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3 Gastroenterology.

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1 3 Gastroenterology

2 Learning Objectives Identify the structures of the gastrointestinal system. Describe the process of digestion. Describe common gastrointestinal diseases and conditions, laboratory and diagnostic procedures, medical and surgical procedures, and drug categories.

3 Learning Objectives Give the medical meaning of word parts related to the gastrointestinal system. Build gastrointestinal words from word parts and divide and define gastrointestinal words. Spell and pronounce gastrointestinal words.

4 Learning Objectives Analyze the medical content and meaning of a gastroenterology report. Dive deeper into gastroenterology by reviewing the activities at the end of this chapter and online at Medical Terminology Interactive.

5 Multimedia Directory Slide 10 Digestive System Animation
Slide 51 GERD Video Slide 57 Appendicitis Animation Slide 91 Ultrasound Video Slide 93 MRI Video Slide 103 Sigmoidscopy Video Slide 110 Medical Assisting Video

6 Gastroenterology The medical specialty that studies the anatomy and physiology of the gastrointestinal system and uses diagnostic tests, medical and surgical procedures, and drugs to treat gastrointestinal diseases. 6

7 Anatomy and Physiology
Gastrointestinal System Begins at the mouth, continues through the thoracic cavity, and fills most of the abdominal cavity Upper gastrointestinal system includes the structures from the mouth through the stomach 7

8 Anatomy and Physiology (con’t)
Gastrointestinal System (con’t) Lower gastrointestinal system includes the small and large intestines Purpose is to digest food, absorb nutrients, and remove undigested material (waste) from the body 8

9 Figure 3-1 Gastrointestinal system
9

10 Digestive System Animation
Click on the screenshot to view an animation showing a tour of the digestive system. The animation may take a few seconds to start playing. Back to Directory 10

11 Anatomy of the Gastrointestinal System
Oral Cavity and Pharynx Begins in the mouth, or oral cavity Oral cavity contains the teeth; tongue; hard palate; and soft palate with its fleshy, hanging uvula. Receptors on the tongue perceive taste and send this information to the gustatory cortex in the brain. 11

12 Anatomy of the Gastrointestinal System (con't)
Oral Cavity and Pharynx (con’t) Lined with mucosa, a mucous membrane that produces thin mucus. The sight, smell, and taste of food cause the salivary glands to release saliva into the mouth; this moistens foods as they are chewed and swallowed. Saliva also contains an enzyme that begins the process of digestion. 12

13 Anatomy of the Gastrointestinal System (con't)
Oral Cavity and Pharynx (con’t) There are three pairs of salivary glands: the parotid glands, the sublingual glands, and the submandibular glands. The teeth tear, chew, and grind the food during the process of mastication. The tongue moves food toward the teeth and mixes food with saliva. 13

14 Anatomy of the Gastrointestinal System (con't)
Oral Cavity and Pharynx (con’t) Swallowing or deglutition moves food into the throat or pharynx. When food is swallowed, the epiglottis closes the entrance to the larynx, so that food in the back of the throat, pressing on the uvula, does not initiate the gag reflex. 14

15 Figure 3-2 Oral cavity and pharynx
15

16 Figure 3-3 Salivary glands
16

17 Anatomy of the Gastrointestinal System (con't)
Esophagus A flexible, muscular tube that connects the pharynx to the stomach. Lined with mucosa that produces mucus. By coordinated contractions of its wall—the process of peristalsis—food moves toward the stomach. 17

18 Anatomy of the Gastrointestinal System (con't)
Stomach A large, elongated sac in the upper abdominal cavity that receives food from the esophagus. Divided into four areas: the cardia, fundus, body, and pylorus. The gastric mucosa is arranged in thick, deep folds known as rugae which expand as the stomach fills with food. 18

19 Anatomy of the Gastrointestinal System (con't)
Stomach (con’t) The mucosa produces mucus that protects the lining of the stomach from the acid the stomach produces. Two sphincters (muscular rings) keep food in the stomach. The lower esophageal sphincter is located in the distal esophagus. 19

20 Anatomy of the Gastrointestinal System (con't)
Stomach (con’t) The pyloric sphincter is located in the distal end of the stomach. Chyme is a semisolid mixture of partially digested food, saliva, and digestive juices in the stomach. 20

21 The wording in Fig. 3-4 needs to be revised. See text page 3-126.
Figure Stomach 21

22 Anatomy of the Gastrointestinal System (con't)
Small Intestine The small intestine is a long, hollow tube that receives chyme from the stomach. It is divided into three parts: the duodenum, jejunum, and ileum. 22

23 Figure 3-5 Small and large intestines
23

24 Anatomy of the Gastrointestinal System (con't)
Large Intestine A larger, hollow tube that receives undigested material and water from the small intestine. Consists of the cecum, colon, rectum, and anus. The walls contain haustra (puckered pouches) that can greatly expand, as needed. 24

25 Anatomy of the Gastrointestinal System (con't)
Large Intestine (con’t) Waves of peristalsis slowly move undigested material through the large intestine as water is absorbed through the intestinal wall and into the blood. The colon is the longest part. It travels through all four quadrants of the abdomen as the ascending colon, transverse colon, descending colon, and sigmoid colon. 25

26 Anatomy of the Gastrointestinal System (con't)
Large Intestine (con’t) The sigmoid colon bends toward the midline in an S-shaped curve that joins the rectum. The rectum is a short, straight segment that connects to the outside of the body. The anus, the external opening of the rectum, is located between the buttocks. The anal sphincter is a muscular ring whose opening and closing is under conscious, voluntary control. 26

27 Anatomy of the Gastrointestinal System (con't)
Abdomen and Abdominopelvic Cavity Contains the largest organs of the gastrointestinal system. The walls of the abdominopelvic cavity are lined by peritoneum, a membrane that secretes peritoneal fluid. This watery fluid fills the spaces between the organs and allows them to slide past each other during the movements of digestion. 27

28 Anatomy of the Gastrointestinal System (con't)
Abdomen and Abdominopelvic Cavity (con’t) The peritoneum extends into the center of the abdominopelvic cavity as the omentum. The omentum supports the stomach and hangs down as a fatty apron to cover and protect the small intestine. The peritoneum also extends as the mesentery, a thick, fan-shaped sheet that supports the jejunum and ileum. 28

29 Anatomy of the Gastrointestinal System (con't)
The blood supply to the stomach, small intestine, liver, gallbladder, and pancreas comes from the celiac trunk of the aorta, the largest artery in the body. 29

30 Anatomy of the Gastrointestinal System (con't)
Liver The liver is the largest solid organ in the body, located in the upper right abdominal cavity. An accessory organ of digestion that contributes to, but is not physically involved in, the process of digestion. Liver cells (hepatocytes) continuously produce bile, a yellow-green, bitter-tasting, thick fluid. 30

31 Anatomy of the Gastrointestinal System (con't)
Liver (con’t) Bile produced by the liver flows through the hepatic ducts, through the common hepatic duct, and then into either the cystic duct to the gallbladder or the common bile duct. All of the ducts that carry bile are collectively known as the biliary tree. 31

32 Figure 3-6 Biliary tree 32

33 Anatomy of the Gastrointestinal System (con't)
Gallbladder An accessory organ of digestion posterior to the liver. Concentrates and stores bile from the liver. The presence of fatty chyme in the duodenum causes the gallbladder to contract, sending bile into the common bile duct and duodenum to digest fats. 33

34 Anatomy of the Gastrointestinal System (con't)
Pancreas An accessory organ of digestion posterior to the stomach. Presence of food in the duodenum causes the pancreas to secrete digestive enzymes into the pancreatic duct to the duodenum. Also functions as an organ of the endocrine system. 34

35 Physiology of Digestion
There are two parts to digestion: Mechanical Chemical Mechanical digestion uses mastication, deglutition, and peristalsis to break down foods. Mechanical digestion also involves breaking apart fats in the duodenum. 35

36 Physiology of Digestion (con't)
Fatty chyme stimulates the duodenum to secrete the hormone cholecystokinin, which stimulates the gallbladder to contract and release bile. Bile breaks apart large globules of fat during the process of emulsification. Chemical digestion uses enzymes and acid to break down foods. 36

37 Physiology of Digestion (con't)
The enzyme amylase in saliva begins to break down carbohydrate foods in the mouth. The stomach secretes the following substances that continue the process of chemical digestion: Hydrochloric acid Pepsinogen Gastrin 37

38 Physiology of Digestion (con't)
The stomach secretes a substance known as intrinsic factor, which helps vitamin B12 be absorbed from the intestine into the blood. When the stomach does not produce enough intrinsic factor, vitamin B12 is not absorbed. 38

39 Physiology of Digestion (con't)
Chemical digestion is completed in the small intestine. Cholecystokinin stimulates the pancreas to secrete four digestive enzymes into the duodenum: Amylase Lipase Other enzymes that break down proteins 39

40 Physiology of Digestion (con't)
The villi of the small intestine produce the digestive enzymes such as lactase to break down sugars. 40

41 Physiology of Digestion (con't)
Absorption of nutrients and water through the intestinal wall into the blood takes place mainly in the duodenum and jejunum. Absorption of water continues in the large intestine. Absorbed nutrients are carried by blood in the portal vein to the liver. 41

42 Physiology of Digestion (con't)
The liver plays an important role in regulating nutrients such as glucose and amino acids. Excess glucose in the blood is stored in the liver as glycogen and released when the blood glucose level is low. The liver uses amino acids to build plasma proteins and clotting factors for the blood. 42

43 Physiology of Digestion (con't)
Elimination occurs when undigested materials and water are eliminated from the body in a solid waste form of feces or stool. The process of elimination is a bowel movement or defecation. 43

44 Figure 3-7 Gastrointestinal system. (Robert W. Ginn/PhotoEdit Inc.)
44

45 Digestive System Animation
Click on the screenshot to view an animation showing the digestive system. Back to Directory 45

46 Diseases and Conditions
Eating Anorexia Dysphagia Polyphagia 46

47 Diseases and Conditions (con't)
Mouth and Lips Cheilitis Sialolithiasis Stomatitis Glossitis 47

48 (Centers for Disease Control and Prevention [CDC])
Figure Glossitis (Centers for Disease Control and Prevention [CDC]) 48

49 Diseases and Conditions (con't)
Esophagus and Stomach Dyspepsia Esophageal varices Gastritis Gastroenteritis Gastroesophageal reflux disease (GERD) 49

50 Figure 3-9 Esophageal varix
(David M. Martin, M.D./Photo Researchers, Inc.) 50

51 Click on the screenshot to view a video on the topic of GERD.
GERD Video Click on the screenshot to view a video on the topic of GERD. Back to Directory 51

52 Diseases and Conditions (con't)
Esophagus and Stomach (con't) Heartburn Hematemesis Nausea and vomiting (N&V) Peptic ulcer disease (PUD) Stomach cancer 52

53 (David M. Martin, M.D./Photo Researchers, Inc.)
Figure Gastric ulcer (David M. Martin, M.D./Photo Researchers, Inc.) 53

54 Diseases and Conditions (con't)
Duodenum, Jejunum, Ileum Ileus Intussusception Volvulus 54

55 Figure 3-11 Intussusception of the intestine
55

56 Diseases and Conditions (con't)
Cecum and Colon Appendicitis Colic Colon cancer Diverticulum Dysentery 56

57 Appendicitis Animation
Click on the screenshot to view an animation showing appendicitis. Back to Directory 57

58 (David M. Martin, M.D./Photo Researchers, Inc.)
Figure Diverticula (David M. Martin, M.D./Photo Researchers, Inc.) 58

59 Figure 3-13 Diverticulitis and polyposis
59

60 Diseases and Conditions (con't)
Cecum and Colon (con’t) Gluten enteropathy Inflammatory bowel disease (IBD) Irritable bowel syndrome (IBS) Polyp 60

61 Figure 3-14 Crohn’s disease
61

62 Figure 3-15 Colonic polyps (Staats/Custom Medical Stock Photo, Inc.)
62

63 Diseases and Conditions (con't)
Rectum and Anus Hemorrhoids Proctitis Rectocele 63

64 Diseases and Conditions (con't)
Defecation and Feces Constipation Diarrhea Flatulence Hematochezia Incontinence Steatorrhea 64

65 Diseases and Conditions (con't)
Abdominal Wall and Abdominal Cavity Adhesions Hernia Peritonitis 65

66 Figure Hernia (From Rudolph, A.M., Hoffman, J.I.E., & Rudolph, C.D. (Eds.) Rudolph’s Pediatrics. (19th ed., p. 1040)) 66

67 (Custom Medical Stock Photo, Inc.)
Figure Peritonitis (Custom Medical Stock Photo, Inc.) 67

68 Diseases and Conditions (con't)
Liver Ascites Cirrhosis Hepatitis 68

69 Figure 3-18 Fatty liver disease and cirrhosis of the liver
(Arthur Glauberman/Photo Researchers, Inc.) 69

70 Diseases and Conditions (con't)
Hepatitis is the most common chronic liver disease. Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E 70

71 Diseases and Conditions (con't)
Hepatitis A is an acute but short-lived infection caused by exposure to water or food that is contaminated with feces from a person who is infected with the hepatitis A virus (HAV). 71

72 Diseases and Conditions (con't)
Hepatitis B is an acute infection caused by exposure to the blood of a person who is already infected with the hepatitis B virus (HBV); it is also known as serum hepatitis. It is also spread during sexual activity by contact with saliva and vaginal secretions. An infected mother can pass hepatitis B to her fetus before birth or when breastfeeding. 72

73 Figure 3-19 Blood transfusion (PhotoDisc/Getty Images)
73

74 Diseases and Conditions (con't)
Hepatitis C is an acute infection caused by exposure to the blood of a person who is already infected with the hepatitis C virus (HCV). Hepatitis C is not readily transmitted by sexual activity or from a mother to her fetus. 74

75 Diseases and Conditions (con't)
Chronic hepatitis C is the main cause of chronic liver disease, cirrhosis, and liver cancer. Hepatitis D is a secondary infection caused by a mutated (changed) hepatitis virus. 75

76 Diseases and Conditions (con't)
Hepatitis D only develops in patients who already have hepatitis B; it is also known as delta hepatitis. Hepatitis E is similar to hepatitis A but rarely occurs in the United States. 76

77 Diseases and Conditions (con't)
Hepatomegaly Jaundice Liver Cancer 77

78 (Dr. M.A. Ansary/Photo Researchers, Inc.)
Figure Jaundice (Dr. M.A. Ansary/Photo Researchers, Inc.) 78

79 (Gca/Photo Researchers, Inc.)
Figure Liver cancer (Gca/Photo Researchers, Inc.) 79

80 Diseases and Conditions (con't)
Gallbladder and Bile Ducts Cholangitis Cholecystitis Cholelithiasis 80

81 Figure 3-22 Cholelithiasis (Custom Medical Stock Photo, Inc.)
81

82 Figure 3-23 Gallstones in the biliary and pancreatic ducts
82

83 Diseases and Conditions (con't)
Pancreas Pancreatic cancer Pancreatitis 83

84 Laboratory and Diagnostic Procedures
Blood Tests Albumin Alkaline phosphatase (ALP) ALT and AST Bilirubin 84

85 Laboratory and Diagnostic Procedures (con't)
Blood Tests (con’t) GGT Liver function tests (LFTs) 85

86 Laboratory and Diagnostic Procedures (con't)
Gastric and Feces Specimen Tests CLO test Culture and sensitivity (C&S) Fecal occult blood test Gastric analysis Ova and parasites (O&P) 86

87 Laboratory and Diagnostic Procedures (con't)
Radiologic Procedures Barium enema Cholangiography 87

88 (Custom Medical Stock Photo, Inc.)
Figure Barium enema (Custom Medical Stock Photo, Inc.) 88

89 Figure 3-25 Endoscopic retrograde cholangiopancreatography
89

90 Laboratory and Diagnostic Procedures (con't)
Radiologic Procedures (con’t) Computerized axial tomography (CAT, CT scan) Flat plate of the abdomen Gallbladder ultrasound 90

91 Click on the screenshot to view a video on the topic of ultrasounds.
Ultrasound Video Click on the screenshot to view a video on the topic of ultrasounds. Back to Directory 91

92 Laboratory and Diagnostic Procedures (con't)
Radiologic Procedures (con’t) Magnetic resonance imaging (MRI) scan Oral cholecystography (OCG) 92

93 MRI Video Click on the screenshot to view a video on the topic of MRI.
The video may take a moment before playing. Back to Directory 93

94 Laboratory and Diagnostic Procedures (con't)
Radiologic Procedures (con’t) Upper gastrointestinal series (UGI) 94

95 Medical and Surgical Procedures
Medical Procedures Insertion of nasogastric tube 95

96 Figure 3-26 Nasogastric tube (Pearson Education/PH College)
96

97 Medical and Surgical Procedures (con't)
Abdominocentesis Appendectomy Biopsy Bowel resection and anastomosis Cholecystectomy Choledocholithotomy 97

98 Figure 3-27 Laparoscopic cholecystectomy
(Geoff Tompkinson/Photo Researchers, Inc.) 98

99 Medical and Surgical Procedures (con't)
Colostomy Endoscopy Exploratory laparotomy 99

100 Figure 3-28 Colostomy and stoma (Pearson Education/PH College)
100

101 Medical and Surgical Procedures (con't)
Endoscopic Procedures Esophagoscopy Gastroscopy Esophagogastroduodenoscopy (EGD) Sigmoidoscopy Colonoscopy 101

102 Figure Colonoscopy (BSIP/Phototake NYC) 102

103 Click on the screenshot to view a video on the topic of sigmoidoscopy.
Sigmoidoscopy Video Click on the screenshot to view a video on the topic of sigmoidoscopy. Back to Directory 103

104 Medical and Surgical Procedures (con't)
Gastrectomy Gastroplasty Gastrostomy Hemorrhoidectomy 104

105 Figure PEG tube 105

106 Medical and Surgical Procedures (con't)
Herniorrhaphy Jejunostomy Liver transplantation Polypectomy 106

107 Drug Categories These categories of drugs are used to treat gastrointestinal diseases and conditions: Antacid drugs Antibiotic drugs Antidiarrheal drugs Antiemetic drugs H subscript 2, not H2 107

108 Drug Categories (con’t)
These categories of drugs are used to treat gastrointestinal diseases and conditions: H2 blocker drugs Laxative drugs Proton pump inhibitor drugs H subscript 2, not H2 108

109 Abbreviations

110 Medical Assisting Video
Click on the screenshot to view a video on the topic of careers in medical assisting. Back to Directory 110


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