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Pearson's ComprehensiveMedical Assisting
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THIRD EDITION
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The Digestive SystemLesson 2:Pathology of the Digestive System
30
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Lesson Objectives
Upon completion of this lesson, students should be able to:
1. Define and spell the terms to learn for this chapter.
2. Briefly explain common disorders associated with the digestive system.
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Critical Thinking Question
1. What are some causes of digestive system disorders?
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Common Disorders Associated with the Digestive System
• Digestive Disorders
Range from nonserious to serious and life-threatening
Most complex with subtle symptoms and often unknown causes
Some may be genetic
Some may develop from stress, fatigue, diet, smoking, alcohol abuse
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Common Disorders Associated with the Digestive System
• Medical history and physical examination for accurate diagnosis
Laboratory tests
Endoscopic procedures
Imaging techniques
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Common Disorders Associated with the Digestive System
• Appendicitis
Inflammation of appendix
Occurs most often between ages 10 and 30
Appears to have no known function
Removal does not cause change in digestive function
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Common Disorders Associated with the Digestive System
• Appendicitis
Acute pain at McBurney point
Pain not relieved by over-the-counter pain relievers, rest, or change of position
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FIGURE 30-9 McBurney point.
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Common Disorders Associated with the Digestive System
• Appendicitis
Surgical removal (appendectomy) only course of treatment
Considered medical emergency
Most common acute surgical emergency of abdomen
If treatment delayed, appendix can burst, causing infection and even death
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Common Disorders Associated with the Digestive System
• Cirrhosis
Potentially life-threatening condition
Scarring (fibrosis) replaces healthy tissue
Prevents liver from functioning normally
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Common Disorders Associated with the Digestive System
• Cirrhosis
Develops after years of liver inflammation
Causes
• Years of excessive alcohol consumption and forms of viral hepatitis
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Common Disorders Associated with the Digestive System
• Cirrhosis
Nonalcoholic fatty liver disease (NAFLD) caused by excessive amounts of fat in liver
Common in obese patients
Other causes
• Problems with immune system or inherited diseases
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Common Disorders Associated with the Digestive System
• Cirrhosis
Fluid buildup in legs (edema); abdomen (ascites)
Fatigue
Yellowing of skin (jaundice)
Itching
Nosebleeds
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Common Disorders Associated with the Digestive System
• Cirrhosis
Redness of palms and easy bruising
Weight loss and muscle loss
Abdominal pain
Frequent infections
Confusion
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Common Disorders Associated with the Digestive System
• Cirrhosis
Avoid substances that further damage liver (alcohol; nonsteroidal antiinflammatory drugs)
Dietary changes
Weight loss
Medications
Surgery
Liver transplant
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Common Disorders Associated with the Digestive System
• Colitis
Inflammation of large intestine
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Common Disorders Associated with the Digestive System
• Colitis
Many disease processes may cause colitis
• Abdominal pain
• Diarrhea
• Dehydration
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Common Disorders Associated with the Digestive System
• Colitis
Many disease processes may cause colitis
• Fever and chills
• Abdominal bloating
• Increased intestinal gas
• Bloody stools
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Common Disorders Associated with the Digestive System
• Colitis
Identified by flexible sigmoidoscopy or colonoscopy
Treating underlying cause:
• Infection
• Inflammation
• Lack of blood flow
• Another cause
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Critical Thinking Question
1. What does the term "colitis" tell about the disorder?
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Common Disorders Associated with the Digestive System
• Colorectal Cancer
Colon cancer
• Cancer of large intestine (colon)
Rectal cancer
• Cancer of rectum
Second-leading cause of cancer-related deaths of men and women in United States
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Common Disorders Associated with the Digestive System
• Colorectal Cancer
Most cases of colon cancer begin as adenomatous polyps that become cancerous
Regular screening tests important
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Common Disorders Associated with the Digestive System
• Colorectal Cancer
Predisposing factors
• Increases with age
• Inflammatory bowel disease
• Type II diabetes
• Family history of colorectal cancer
• Race and ethnicity
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Critical Thinking Question
1. What are some ways to prevent colon cancer?
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Common Disorders Associated with the Digestive System
• Colorectal Cancer
Change in bowel habits
Bloody stools
Long and thin stool
Persistent abdominal cramping
Gas abdominal pain
Appetite loss and weight loss
Excessive fatigue
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Common Disorders Associated with the Digestive System
• Colorectal Cancer
Surgery main treatment
If part of colon removed, sometimes remaining colon brought to surface of abdomen so stool comes out of a stoma (colostomy) into attached receptacle instead of through rectum
Chemotherapy
Radiation
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Common Disorders Associated with the Digestive System
• Crohn's Disease and Ulcerative Colitis
Chronic inflammatory disease of intestines
Closely related to ulcerative colitis
Two diseases referred to as inflammatory bowel disease (IBD)
Not contagious
Exact cause unknown
May have genetic component
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Common Disorders Associated with the Digestive System
• Crohn's Disease and Ulcerative Colitis
Abdominal pain
Pain with defecation
Watery diarrhea
Weight loss
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Common Disorders Associated with the Digestive System
• Crohn's Disease and Ulcerative Colitis
Poor appetite
Fever
Night sweats
Rectal pain
Rectal bleeding
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Common Disorders Associated with the Digestive System
• Crohn's Disease and Ulcerative Colitis
No cure
Goals of treatment
• Induce remission
• Maintain remission
• Minimize side effects of treatment
• Improve quality of life
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Common Disorders Associated with the Digestive System
• Diverticulosis and Diverticulitis
Diverticulosis
• Condition of having diverticula, small pouches or sacs in wall of colon
• Few or no symptoms
• Abdominal cramping and bloating
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Common Disorders Associated with the Digestive System
• Diverticulosis and Diverticulitis
Diverticulitis
• Inflammation or infection of diverticula
• Pain
• Fever
• Chills
• Cramping
Page 33
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Common Disorders Associated with the Digestive System
• Diverticulosis and Diverticulitis
Diverticulitis
• Inflammation or infection of diverticula
• Bloating
• Decreased appetite
• Constipation
• Diarrhea
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Common Disorders Associated with the Digestive System
• Diverticulosis and Diverticulitis
Preventing formation of diverticula in colon
High-fiber diet
Treatment of diverticulitis depends on severity of condition and symptoms
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FIGURE 30-10 Colon with diverticulosis. An inflamed or infected diverticulum is called diverticulitis.
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Critical Thinking Question
1. Why is there a higher incidence of diverticulosis in the elderly?
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Cardiac sphincter does not close tightly or relaxes inappropriately
Gastric fluids and stomach contents back up into esophagus (reflux)
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Risk factors
• Obesity
• Hiatal hernia
• Pregnancy
• Smoking
• Certain types of medications
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Complications
• Reflux esophagitis
• Barrett's esophagitis
• Perforation of esophagus
• Esophageal cancer
• Esophageal stricture
• Esophageal ulcers
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Heartburn (worse when lying down)
Sore throat
Hoarse voice
Bad taste in mouth
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Sensation of food being stuck behind breast bone
Belching
Regurgitation of food
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Common Disorders Associated with the Digestive System
• Gastroesophageal Reflux Disease (GERD)
Treatment
• Medications that block production of hydrochloric acid and protect mucosa of esophagus
• Surgery that tightens cardiac sphincter
• Dilation, or expansion, of narrowed area
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Common Disorders Associated with the Digestive System
• Hemorrhoids
Dilated, or enlarged, vein in walls of anus and sometimes rectum
Caused by increased pressure in the anus
Major sign is bleeding after defecation, particularly bright red blood
Itching and pain in anal region
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Critical Thinking Question
1. How can increasing fiber intake help to control hemorrhoids?
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Common Disorders Associated with the Digestive System
• Hemorrhoids
Topical hemorrhoid creams relieve discomfort from itching and irritation
Corticosteroid creams reduce swelling and inflammation
Hemorrhoid removal (hemorrhoidectomy)
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Common Disorders Associated with the Digestive System
• Hernia
Abnormal protrusion of an organ or part of an organ through a weakness in the wall of the body cavity that contains it
Common types of abdominal hernias include:
• Hiatal hernias
• Inguinal hernias
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Common Disorders Associated with the Digestive System
• Hiatal Hernia
Upper portion of stomach protrudes into chest cavity through opening in diaphragm
• Obesity
• Poor seated posture
• Frequent coughing
Page 48
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Common Disorders Associated with the Digestive System
• Hiatal Hernia
Upper portion of stomach protrudes into chest cavity through opening in diaphragm
• Straining with constipation
• Frequent bending over or heavy lifting
• Heredity
• Smoking
• Congenital defects
Page 49
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FIGURE 30-11 Hiatal hernia.
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Common Disorders Associated with the Digestive System
• Hiatal Hernia
Chest pain or pressure
Difficulty swallowing
Coughing, belching, hiccups
Can be associated with GERD
Heartburn
Treatment: medications used to treat acid reflux
Only cure is surgical repair
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Critical Thinking Question
1. What other serious condition has symptoms of chest pain and/or pressure?
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Common Disorders Associated with the Digestive System
• Inguinal Hernia
Part of intestine pushes through abdominal wall in groin area causing a bulge
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Common Disorders Associated with the Digestive System
• Inguinal Hernia
Causes
• Appear gradually or suddenly
• Lifting heavy weights
• Coughing
• Bending
• Straining
• Even laughing
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Common Disorders Associated with the Digestive System
• Inguinal Hernia
Incarcerated hernia can worsen to point of strangulation
Strangulated hernia so constricted that blood supply to intestine is cut off
Can be potentially life-threatening condition
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FIGURE 30-12 Inguinal hernia.
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Common Disorders Associated with the Digestive System
• Inguinal Hernia
Pain and discomfort
Swelling, heaviness, tugging or burning sensation in area of hernia, scrotum, or inner thigh
Nausea and vomiting
Surgery is the only treatment and cure
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Common Disorders Associated with the Digestive System
• Irritable Bowel Syndrome (IBS)
Common disorder that interferes with normal colon function
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Common Disorders Associated with the Digestive System
• Irritable Bowel Syndrome (IBS)
Causes
• Unclear and may be stress-related
• Abdominal pain and cramps
• Changes in bowel movements
• Gassiness and bloating
• Nausea
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Common Disorders Associated with the Digestive System
• Irritable Bowel Syndrome (IBS)
Causes
• Unclear and may be stress-related
• Urgency to defecate
• Passage of mucus during bowel movements
• Feeling bowels are not emptied
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Common Disorders Associated with the Digestive System
• Irritable Bowel Syndrome (IBS)
No cure
Treatment
• Controlling symptoms and improving day-to-day quality of life
Dietary and lifestyle changes
Psychological treatment
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Common Disorders Associated with the Digestive System
• Oral Cancer
Starts in flat squamous cells that line mouth
• Aging, particularly after 50
• Gender: more men
• Smoking and heavy alcohol consumption, particularly if combined
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Common Disorders Associated with the Digestive System
• Oral Cancer
Starts in flat squamous cells that line mouth
• Using chewing tobacco, snuff, chewing betel nut
• Excessive sun exposure to lips
• Human papillomavirus (HPV)
• Poor dental hygiene
• Immunosuppressant medications
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Common Disorders Associated with the Digestive System
• Oral Cancer
Sores, ulcers, irritation, or swelling in mouth that lasts longer than two weeks
Velvety red or white patches in mouth
Persistent sore throat
Sores under dentures
Lump in lip, tongue, or neck
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Common Disorders Associated with the Digestive System
• Oral Cancer
Weight loss
Swollen lymph nodes in neck
Trouble chewing, swallowing, or speaking
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Common Disorders Associated with the Digestive System
• Oral Cancer
Treatment depends on extent and stage of condition when diagnosed
Surgery
Radiation
Chemotherapy
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Common Disorders Associated with the Digestive System
• Pancreatic Cancer
Adenocarcinoma
• Develops in exocrine glands of pancreas
Very rare form
• Pancreatic neuroendocrine carcinoma (islet cell tumor)
One of the deadliest of all cancers
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Common Disorders Associated with the Digestive System
• Pancreatic Cancer
Signs and symptoms generally vague
• Clay-colored stool and/or diarrhea
• Dark urine
• Jaundice or yellowing of skin
• Upper abdominal pain or discomfort
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Common Disorders Associated with the Digestive System
• Pancreatic Cancer
Signs and symptoms generally vague
• Weight loss and loss of appetite
• Nausea and/or indigestion
• Fatigue
• Back pain
• Blood clots
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Common Disorders Associated with the Digestive System
• Pancreatic Cancer
Complete surgical removal of the cancer only known cure
Most common procedure performed is Whipple procedure
Radiation
Chemotherapy
High mortality rate
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Common Disorders Associated with the Digestive System
• Peptic Ulcer Disease (PUD)
Disruption in lining of stomach, esophagus, or duodenum
Duodenal ulcers most common
Ulcers in stomach also common
Common cause is infection with bacterium Helicobacter pylori (H. pylori)
Causes erosion of the stomach mucosa
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FIGURE 30-13 Peptic ulcer disease (PUD).
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Common Disorders Associated with the Digestive System
• Peptic Ulcer Disease (PUD)
Prevented by avoiding alcohol and tobacco and limiting use of NSAIDs and aspirin
• Abdominal pain
• Nausea and vomiting
• Weight loss
• Heartburn
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Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
Common Disorders Associated with the Digestive System
• Peptic Ulcer Disease (PUD)
Prevented by avoiding alcohol and tobacco and limiting use of NSAIDs and aspirin
• Chest pain
• Tarry black or maroon stools
• Bright red blood in stools
• Burning or gnawing pain in stomach or back
Page 74
Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
Common Disorders Associated with the Digestive System
• Stomach or Gastric Ulcers
Pain or burning sensation (similar to indigestion)
Pain made worse by eating
Difficulty swallowing or regurgitation
Bloating, retching, and feeling sick
Vomiting and nausea
Loss of appetite and weight loss
Bleeding may indicate a serious problem
Page 75
Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
Common Disorders Associated with the Digestive System
• Peptic Ulcer Disease (PUD)
Avoidance of tobacco and alcohol
Antibiotics
Medication change
Proton pump inhibitors
Histamine (H2) blockers
Occasionally, surgery may be required
Page 76
Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
Common Disorders Associated with the Digestive System
• Pyloric Stenosis
Develops in some infants when pylorus gradually swells and thickens, interfering with flow of food into intestine
Can occur between birth and 6 months of age
Page 77
Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
Common Disorders Associated with the Digestive System
• Pyloric Stenosis
Main symptom is infant's repeated vomiting after feeding
Always treated with surgery (pyloromyotomy)
Page 78
Pearson's Comprehensive Medical Assisting:Administrative and Clinical Competencies, 3/eBeaman | Routh | Papazian-Boyce | Sesser | Mills | Maly
Copyright © 2015, 2011 by Pearson Education, Inc.All Rights Reserved
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