingivitis • Inflammation of the gums • Earliest stage of periodontal disease

7. Pathology • Temporomandibular disorders (TMD) • Group of symptoms including pain, headache, difficulty in chewing related to problems with the TM joint

8. Pathology • Esophagus • GERD (Gastroesophageal Reflux Disease) • Upward flow of stomach acid into the esophagus • Common cause of indigestion • Achalasia • Failure of the lower esophageal (cardiac) sphincter to relax • Due to a lack of peristalsis • -chalasia means relaxation

9. Pathology • Esophageal Varices • Enlarged and swollen veins at the lower end of the esophagus • May rupture and bleed

10. Pathology • Stomach • Gastritis • Gastroenteritis • Gastrorrhea

11. Pathology • Ulcers • Erosion of the skin or mucous membrane • Frequently caused by Helicobacter pylori • Perforating Ulcer – erosion through entire wall • Gastric Ulcer – occur in stomach • Duodenal Ulcer – occurs in small intestine (most common)

12. Ulcers

13. Pathology • Eating Disorders • Anorexia Nervosa • Characterized by a false perception of body appearance • Compulsive dieting and/or exercise lead to emaciation (abnormal thinness)

14. Pathology • Bulimia nervosa • False perception of body image leads to episodes of binge eating followed by compulsive behaviours like vomiting or misuse of laxatives, etc • Bulimia means excessive, continuous hunger • Pica • Persistent eating of non-food substances

15. Pathology • Nutritional Conditions • Dehydration • Fluid loss exceeds fluid intake • Disrupts electrolyte balance • Malnutrition • Lack of proper food or nutrients due to shortage in intake or malabsorption (a condition in which the small intestine cannot absorb nutrients)

16. Pathology • Indigestion and Vomiting • Aerophagia • Excessive swallowing of air while eating or drinking • Aer/o means air • Dyspepsia • Pain or discomfort in digestion • -pepsia means digestion

17. Pathology • Intestines • Diverticulum • Pouch or sac occurring in the wall of a tubular organ • Diverticulitis • Inflammation of a diverticulum • Diverticulosis • Presence of several diverticula in the colon

18. Pathology • Enteritis • Inflammation of the small intestine • Caused by eating or drinking contaminated substances • Ileus • Partial or complete blockage of the intestines • Caused by cessation of peristalsis • Symptoms include pain, cramping, abdominal distension, vomiting, failure to pass gas or defecate • Often occurs after abdominal surgery

19. Pathology • Irritable Bowel Syndrome • AKA Spastic Colon • Idiopathic condition that results in cramping, abdominal pain, bloating, constipation, diarrhea • Usually aggravated by stress

20. Pathology • Inflammatory Bowel Diseases • Chronic, incurable diseases that result in intestinal inflammation • Symptoms include pain, weight loss, fatigue, fever, rectal bleeding, diarrhea • Often have a cycle of flares and remissions • Treatment includes medication and surgery to remove diseased tissue

21. Pathology • Examples of IBD’s • Ulcerative Colitis • Idiopathic • Repeated episodes of inflammation in the rectum and colon cause ulcers and irritation • Affects only lining of the colon

22. Pathology • Crohn’s Disease • Autoimmune disorder • Can occur anywhere in the digestive tract • Penetrates every layer of tissue – results in scarring and thickening of walls • AKA ileitis, crohn’s colitis

23. Pathology • Intestinal Obstructions • Partial or complete blockage due to physical obstruction • Adhesions – bands of fibrous tissue that abnormally connect the intestines to each other, to other organs, or to the abdominal wall • Strangulating obstruction – blood flow to a segment of the intestine is cut off (leads to gangrene or perforation)

24. Pathology • Volvulus – twisting of the intestine (usually occurs in infancy) • Intussusception – telescoping of one part of the small intestine into another

25. Pathology • Infectious diseases of the intestines • Amebic Dysentery • Symptoms: loose stool, pain, cramping • Transmitted by contaminated food or water • Botulism • Symptoms: Paralysis, death • AKA food poisoning (rare) • Cholera • Symptoms: diarrhea, vomiting, rapid dehydration • Transmitted by contaminated food or water

26. Infectious Diseases • E.coli • Symptoms: bloody diarrhea, abdominal cramping • Transmitted through undercooked food • Salmonella • Symptoms: diarrhea, nausea, vomiting, high fever • Transmitted by fecal contaminated food • Typhoid Fever • Symptoms: headache, delirium, cough, watery diarrhea, rash, high fever • Caused by eating food that has been handled by a carrier

27. Pathology • Hernias • Occurs when part of an organ protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place. • Types: • Hiatal – protrusion of the stomach through the esophageal sphincter in the diaphragm • Incisional – protrusion of a loop of the intestines through a weak point created by surgery

28. Pathology • Inguinal – protrusion of a loop of the intestines through the lower abdominal wall or groin • Umbilical – protrusion of a loop of the intestines through the weak point at the umbilicus • Strangulated – occurs when blood supply is cut off from the herniated tissue

29. Pathology • Anorectal disorders • Anal fissure • Small tear in the skin of the anus • Causes pain during bowel movements • Bowel incontinence • Inability to control defecation

30. Pathology • Hemorrhoids • AKA piles • Cluster of veins, muscles, and tissues slip near or through the anal opening • Veins become inflamed and lead to pain, fecal leaking, and bleeding

31. Pathology • Liver • Hepatomegaly • Hepatitis • Inflammation of the liver • Caused by a virus (5 kinds A-E) • **Hepatitis A is spread by contaminated food and water • **Hepatitis B is spread through contaminated blood and sexual contact • Hepatitis C is spread through contaminated blood • Hepatitis D only develops in the presence of Hepatitis B **vaccine available

32. Pathology • Cirrhosis • Degenerative disease of the liver • Scar tissue replaces normal tissue • Blocks the flow of blood, so jaundice may result • Also may lead to ascites and brain or kidney damage

33. Pathology • Gallbladder • Cholecystalgia • Cholecystitis • Usually associated with gallstones blocking the flow of bile

34. Pathology • Gallstones • AKA biliary calculi, cholelith • Hard deposit that forms in the gallbladder and bile ducts • Cholelithiasis • Presences of gallstones • -lithiasis means presence of stones

35. Diagnostic Procedures • CT Scan • Radiographic cross-sectional analysis of tissue structure • Ultrasound • Uses sound waves to visualize soft tissues • Capsule Endoscopy • AKA Given Diagnostic Imaging system • Patient swallows a capsule with a tiny camera inside

36. Diagnostic Procedures • Esophagogastroduodenoscopy • Anoscopy • Colonoscopy • Sigmoidoscopy • Upper and Lower GI Series • Contrast media are used to help display the tissues of the digestive tract • Fecal Occult Blood Test • AKA Hemoccult • Test for blood in stool

37. Treatments • Medications • Antacids • Emetics • Antiemetics • Laxatives

38. Treatment • Oral Cavity and Esophagus • Gingivectomy • Palatoplasty • Dental prophylaxis • Cleaning of teeth to remove plaque and calculus • Stomach • Gastrectomy • Gastric bypass • Nasogastric intubation – used for artificial feeding

39. Treatment • Intestines • Colectomy • Diverticulectomy • Hemorrhoidectomy • May also use ligation • Gastroduodenostomy • Removal of the pylorus and creation of an anastomosis between the rest of the stomach and the small intestine • Anastomosis: surgical connection between two hollow organs

40. Treatment • Ostomies • Creation of an opening (stoma) between a hollow organ and the body surface • Colostomy • Ileostomy • Gastrostomy • Rectum and Anus • Proctectomy • Proctopexy • -pexy means surgical fixation of a prolapsed organ • Proctoplasty

41. Treatment • Liver • Hepatectomy • Hepatorrhaphy • Liver transplant • May be full or partial (if partial, usually donated by a living relative) • Gallbladder • Choledocholithotomy • Cholecystectomy • Laparoscopic cholecystectomy