Digestive Diseases

Introduction to Human Diseases Chapter 10

Gastrointestinal System Anatomy

Oropharynx Esophagus Stomach Small intestine Large intestine Rectum Other digestive organs: liver, gall bladder, pancreas

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

S/S: painful blisters or ulcers Treatment: 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 esophagus More GERD in people over 40 YOA Stats:
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 Antacids, H2 blockers, PPI, prokinetic agents 80% GERD is controlled with meds, 20% need surgery 50% GERD get esophagitis 8-15% GERD have Barretts esophagus (stricture)

Treatment:

Other issues:

Gastritis
Acute or chronic inflammation & erosion of the gastric mucosa Etiology: idiopathic frequently, may be due to foods, meds, alcohol, caffeine S/S: epigastric pain, nausea & vomiting, belching, full feeling in epigastrium Treatment: avoidance of irritants, H2 blockers or antacids

Gastroenteritis
Inflammation of the stomach & small intestine

Some types: travelers diarrhea, food poisoning

Etiology: commonly infectious (viral, bacterial, protozoal, parasitic), also meds and toxins Diagnosis: history, stool culture for bacteria or stool exam for parasites Treatment: 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 thorax Types:

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 duodenum Etiology:

Gastric acid hypersecretion conditions, Helicobacter pylori infection, mucosal damage from aspirin, NSAIDs, alcohol, tobacco Middle-aged and older males, smokers, alcohol and NSAID users, Type A blood type (gastric) and type O blood type (duodenal)

More common in:

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 cramping First 3 months of life Etiology:

Excessive fermentation & gas production, overeating, air swallowing, rapid feeding, inadequate burping

S/S: crying, drawing up legs Diagnostics: Rule of Threes (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 Enteropathy Malabsorption due to immunologic reaction to part of gluten (wheat), gluten intolerance, and mucosal damage to intestine Inherited, female to male = 2 to 1 S/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 glutenfree 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 exclusion Most frequent GI disorder in US Etiology: unknown Disorder of adults

IBS
Treatment:
Variable, avoidance of foods or other factors that provoke episodes No single successful treatment

Crohns 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

Crohns 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 proximally Only mucosa is involved Uniform involvement of the area, no segments or patches of healthy tissue Etiology, diagnostic test, treatment: like Crohns Disease

Diverticular Disease
Diverticulosis

Outpouching of colonic mucosa that bulge through wall into peritoneum Infection of diverticuli

Diverticulitis

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

Dietary changes (high fiber), antibiotics for flare-up, surgery if needed

Treatment

Acute Appendicitis
Inflammation & infection of appendix, often due to obstruction by fecalith S/S: RLQ pain (McBurneys 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 always Disease 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 habits Diagnosis: 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 chronic Mild or life-threatening Etiology: 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