Digestive Diseases

GASTROENTEROLOGIST A physician that specializes in disorders and diseases of the digestive system

REVIEW Small intestine – where digestion is completed and absorption occurs Here you have the addition of enzymes from pancreas and bile from liver/gallbladder

Absorption Absorption occurs when: 1. Carbohydrates are converted to glucose 2. Proteins broken down to amino acids 3. Fats changed to fatty acids and glycerol

GASTROENTERITIS Inflammation of mucus membrane lining of stomach and intestine Common causes – virus Symptoms – diarrhea and vomiting for 24 – 36 hours Complication - dehydration

REVIEW Regulation of H2O balance by absorbing large quantities back into bloodstream Also absorbs Vitamin B complex and K Bacterial action on undigested food – decomposed products excreted through colon – bacteria form moderate amounts of B complex and Vitamin K

FECES Is undigested semi-solid consisting of bacteria, waste products, mucous and cellulose Defecation – when lg intestine fills, defecation reflex triggered – colon and rectal muscles contract while internal sphincter relaxes E-Coli live in lg intestine and feed on undigested fiber in fecal material to help reduce amount of feces produced. 1/3 of feces excreted is made up of E-Coli bacteria

DIARRHEA Loose, watery, frequent bowel movements when feces pass along colon too rapidly and not enough water is absorbed Caused by infection, poor diet, nervousness, toxic substances or irritants in food When the lg. Intestine is irritated and inflamed, the intestinal mucosa secretes large amounts of water and electrolytes in addition to mucus.

CONSTIPATION Slow movement of feces through the large intestine Feces become dry and hard because of the increased fluid absorption during its extended time in the large intestine

CONSTIPATION If passage of feces through lg intestine is prolonged beyond 5 days, the feces lose volume and become more solid Causes include irregular defecation patterns, intestinal blockages, tumors, and diverticulitis

CONSTIPATION Treatment includes diet with cereals, fruits, vegetables, (roughage), drinking plenty of fluids, exercise, and avoiding tension

                                              Colon removed from a man that did not have a bowel movement for 30 days.

HEMORRHOIDS or PILES Enlarged or inflamed veins (varicose veins) that protrude from the anal lining Cause – excessive straining during defecation or childbirth Rx – remove pressure that causes the condition or in severe cases they can be removed surgically

FLATULENCE Gas formation (flatus) is from 1-3 pints per day It passes through the rectum at least 14 times a day Bacteria in the large intestine produce the gases (methane – CH4

COLITIS (Irritable Bowel Syndrome) Any inflammatory condition of the lg intestine Cause unknown – may be result of emotional stress or an autoimmune disease such as ulcerative colitis Symptoms – alternating episodes of constipation or diarrhea and abdominal cramps Rx – high fiber diet, relaxation, and antispasmodic drugs. If these don’t work – affected part can be surgically removed.

DIVERTICULOSIS Little sacs (diverticuli) develop in wall of colon Most people over the age of 50 who eat low fiber foods have this When the sacs become inflamed = DIVERTICULITIS Symptoms – abdominal pain and swelling, diarrhea, constipation,gas, and rectal bleeding

APPENDICITIS Inflammation of the appendix that usually occurs because of obstruction of the appendix If it ruptures, bacteria from appendix can spread to the peritoneal cavity causing PERITONITIS Symptoms – acute pain in RLQ, loss of appetite, nausea, vomiting, and mild fever Rx – surgical removal

COLORECTAL CANCER 2nd leading cause of death from cancer in the United States Occurs most frequently after age 50 and even more frequently after the age of 70 Risk factors – family history, inflammatory bowel disease, intestinal polyps, high saturated-fat intake diet, and increasing age Symptoms – fecal blood, a change in bowel habits, decrease in stool diameter, weight loss, fatigue, and onset of abdominal pain

COLONOSCOPY Early detection for colon cancer is critical – need a colonoscopy after age 50 Colonscope (flexible viewing tube) is passed through the anus into the colon Can take pictures and obtain tissue samples

HEMOCCULT SLIDE Stool slide specimen to look for hidden (occult) blood Hemoccult annual screening tests can reduce the risk of death from CRC by up to 33% In the privacy of their home, they collect a small amount of stool specimen on 3 different days and return the test card to your doctor or laboratory

COLON CANCER Rx – surgical resection May also require a COLOSTOMY – opening in abdomen, healthy bowel brought to skin after cancer removed Pouch worn to collect waist

CIRRHOSIS Chronic progressive disease of the liver Normal tissue is replaced by fibrous connective tissue Symptoms – nausea, anorexia, gray-white stools, weakness, and pain

CIRRHOSIS Causes – hepatitis, chronic alcohol abuse, malnutrition, or infection 75% caused by excessive alcohol consumption Rx – Remove cause and put on high protein diet. Liver transplant may be needed for extensive damage

CIRRHOSIS OF THE LIVER Ascites is an abnormal accumulation of fluid containing large amounts of protein and electrolytes – detectable when more than 500 ml of fluid has accumulated Is a complication of cirrhosis Rx – diet therapy and diuretic therapy

CIRRHOSIS Jaundice – yellow color of skin and sclera when bile pigment gets in bloodstream Best place to assess for jaundice is the hard palate Is a symptom of liver disease and biliary obstruction

HEPATITIS A Known as infectious hepatitis Cause – virus Spread through contaminated food and water Occurs commonly in young people

HEPATITIS A Symptoms – Makes you feel like you have the flu – tired, sick to your stomach, fever, anorexia, diarrhea, dark yellow urine (tea colored), gray stools, and jaundice Rx – Bedrest and no alcohol Can protect yourself by getting a Hepatitis A Vaccine. Also always wash your hands after using the bathroom and drink bottled water when you are in another country

HEPATITIS B (Serum Hepatitis Caused by virus found in the blood Transmitted by blood transfusion or being stuck with contaminated needles (drug addicts) Can block the flow of blood through the liver, thus causing it to back up into the hepatic portal circulation. This causes portal hypertension and to relieve the pressure – new veins that connect to the systemic veins are formed.

HEPATITIS B Health care workers at risk and should be vaccinated Use standard precautions for prevention

CHOLELITHIASIS Condition of gallstones Gallstones are solid clumps of material (mostly cholesterol) Can block the bile duct causing pain and digestive disorders Small ones may pass on their own, large ones surgically removed Surgical removal of gallbladder - CHOLECYSTECTOMY

CHOLECYSTITIS (Gallbladder Inflammation Often seen with gallstones Risk factors for gallstone formation –severely obese people because the liver produces higher level of cholesterol and also people who have a significant weight loss in a short amount of time

LAPAROSCOPIC CHOLECYSTECTOMY Most common method of cholecystectomy Small abdominal incisions allow insertion of surgical instruments and small video camera Surgeon performs procedure by watching monitor and manipulating instruments Stomach muscles are not cut, healing is quicker

LAPAROSCOPIC CHOLECYSTECTOMY

ULCERS Craterlike sore or lesion that forms in the mucosal lining of the stomach 1 in 10 people in the US will suffer from an ulcer Gastric ulcers in the stomach and duodenal ulcers in the duocenum Cause – H. pylori (bacteria) is primary cause – burrows through the mucosa and impairs the lining’s ability to produce protective mucus

ULCERS Lifestyle factors that contribute: Cigarette smoking Alcohol Stress Certain Drugs Symptoms – burning pain in abdomen, between meals and early morning, may be relieved by eating or taking antacid

ULCERS Diagnosis -X-ray and presence of H.pylori (bacteria) The bacteria is diagnosed by biopsy, breath, or blood antibody tests If not treated, these lesions may result in hemorrhage, perforation, widespread infection, scarring, and other serious medical complications Rx – H2 blockers (drugs) that block release of histamine

PANCREAS REVIEW Lies behind stomach Both endocrine and exocrine gland Pancreatic juice is the most important digestive juice It contains enzymes that digest all three major kinds of foods Pancreatic juice contains sodium bicarbonate, an alkaline substance that neutralizes the hydrochloric acid Pancreatic juice enters the duodenum in the same place bile enters

PANCREATITIS Inflammation of pancreas Acute pancreatitis usually results from blockage of the common bile duct – pancratic enzymes “back up” and digests it. In some cases of stomach inflammation from excess alcohol consumption or in gallbladder disease, irritation may extend to the pancreas and cause abnormal activation of the pancreatic enzymes ½ of cases are fatal

PYLORIC STENOSIS Normally stomach contents are moved through the pyloric sphincter within about 2 to 6 hours after eating Narrowing of pyloric sphincter, often found in infants- more common in boys Symptoms – projectile vomiting Treatment – surgery to modify the muscle to food can pass from the stomach into the duodenum

GASTROESOPHAGEAL REFLUX DISEASE (GERD) Cardiac sphincter is weak and relaxes inappropriately Esophagus is irritated by acid that comes up from the stomach Also called “Acid Reflux” Some people feel nothing Symptoms – heartburn pain, a bitter taste in your mouth, coughing at night, hoarseness in the morning, or worsening asthma Stomach acid in the esophagus can cause ulcers, stenosis, and cancer

GERD Dietary habits that improve GERD 1. Eat small portions 2. Avoid onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes Avoid drinking citrus juices, alcohol, coffee, tea, soft drinks, and other caffeinated and carbonated drinks Avoid eating or drinking for 3 hours before going to bed

GERD Lifestyle habits that improve GERD 1. Lose weight if overweight 2. Stop smoking 3. Avoid wearing tight fitting clothing or belts 4. Avoid lying down or prolonged bending over, especially after eating 5. Avoid straining and constipation 6. Elevate the HOB 6 to 8 inches 7. Avoid stress

GERD Additional treatments: 1. Over-the-counter antacids or non-prescription-strength acid-blocking medications called H2 receptor antagonists such as Tagamet, Zantac, or Pepcid 2. Severe cases require surgery

HIATAL HERNIA When stomach protrudes above diaphragm through esophageal opening More common in people over 50 GERD is a symptom for hiatal hernia

TO BE CONTINUED

Hepatitis part 1 Hepatitis A-fecal contamination of food or water ( improper food handling,raw shellfish,) Hepatitis B- sexual contact blood transfusions or needle sticks Hepatitis C –blood contact and dirty neeles( Tattoo parlors)Low incidence of this kind Hep D- Only people who have B, get D Hep E mainly in asia

Hepatitis part 2 Hepatitis E-mainly in Asia, Mexico,India and Africa. Also thru feces contaminated foods.Pregnant women often die with this form Hepatitis F-Nonexistent in the US.In Far East only.It is non A,non B and non C types, so its called F Hepatitis G- Not infectious,doesn’t cause sickness. Found in a MD in Chicago.Rx:rest