The Essentials of the Language of Gastroenterology

The Essentials of the Language of Gastroenterology
PowerPoint to accompany Essentials of Medical Language 2e Allan, Lockyer Chapter 9: The Digestive System The Essentials of the Language of Gastroenterology Talking Points: At the conclusion of this chapter, the student will be able to: • LO 9.1 Apply the language of gastroenterology to the gastrointestinal tract, liver, gallbladder, and pancreas. • LO 9.2 Comprehend, analyze, spell, and write the medical terms of gastroenterology. • LO 9.3 Recognize and pronounce the medical terms of gastroenterology. Lo 9.4 Discuss the cause, diagnosis, and treatment of common disorders of the gastrointestinal tract.

Health Professionals You may work directly and/or indirectly with one or more of the following: • Gastroenterologists are medical specialists in the field of gastroenterology. • Proctologists are surgical specialists in diseases of the anus and rectum. • Dentists are qualified practitioners in the anatomy, physiology, and pathology of the oral-facial complex. • Periodontists are specialists in disorders of the tissues surrounding the teeth. • Nutritionists are professionals who prevent and treat illness by promoting healthy eating habits. • Dietitians manage food services systems and promote sound eating habits. 9-2

Lesson 9.1: The Digestive System
Talking Points: The digestive system comprises many organs, all with their own specific functions. By the end of lesson 9.1 the student will be able to use correct medical terminology to: 9.1.1 Name the health professionals involved in gastroenterology. • List the organs and accessory organs of the digestive system. • Identify the components of the alimentary canal. • Describe the structure and functions of the digestive system.

The Digestive System Alimentary canal and accessory organs 9-4
Talking Points: Use Figure 9.1 to illustrate the entire alimentary canal for the students. What structures does the alimentary canal consist of? Mouth, pharynx, esophagus, stomach, small intestine, and large intestine. What are the accessory organs of digestion? Teeth, tongue, salivary glands, liver, gallbladder, and pancreas. Deconstruct and define the term gastroenterology. Gastr/o stomach; -enter/o- intestine. Suffix –logy study of. Study of the digestive system, medical specialty of the stomach and intestines. 9-4

Word Analysis and Definition
Define the following root elements: – aliment – bari – digest - gastr – laparo Talking Points: Knowing the meanings of root elements helps you put the pieces of a word together. Define the following root elements. aliment—nourishment, food bari—weight digest—to break down gastr - stomach laparo—abdomen 9-5

The Digestive System Actions and functions of the digestive system
Five components: 1. propulsion 2. digestion 3. secretion 4. absorption 5. elimination Talking Points: List the five basic functions of the digestive system. Propulsion, digestion, secretion, absorption and elimination. Explain the difference between chemical and mechanical digestion. Chemical digestion breaks large food molecules down into smaller and simpler chemicals. Mechanical digestion breaks large pieces of food down into smaller pieces of food without altering the chemical composition of the food. The digestive enzymes secreted by the salivary glands, stomach, small intestine, and pancreas break down the three main groups of foods: carbohydrates, proteins, and fats into simple, absorbable chemicals.

Identify and define the root elements of the following terms: – mastication – deglutition – peristalsis – elimination – secretion Talking Points: Have students identify and define the root elements of the following terms. Mastication: root is mastic; definition is to chew. Deglutition: root is deglutit; definition is to swallow. Peristalsis: root is stalsis; definition is to constrict. Elimination: root is elimin; definition is to throw away. Secretion: root is secret; definition is to secrete, produce. Optional: You may wish to identify the three different enzyme groups: amylase digests carbohydrates, lipase digests fats, and proteases digest protein. amylase—root is amyl; definition is starch lipase—root is lip; definition is fat protease—root is prot; combining form is prot/e; definition is protein

Lesson 9.2: Mouth, Pharynx, and Esophagus
Digestive System Lesson 9.2: Mouth, Pharynx, and Esophagus Talking Points: The mouth, pharynx, and esophagus are located at the beginning of the alimentary canal. By the end of lesson 9.2 the student will be able to use correct medical terminology to: • Identify the structures and functions of the teeth, tongue, and salivary glands. • Document the processes and outcomes of mastication and swallowing of food. • Describe the structures, functions, and disorders of the mouth, pharynx, and esophagus.

Mouth, Pharynx, and Esophagus
The mouth and mastication – palate – uvula Talking Points: Use Figure 9.2 to illustrate the oral cavity and structures for your students. Name and locate the divisions of the palate. These can be felt in each student’s own mouth by their tongue. The hard palate is the anterior two-thirds and contains bone. The soft palate is the posterior one-third and is made of muscle. What function does the uvula serve? The uvula hangs from the soft palate and closes off the nasopharynx during swallowing.

The mouth and mastication – tongue – papillae Talking Points: Use the figure 9.3 to illustrate the tongue and papillae. How does the tongue facilitate chewing? It moves the food around the mouth and helps the cheeks, lips, and gums hold food in place while it is being chewed. What are papillae of the tongue better known as? Taste buds. How long does a taste bud live? Seven to 10 days.

– adult teeth • upper jaw (maxilla) • lower jaw (mandible) Talking Points: How many teeth do adults have? 32 normal adult teeth, 16 rooted in the upper jaw (maxilla) and 16 in the lower jaw (mandible). Optional details: Name the types of teeth and their functions (the figure on slide 9-9 shows most of the teeth): Incisors cut into food. Cuspids puncture and tear food. Bicuspids grind and crush food. Molars grind and crush food. What are the two parts to every tooth? Root and crown.

Define the following terms: – dentine – enamel – pulp Talking Points: Knowing root elements assists in building words. Define the following root elements: dentine, or spelled dentin (both pronounced DEN-tin), the root of which is dent, meaning tooth. enamel, from the French enamel. pulp, from the Latin meaning flesh. The bulk of the tooth is made of dentin. The pulp cavity contains blood vessels and nerves and connective tissue. 9-12 12

Salivary glands Talking Points: Use Figure 9.4 to illustrate the salivary glands. Identify the different salivary glands. Parotid, submandibular, and sublingual. What is the function of saliva? To begin starch digestion, begin fat digestion, and lubricate food for swallowing.

Define the following root elements: – par – lingu – mandibul – saliv - or - ot Talking Points: Knowing root elements assists in building words. Define the following root elements: par—beside lingu—tongue mandibul—mandible saliv—saliva or - mouth ot- ear The parotid gland is the salivary gland beside the ear. The sublingual gland is underneath the tongue. The submandibular gland is underneath the mandible. Saliva is the secretion in the mouth from salivary glands. Or (os) is a root for the mouth.

Disorders of the mouth – plaque – tartar – dental caries Talking Points: Define dental plaque. A collection of microorganisms and their products. Plaque is the first stage in dental disease. Tartar is calcified deposits at the gingival (gum) margin of the teeth. Use Figure 9.5 to illustrate dental caries, which results in cavities and loss of teeth. What causes a cavity? Bacteria erode the tooth surface. What is the difference between periodontitis and gingivitis? Periodontitis causes the gums to pull away from the teeth forming infected pockets. Gingivitis is an infection of the gums. © Photo Network Stock/Grant Heilman Photography Inc.

Disorders of the mouth – stomatitis 1. mouth ulcers 2. cold sores 3. thrush Talking Points: Stomatitis is the term used for any infection of the mouth. What are the most common forms of mouth ulcers? Aphthous ulcers, which are small clusters lasting for 3-4 days and are related to stress or illness. Aphthous ulcers are also known as what? Canker sores. Cold sores are also known by what term? Fever blisters. Cold sores occur as a result of what virus? Herpes simplex type I. Use Figure 9.7 to illustrate thrush. What is thrush caused by? The fungus Candida albicans. Thrush is commonly found among what age population? Newborns. © Medical-on-line/Alamy

Disorders of the mouth – stomatitis - oral cancer - halitosis Talking Points: Stomatitis is any infection of the mouth What are the most common causes of oral cancer? Smoking and chewing tobacco. Halitosis is better known as what? Bad breath.

Define the following suffixes: – ectomy – osis – al – ics – itis – ist Talking Points: Adding a suffix to a root can alter the meaning. It is important to recognize and know the meaning of suffixes. Define the following suffixes: ectomy—surgical excision osis—abnormal condition al—pertaining to ics—knowledge itis – inflammation ist - specialist A gingivectomy is the surgical removal of diseased gum tissue. Halitosis is bad odor of the breath. Periodontal means around a tooth. Periodontics is the branch of dentistry specializing in disorders of tissues around the teeth. A periodontist is a specialist in periodontics. Periodontitis is an inflammation of tissues around a tooth.

– disorders of the esophagus 1. esophagitis (GERD) 2. hiatal hernia 3. esophageal varices 4. cancer of the esophagus Talking Points: Food is swallowed down the oropharynx into the esophagus, a tube 9 to 10 inches long (see Figure 9.9 on page 268 ). Define esophagitis. An inflammation of the lining of the esophagus. The most common cause of reflux is GERD. What does GERD stand for? Gastroesophageal reflux disease. Ask students to define GERD. Regurgitation of stomach contents into mouth. What is a hiatal hernia? A protrusion of a portion of stomach through the diaphragm alongside the esophagus. What are varices? Dilated, tortuous veins. Esophageal varices are complications of what disease? Cirrhosis of the liver. List the risk factors for developing esophageal cancer. Smoking, alcohol, betel nut chewing, and persistent esophageal reflux.

Identify the correct term for the definitions below: – vomiting of red blood hematemesis – difficulty swallowing dysphagia – following a meal postprandial – an opening through a structure hiatus Talking Points: Ask student to try to identify the word associated with the following definitions; answers appear on mouse click. Hematemesis (he-mah-TEM-eh-sis) is vomiting of red blood. Dysphagia (dis-FAY-jee-ah) is difficulty swallowing. Postprandial (post-PRAN-dee-al) refers to the period following a meal. Hiatus (high-AY-tus) is an opening through a structure.

Lesson 9.3: Digestion—Stomach and Small Intestine
Digestive System Lesson 9.3: Digestion—Stomach and Small Intestine Talking Points: Mechanical breakdown continues in the stomach. It is in the small intestine that the greatest amount of digestion and absorption occurs. By the end of lesson 9.3 the student will be able to use correct medical terminology to: • Define the functions of the stomach and small intestine in digestion. • Explain how food is propelled through the stomach and small intestine. • Describe the process of digestion.

Digestion—Stomach and Small Intestine
Digestion: the stomach – peristalsis – secretions Talking Points: Use Figure 9.12 to illustrate the stomach for students. The peristaltic waves (constricting) of the stomach mix food boluses together and push the mixture towards the pylorus, or opening of the stomach to the small intestine. What is a bolus? A single mass of a substance or substances. Ask students to describe the function of the following secretions of the stomach. Mucus lubricates and protects. Hydrochloric acid (HCl) breaks up ingested food. Pepsin digests protein. Intrinsic factor helps the small intestine absorb vitamin B12. Gastrin – hormone (chemical messenger) that stimulates other gastric cells to produce pepsin and HCl and stimulates gastric motility.

Identify the suffixes and their meanings in the following terms, and then define the terms: – duodenum – gastrin – digestion – pepsinogen – pylorus Talking Points: Adding suffixes to root elements change their meaning. It is important to be able to define not only roots but suffixes as well. Identify the suffixes and their meanings in the following terms, and then define the terms. Duodenum: suffix -um means structure; root duoden- means twelve. The duodenum is the first part of the small intestine; approximately twelve finger-breadths in length. gastrin: suffix -in means substance, chemical compound; root gastr- means stomach. gastrin is a hormone secreted in the stomach that stimulates secretion of HCl and increases gastric motility. digestion: suffix -ion means action, process; root digest- means to break down. Digestion is the breakdown of food. Pepsinogen: suffix -gen means produce ; root pepsin/o- means pepsin. Pepsinogen is converted by HCl in the stomach to produce pepsin. Pylorus: suffix -us means pertaining to; root pylor- means gate, pylorus. The pylorus is the exit area of the stomach.

Disorders of the stomach – gastroesophageal reflux disease (GERD) – vomiting – gastritis Talking Points: GERD symptoms occur mostly at night or anytime when the patient is lying flat. What is vomiting? Muscles of diaphragm and abdominal wall contract and expel contents of stomach. What causes vomiting? Vomiting can result from over distension or irritation of any part of the digestive tract. List symptoms of gastritis. Feeling of fullness, nausea, and epigastric pain.

Disorders of the stomach – peptic ulcers – dyspepsia – gastric ulcers - gastric cancer Talking Points: Peptic ulcers occur in the stomach and duodenum when the mucosal lining breaks down. Dyspepsia, epigastric pain with bloating and nausea, is the most common symptom of peptic ulcers. Gastric ulcers are peptic ulcers that occur in the stomach. What are some symptoms of a gastric ulcer? Epigastric burning after eating and nausea, vomiting, and belching. Gastric cancers can be present for long periods of time before symptoms develop. Gastric cancer is more common in men than women. How is gastric cancer treated? Surgical removal, chemotherapy and radiation.

Define the following terms: – anorexia – gastroscope – stricture – dyspepsia – dysphagia Talking Points: The following are terms associated with the digestive system that were discussed in this lesson. Define the following terms: anorexia—having an aversion to food, no appetite gastroscope—an endoscope used to view the inside of the stomach. It is a long flexible telescope fed through the mouth into the esophagus down to the stomach stricture– narrowing of a tube dyspepsia is an “upset stomach” while dysphagia is difficultly in swallowing.

– three segments duodenum, jejunum, ileum Talking Points: Use Figure 9.15 to identify the three segments of the small intestine and the functions of each: The duodenum is the first 9-10 inches of the small intestine; pancreatic juices and bile enter here. The jejunum (je-JEW-num) comprises 40% of small intestine length; it is the primary region for chemical digestion and absorption. The ileum makes up 55% of the small intestine and is the area closest to the large bowel. What valve separates the ileum from the large intestine? Ileocecal valve at the ileocecal junction. Optional: The small intestine is made up of four layers. Mucosa secretes digestive enzymes and supports connective tissue. Submucosa contains blood vessels, lymphatic vessels, and nerves. Muscularis is a layer of smooth muscle that creates peristalsis. Serosa is the outermost layer which covers the small intestine. What are plicae in the small intestine? Plicae are circular folds that slow down passage of chyme through the intestine to allow for digestion and absorption of nutrients.

Change the following terms into the adjective form and define them: – jejunum – cecum Talking Points: Students must be able to change a root noun into the adjective form. Change the following terms into their adjective form and define them: Jejunum becomes jejunal; this is the segment of small intestine between the duodenum and ileum. jejunal—pertaining to the jejunum Cecum becomes cecal; this is the blind pouch that is the first part of the large intestine. cecal—pertaining to the cecum Suffix –al means pertaining to.

Lesson 9.4: Digestion—Liver, Gallbladder, and Pancreas
Digestive System Lesson 9.4: Digestion—Liver, Gallbladder, and Pancreas Talking Points: The liver and pancreas secrete enzymes into the small intestine that aid in digestion. By the end of lesson 9.4 the student will be able to use correct medical terminology to: • Describe the functions and common disorders of the liver, gallbladder, bile ducts, and pancreas.

Digestion—Liver, Gallbladder, and Pancreas
– location – functions Talking Points: Where is the liver located? Under the ribs on the right side of the body just below the diaphragm. (Figure 9.16) List the functions of the liver: Manufactures and excretes bile. Removes bilirubin from the bloodstream. Removes excess glucose from the blood and stores it as glycogen. Converts proteins and fat into glucose. Stores fat and vitamins A, D, E, and K. Manufactures blood proteins, especially those needed for clotting. Removes toxins from the blood.

KEYNOTE: Only the production of bile relates the liver to digestion. Talking Points: Only the production of bile relates the liver to digestion. Although the liver does not digest food, it produces bile and enzymes for the small intestine to aid in food digestion.

Disorders of the Liver – hepatitis • HAV • HBV • HCV – cirrhosis Talking Points: Hepatitis is an inflammation of the liver causing jaundice. Hepatitis is caused by a virus. There are five forms of hepatitis: A,B,C,D, and E. Describe each. Hepatitis A is highly contagious and is transmitted through ingesting food contaminated with feces. It produces flu-like symptoms. Hepatitis B is transmitted through contact with blood and body fluids. A vaccine is available to control the spread of hepatitis B. Hepatitis C is the most common form of blood-borne infection in the U.S. There is no cure for hepatitis C, only symptomatic treatment; it leads to cirrhosis of the liver. Hepatitis D occurs in people with hepatitis B and makes the infection worse. Hepatitis E is similar to hepatitis A and is found in underdeveloped countries. What is chronic hepatitis? Hepatitis that is not healed within six months. What is cirrhosis of the liver? An irreversible disease in which liver tissue is replaced by hard, fibrous scar tissue. What is the most common cause of cirrhosis? Alcoholism What is ascites? An accumulation of fluid within the abdominal (peritoneal) cavity due to portal vein hypertension caused by the cirrhosis.

Disorders of the liver – cancer – benign tumors – hemochromatosis – Wilson disease Talking Points: Liver cancer is commonly caused by hepatitis B infections. Benign tumors are usually small and symptom free; they do not require treatment. Hemochromatosis is an excessive absorption of what mineral? Iron. Define Wilson disease. The retention of too much copper in the liver leading to liver failure.

Give the term associated with the following definitions: a fluid secreted by the liver bile a mass of proliferating blood vessels hemangioma Talking Points: Have students place terms with the following definitions. A fluid secreted by the liver is bile, which aids in the process of digestion of lipids. A mass of proliferating blood vessels is called a hemangioma. Roots hem- blood, angi- blood vessel together with suffix -oma tumor

The following terms have colorful elements: – hemochromatosis – cirrhosis – bilirubin – jaundice Talking Points: Hemochromatosis has two root words: hem/o- meaning blood and chromat- meaning color. Cirrhosis, an extensive fibrotic liver disease, comes from the root cirrh-, meaning yellow. Bilirubin, a bile pigment formed in the liver from hemoglobin, contains the suffix –rubin for rust colored. Jaundice, a yellow staining of tissues with bile pigments, including bilirubin, comes from the French word for yellow. 9-35 35

Gallbladder, biliary tract, and pancreas – disorders of the gallbladder 1. gallstones Talking Points: The gallbladder lies tucked up under the liver on the right side of the body. What is the function of the gallbladder? To store and secrete bile used to digest food in the small intestine. What is the medical term for gallstones? Cholelithiasis. What are the risk factors for developing gallstones? A diet high in cholesterol, multiple pregnancies, obesity, and rapid weight loss. Use Figure 9.18 to illustrate the appearance of gallstones. Remind students that the stones may vary per individual in number and size. © SIU Biomedical/Photo Researchers, Inc

Gallbladder, biliary tract, and pancreas – disorders of the gallbladder 1. gallstones 2. cholecystitis 3. jaundice Talking Points: Gallstones form in the gallbladder from excess cholesterol, bile salts, and bile pigment. Define cholecystitis. Inflammation of the gallbladder caused by either an infection or gallstones. Describe the symptoms of cholecystitis. Acute pain in the upper right quadrant, nausea, vomiting, dark urine, jaundice, and pale stools. What is another term for jaundice? Icterus. What is jaundice? A yellow discoloration of the skin and sclera caused by increased deposits of bilirubin. Optional: Identify the types of jaundice: Obstructive jaundice results when bile flow is blocked between the liver and duodenum. Hemolytic jaundice is caused by an increased destruction of red blood cells resulting in excess bilirubin. Hepatocellular jaundice is caused by an infection or poison injuring liver tissue.

Procedures for the biliary system – cholangiography – cholecystectomy 1. ERCP 2. ESWL Talking Points: To diagnose biliary tract disorders, a cholangiography may be performed. Ask students to define the study. An intravenous injection of dye, followed by X-ray, to visualize the biliary system. What is a cholecystectomy? The surgical removal of the gallbladder. What procedures may be performed to remove gallstones before the more invasive cholecystectomy is performed? In ERCP, endoscopic retrograde cholangiopancreatography, an endoscope is passed from the mouth to the duodenum and into the biliary tract to locate and remove small gallstones. In ESWL, extracorporeal shock wave lithotripsy, ultrasonic shock waves and a solvent are used during the ERCP procedure to break up stones and dissolve them, allowing them to pass through the biliary and digestive systems.

Identify the elements and define the following terms: – cholecystitis chol/e- -cyst- -itis – cholecystectomy chol/e- -cyst- -ectomy – cholelithotomy chol/e- -lith- -omy – choledocholithiasis choledoch/o- -lith iasis Talking Points: The student must become familiar with roots and suffixes to help remember these terms. Define the following terms: The common root is chol/e, bile Cholecystitis: -itis, inflammation; inflammation of the gallbladder. Cholecystectomy: -cyst-, bladder; -ectomy, surgical excision; surgical removal of the gallbladder. Cholelithotomy: -otomy, surgical incision; surgical removal of a gallstone(s). Choledocholithiasis: choledoch/o-, common bile duct; -lith- stone; -iasis condition; presence of a gallstone(s) in the common bile duct.

– location Talking Points: The pancreas is located in the upper left abdomen next to the spleen. The head of the pancreas is encircled by the duodenum. Use Figure 9.17 to illustrate the pancreas for the students.

– function 1. exocrine gland 2. pancreatic juices Talking Points: The pancreas is both an endocrine and exocrine gland. What is the difference between an exocrine and an endocrine gland? An endocrine gland secretes directly into the blood system; an exocrine gland secretes fluid directly to an epithelial surface. Why are pancreatic juices alkaline? Because they contain sodium bicarbonate as an electrolyte, which is alkaline. The alkaline secretions help neutralize acidic chyme.

– disorders of the pancreas 1. pancreatitis 2. pancreatic cancer 3. diabetes 4. cystic fibrosis Talking Points: Pancreatitis occurs in both acute and chronic forms. Acute pancreatitis can be life threatening. What are some causes of pancreatitis? Gallstone formation, biliary tract disease, and alcoholism. Pancreatic cancer is the fourth leading cause of cancer-related deaths. It has no cure and prognosis is poor. Explain the difference between type 1 diabetes and type 2 diabetes. In type 1 diabetes, insulin production by the pancreas is severely reduced or stopped. In type 2 diabetes, insulin production is normal but body cells no longer react to it. Cystic fibrosis is an inherited disease. What glands and body systems does it effect? The respiratory system, digestive system, pancreas, liver, intestines, and sweat glands.

Define the following prefixes and roots: – endo – exo – chol – cyst – lith – insul – pancreat Talking Points: Adding prefixes to a term can change the meaning. Students must memorize prefixes to understand terminology. Define the following prefixes: endo—within, inside; endocrine exo—outward, outside; exocrine Define the following roots: chol—bile; cholecystitis, cholesterol cyst—bladder; cholecystectomy lith—stone; cholelithomy insul—island; insulin pancreat—pancreas; pancreatic

Lesson 9.5: Absorption and Malabsorption
Digestive System Lesson 9.5: Absorption and Malabsorption Talking Points: An important function of the digestive system is the absorption of nutrients vital to sustain life. By the end of lesson 9.5 the student will be able to use correct medical terminology to: • Explain the chemical digestion and absorption of proteins, carbohydrates, and fats. • Describe disorders of chemical digestion, absorption, and malabsorption.

Chemical digestion, absorption, and transport – carbohydrates – proteins – lipids – water – minerals Talking Points: In the small intestine, carbohydrates, such as starches, are broken down into simple sugars, such as glucose and fructose. They are then carried by the portal vein to the liver, where the nonglucose sugars are converted to glucose. Proteins arrive in the duodenum and small intestine only 10% to 20% digested and they are broken down to amino acids. Lipids (fats) enter the duodenum and small intestine as large globules. These have to be emulsified by the bile salts into smaller droplets so that pancreatic lipase can digest the fats into very small droplets of free fatty acids and monoglycerides. Water is 92% absorbed by the small intestine and taken into the bloodstream. Minerals are absorbed along the whole length of the small intestine. Iron and calcium are absorbed according to the body’s needs. The other minerals are absorbed regardless of need, and the kidneys excrete the surplus. 9-45 45

Absorption and Malabsorption
Disorders of absorption – malabsorption syndrome – malnutrition KEYNOTE: In malnutrition, the body breaks down its own tissues to meet its nutritional and metabolic needs. Talking Points: Malabsorption syndrome refers a group of diseases in which intestinal absorption of nutrients is impaired. Malnutrition occurs when food intake and absorption is insufficient to meet the body’s nutritional demands. The body will break down its own tissue in an attempt to get the elements of nutrition it needs.

Disorders of absorption – lactose intolerance KEYNOTE: Milk sugar is lactose. – Crohn disease (regional enteritis) Talking Points: Lactose intolerance occurs when the small intestine does not produce enough lactase to break down lactose to glucose. The sugar found in milk is lactose. Crohn disease is an inflammatory disease of the small intestine that causes pain, diarrhea, fatigue, and weight loss. What part of the small intestine is commonly affected by Crohn disease? The ileum.

Disorders of absorption – constipation – gastroenteritis – dysentery KEYNOTE: Diarrhea is caused by irritation of the intestinal lining so that feces pass through the intestine too quickly for adequate amounts of water to be reabsorbed. Talking Points: Constipation occurs when fecal movement through the large intestine is slow and too much water is reabsorbed. What factors can cause constipation? Lack of dietary fiber, lack of exercise, and emotional upset. Gastroenteritis is commonly called the stomach “flu.” What are some symptoms of gastroenteritis? Vomiting, diarrhea, and fever. What is found in the stools of patients suffering from dysentery? Blood and mucus. Diarrhea is the opposite of constipation. The feces travels too fast through the intestine to allow water to be reabsorbed into the cell lining, and the stool becomes watery.

Define the following root elements: – amin – hydr – carb – lact Talking Points: Students must memorize root elements in order build words. Define the following root elements: amin—nitrogen containing; amino acid; the basic building block for protein hydr—water; dehydration; process of losing body water carb—carbon; carbohydrate; group of organic food compounds that includes sugars, starch, glycogen, and cellulose lact—milk; lactose; milk sugar 9-49 49

Define the following root elements and define the terms: – celiac disease – endoscopy – malabsorption – gastroenteritis – diarrhea – flatulence Talking Points: Students must memorize root elements in order build words. Define the following terms and identify the root elements: Celiac disease: the root is celi-, abdomen; disease caused by sensitivity to the protein gluten. Endoscopy: the root is scopy, to examine, view; the use of an endoscope. Malabsorption: the root is absorpt-, swallow, take in; inadequate gastrointestinal absorption of nutrients. Gastroenteritis: the roots are gastr/o-,stomach, and enter-,intestine; inflammation of the stomach and intestines. Diarrhea: the root is rrhea, to flow; abnormally frequent and loose stools. Flatulence:the root is flatul-, excessive gas; excessive amount of gas in the stomach and intestines.

Lesson 9.6: The Large Intestine and Elimination
Digestive System Lesson 9.6: The Large Intestine and Elimination Talking Points: The large intestine prepares the waste products of ingested food for elimination. By the end of lesson 9.6 the student will be able to use correct medical terminology to: • Describe the structure and functions of the large intestine. • Outline disorders of the large intestine.

The Large Intestine and Elimination
Structure and functions of the large intestine – functions of the large intestine 1. absorption 2. secretion 3. digestion 4. peristalsis 5. elimination Talking Points: The large intestine has 5 major functions. Ask students to describe each function. Absorption of water and electrolytes; secretion of mucus to protect the lining of the intestine and keep fecal matter intact; digestion of any remaining food product by bacteria in the large intestine; peristalsis, movement of feces toward anus for expulsion by peristaltic waves of muscle contraction; elimination of unused food products from the body.

The following two sets of terms share the same root; define their meaning: – colon colic colitis – feces fecal defecation Talking Points: Adding suffixes or prefixes can change the meaning of a a root element. The following terms share the same root; define their meaning: colon—large intestine colic—spasmodic crampy pains in the abdomen colitis—inflammation of the colon feces—undigested, waste material discharged from the bowel. fecal—pertaining to feces defecation—evacuation of feces from rectum and anus.

Disorders of the large intestine and anal canal – appendicitis – diverticulosis - diverticulitis Talking Points: Pain from an acute episode of appendicitis is felt in what side of the abdomen? In the right lower quadrant, in an area known as McBurney’s point. Surgical excision is the treatment for appendicitis. What is diverticulosis? Several small pouches bulging from the wall of the large intestine. Diverticulitis is the inflammation and infection of one or more of these small sacs. Use Figure 9.23 to illustrate diverticulosis. © Susan Leavine/Photo Researchers Inc.

Disorders of the large intestine and anal canal – ulcerative colitis – irritable bowel syndrome – polyps Talking Points: Ulcerative colitis is an extensive inflammation of the large intestinal lining. What are some symptoms of ulcerative colitis? Bloody diarrhea, crampy pain, weight loss, and electrolyte imbalance. Irritable bowel syndrome, abbreviated IBS, causes diarrhea or constipation; the cause of IBS is unknown. Polyps are masses of tissue arising from the intestinal wall. They are often benign and removed via endoscopic biopsy.

Disorders of the large intestine and anal canal – colon cancer Talking Points: Colon and rectal cancers are the second leading cause of cancer deaths. How are the majority of colon and rectal cancers spread? By direct extension through the bowel wall; by metastasis to regional lymph nodes; by moving down the lumen of the bowel; by metastasis through the bloodstream.

Disorders of the large intestine and anal canal – obstruction – intussusception – proctitis Talking Points: An obstruction is a blockage. What disorders can cause obstruction of the large intestine? Cancers, large polyps, or diverticulitis. Intussusception is a form of obstruction that occurs when one segment of bowel slips inside another segment, causing an obstruction. This is when the bowel telescopes into itself. Proctitis is the inflammation of the lining of the rectum. What are some symptoms of proctitis? Anorectal pain, rectal bleeding, and excess mucus in the stool.

Disorders of the anal canal – hemorrhoids Talking Points: What are hemorrhoids? Dilated veins in the submucosa of the anal canal Hemorrhoids can be either internal or external in nature. Figure 9.24 illustrates an external hemorrhoid. What are some symptoms of hemorrhoids? Pain, bright red blood, and itching. © Dr. P. Marazzi/SPL/Photo Researchers, Inc.

Disorders of the anal canal – anal fissures – anal fistulas Talking Points: Anal fissures are splits or tears in the lining of the anal canal. An anal fistula occurs following an abscess in the anal glands. A fistula is an abnormal passage created between two structures or between a structure and the outside.

Define the meaning of the following suffixes: – um – rrhoid – ion – osis Talking Points: Students must memorize suffixes to understand medical terminology. Define the meaning of the following suffixes: um—tissue Example: diverticulum rrhoid—flow Example: hemorrhoid ion—action Example: intussusception osis— abnormal condition Example: polyposis

Gastrointestinal bleeding – hematemesis – vomiting “coffee grounds” – melena – occult blood Talking Points: Bleeding can occur anywhere within the gastrointestinal tract. It can be painless or associated with a lot of pain. Hematemesis is the term for vomiting bright, red blood. Vomiting bright, red blood and vomiting material that looks like coffee grounds are both signs of upper gastrointestinal bleeding. Melena is the passing of black, tarry stools that indicates bleeding in the upper GI tract. Occult blood is when no blood is seen in a stool but staining occurs when a special chemical is applied to the stool; this indicates the presence of occult blood from bleeding anywhere in the GI tract.

The following sets of terms share the same root; define their meaning: – hemoglobin – hemangioma – hemorrhoid – hematemesis – hemoccult test Talking Points: Adding suffixes or prefixes can change the meaning of a a root element. The following terms share the same root; define their meaning. These words use two different combining forms of the root hem-, meaning blood. hemoglobin : hem/o,- blood, and –globin, protein; red protein component of red blood cells Hemangioma: hem-, blood, and -angi- blood vessel, and oma, tumor; abnormal mass of proliferating blood vessels. hemorrhoid: hem/o-, blood, and –rrhoid, flow; dilated rectal vein producing painful anal swelling. hematemesis: hemat-, blood, and –emesis, to vomit: the term for vomiting bright, red blood hemoccult test: hem/o,- blood, and –occult, to hide; a fecal occult blood test 9-62 62

Diagnostic and Therapeutic Procedures
Procedures for the biliary system cholangiography cholangi/o- -graphy cholecystectomy chol/e- cyst- -ectomy cholelithotomy chol/e- lith- -otomy Talking Points: The root chol- means bile. Cholangiography requires injection of a dye intravenously, followed by x-ray of the biliary system so that the biliary system can be visualized. (cholangi/o-, bile duct) Cholecystectomy is surgical removal of the gallbladder through an open incision or by laparoscopic cholecystectomy. Cholelithotomy is operative removal of gallstones.

Diagnostic procedures for the digestive tract barium swallow barium meal enteroscopy angiography Talking Points: The following are diagnostic and therapeutic procedures used to diagnose and treat disorders of the digestive system. Students should become familiar with these terms. Barium swallow involves ingestion of barium sulfate, a contrast material, to show details of the pharynx and esophagus on x-ray. Barium meal (Figure 9.29 ) uses barium sulfate to study the distal esophagus, stomach, and duodenum on x-ray. Enteroscopy through an oral endoscope is used to visualize and biopsy tumors and ulcers and to control bleeding from the esophagus, stomach, and duodenum. Angiography uses dye to highlight blood vessels. It can be used to define the site of a bleed. 9-64 64

Diagnostic procedures for the digestive tract fecal occult blood test nasogastric aspiration and lavage upper GI barium x-ray endoscopy anoscopy Talking Points: Fecal occult blood test detects the presence of not overt blood in stools. Nasogastric aspiration and lavage are used to aspirate blood or contents from the stomach. An upper GI barium xray allows visualization of the GI system under x-ray. Endoscopy is a direct visual examination of the GI system with an endoscope. Anoscopy is a visual examination of the anus and rectum with a rigid anoscope. 9-65 65

Diagnostic procedures for the digestive tract flexible sigmoidoscopy colonoscopy gastroscopy digital rectal exam Talking Points: The following are diagnostic and therapeutic procedures used to diagnose and treat disorders of the digestive system. Students should become familiar with these terms. Flexible sigmoidoscopy allows for the examination of the rectum and sigmoid colon with a sigmoidoscope. Colonoscopy is the visual examination of the colon with a colonoscope. Gastroscopy is the visual examination of the stomach with a gastroscope. Digital rectal exam is the palpation of the rectum and prostate gland with a gloved finger.

Surgical procedures for the digestive tract intestinal resection anastomosis ostomy ileostomy colostomy Talking Points: Intestinal resection is the surgical removal of a portion of a diseased bowel. The cut ends are then joined through an anastomosis (Figure 9.26a) . If there is insufficient bowel remaining, an ostomy (Figure 9.26b) can be performed, in which the end of the proximal bowel opens onto the skin at a stoma. Ileostomy and colostomy are two common procedures. 9-67 67

Identify the common suffix and define the following terms: – enteroscopy – endoscopy – anoscopy – colonoscopy – gastroscopy Talking Points: Have students define the following terms associated with Diagnostic Procedures for the Digestive Tract. [WHY IS THIS CAPPED? IS IT A BOOK SECTION?] The common suffix is –scopy meaning to examine, to view. Enteroscopy: enter/o-, intestine; the examination of the lining of the digestive tract. Endoscopy: endo-, within, inside; the use of an endoscope. Anoscopy: an/o-, anus; examination of the anus by endoscopy (also proctoscopy). Colonoscopy: colon-, colon; examination of the colon. Gastroscopy: gastr/o stomach; examination of the inside of the stomach by endoscopy. Additional: Panendoscopy (note the two prefixes): examination of the inside of the urethra and bladder. Sigmoidoscopy: endoscopic examination of the sigmoid colon. 9-68 68

Define the following terms and abbreviations. – enema – ostomy – stoma – BM – GI – IBS Talking Points: Have students define the following terms associated with disorders of the GI system. An enema is an instillation of fluid into the rectum. An ostomy refers to an artificial opening of a tubular structure. The root os- means mouth. Example: colostomy, ileostomy. A stoma is an artificial opening. BM—bowel movement GI—gastrointestinal IBS—irritable bowel syndrome

The Essentials of the Language of Gastroenterology

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