460 ~ 4 April 2006

• Still no handout / notes from: Saw Palmetto: McDonagh to Persico ?

• Module VII – Integrative Approaches re Common Health Issues:

~ GI system today~ chronic fatigue & oncology next

day

Tomorrow …

• … Wednesday of this week, at two minutes and three seconds after 1:00 in the  morning, the time and date will be 01:02:03 04/05/06

That won't  ever happen again

You are what you eat, Or,

You are what you ingest, And

. . . what you can’t ingest ?

Bodily

Systems

GI Groups

1. Abu-Romeh to Blanchette

2. Blommers to Connor 3. Crowther to

Eastwood 4. Fabian to Geddis 5. Girvan to Hudders

6. Jagielnik to Korczynski

7. Kusmider to Mazur 8. McDonagh to Persico 9. Pone to Sklazeski 10. Snider to Zettler

Groups 1 – 3 What is the GI system, how does it work ?

Groups 4 – 6 How do we care for it & what goes wrong ?

Groups 7 – 10 What are possible CAM preventions/therapies ?

GI Components

• Esophagus • Stomach • Duodenum • Small bowel • Colon • Liver and biliary system • Spleen • Pancreas • GI - Other

Functions of GI System

• Broadly: ingest, digest, absorb food

• Immune surveillance & response• Detoxification• Neuro-endocrine regulation

gland

Stomach

Small Intestine

Esophagus

Large Intestine

Digestive function support by

• Mastication

• Peristalsis

• Enzymes & secretions that facilitate enzymes’ functions

Absorptive function facilitated by

– Immense surface area of small intestine (villi and microvilli)

– Active transport and diffusion (transmucosal, energy-driven processes) along entire lengths of small and large intestines

•diseases  •radiological findings,  •differential-diagnosis lists   •pertinent anatomy, pathology, and physiology

Esophageal Issues

“every centimeterof GI tract is colonized bybacteria…every meal bathes thissurface with antigens, organisms,& active substances derived from food &drink” [text]

The GI’s Strategy of Digestion

Sudbury’s Science North

GI Slide:• Kids can slide

and crawl through a giant 3D model of the digestive system from mouth to large intestine.  This exhibit is 8’ high and over 30’ long

A brief travel thru main components ofGI tract . . .

The Oesophagus

The Stomach

The Stomach

Histology

The Small Intestine

• Duodenum

• Jejunum

• Ileum

The SmallIntestine ~The Jejunum

The Pancreas• structurally, the pancreas has four sections; head, neck,

body and tail; the tail stretches back to just in front of the spleen.

• The pancreas consists mainly of exocrine glands that secrete enzymes to aid in the digestion of food in the small intestine. the main enzymes produced are lipases, peptidases and amylases for fats, proteins and carbohydrates respectively. These are released into the duodenum via the duodenal ampulla, the same place that bile from the liver drains into

•Pancreatic exocrine secretion is hormonally regulated, and the same hormone that encourages secretion (cholesystokinin) also encourages discharge of the gall bladder's store of bile

• As bile is essentially an emulsifying agent, it makes fats water soluble and gives the pancreatic enzymes lots of surface area to work on

The Large Intestine

What goes wrong ?

• Cancers of GI tract [ some 21% of all cancers are GI ones ]

• Eating too much• Drinking too much • Diarrhea• Anorexia, nausea, vomiting, pain• Acid reflux• Gas, bloating, flatulence, heartburn• Irritable bowel syndrome• Dyspepsia• Ulcers• GI toxicity from NSAIDs • Hemorrhoids

Medline Plus is aterrific allopathicsource of GIissues & treatments

Allopathy and your gastroenterologist ?

Gastroenterology:• The branch of medicine dealing

with the study of disorders affecting the stomach, intestines, and associated organs

Gastroenterology – complex field of medicine:

• CPT Codes • ICD-9 Codes • HCPCS Supply Codes • Modifiers • RBRVS Values • CCI Edits

• Medicare Guidelines • Documentation

Requirements • National Coverage

Decisions • Local Medicare Review

Policies • Anatomy & Terminology

Reference • Evaluation & Management

Guidelines

Learn proven tips for correctly coding and billing dozens of Gastroenterology procedures and services including: Diagnostic Sigmoidoscopy Therapeutic Colonoscopy Diagnostic & Therapeutic Esophagogastroduodenoscopy (EGD) Endoscopic Examination--Upper Gastrointestinal Tract Modified Barium Swallow Studies Telemetric Gastrointestinal Capsule Imaging Gastric Bypass Surgery for Morbid Obesity

Complex area is this system – consider allopathic text re

drugs• Pharmacology in Nursing Practice · Introduction · Drugs Affecting the

Immune System · Antivirals and Antifungals · Biologic Response Modifiers and Immunosuppressants · Antineoplastics · Drugs Affecting the Nervous System · Sympathetic Nervous System Agents · Parasympathetic Nervous System and Antiparkinsonism Agents · Central Nervous System Stimulants and Skeletal Muscle Relaxants · Anticonvulsants · Anesthetics · Anxiolytics, Antidepressants, Mood Stabilizers, and Antipsychotics · Drugs Affecting the Hematologic System · Agents Affecting Coagulation, Bleeding and Blood Formation · Drugs Affecting Blood Pressure and Blood Flow · Antihypertensives · Antilipidemics · Drugs Affecting the Cardiac System Agents Affecting Cardiac Output · Antiarrhythmics · Drugs Affecting the Respiratory System · Agents Affecting Upper Respiratory Disorders · Antihistamines · Antiasthmatics and Bronchodilators · Drugs Affecting the Endocrine System · Thyroid, Parathyroid Agents · Anterior Pituatory Hormones, Glucocorticoids, Mineralcorticoids, and Adrenal Hormone Inhibitors · Antidiabetics · Drugs Affecting the Gastrointestinal System · Agents Affecting Hyperacidity, Gastric Mucosa, Motility and Flatulance · Antiemetics, Emetics and Agents Used for Digestive Problems · Laxatives and Antidiarrheals · Drugs Affecting the Genitourinary Tract and Renal Disorders · Agents Used in Urinary Tract Alterations and to Improve Renal Output · Agents used in Renal Failure · Drugs Affecting the Reproductive System · Male and Female Hormones · Agents Affecting Uterine Motility, Fertility, and Infertility · Drugs Affecting the Musculoskeletal System · Anti-Inflammatory Agents · Drugs Affecting Nutrition · Agents Used for Nutritional Imbalances · Drugs Affecting the Sensory System · Ophthalmics and Otics · Dermatologics · Analgesics for Pain Relief

Aspirin

• BMJ 2000;321:1170-1171 ( 11 November 2001 ):

• Aspirin, like all other drugs, is a poison: “We do not know who should be given what dose and for how long”

• Long term use has resulted in severe GI hemorrhaging

• Enteric or coated aspirin

Solutions from Sci North

Burp Man • A larger than life

cartoon character drinks from a three-foot pop can pumped by visitor

• The stomach pressure increases until the character releases a giant burp, while a second interactive exhibit shows how the sphincter works

Solutions from Sci North

Gas Attack!

• Everyone loves to play pinball 

• Two custom pinball games are positioned in front of an animated pig sitting atop a pile of poop  

• The games are customized to teach children which foods create more gas in their bodies  

• The animated pig says funny quips at the start and end of each game

Text & Integrative Approaches to GI System

• Complex terminology? • Know concepts, not host of medical

terms• Concept of dysbiosis or dys-symbiosis• Dysbiosis is re indigenous “flora” of

the gut start to promote illness [ NOT infection ]

• Discusses regulation of GI flora by diet, motility, secretions like HCl, immunity, antibiotics, and probiotics

Text & Intestinal Permeability & Gut Barrier Function

• Nutrient absorption• How nutritional deficiencies affect

absorption• Treatment of increased

permeability (hyper-permeability) by removing the cause [ex: NSAIDs ] then nourishing the gut

• Problems of fiber supplements

Text and specific GI Disorders

• discusses multi-component, integrative, evidence-based approaches to: ~ Inflammatory bowel disease ~ Crohn’s disease ~ Ulcerative colitis ~ “functional bowel disorders”

• examines integrative therapies for Irritable Bowel Syndrome by asking series of questions

• Finishes by looking at Acid-Peptic diseases like ulcers and the use of acupuncture, herbs, dietary regulation

Next Day . . .

• Chronic Fatigue

• Oncology