Alterations of Digestive Function Chapter 39 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Alterations of Digestive FunctionAlterations of Digestive Function

Chapter 39Chapter 39

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

22Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction

AnorexiaAnorexia A lack of desire to eat despite physiologic stimuli A lack of desire to eat despite physiologic stimuli

that would normally produce hungerthat would normally produce hunger VomitingVomiting

The forceful emptying of the stomach and The forceful emptying of the stomach and intestinal contents through the mouthintestinal contents through the mouth

Several types of stimuli initiate the vomiting reflexSeveral types of stimuli initiate the vomiting reflex



NauseaNausea A subjective experience associated with a number of A subjective experience associated with a number of

conditionsconditions Common symptoms: hypersalivation and tachycardiaCommon symptoms: hypersalivation and tachycardia

RetchingRetching Nonproductive vomitingNonproductive vomiting

Projectile vomitingProjectile vomiting Spontaneous vomiting that does not follow nausea or Spontaneous vomiting that does not follow nausea or

retching retching



ConstipationConstipation Infrequent or difficult defecationInfrequent or difficult defecation PathophysiologyPathophysiology

• Neurogenic disorders, functional or mechanical Neurogenic disorders, functional or mechanical conditions, low-residue diet, sedentary lifestyle, conditions, low-residue diet, sedentary lifestyle, excessive use of antacids, changes in bowel habitsexcessive use of antacids, changes in bowel habits



DiarrheaDiarrhea Increased frequency of bowel movementsIncreased frequency of bowel movements Increased volume, fluidity, weight of the fecesIncreased volume, fluidity, weight of the feces

• May be protectiveMay be protective

Major mechanisms of diarrheaMajor mechanisms of diarrhea• Osmotic diarrheaOsmotic diarrhea

• Secretory diarrheaSecretory diarrhea

• Motility diarrheaMotility diarrhea



Systemic effects of GI dysfunctionSystemic effects of GI dysfunction Manifestations of diarrheaManifestations of diarrhea

• Dehydration, electrolyte imbalance, metabolic acidosis, and Dehydration, electrolyte imbalance, metabolic acidosis, and weight lossweight loss

Manifestations of acute bacterial or viral infectionManifestations of acute bacterial or viral infection• Fever, with or without cramping pain Fever, with or without cramping pain

Manifestations of inflammatory bowel diseaseManifestations of inflammatory bowel disease• Fever, cramping pain, bloody stools Fever, cramping pain, bloody stools

Manifestations of malabsorption syndromesManifestations of malabsorption syndromes• Steatorrhea (fat in the stools) and diarrheaSteatorrhea (fat in the stools) and diarrhea



Abdominal painAbdominal pain A symptom of a number of GI disordersA symptom of a number of GI disorders Parietal painParietal pain Visceral painVisceral pain Referred painReferred pain

Biochemical mediators of the inflammatory Biochemical mediators of the inflammatory response (histamine, bradykinin, and response (histamine, bradykinin, and serotonin) stimulate organic nerve endings serotonin) stimulate organic nerve endings producing abdominal pain producing abdominal pain



GI bleedingGI bleeding Upper GI bleedingUpper GI bleeding

• Esophagus, stomach, or duodenumEsophagus, stomach, or duodenum

Lower GI bleedingLower GI bleeding• Below the ligament of Treitz, or bleeding from the Below the ligament of Treitz, or bleeding from the

jejunum, ileum, colon, or rectumjejunum, ileum, colon, or rectum

HematemesisHematemesis HematocheziaHematochezia MelenaMelena Occult bleedingOccult bleeding


Disorders of MotilityDisorders of Motility DysphagiaDysphagia

Difficulty swallowingDifficulty swallowing TypesTypes

• Mechanical obstructionsMechanical obstructions

• Functional obstructionsFunctional obstructions

AchalasiaAchalasia• Denervation of smooth muscle in the esophagus and Denervation of smooth muscle in the esophagus and

lower esophageal sphincter relaxationlower esophageal sphincter relaxation


Disorders of MotilityDisorders of Motility Gastroesophageal reflux disease (GERD)Gastroesophageal reflux disease (GERD)

The reflux of chyme from the stomach to the The reflux of chyme from the stomach to the esophagusesophagus

If GERD causes inflammation of the esophagus, it If GERD causes inflammation of the esophagus, it is called reflux esophagitisis called reflux esophagitis

A normal functioning lower esophageal sphincter A normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent maintains a zone of high pressure to prevent chyme refluxchyme reflux


Disorders of MotilityDisorders of Motility Gastroesophageal reflux disease (GERD)Gastroesophageal reflux disease (GERD)

Conditions that increase abdominal pressure can Conditions that increase abdominal pressure can contribute to GERD contribute to GERD

ManifestationsManifestations• Heartburn, regurgitation of chyme, and upper abdominal Heartburn, regurgitation of chyme, and upper abdominal

pain within 1 hour of eatingpain within 1 hour of eating


Gastroesophageal Reflux DiseaseGastroesophageal Reflux Disease


Disorders of MotilityDisorders of Motility Hiatal herniaHiatal hernia

Sliding hiatal herniaSliding hiatal hernia Paraesophageal hiatal herniaParaesophageal hiatal hernia


Hiatal HerniaHiatal Hernia


Disorders of MotilityDisorders of Motility Pyloric obstructionPyloric obstruction

The blocking or narrowing of the opening between The blocking or narrowing of the opening between the stomach and the duodenumthe stomach and the duodenum

Can be acquired or congenitalCan be acquired or congenital ManifestationsManifestations

• Epigastric pain and fullness, nausea, succussion splash, Epigastric pain and fullness, nausea, succussion splash, vomiting, and with a prolonged obstruction, malnutrition, vomiting, and with a prolonged obstruction, malnutrition, dehydration, and extreme debilitationdehydration, and extreme debilitation


Disorders of MotilityDisorders of Motility Intestinal obstruction and ileusIntestinal obstruction and ileus

An intestinal obstruction is any condition that An intestinal obstruction is any condition that prevents the flow of chyme through the intestinal prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the lumen or failure of normal intestinal motility in the absence of an obstructing lesionabsence of an obstructing lesion

An ileus is an obstruction of the intestinesAn ileus is an obstruction of the intestines ManifestastionsManifestastions

• Colicky pain, vomiting, distention, hypovolemia, Colicky pain, vomiting, distention, hypovolemia, metabolic acidosismetabolic acidosis


Disorders of MotilityDisorders of Motility Intestinal obstruction and ileusIntestinal obstruction and ileus

Simple obstructionSimple obstruction Functional obstructionFunctional obstruction Small intestinal obstructionSmall intestinal obstruction Large bowel obstructionLarge bowel obstruction


Intestinal ObstructionIntestinal Obstruction


GastritisGastritis Inflammatory disorder of the gastric mucosaInflammatory disorder of the gastric mucosa Acute gastritisAcute gastritis

H. pylori,H. pylori, NSAIDs NSAIDs Chronic gastritisChronic gastritis

Chronic fundal gastritisChronic fundal gastritis Chronic antral gastritisChronic antral gastritis

• Signs and symptoms of chronic gastritis often do not Signs and symptoms of chronic gastritis often do not correlate with the severity of the disease correlate with the severity of the disease


Peptic Ulcer DiseasePeptic Ulcer Disease A break or ulceration in the protective A break or ulceration in the protective

mucosal lining of the lower esophagus, mucosal lining of the lower esophagus, stomach, or duodenumstomach, or duodenum

Acute and chronic ulcersAcute and chronic ulcers SuperficialSuperficial

Erosions Erosions DeepDeep

True ulcersTrue ulcers


Chronic Peptic UlcerChronic Peptic Ulcer


Peptic Ulcer DiseasePeptic Ulcer Disease Duodenal ulcersDuodenal ulcers

Most common of the peptic ulcersMost common of the peptic ulcers Developmental factorsDevelopmental factors

• H. pyloriH. pylori infection infection Toxins and enzymes that promote inflammation and Toxins and enzymes that promote inflammation and

ulcerationulceration

• Hypersecretion of stomach acid and pepsinHypersecretion of stomach acid and pepsin• Use of NSAIDsUse of NSAIDs• High gastrin levelsHigh gastrin levels• Acid production by cigarette smokingAcid production by cigarette smoking


Duodenal UlcerDuodenal Ulcer


Gastric UlcerGastric Ulcer Tends to develop in the antral region of the Tends to develop in the antral region of the

stomach, adjacent to the acid-secreting stomach, adjacent to the acid-secreting mucosa of the bodymucosa of the body

PathophysiologyPathophysiology The primary defect is an increased mucosal The primary defect is an increased mucosal

permeability to hydrogen ionspermeability to hydrogen ions Gastric secretion is normal or less than normalGastric secretion is normal or less than normal


Gastric UlcerGastric Ulcer


Gastric UlcerGastric Ulcer


Stress UlcerStress Ulcer Stress ulcer is a peptic ulcer that is related to Stress ulcer is a peptic ulcer that is related to

severe illness, neural injury, or systemic severe illness, neural injury, or systemic traumatrauma Ischemic ulcersIschemic ulcers Cushing ulcersCushing ulcers

• Ulcers that develop as a result of a burn injuryUlcers that develop as a result of a burn injury

ManifestastionsManifestastions• Bleeding most commonBleeding most common


Dumping SyndromeDumping Syndrome Rapid emptying of chyme from surgically Rapid emptying of chyme from surgically

created residual stomach into small intestine created residual stomach into small intestine A clinical complication of partial gastrectomy A clinical complication of partial gastrectomy

or pyloroplasty surgeryor pyloroplasty surgery Developmental factorsDevelopmental factors

Loss of gastric capacity, loss of emptying control, Loss of gastric capacity, loss of emptying control, and loss of feedback control by the duodenum and loss of feedback control by the duodenum when it is removed when it is removed

Late dumping syndromeLate dumping syndrome


Postgastrectomy SyndromesPostgastrectomy Syndromes Alkaline reflux gastritisAlkaline reflux gastritis Afferent loop obstructionAfferent loop obstruction DiarrheaDiarrhea Weight lossWeight loss AnemiaAnemia


MalabsorptionMalabsorption Syndromes Syndromes Inadequate digestionInadequate digestion Pancreatic insufficiencyPancreatic insufficiency Lactase deficiencyLactase deficiency Bile salt deficiencyBile salt deficiency Gluten-sensitive enteropathyGluten-sensitive enteropathy


Malabsorption SyndromesMalabsorption Syndromes Pancreatic insufficiencyPancreatic insufficiency

Insufficient pancreatic enzyme productionInsufficient pancreatic enzyme production• Lipase, amylase, trypsin, or chymotrypsinLipase, amylase, trypsin, or chymotrypsin

Causes: pancreatitis, pancreatic carcinoma, Causes: pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosispancreatic resection, and cystic fibrosis

Fat maldigestion is the main problem, so the Fat maldigestion is the main problem, so the person will exhibit fatty stools and weight lossperson will exhibit fatty stools and weight loss


Malabsorption SyndromesMalabsorption Syndromes Lactase deficiencyLactase deficiency

Inability to break down lactose into Inability to break down lactose into monosaccharides and thus prevent lactose monosaccharides and thus prevent lactose digestion and monosaccharide absorptiondigestion and monosaccharide absorption

Fermentation of lactose by bacteria causes gas Fermentation of lactose by bacteria causes gas (cramping pain, flatulence, etc.) and osmotic (cramping pain, flatulence, etc.) and osmotic diarrheadiarrhea


Malabsorption SyndromesMalabsorption Syndromes

Bile salt deficiencyBile salt deficiency Conjugated bile salts needed to emulsify and absorb Conjugated bile salts needed to emulsify and absorb

fatsfats Conjugated bile salts are synthesized from cholesterol Conjugated bile salts are synthesized from cholesterol

in the liverin the liver Result from liver disease and bile obstructionsResult from liver disease and bile obstructions Poor intestinal absorption of lipids causes fatty stools, Poor intestinal absorption of lipids causes fatty stools,

diarrhea, and loss of fat-soluble vitamins (A, D, E, K)diarrhea, and loss of fat-soluble vitamins (A, D, E, K)


Malabsorption SyndromesMalabsorption Syndromes Fat-soluble vitamin deficienciesFat-soluble vitamin deficiencies

Vitamin AVitamin A• Night blindnessNight blindness

Vitamin DVitamin D• Decreased calcium absorption, bone pain, osteoporosis, Decreased calcium absorption, bone pain, osteoporosis,

fracturesfractures Vitamin KVitamin K

• Prolonged prothrombin time, purpura, and petechiaeProlonged prothrombin time, purpura, and petechiae Vitamin EVitamin E

• Uncertain Uncertain


Inflammatory Bowel DiseasesInflammatory Bowel Diseases Chronic, relapsing inflammatory bowel Chronic, relapsing inflammatory bowel

disorders of unknown origindisorders of unknown origin GeneticsGenetics Alterations of epithelial barrier functionsAlterations of epithelial barrier functions Immune reactions to intestinal floraImmune reactions to intestinal flora Abnormal T-cell responsesAbnormal T-cell responses


Ulcerative ColitisUlcerative Colitis Chronic inflammatory disease that causes Chronic inflammatory disease that causes

ulceration of the colonic mucosa ulceration of the colonic mucosa Sigmoid colon and rectumSigmoid colon and rectum

Suggested causesSuggested causes Infectious, immunologic (anticolon antibodies), Infectious, immunologic (anticolon antibodies),

dietary, genetic (supported by family studies and dietary, genetic (supported by family studies and identical twin studies)identical twin studies)


Ulcerative ColitisUlcerative Colitis SymptomsSymptoms

Diarrhea (10-20/day), bloody stools, crampsDiarrhea (10-20/day), bloody stools, cramps TreatmentTreatment

Broad-spectrum antibiotics and steroidsBroad-spectrum antibiotics and steroids Immunosuppressive agentsImmunosuppressive agents SurgerySurgery

Increased colon cancer risk demonstratedIncreased colon cancer risk demonstrated


Crohn DiseaseCrohn Disease Granulomatous colitis, ileocolitis, or regional Granulomatous colitis, ileocolitis, or regional

enteritisenteritis Idiopathic inflammatory disorder; affects any Idiopathic inflammatory disorder; affects any

part of the digestive tract, from mouth to anuspart of the digestive tract, from mouth to anus Difficult to differentiate from ulcerative colitisDifficult to differentiate from ulcerative colitis

Similar risk factors and theories of causationSimilar risk factors and theories of causation


Crohn DiseaseCrohn Disease Causes “skip lesions”Causes “skip lesions” Ulcerations can produce longitudinal and Ulcerations can produce longitudinal and

transverse inflammatory fissures that extend transverse inflammatory fissures that extend into the lymphaticsinto the lymphatics

Anemia may result due to malabsorption of Anemia may result due to malabsorption of vitamin Bvitamin B1212 and folic acid and folic acid

Treatment is similar to ulcerative colitisTreatment is similar to ulcerative colitis


Ulcerative Colitis and Ulcerative Colitis and Crohn DiseaseCrohn Disease


Crohn DiseaseCrohn Disease


Diverticular Disease of the ColonDiverticular Disease of the Colon DiverticulaDiverticula

Herniations of mucosa through the muscle layers Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colonof the colon wall, especially the sigmoid colon

DiverticulosisDiverticulosis Asymptomatic diverticular diseaseAsymptomatic diverticular disease

DiverticulitisDiverticulitis The inflammatory stage of diverticulosisThe inflammatory stage of diverticulosis

ManifestationsManifestations Low abdominal pain, diarrhea, constipation, fever, Low abdominal pain, diarrhea, constipation, fever,

leukocytosisleukocytosis


AppendicitisAppendicitis

Inflammation of the vermiform appendix Inflammation of the vermiform appendix Possible causesPossible causes

Obstruction, ischemia, increased intraluminal Obstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc.pressure, infection, ulceration, etc.

ManifestationsManifestations Epigastric and right lower quadrant pain, rebound Epigastric and right lower quadrant pain, rebound

tendernesstenderness Nausea, vomiting, fever, leukocytosisNausea, vomiting, fever, leukocytosis

Most serious complication is peritonitisMost serious complication is peritonitis


Vascular InsufficiencyVascular Insufficiency Blood supply to the stomach and intestineBlood supply to the stomach and intestine

Celiac axisCeliac axis Superior and inferior mesenteric arteriesSuperior and inferior mesenteric arteries Two of three must be compromised to cause Two of three must be compromised to cause

ischemiaischemia Mesenteric venous thrombosisMesenteric venous thrombosis Acute occlusion of mesenteric artery blood Acute occlusion of mesenteric artery blood

flowflow Chronic mesenteric insufficiencyChronic mesenteric insufficiency


ObesityObesity Obesity is an increase in body fat massObesity is an increase in body fat mass

Body fat index >30Body fat index >30 A major cause of morbidity, death, and A major cause of morbidity, death, and

increased health care costsincreased health care costs Risk factor for many diseases and conditionsRisk factor for many diseases and conditions


ObesityObesity HypothalamusHypothalamus Hormones that control appetite and weightHormones that control appetite and weight

Insulin, ghrelin, peptide YY, leptin, adiponectin, Insulin, ghrelin, peptide YY, leptin, adiponectin, and resistinand resistin

Leptin resistanceLeptin resistance HyperleptinemiaHyperleptinemia


Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa

Characterized by abnormal eating behavior, Characterized by abnormal eating behavior, weight regulation, and disturbed attitudes weight regulation, and disturbed attitudes toward body weight, body shape, and sizetoward body weight, body shape, and size



Anorexia nervosaAnorexia nervosa Person has poor body image disorder and refuses Person has poor body image disorder and refuses

to eatto eat Person can lose 25% to 30% of ideal body weight Person can lose 25% to 30% of ideal body weight

due to fat and muscle depletiondue to fat and muscle depletion Can lead to starvation-induced cardiac failureCan lead to starvation-induced cardiac failure In females, characterized by absence of three In females, characterized by absence of three

consecutive menstrual periodsconsecutive menstrual periods Binge eating/purgingBinge eating/purging



Bulimia nervosaBulimia nervosa Body weight remains near normal but with Body weight remains near normal but with

aspirations for weight lossaspirations for weight loss FindingsFindings

• Recurrent episodes of binge eatingRecurrent episodes of binge eating• Self-induced vomitingSelf-induced vomiting• Two binge-eating episodes per week for at least 3 Two binge-eating episodes per week for at least 3

monthsmonths• Fasting to oppose the effect of binge eating, or excessive Fasting to oppose the effect of binge eating, or excessive

exerciseexercise



Bulimia nervosaBulimia nervosa Continual vomiting of acidic chyme can cause Continual vomiting of acidic chyme can cause

pitted teeth, pharyngeal and esophageal pitted teeth, pharyngeal and esophageal inflammation, and tracheoesophageal fistulaeinflammation, and tracheoesophageal fistulae

Overuse of laxative can cause rectal bleedingOveruse of laxative can cause rectal bleeding



StarvationStarvation Decreased caloric intake leading to weight lossDecreased caloric intake leading to weight loss Short-term starvationShort-term starvation

• Glycogenolysis Glycogenolysis

• GluconeogenesisGluconeogenesis

Long-term starvationLong-term starvation• MarasmusMarasmus

• KwashiorkorKwashiorkor


Manifestations of Liver DiseaseManifestations of Liver Disease

Portal hypertensionPortal hypertension AscitesAscites Hepatic-encephalopathyHepatic-encephalopathy JaundiceJaundice Hepatorenal syndromeHepatorenal syndrome


Liver DisordersLiver Disorders Portal hypertensionPortal hypertension

Abnormally high blood pressure in the portal Abnormally high blood pressure in the portal venous system due to resistance to portal blood venous system due to resistance to portal blood flow flow • PrehepaticPrehepatic

• IntrahepaticIntrahepatic

• Posthepatic Posthepatic


Liver DisordersLiver Disorders Portal hypertensionPortal hypertension

ConsequencesConsequences• VaricesVarices

Lower esophagus, stomach, rectumLower esophagus, stomach, rectum

• SplenomegalySplenomegaly

• AscitesAscites

• Hepatic encephalopathyHepatic encephalopathy


VaricesVarices


Hepatic EncephalopathyHepatic Encephalopathy

Accumulation of toxins related to liver failure Accumulation of toxins related to liver failure cause disruption of neurotransmissioncause disruption of neurotransmission Ammonia-bacterial urease acting on gut proteinsAmmonia-bacterial urease acting on gut proteins Neurotoxins: result from hepatic failureNeurotoxins: result from hepatic failure

SymptomsSymptoms Personality changesPersonality changes ConfusionConfusion Memory lossMemory loss Stupor, coma, deathStupor, coma, death


Liver DisordersLiver Disorders Jaundice (icterus)Jaundice (icterus)

Obstructive jaundiceObstructive jaundice• Extrahepatic obstructionExtrahepatic obstruction

• Intrahepatic obstructionIntrahepatic obstruction

Hemolytic jaundice Hemolytic jaundice • Prehepatic jaundicePrehepatic jaundice

• Excessive hemolysis of red blood cells or absorption of a Excessive hemolysis of red blood cells or absorption of a hematomahematoma


JaundiceJaundice


Hepatorenal Syndrome (HRS)Hepatorenal Syndrome (HRS) Renal failure demonstrating oliguria, sodium Renal failure demonstrating oliguria, sodium

and water retention, hypotension, and and water retention, hypotension, and peripheral vasodilation due to advanced liver peripheral vasodilation due to advanced liver diseasedisease


Hepatorenal SyndromeHepatorenal Syndrome

Renal failure associated with liver failureRenal failure associated with liver failure HypovolemiaHypovolemia HypotensionHypotension Decreased renal blood flowDecreased renal blood flow Intrarenal vasoconstrictionIntrarenal vasoconstriction Decreased GFR and urine outputDecreased GFR and urine output


Viral HepatitisViral Hepatitis Systemic viral disease that primarily affects Systemic viral disease that primarily affects

the liverthe liver Hepatitis AHepatitis A

• Formally known as infectious hepatitisFormally known as infectious hepatitis

Hepatitis BHepatitis B• Formally known as serum hepatitisFormally known as serum hepatitis

Hepatitis C, D, E, GHepatitis C, D, E, G


Hepatitis AHepatitis A Can be found in the feces, bile, and sera of Can be found in the feces, bile, and sera of

infected individualsinfected individuals Usually transmitted by the fecal-oral routeUsually transmitted by the fecal-oral route Risk factorsRisk factors

Crowded, unsanitary conditionsCrowded, unsanitary conditions Food and water contaminationFood and water contamination


Hepatitis AHepatitis A


Hepatitis BHepatitis B Transmitted through contact with infected Transmitted through contact with infected

blood, body fluids, contaminated needlesblood, body fluids, contaminated needles Maternal transmission if the mother is Maternal transmission if the mother is

infected during the third trimesterinfected during the third trimester Hepatitis B vaccine prevents transmission Hepatitis B vaccine prevents transmission

and development of hepatitis Band development of hepatitis B


Hepatitis BHepatitis B


Hepatitis CHepatitis C Responsible for most cases of post-Responsible for most cases of post-

transfusion hepatitistransfusion hepatitis Also implicated in infections related to IV drug Also implicated in infections related to IV drug

useuse 50% to 80% of hepatitis C cases result in 50% to 80% of hepatitis C cases result in

chronic hepatitischronic hepatitis


HepatitisHepatitis Hepatitis DHepatitis D

Depends on hepatitis B for replication Depends on hepatitis B for replication Hepatitis EHepatitis E

Fecal-oral transmissionFecal-oral transmission Developing countriesDeveloping countries

Hepatitis GHepatitis G Recently discoveredRecently discovered Parenterally and sexually transmittedParenterally and sexually transmitted


HepatitisHepatitis

SequenceSequence Incubation phaseIncubation phase Prodromal (preicteric) phaseProdromal (preicteric) phase Icteric phaseIcteric phase Recovery phaseRecovery phase

Chronic active hepatitisChronic active hepatitis Fulminant hepatitisFulminant hepatitis

From impairment or necrosis of hepatocytesFrom impairment or necrosis of hepatocytes Acute hepatic failureAcute hepatic failure

Acetaminophen overdoseAcetaminophen overdose


CirrhosisCirrhosis Irreversible inflammatory disease that Irreversible inflammatory disease that

disrupts liver function and even structuredisrupts liver function and even structure Decreased hepatic function from nodular and Decreased hepatic function from nodular and

fibrotic tissue synthesis (fibrosis)fibrotic tissue synthesis (fibrosis) Biliary channels become obstructed and Biliary channels become obstructed and

cause portal hypertension; due to the cause portal hypertension; due to the hypertension, blood shunted away from the hypertension, blood shunted away from the liver, and a hypoxic necrosis developsliver, and a hypoxic necrosis develops


CirrhosisCirrhosis

AlcoholicAlcoholic Oxidation of alcohol damages hepatocytesOxidation of alcohol damages hepatocytes

Biliary (bile canaliculi)Biliary (bile canaliculi) Cirrhosis begins in bile canaliculi and ductsCirrhosis begins in bile canaliculi and ducts Primary biliary cirrhosis (autoimmune)Primary biliary cirrhosis (autoimmune) Secondary biliary cirrhosis (obstruction)Secondary biliary cirrhosis (obstruction)

PostnecroticPostnecrotic Consequence of chronic diseaseConsequence of chronic disease


CirrhosisCirrhosis


CirrhosisCirrhosis


Disorders of the GallbladderDisorders of the Gallbladder CholecystitisCholecystitis GallstonesGallstones

Cholesterol stones form in bile that is Cholesterol stones form in bile that is supersaturated with cholesterol. Theories:supersaturated with cholesterol. Theories:• Enzyme defect; increases cholesterol synthesisEnzyme defect; increases cholesterol synthesis

• Decreased secretion of bile acids to emulsify fatsDecreased secretion of bile acids to emulsify fats

• Decreased resorption of bile acids from the ileumDecreased resorption of bile acids from the ileum

• Gallbladder smooth muscle hypomotility, stasisGallbladder smooth muscle hypomotility, stasis

• Genetic predispositionGenetic predisposition

• Combination of any or all of the aboveCombination of any or all of the above


Disorders of the PancreasDisorders of the Pancreas PancreatitisPancreatitis

Inflammation of the pancreasInflammation of the pancreas Associated with several clinical disorders (alcohol Associated with several clinical disorders (alcohol

intake and cholelithiasis)intake and cholelithiasis)• Caused by injury or damage to pancreatic cells and ducts, Caused by injury or damage to pancreatic cells and ducts,

causing a leakage of pancreatic enzymes into the pancreatic causing a leakage of pancreatic enzymes into the pancreatic tissuetissue

These enzymes cause autodigestion of pancreatic These enzymes cause autodigestion of pancreatic tissue and leak into the bloodstream to cause injury to tissue and leak into the bloodstream to cause injury to blood vessels and other organsblood vessels and other organs


Disorders of the PancreasDisorders of the Pancreas PancreatitisPancreatitis

Manifestations and evaluationManifestations and evaluation• Epigastric pain radiating to the backEpigastric pain radiating to the back• Fever and leukocytosisFever and leukocytosis• Hypotension and hypovolemiaHypotension and hypovolemia

Enzymes increase vascular permeabilityEnzymes increase vascular permeability

• Characterized by an increase in a patient’s serum Characterized by an increase in a patient’s serum amylase levelamylase level

Chronic pancreatitisChronic pancreatitis• Related to chronic alcohol abuseRelated to chronic alcohol abuse


Cancer of the Gastrointestinal Cancer of the Gastrointestinal TractTract

EsophagusEsophagus StomachStomach Colon and rectumColon and rectum LiverLiver GallbladderGallbladder PancreasPancreas


Stomach CancerStomach Cancer


Colon CancerColon Cancer





Alterations of Digestive Function Chapter 39 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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