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

GASTROENTERITISInflammation of mucus membrane lining of stomach and intestineCommon causes – virusSymptoms – diarrhea and vomiting for 24 – 36 hoursComplication - dehydration

REVIEWRegulation of H2O balance by absorbing large quantities back into bloodstreamAlso absorbs Vitamin B complex and KBacterial action on undigested food – decomposed products excreted through colon – bacteria form moderate amounts of B complex and Vitamin K

FECESIs undigested semi-solid consisting of bacteria, waste products, mucous and celluloseDefecation – when lg intestine fills, defecation reflex triggered – colon and rectal muscles contract while internal sphincter relaxesE-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

CONSTIPATIONIf passage of feces through lg intestine is prolonged beyond 5 days, the feces lose volume and become more solidCauses 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 froma 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 liningCause – 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 dayIt passes through the rectum at least 14 times a dayBacteria in the large intestine produce the gases (methane – CH4

COLITIS (Irritable Bowel Syndrome)

Any inflammatory condition of the lg intestineCause unknown – may be result of emotional stress or an autoimmune disease such as ulcerative colitisSymptoms – alternating episodes of constipation or diarrhea and abdominal crampsRx – high fiber diet, relaxation, and antispasmodic drugs. If these don’t work – affected part can be surgically removed.

DIVERTICULOSISLittle 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

APPENDICITISInflammation 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 CANCER2nd 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

COLONOSCOPYEarly 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) bloodHemoccult 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

CIRRHOSISCauses – 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 accumulatedIs a complication of cirrhosisRx – diet therapy and diuretic therapy

CIRRHOSIS

Jaundice – yellow color of skin and sclera when bile pigment gets in bloodstreamBest place to assess for jaundice is the hard palateIs 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 cholecystectomySmall abdominal incisions allow insertion of surgical instruments and small video cameraSurgeon performs procedure by watching monitor and manipulating instrumentsStomach muscles are not cut, healing is quicker

LAPAROSCOPIC CHOLECYSTECTOMY

ULCERS Craterlike sore or lesion that forms in the mucosal lining of the stomach1 in 10 people in the US will suffer from an ulcerGastric ulcers in the stomach and duodenal ulcers in the duocenumCause – H. pylori (bacteria) is primary cause – burrows through the mucosa and impairs the lining’s ability to produce protective mucus

ULCERSLifestyle 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

ULCERSDiagnosis -X-ray and presence of H.pylori (bacteria)The bacteria is diagnosed by biopsy, breath, or blood antibody testsIf not treated, these lesions may result in hemorrhage, perforation, widespread infection, scarring, and other serious medical complicationsRx – H2 blockers (drugs) that block release of histamine

PANCREAS REVIEW

Lies behind stomach Both endocrine and exocrine glandPancreatic juice is the most important digestive juiceIt contains enzymes that digest all three major kinds of foods

Pancreatic juice contains sodium bicarbonate, an alkaline substance that neutralizes the hydrochloric acidPancreatic juice enters the duodenum in the same place bile enters

PANCREATITISInflammation of pancreasAcute 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 enzymes½ of cases are fatal

PYLORIC STENOSIS

Normally stomach contents are moved through the pyloric sphincter within about 2 to 6 hours after eatingNarrowing of pyloric sphincter, often found in infants- more common in boysSymptoms – projectile vomitingTreatment – 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 inappropriatelyEsophagus is irritated by acid that comes up from the stomachAlso called “Acid Reflux”Some people feel nothingSymptoms – 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

GERDDietary habits that improve GERD1. Eat small portions2. Avoid onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoesAvoid drinking citrus juices, alcohol, coffee, tea, soft drinks, and other caffeinated and carbonated drinksAvoid eating or drinking for 3 hours before going to bed

GERDLifestyle 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 non-prescription-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

Hep D- Only people who have B, get D

Hep E mainly in asia

Hepatitis part 21. 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