Digestive Diseases

Introduction to Human Diseases

Chapter 10

Gastrointestinal System Anatomy

OropharynxEsophagusStomachSmall intestineLarge intestineRectumOther digestive organs: liver, gall bladder, pancreas

Stomatitis

Inflammation of the oral mucosaEtiology: Herpetic stomatitis (cold sores, HSV 1) Aphthous stomatitis (canker sores) Temporary immunosuppression involve in both

S/S: painful blisters or ulcersTreatment: topical anesthetics & rinses, antiviral meds for herpes (1 day of meds)

Gastroesophageal Reflux Disease(GERD)

Backup (reflux) of gastric & duodenal contents (food & acid) past the incompetent lower esophageal sphincter into the esophagusMore GERD in people over 40 YOAStats: 7% of US population have daily heartburn 20-40% with heartburn have GERD

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)

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)

Gastritis

Acute or chronic inflammation & erosion of the gastric mucosaEtiology: idiopathic frequently, may be due to foods, meds, alcohol, caffeineS/S: epigastric pain, nausea & vomiting, belching, full feeling in epigastriumTreatment: avoidance of irritants, H2 blockers or antacids

Gastroenteritis

Inflammation of the stomach & small intestine Some types: traveler’s diarrhea, food poisoning

Etiology: commonly infectious (viral, bacterial, protozoal, parasitic), also meds and toxinsDiagnosis: history, stool culture for bacteria or stool exam for parasitesTreatment: varies with etiology Meds for parasitic, helminthic, protozoal Antiemetics, sometimes antidiarrheals Avoids of fatty or dairy foods, increased fluid intake

Hiatal Hernia

Protrusion of part of the stomach through the diaphragmatic opening into the thoraxTypes: 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

Hiatal Hernia (HH)

S/S: 50% asymptomatic Heartburn, chest pain, dysphagia, reflux

Diagnosis: CXR, endoscopy

Treatment: Diet, meds for reflux, change in activities,

surgery

Peptic Ulcers

Well-defined lesion (ulcers) in the mucosa of the lower esophagus, stomach, pylorus, or duodenumEtiology: 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)

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

Infantile Colic

Paroxysmal abdominal pain or crampingFirst 3 months of lifeEtiology: Excessive fermentation & gas production, overeating,

air swallowing, rapid feeding, inadequate burping

S/S: crying, drawing up legsDiagnostics: 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.

Lower GI Tract Diseases

Celiac Disease/ Gluten Induced EnteropathyMalabsorption due to immunologic reaction to part of gluten (wheat), gluten intolerance, and mucosal damage to intestineInherited, female to male = 2 to 1S/S: abdominal distention, diarrhea (large, greasy, grey-yellow), poor absorption of B12 & folate, weight loss,

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.

Irritable Bowel Syndrome

GI symptom complex with no known organic cause: Alternating constipation & diarrhea Some change in colon motility

A diagnosis of exclusionMost frequent GI disorder in USEtiology: unknownDisorder of adults

IBS

Treatment: Variable, avoidance of foods or other factors

that provoke episodes No single successful treatment

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

Crohn’s Disease

Diagnosis Colonoscopy & biopsy

Treatment: Immunosuppressives, anti-inflammatories,

surgery (colectomy, ileostomy)

Ulcerative Colitis

Inflammation & ulceration of the colon, beginning in rectum or sigmoid and extending proximallyOnly mucosa is involvedUniform involvement of the area, no segments or patches of healthy tissueEtiology, diagnostic test, treatment: like Crohn’s Disease

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

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

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

Hemorrhoids

Dilated, tortuous veins of anus or rectum Internal or external

S/S: itching, bleeding, pain

Etiology: high intraabdominal pressure conditions

Treatment: antiinflammatories, hemorrhoidectomy

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

Hernias

Incarcerated vs. strangulated hernia

Treatment: Surgery (herniorraphy)

Colorectal Cancer

Adenocarcinoma almost alwaysDisease 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 habitsDiagnosis: sigmoidoscopy or colonoscopy and biopsy, routine screening after age 50

Colorectal Cancer

Treatment: Surgery if early Chemotherapy/radiation if mets

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

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

Pancreatitis

Inflammation of pancreas Autodigestion due to leaking pancreatic

digestive enzymes

Acute or chronicMild or life-threateningEtiology: associated with alcoholism, biliary disease, trauma, severe hyperlipidemias

Pancreatitis

S/S: Upper abdominal pain, vomiting

Diagnosis: blood tests helpful

Treatment: IV hydration, treatment of vomiting, no oral foods (GI rest)

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

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

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

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

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

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

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