Gastrointestinal Tract
Anatomy
mouth•teeth•tongue•salivary glands
esophagus
pharynx
stomach
small intestine
colon
liver
gallbladder
pancreas
Functions
1. Ingestion: eating
2. Secretion: release of water, enzymes & buffers3. Mixing & propulsion: movement along GI tract4. Digestion: mechanical and chemical breakdown of
foods5. Absorption: getting it into the body6. Defecation: dumping waste products = defecation
DigestionProteins
Carbohydrates
Fats
Fig. 16.9Fig. 16.9
Fig. 16.2Fig. 16.2
Diagnostic techniquesCBC
Upper GI series
Barium enema
UTZ
CT scan
Disorders of the Digestive System
Reflux esophagitis
gastritis
peptic ulcers
irritable bowel syndrome
neoplasms
Reflux EsophagitisLES
Heartburn
Barret’s Esophagus
Antacids
H2-receptor blockers
GastritisInflammation of the lining of the stomach
The stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine.
Left untreated, these ulcers may bleed
Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis).
Signs and Symptoms:
most common - stomach upset and pain
Other symptoms of gastritis: * Indigestion (also called dyspepsia) * Heartburn * Abdominal pain * Hiccups * Loss of appetite * Nausea * Vomiting, possibly of blood (called hematemesis) or material that looks like coffee-grounds * Dark stools
Causes
• infection, • irritation, • autoimmune disorders (disorders caused by the body's immune response against its own tissues), or • backflow of bile into the stomach (bile reflux)
Infections can be any of the following types:
* Bacterial (usually Helicobacter pylori ) * Viral (including herpes simplex virus) * Parasitic * Fungal
Irritation can be caused by a number of things, such as the following:
* Long-term medication use (for example, aspirin, ibuprofen or other anti-inflammatory drugs [called NSAIDS]) * Alcohol use * Cigarette smoking * Chronic vomiting * Coffee and acidic beverages * Excess gastric acid secretion (such as from stress) * Eating or drinking caustic or corrosive substances (such as poisons) * Trauma (for example, radiation treatments or having swallowed a foreign object)
Helicobactor pylori- a common bacterial cause of gastritis and ulcersTreated with a combination of drugs.
antibiotics, a bismuth compound, and a proton pump inhibitor. (Proton pump inhibitors reduce stomach acid secretion.)
taken for at least 14 days.
In addition to the medications used for Helicobacter pylori infection, other medications that may be used to relieve symptoms of gastritis include those that reduce stomach acid secretion:
* Antacids such as calcium carbonate and magnesium hydroxide with aluminum salts * H2 blockers such as ranitidine, cimetidine, nizatidine, and famotidine * Proton pump inhibitors such as omeprazole and lansoprazole
Drugs that reduce stomach acid secretion help protect against or treat ulcers. Other drugs used for ulcers include:
* Misoprostol – protects against the major intestinal toxicity of NSAIDS, and can reduce the formation of ulcers * Sucralfate – helps to heal ulcers in the stomach
Peptic ulcersstomach and proximal duodenum
smoking, NSAIDS, steroid, alcohol, family history
duodenal - benign; gastric - malignant
H. pylori
endoscopy and biopsy
antacids with antibiotic
Diarrhea increased volume and liquidity of stool
secretoryosmotic
fluid replacement
Constipation less than 3 bowel movements per week
low fiber diet or a disease process
Appendicitisabdominal pain
RLQ
surgery
Acute Pancreatitisacute inflammation of the pancreas with
edema, autodigestion, necrosis and hge.
alcohol ingestion & biliary tract dse.
nausea & vomiting usually not present
IV fluid replacement and pain relievers
NGT suction
Acute cholecystitis inflammation of the gall bladder
obstruction of the cystic duct
crampy epigastric or RUQ postprandial pain
fever, nausea and vomiting
jaundice
surgery
Cholelithiasisgallstone in the common bile duct
fever, jaundice, RUQ pain (Charcot’s triad)
antibiotics
surgical - Cholecystectomy
CholelithiasisCholesterol stones
radiolucent with 10-20% opaque (calcifications)associated with Obesity
Pigment stones radiopaquealcoholic cirrhosis and biliary infection
Mixed stones radiolucentmost common type
Viral HepatitisHAV, HBV, HCV
jaundice, hepatomegaly, tender
HAV - fecal-oral
HBV - parenteral
HCV - parenteral
vitamin K
no specific therapy
Viral HepatitisHBsAg - infected
HBsAb - treated/immune/vaccinated
HBeAg - infectious
HBeAb - non-infectious
HBcAg – chronic/carrier
Alcoholic Liver Dse. leads to Liver
cirrhosis
Cirrhosis (Portal Hypertension)
diffuse fibrosis of liver, destroys normal architecture
Nodular regenerationMicronodular
<3mmuniform sizedue to metabolic insult (alcohol)
Cirrhosis (Portal Hypertension)
Macronodular>3mmvaried sizedue to significant liver injury leading to hepatic
necrosis (postinfectious or drug induced hepatitis) Increased risk of hepatocellular carcinoma
Cirrhosis (Portal Hypertension)esophageal varices
hematemesisMelena
peptic ulcerSplenomegalyCaput medusae/Spider angiomaAscitesHemorrhoids
GI BleedHematemesis
Melena
Hematochezia
Peutz-Jeghers Syndrome (PJS)an autosomal dominant inherited disorder
characterized by intestinal hamartomatous polyps in association with mucocutaneous melanocytic macules.
15-fold increased risk of developing intestinal cancerincludes gastrointestinal and
extraintestinal sites.
Inflammatory Bowel Diseases
Ulcerative Colitis
idiopathic chronic inflammatory disorder limited to the colon
lifelong illness that has a profound emotional and social impact on patients who are affected.
rectum (>95% of cases), extends proximally from the anal verge in an uninterrupted pattern to involve part or all of the colon.
Ulcerative Colitis
* Frequent episodes of rectal bleeding occur, with or without mucus. The characteristic feature is blood in each bowel movement.
* Urgency and tenesmus
* Abdominal cramps
* Weight loss in severe cases
Crohn's Diseaseform of inflammatory bowel disease (IBD)
usually affects the ILEUM, but may occur anywhere from the mouth to the end of the rectum (anus).
Causes: autoimmune disorder
ongoing (chronic) inflammation of the GIT --> healthy patches of tissue between diseased areas --> causes the intestinal wall to become thick.
A person's genes and environmental factors seem to play a role in the development of Crohn's disease. The body may be overreacting to normal bacteria in the intestines.
Crohn's Disease
5 different types of Crohn's disease:
* Ileocolitis is the most common form. It affects the lowest part of the small intestine (ileum) and the large intestine (colon).
* Ileitis affects the ileum.
* Gastroduodenal Crohn's disease causes inflammation in the stomach and the duodenum.
* Jejunoileitis causes spotty patches of inflammation in the jejunum.
* Crohn's (granulomatous) colitis only affects the large intestine.
INCREASED RISK OF DEVELOPING CANCER
The main symptoms of Crohn's disease are:
* Crampy abdominal (belly area) pain
* Fever
* Fatigue
* Loss of appetite
* Pain with passing stool (tenesmus)
* Persistent, watery diarrhea
* Unintentional weight loss
Other symptoms may include:
* Constipation
* Eye inflammation
* Fistulas (usually around the rectal area, may cause draining of pus, mucus, or stools)
* Joint pain
* Liver inflammation
* Mouth ulcers
* Rectal bleeding and bloody stools
* Skin rash
* Swollen gums
END
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