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Introduction to Human Diseases Chapter 10

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1 Introduction to Human Diseases Chapter 10
Digestive Diseases Introduction to Human Diseases Chapter 10

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

3 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)

4 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

5 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)

6 GERD S/S: Treatment: Other issues:
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)

7 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

8 Gastroenteritis Inflammation of the stomach & small intestine
Some types: traveler’s 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

9 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

10 Hiatal Hernia (HH) S/S: Diagnosis: Treatment: 50% asymptomatic
Heartburn, chest pain, dysphagia, reflux Diagnosis: CXR, endoscopy Treatment: Diet, meds for reflux, change in activities, surgery

11 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, 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)

12 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

13 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 Three’s (1st 3 months of life, crying 3 hrs/day, 3 days/week, at least 3 weeks.) Treatment: calming child, feeding techniques, etc.

14 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,

15 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.

16 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

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

18 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

19 Crohn’s Disease Diagnosis Treatment: Colonoscopy & biopsy
Immunosuppressives, anti-inflammatories, surgery (colectomy, ileostomy)

20 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 Crohn’s Disease

21 Diverticular Disease Diverticulosis Diverticulitis
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

22 Diverticular Disease S/S Diagnostics Treatment
LLQ pain, fever, nausea, diarrhea Diagnostics Blood tests nondiagnostic, CT scan Treatment Dietary changes (high fiber), antibiotics for flare-up, surgery if needed

23 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

24 Hemorrhoids Dilated, tortuous veins of anus or rectum
Internal or external S/S: itching, bleeding, pain Etiology: high intraabdominal pressure conditions Treatment: antiinflammatories, hemorrhoidectomy

25 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

26 Hernias Incarcerated vs. strangulated hernia
Treatment: Surgery (herniorraphy)

27 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

28 Colorectal Cancer Treatment: Surgery if early
Chemotherapy/radiation if mets

29 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

30 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

31 Pancreatitis Inflammation of pancreas Acute or chronic
Autodigestion due to leaking pancreatic digestive enzymes Acute or chronic Mild or life-threatening Etiology: associated with alcoholism, biliary disease, trauma, severe hyperlipidemias

32 Pancreatitis S/S: Diagnosis: blood tests helpful
Upper abdominal pain, vomiting Diagnosis: blood tests helpful Treatment: IV hydration, treatment of vomiting, no oral foods (GI rest)

33 Biliary Diseases Cholelithiasis Cholecystitis
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

34 Biliary Diseases S/S: Diagnosis: ultrasound, blood tests Treatment:
Severe RUQ pain, often spasmic, nausea, vomiting, intolerance of fatty foods Diagnosis: ultrasound, blood tests Treatment: If mild: dietary avoidance If severe: laparoscopic cholecystectomy

35 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

36 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

37 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

38 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

39 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

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