Digestive Diseases
Dec 23, 2015
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