The Digestive System Lesson 2: Pathology of the Digestive System 30 The Digestive System Lesson 2: Pathology of the Digestive System

Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. Briefly explain common disorders associated with the digestive system.

Overview of Digestive Disorders Can be minor or serious Symptoms may be subtle Causes can vary Diagnosis: Medical history Physical exam Laboratory tests Endoscopic procedures Imaging techniques 3

Critical Thinking Question What are some causes of digestive system disorders? 4

Appendicitis Inflammation of the appendix Symptoms: Acute pain at the McBirney point on the abdomen Treatment is surgical removal of the appendix Complication: Appendix can burst, causing infection and even death The appendix is a pouch extending off the cecum of the large intestine. Bacteria can collect in the pouch, causing infection. 5

McBurney’s Point

Cirrhosis Damage to the liver caused by fibrosis Chronic inflammation of the liver prevents normal liver function Numerous causes Symptoms include: Edema and ascites Fatigue and jaundice Itching and bleeding Weight and muscle loss Abdominal pain 7

Treatment of Cirrhosis Avoiding substances harmful to the liver Dietary modifications Medications and surgery to prevent and treat complications Liver transplant in extreme cases 8

Colitis Inflammation of the large intestine Many causes and types Symptoms: Abdominal pain Diarrhea and bloating Dehydration Bloody stools 9

Colitis Treatment: Directed at underlying cause–infection, inflammation, lack of blood flow, or another cause 10

Critical Thinking Question What does the term “colitis” tell about the disorder? 11

Colorectal Cancer Begins as benign polyps Because the polyps are small and produce few, if any, symptoms, regular screening tests are important to help prevent end-stage cancer If signs and symptoms of cancer do appear, they may include a change in bowel habits, bloody stools, persistent cramping, gas, or abdominal pain 12

Colorectal Cancer Screening tests and a few simple changes in diet and lifestyle can dramatically reduce a person’s overall risk of developing colon cancer Treatment options: Surgery Chemotherapy Radiation 13

Critical Thinking Question What are some ways to prevent colon cancer? 14

Constipation Occurs when: Person has less than 2 bowel movements a week, or 2 of the following problems 25 percent of time: Straining to eliminate Feeling that bowels are not emptied Hard or pellet-like stools 15

Constipation Causes: Lack of dietary fiber Dehydration Lack of exercise Lifestyle changes 16

Critical Thinking Question What is the relationship between diet, constipation, and colon cancer prevention? 17

Constipation Additional Symptoms: Treatment: Cramping Bloating Nausea Exercise Good nutritional habits Scheduling a certain time each day for bowel movements Laxatives may be useful 18

Crohn’s Disease Chronic inflammation of the intestines Related to ulcerative colitis Cause unknown, but may be bacterial Common Symptoms: Abdominal pain Diarrhea Weight loss 19

Crohn’s Disease Course of remissions and exacerbations Treatment: No cure Medications Mild cases may not need treatment 20

Critical Thinking Question What do “remissions and exacerbations” mean? 21

Diarrhea Frequency or looseness of stool Types: Causes: Acute–a few days to a week Chronic–lasts more than 3 weeks Causes: Depends on type Usually bacterial, viral, or parasitic infection Side effects of medication 22

Diarrhea Treatment: Absorbents to absorb excess water Antimotility medication to relax muscles 23

Diverticulitis Inflammation of a diverticulum in the walls of the colon (can follow diverticulosis) Cause unknown May be result of stool in a diverticulum Symptoms: Pain and cramping Fever Chills Bloating Constipation or diarrhea Treatment depends on severity of condition 24

Diverticulosis Out-pouchings (diverticula) from the colon Caused by pressure on and weakening of intestinal wall Higher incidence in the elderly Mild symptoms: Bloating Cramping 25

Diverticulosis Sets stage for inflammation and infection of the diverticula (diverticulitis) Prevention: High fiber diet 26

Critical Thinking Question Why is there a higher incidence of diverticulosis in the elderly? 27

Colon with diverticulosis. 28

Gastroesophageal Reflux Disease (GERD) Back flow of gastric fluids into the esophagus Lower esophageal sphincter doesn’t close Symptoms: Heartburn Sore throat Hoarseness Bad taste in mouth Belching Regurgitation May be symptom-free 29

Gastroesophageal Reflux Disease (GERD) Treatment: Medications Positioning Fundoplication (surgery to tighten the cardiac sphincter) 30

Gastroesophageal Reflux Disease (GERD) Complications: Reflux esophagitis (inflammation of the esophagus) Barrett’s esophagitis (precancerous condition) Perforation of the esophagus Esophageal cancer Esophageal stricture Esophageal ulcers 31

Mechanisms of GERD

Hemorrhoids Dilated vein in the walls of the anus Associated with constipation or chronic diarrhea Symptoms: Bleeding after defecation Protrusion of hemorrhoids from anus (severe) Treatment: Dietary changes Topical medication Surgery (severe) 33

Critical Thinking Question How can increasing fiber intake help to control hemorrhoids? 34

Internal and External Hemorrhoids

Hiatal Hernia Upper stomach protrudes into chest through an esophageal hiatus Causes: Obesity and smoking Poor seated posture Frequent coughing Straining with constipation Heavy and frequent lifting Heredity Congenital defects 36

Critical Thinking Question What other serious condition has symptoms of chest pain and/or pressure? 37

Symptoms of a Hiatal Hernia Chest pain and/or pressure Heartburn Difficulty swallowing Coughing, belching, and hiccups Can be associated with GERD 38

Hiatal Hernia 39

Inguinal Hernia Intestine pushes through the abdominal wall in the groin area causing a bulge Causes: Weakness in abdominal wall Heavy lifting Straining resulting from coughing, or bending, straining, or even laughing 40

Symptoms and Treatment for an Inguinal Hernia Bulge in groin, scrotum, or labia Pain and discomfort, worsening with bending or lifting Nausea and vomiting Heaviness, swelling, and a tugging or burning sensation in the area Only treatment is surgery 41

Inguinal Hernia

Irritable Bowel Syndrome (IBS) Common intestinal condition Causes: Largely unknown May be stress-related Treatment: Dietary modifications Medication Psychotherapy (for stress) 43

Symptoms of Irritable Bowel Syndrome (IBS) Abdominal cramping and pain Changes in bowel movements Uncontrollable urgency to defecate Gassiness and bloating Nausea Passing of mucus during bowel movements Feeling that bowels are not emptied 44

Oral Cancer Can start anywhere in the mouth Risk factors: Age and gender Smoking and use of chewing tobacco Excessive sun exposure 45

Oral Cancer Symptoms: Sore, irritation, or swelling in the mouth or lump on the neck lasting more than 2 weeks Red or white patches in mouth Sore, wart-like patch or lump on the lip Persistent sore throat Difficulty chewing, swallowing, or speaking 46

Treatment of Oral Cancer Surgery Radiation Chemotherapy 47

Pancreatic Cancer Types: Symptoms: Adenocarcinoma of the pancreas Pancreatic neuroendocrine carcinoma (rare) Symptoms: Easily attributed to other disorders Abdominal and/or back pain Weight loss Bloating Diarrhea or fatty bowel movements Jaundice 48

Treatment for Pancreatic Cancer Complete surgical removal of the cancer Radiation Chemotherapy High mortality rate 49

Peptic Ulcer Disease (PUD) Lesion in the lining of the stomach, esophagus, or duodenum Duodenal ulcers most common Ulcers in the stomach are also common Caused by imbalance in stomach acids Can be aggravated by bacterial infection The most common location for PUD is the duodenum. 50

Peptic Ulcer Disease (PUD) Symptoms Abdominal pain Nausea and vomiting Weight loss Heartburn and chest pain 51

Peptic Ulcer Disease (PUD) Symptoms of Stomach ulcers Pain and/or burning sensation in upper abdomen when stomach is empty Difficulty swallowing and/or regurgitation Bloating, retching, feeling ill after eating Nausea and vomiting Loss of appetite and weight 52

Development of a Peptic Ulcer 53

Treatment of PUD Treatment: Medication change Avoidance of tobacco and alcohol Medications to protect the stomach by stopping the secretion of stomach acids Antibiotics to treat H. pylori infections Occasionally surgery may be required 54

Once pyloric stenosis is surgically corrected, it does not recur. Occurs in infants, usually before 5 months of age Pyloric sphincter swells and thickens Symptoms: Vomiting of increasing severity Dehydration Fussiness Treatment: Surgery Once pyloric stenosis is surgically corrected, it does not recur. 55

Questions? 56