1. Digestive System Chapter 24
The digestive system consists of a muscular tube, the digestive tract, also called the gastrointestinal (GI) tract and various accessory organs.
The oral cavity (mouth), pharynx (throat), esophagus, stomach, small intestine, and large intestine make up the digestive tract.
Accessory digestive organs include teeth, tongue, and various glandular organs, such as the salivary glands, liver and pancreas.

2. Digestive Tract Figure 24–1 The Components of the Digestive System.
There are multiple components of the digestive system. Go through these two slides and outline the organs involved including general functions.
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3. Digestive Tract Figure 24–1 The Components of the Digestive System.
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4. Video

5. The Oral Cavity

6. Oral Cavity Figure 24–6a The Oral Cavity. Teeth
The functions of the oral cavity include 1. sensory analysis of material before swallowing 2. mechanical processing through the actions of teeth, tongue and palatal surfaces 3. lubrication by mixing with mucus and salivary gland secretions and 4. limited digestion of carbohydrates and lipids.
The nasopharynx is the superior portion of the pharynx. It is connected to the posterior portion of the nasal cavity through the internal nares. The soft palate separates it from the oral cavity.
The oropharynx extends between the soft palate and the base of the tongue at the level of the hyoid bone. The posterior portion of the oral cavity communicates directly with the oropharynx, as does the posterior inferior portion of the nasopharynx.
The narrow laryngopharynx is the inferior part of the pharynx. It includes that portion of the pharynx between the hyoid bone and the entrance to the larynx and esophagus
The teeth are responsible for breaking up food within the oral cavity. Mastication-involves chewing with teeth to break down food into compact particles.
Tongue helps push food to back and begin swallowing motion. The tongue is divided into an anterior body, a posterior root and the superior surface called the dorsum.
The epiglottis is a blade-shaped flap of tissue, reinforced by cartilage, that is attached to the dorsal and superior surface of the thyroid cartilage; folds over the entrance to the larynx during swallowing.
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7. Oral Cavity Figure 24–6b The Oral Cavity. Frenulum of the Upper Lip
The palatine processes of the maxilary bones and the horizontal plates of the palatine bones form the hard palate.
The soft palate lies posterior to the hard palate. A thinner and more delicate mucosa covers the posterior margin of the hard palate and extends into the soft palate.
Along the inferior midline of the tongue is the lingual frenulum, a thin fold of mucous membrane that connects the body of the tongue to the mucosa covering the floor of the oral cavity.
The frenulum of the upper lip attaches the upper lip to the gums.
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8. Oral Cavity Figure 24–6a The Oral Cavity.
The posterior margin of the soft palate supports the uvula, a dangling process that helps prevent food from entering the pharynx too soon.
The more anterior palatoglossal arch extends between the soft palate and the base of the tongue.
The more posterior palatopharyngeal arch extends from the soft palate to the pharyneal wall.
A palatine tonsil lies between the palatoglossal and palatopharyngeal arches on either side.
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9. Teeth Dentin Tubule LE Figure 24-8a
The bulk of each tooth consists of a mineralized matrix similar to that of bone. This material, called dentin, differs from bone in that it doesn’t contain cells. Instead, cytoplasmic processes called dentin tubules extend into the dentin from the cells in the central pulp cavity, an interior chamber.
A layer of enamel covers the dentin of the crown. *Enamel, which contains calcium phosphate in a crystalline form, is the hardest biologically manufactured substance.
The gingivae, or gums, are ridges of oral mucosa that surround the base of each tooth on the alveolar processes of the maxilary bones and mandible.
LE Figure 24-8a

10. Teeth
Incisors are blade-shaped teeth located at the front of the mouth. Incisors are useful for clipping or cutting.
The cuspids, or canines, are conical, with a sharp ridgeline and a pointed tip. They are used for shearing food.
Bicuspids, or premolars, have flattened crowns with prominent ridges. They crush, mash, and grind.
Molars have very large, flattened crowns with prominent ridges adapted for crushing and grinding. They are also used for crushing and grinding.
The third molars or wisdom teeth, may not erupt before age 21. Wisdom teeth may fail to erupt because they develop in inappropriate positions or because space on the dental arcade is inadequate.
LE Figure 24-9b

11. Maxilla exposed to show developing permanent teeth
LE 24-9c
Maxilla exposed to show developing permanent teeth
Erupted deciduous teeth
First and second molars
Mandible exposed to show developing permanent teeth
Exposed unerupted teeth

12. Oral Cavity Figure 24–7 The Salivary Glands.
The parotid salivary glands lie inferior to the zygomatic arch deep to the skin covering the lateral and posterior surface of the mandible. They produce salivary amylase to begin break down starches.
The sublingual salivary glands are covered by the mucous membrane of the floor of the mouth. They produce a mucous secretion that acts as a buffer and lubricant.
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13. The Esophagus

14. Layers of the Esophagus
The esophagus is a hollow muscular tube that conveys solid food and liquids to the stomach. Its length is approximately 25 cm (10 in) and its diameter is about 2 cm (0.8 in) at its widest point. The esophagus begins posterior to the cricoid cartilage, at the level of vertebra C6.

15. The Esophagus Figure 24–11 The Swallowing Process.
The buccal phase begins with the compression of the bolus against the hard palate. Subsequent retraction of the tongue then forces the bolus into the oropharynx and assists in the elevation of the soft palate, thereby sealing off the nasopharynx. Once the bolus enters the oropharynx, reflex responses begin and the bolus is moved toward the stomach.
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16. The Esophagus Figure 24–11 The Swallowing Process.
The pharyngeal phase begins as the bolus into contact with the palatoglossal and palatopharyngeal wall. Elevation of the larynx and folding of the epiglottis direct the bolus past the closed glottis. At the same time, the uvula and soft palate block passage back to the nasopharynx.
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17. The Esophagus Figure 24–11 The Swallowing Process.
The esophageal phase begins as the contraction of pharyngeal muscles forces the bolus through the entrance to the esophagus, the bolus is pushed toward the stomach by a peristaltic wave.
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18. The Esophagus Figure 24–11 The Swallowing Process.
The approach of the bolus triggers the opening of the lower esophageal sphincter. The bolus then continues into the stomach.
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19. The Stomach

20. Digestive Tract Figure 24–2b Organization of Mesenteries in an Adult.
Stomach
Portions of the digestive tract are suspended within the peritoneal cavity by sheets of serous membrane that connect the parietal peritoneum with the visceral peritoneum.
These mesenteries are double sheets of peritoneal membrane.
All but the first 25 cm (10 in) of the small intestine is suspended by the mesentary proper, a thick mesenterial sheet.
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21. Digestive Tract
Figure 24–2d Sagittal Section Showing the Mesenteries of an Adult.
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22. The Stomach Figure 24–12b The Structure of the Stomach Wall.
The stomach performs four major functions: 1. storage of ingested food 2. mechanical breakdown of ingested food 3. disruption of chemical bonds in food through the action of acid enzymes and 4. production of intrinsic factor, a glycoprotein needed in the digestive tract for the absorption of vitamin B12 by the small intestine.
Ingested substances combine with secretions of the glands of the stomach, producing a viscous, highly acidic, soupy mixture of partially digested food called chyme.
The cardia is the smallest part of the stomach. It consists of the superior, medial portion of the stomach within 3 cm (1.2 in) of the junction between the stomach and the esophagus.
The fundus is the portion of the stomach that is superior to the junction between the stomach and the esophagus. The fundus contacts the inferior posterior surface of the diaphragm.
The area of the stomach between the fundus and the curve of the J is the body, the largest region of the stomach. The body acts as a mixing tank for injested food and secretions produced in the stomach.
The pylorus forms the sharp curve of the J. The pylorus is divided into a pyloric antrum, which is connected to the body, and a pyloric canal, which empties into the duodenum, the proximal segment of the small intestine. As mixing movements take place during digestion, the pylorus frequently changes shape. A muscular pyloric sphincter regulates the release of chyme into the duodenum.
The stomach’s volume increases while you eat and then decreases as chyme enters the small intestine. When the stomach is relaxed (empty), the mucosa has prominent folds called rugae. These temporary features let the gastric lumen expand.
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23. Cardiac sphincter Fundus Cardiac region Lesser curvature Body
Pyloric sphincter
The cardiac sphincter prevents the backflow of materials from the stomach into the esophagus.
The pyloric sphincter regulates the passage of chyme into the small intestine.
Greater curvature
Pyloric canal
Pyloric antrum

24. LE 24-12
Esophagus
Diaphragm
Right lobe of liver
Fundus
Cardia
Spleen
Lesser omentum
Lesser curvature
Body
Duodenum
Greater curvature with greater omentum attached
Pyloric sphincter
Pylorus
Greater omentum
Cardiac Notch
Esophagus
Fundus
Anterior surface
Cardia
A short lesser curvature forms the medial surface of the organ, and a long greater curvature forms the lateral surface.
The greater omentum is a large fold of peritoneum that hangs down from the stomach. It extends from the greater curvature of the stomach, passing in front of the small intestines and reflects on itself to ascend to the transverse colon before reaching to the posterior abdominal wall.
The lesser omentum is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the start of the duodenum.
Lesser curvature (medial surface)
Body
Pylorlic sphincter
Duodenum
Rugae
Greater curvature (lateral surface)
Pyloric canal
Pylorus
Pyloric antrum

25. The Spleen
Spleen
The spleen is important for the phagocytosis of red blood cells, the immune response, and lymphocyte production.

26. Endoscopy Video of the Stomach
Endoscopy of the esophagus, stomach and duodenum (upper endoscopy) is a way to examine your swallowing tube (esophagus), stomach, and first part of your small intestine (duodenum).
A narrow, flexible lighted tube is swallowed and
advanced down your esophagus and into your stomach and small intestine. The lighted tube projects pictures to a monitor and allows the doctor to see the lining of your esophagus, stomach and intestine.

27. The Stomach Figure 24–13b The Stomach Lining.
The stomach is composed of gastric pits and is lined with a mucosal layer preventing self digestion
In the fundus and body of the stomach, each gastric pit communicates with several gastric glands, which extend deep in the underlying lamina propria.
The mucous cells produce and secrete a carpet of mucous that covers the interior surface of the stomach. This alkaline mucous layer protects the epithelial cells against the acid and enzymes in the gastric lumen
Parietal cells secrete intrinsic factor to help the absorption of vitamin B12 across the intestinal lining and hydrochloric acid making the stomach environment highly acidic which 1. kills most of the microorganisms ingested with food 2. denatures proteins and inactivates most of the enzymes in food 3. helps break down plant cell walls and the connective tissues in meat 4. is essential for the activation and function of pepsin.
Chief cells secrete pepsinogen, an inactive proenzyme. Acid in the gastric lumen converts pepsinogen to pepsin, an active protein-digesting enzyme.
Gastrin is produced by G cells and stimulates secretion by both parietal and chief cells, as well as contractions of the gastric wall that mix and stir the gastric contents.
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28. The Stomach Figure 24–15 The Phases of Gastric Secretion.
The cephalic phase of gastric secretion begins when you see, smell, taste or think of food. This phase, which is directed by the CNS, prepares the stomach to receive food. The neural output proceeds by the way of the parasympathetic division of the autonomic nervous system. The vagus nerves innervate the submucosal plexus of the stomach. Next, postganglionic parasympathetic fibers innervate mucous cells, chief cells, parietal cells, and G cells of the stomach. In response to stimulation, the production of gastric juice speeds up, reaching rates of about 500ml/h, or about 2 cups per hour.
This phase generally lasts only minutes.
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29. The Stomach Figure 24–15 The Phases of Gastric Secretion.
The gastric phase begins with the arrival of food in the stomach and builds on the stimulation provided during the cephalic phase. This phase may continue for three to four hours while the acid and enzymes process the ingested materials. The stimuli that initiate the gastric phase are 1. distention of the stomach 2. an increase in the pH of the gastric contents and 3. the presence of undigested materials in the stomach, especially proteins and peptides.
Local response: Distention of the gastric wall stimulates the release of histamine in the lamina propria, which binds to receptors on the parietal cells and stimulates acid secretion.
Neural response: The stimulation of stretch receptors and chemoreceptors triggers short reflexes coordinated in the submucosal and myenteric plexuses. This in turn activates the stomach’s secretory cells. The stimulation of the myenteric plexus produces powerful contractions called mixing waves in the muscularis externa.
Hormonal response: Neural stimulation and the presence of peptides and amino acids in chyme stimulate the secretion of the hormone gastrin, primarily by G cells. Gastrin travels via the bloodstream to parietal and chief cells, whose increased secretions reduce the pH of the gastric juice. In addition, gastrin also stimulates gastric motility.
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30. The Stomach Figure 24–15 The Phases of Gastric Secretion.
The intestinal phase of gastric secretion begins when chyme first enters the small intestine. The function of the intestinal phase is controlling the rate of gastric emptying to ensure that the secretory, digestive, and absorptive functions of the small intestine can proceed with reasonable efficiency. Although here we consider the intestinal phase, as it affects stomach activity. Although here we consider the intestinal phase as it affects stomach activity, the arrival of chyme in the small intestine also triggers other neural and hormonal events that coordinate that activities of the intestinal tract and panreas, liver and gallbladder.
Neural responses: Chyme leaving the stomach decreases the distention in the stomach, thereby reducing the stimulation of stretch receptors. Distention of the duodenum by chyme stimulates stretch receptors and chemoreceptors that trigger the enterogastric reflex. This reflex inhibits both gastrin production and gastric contractions and stimulates the contraction of the pyloric sphincter, which prevents further discharge of chyme. At the same time, local reflexes at the duodenum stimulate mucous production, which helps protect the duodenal lining from arriving acid and enzymes.
Hormonal responses: The arrival of chyme in the duodenum triggers hormonal responses. Arrival of lipids and carbohydrates stimulates the secretion of cholycystokinin (CCK) and gastric inhibitory peptide (GIP). A drop in pH below 4.5 stimulates the secretion of secretin. Partially digested proteins in the duodenum stimulates G cells that secrete gastrin, which circulates to the stomach and speeds gastric processing.
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31. The Small Intestine Figure 24–16 Segments of the Intestine.
Most of the important digestive and absorptive steps of digestion take place in the small intestine, where chemical digestion is completed and the products of digestion are absorbed.
The small intestine has three segments: the duodenum, jejunum and ileum.
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32. The Small Intestine The Duodenum
The segment of small intestine closest to stomach
25 cm (10 in.) long
“Mixing bowl” that receives chyme from stomach and digestive secretions from pancreas and liver
Functions of the duodenum
To receive chyme from stomach
To neutralize acids before they can damage the absorptive surfaces of the small intestine

33. The Small Intestine The Jejunum
Is the middle segment of small intestine
2.5 meters (8.2 ft) long
Is the location of most
Chemical digestion
Nutrient absorption

34. The Small Intestine The Ileum The final segment of small intestine
3.5 meters (11.48 ft) long
Ends at the ileocecal valve, a sphincter that controls flow of material from the ileum into the large intestine

35. The Large Intestine
Figure 24–23a The Gross Anatomy and Regions of the Large Intestine.
Material arriving from the ileum first enters an expanded pouch called the cecum. The ileum attaches to the medial surface of the cecum and opens into the cecum at the ileocecal valve. The cecum collects and stores materials from the ileum and begins the process of compaction.
The slender, hollow appendix, or vermiform appendix, is attached to the posteriomedial surface of the cecum. Lymphois nodules dominate the mucosa and submucosa of the appendix. The primary function of the appendix is as an organ of the lymphoid system.
The wall of the colon forms a series of pouches, or haustra, which permit the colon to expand and elongate.
Three separate longitudinal bands of smooth muscle, called taeniea coli, run along the outer surfaces of the colon. Muscle tone within the taeniae coli is what creates the haustra.
The serosa of the colon contains numerous teardrop shaped sacs of fat called fatty or epiploic appendices.
The ascending colon begins at the superior border of the cecum and ascends along the right lateral and posterior wall of the peritoneal cavity to the inferior surface of the liver.
There, the colon bends sharply to the left at the right colic flexure, or hepatic flexure. This bend marks the end of the ascending colon and the beginning of the transverse colon.
The transverse colon curves anteriorly from the right colic flexure and crosses the abdomen from right to left.
Near the spleen, the colon makes a 90⁰ turn at the left colic flexure, or splenic flexure, and becomes the descending colon.
The descending colon proceeds inferiorly along the left side until reaching the iliac fossa formed by the inner surface of the left ilium.
At the iliac fossa, the descending colon curves at the sigmoid flexure and becomes the sigmoid colon.
The sigmoid colon is an S-shaped segment that is only about 15 cm (6 in) long and empties into the rectum.
The rectum forms the last portion of the digestive tract. It is an expandable organ for temporary storage of feces. The movement of fecal material into the rectum triggers the urge to defecate.
The anus is the exit of the anal canal. The circular muscular layer in this region forms the internal anal sphincter. The smooth muscle cells of this sphincter are not under voluntary control. The external anal sphincter, which guards the anus, consists of a ring of skeletal muscle fibers that encircles the distal portion of the anal canal. This sphincter consists of skeletal muscle and is under voluntary control.
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36. The Large Intestine
Figure 24–24 The Gross Anatomy and Regions of the Large Intestine.
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37. The Large Intestine Physiology of the Large Intestine
Less than 10% of nutrient absorption occurs in large intestine
Prepares fecal material for ejection from the body
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38. The Large Intestine Absorption in the Large Intestine
Reabsorption of water
Reabsorption of bile salts
In the cecum
Transported in blood to liver
Absorption of vitamins produced by bacteria
Absorption of organic wastes
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39. A Normal Colonoscopy http://www.youtube.com/watch?v=6kg5wZQfADQ
A colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions.

40. The Liver

41. The Liver Figure 24–19b, c The Anatomy of the Liver.
The liver is the largest organ after skin and performs many functions
It is the center of carbohydrate metabolism (gluconeogeneis, glycogenolysis, glycogenesis)
lipid metabolism (cholesterol synthesis, Lipogenesis)
secretes bile
Multi-lobed; Two can be seen on the anterior surface of the liver, the right and left lobes.
Connected to the anterior portion of the abdominal cavity by the falciform ligament.
In intimate contact with the gallbladder (which will be discussed in a later slide)
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42. The Liver Figure 24–19b, c The Anatomy of the Liver.
The inferior vena cava travels down the abdominal cavity posterior to the liver.
On the posterior surface of the liver, the impression left by the inferior vena cava marks the division between the right lobe and the small caudate lobe.
Inferior to the caudate lobe lies the quadrate lobe, sandwiched between the left lobe and the gallbladder.
Three tubular structures emerge from the liver in a region known as the porta hepatis. The hepatic artery proper carries oxygenated blood from the heart to the liver and the hepatic portal vein carries deoxygenated blood from the liver to the heart. The common bile duct also emerges from the liver in this area (this will be discussed in the next slide)
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43. Left hepatic vein Coronary ligament Inferior vena cava Left lobe
LE 24-19c
Left hepatic vein
Coronary ligament
Inferior vena cava
Left lobe
Caudate lobe
Common bile duct
Renal Impression
Hepatic portal vein
Hepatic artery proper
Right lobe
Porta hepatis
The coronary ligament holds the liver to the inferior surface of the diaphragm.
The renal impression is a depression on the liver occupied by the upper part of the right kidney and lower part of the right suprarenal gland
The colic impression is more shallow than the renal impression and is occupied by the right colic flexture.
Colic Impression
Quadrate lobe
Gallbladder
Posterior surface

44. Round ligament Left hepatic duct Right hepatic duct Left hepatic
LE 24-21a
Round ligament
Left hepatic
duct
Right hepatic duct
Left hepatic
artery
Cystic duct
Common
hepatic duct
Fundus
Gallbladder
Body
Cut edge of
lesser
omentum
Neck
Hepatic
portal vein
Common bile
duct
Common
hepatic
artery
Liver
Duodenum
Right gastric
artery
The right and left hepatic ducts collect bile from all the bile ducts of the liver lobes. These ducts unite to form the common hepatic duct, which leaves the liver. The bile in the common hepatic duct either flows into the common bile duct, which empties into the duodenal ampulla, or enters the cystic duct, which leads to the gallbladder. The common bile duct is formed by the union of the cystic duct and the common hepatic duct.
Stomach
Pancreas

45. Digestive Tract
Figure 24–2c Mesenteries: Anterior View of the Empty Peritoneal Cavity.
This diagram shows an empty peritineal cavity with the attachment of mesentaries to the posterior body wall.
The falciform ligament helps stabilize the position of the liver relative to the diaphragm and abdominal wall.
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46. The Liver Figure 24–19a The Anatomy of the Liver.
This figure shows a cross section of the abdomen
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47. The Pancreas
The pancreas lies posterior to the stomach. It produces digestive enzymes and buffers and delivers them to the duodenum via the pancreatic duct. The pancreatic duct extends within the attached mesentery to reach the duodenum, where it meets the common bile duct from the liver and gallbladder.
The exocrine cells of the pancreas secrete pancreatic juice, an alkaline mixture of digestive enzymes, water and ions, into the small intestine. Pancreatic enzymes break down ingested materials into small molecules suitable for absorption.

48. The Gallbladder
A major function of the gallbladder is bile storage, but it is released into the duodenum only under the stimulation of the intestinal hormone CCK. Without CCK, the hepatopancreatic sphincter remains closed, so bile exiting the liver in the common hepatic duct cannot flow through the common bile duct and into the duodenum. Instead it enters the cystic duct and is stored within the expandable gallbladder.

49. Coordination of Secretion and Absorption
Figure 24–22 The Activities of Major Digestive Tract Hormones.
Digestive hormones can enhance or inhibit the sensitivity of the smooth muscle cells to neural commands. These hormones, produced by enteroendocrine cells in the digestive tract, travel through the bloodstream to reach their target organs.
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50. Coordination of Secretion and Absorption
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51. Coordination of Secretion and Absorption
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52. Common Diseases Stomach Ulcers
Acid Reflux/GERD (Gastroesophageal reflux disease)
Irritable Bowel Syndrome (IBS)
Ulcerative Colitis
Stomach Ulcer
Ulcerative Colitis
Stomach ulcers, or peptic ulcers, are painful sores in the lining of the stomach or first part of the small intestine. They can be the result of infection with a type of bacteria called Heliobacter pylori; use of NSAIDs, such as asprin, naproxen, ibuprofen; and excess acid production from a tumor. Symptoms include: pain in the middle or upper stomach between meals or at night, bloating, heartburn and nausea or vomiting. Ulcers can be treated by discontinuing use of tobacco, alcohol or NSAIDs; taking proton pump medications to reduce acid levels; taking antibiotics to eliminate an H. pylori infection; or surgery if the ulcer has created a hole in the wall of the stomach.
The symptoms of acid reflux/GERD include: pain when swallowing, bad breath and/or bad taste in the mouth, burping, chest pain, heartburn, hoarseness, regurgitation and sore throat. Acid reflux is triggered by an increase in acid in the esophagus and may develop for a variety of reasons such as: a haital hernia, smoking, certain foods and obesity. Treatments for acid reflux are primarily diet and lifestyle changes.
Irritable bowel syndrome is a common condition that affects between 25 and 55 million Americans. It is a combination of abdominal discomfort or pain and altered bowel habits: either altered frequency (diarrhea or constipation) or altered stool form (thin, hard, or soft and liquid). Experts still don’t completely understand what causes IBS symptoms, but a defect in bowel motility, a hypersensitive colon or dysregulation of substances involved in transmission or nerve signals between the brain and GI tract may be involved. Treatment may consist of lifestyle changes and drug treatments.
Ulcerative colitis is a long-lasting disease that inflames the lining of the large intestine and the rectum. People with ulcerative colitis have tiny ulcers and small abscesses in their colon and rectum that flare up periodically and cause bloody stools and diarrhea. Symptoms include blood or pus in diarrhea, dehydration, abdominal pain, fever and painful, urgent bowel movements. It is caused by abnormal response of the immune system where food or bacteria in the intestines, or even the lining of the bowel may cause the uncontrolled inflammation associated with ulcerative colitis. Treatments can include drug therapy in the form of immunosuppressants and antibiotics, changes in diet, and/or surgery.

53. Common Diseases Diverticulitis Pancreatic Cancer Barrett’s Esophagus
Crohn’s Disease
Diverticulosis happens when pouches form in the wall of the colon. If these pouches get inflamed or infected, it is called diverticulitis. This happens when feces get trapped in the bacteria and allows bacteria to grow. Symptoms of diverticulitis include: belly pain, bloating and gas, diarrhea or constipation, nausea and sometimes vomiting and not feeling like eating. Treatments courses depend on how bad the symptoms are and if an infection is present. If there is an infection, antibiotics will be prescribed. Surgery may be necessary if it doesn’t get better with other treatments, if there is chronic pain, if there is a bowel obstruction or a pocket of infection (abscess).
Pancreatic cancer is classified according to which part of the pancreas is affected: the part that makes the digestive secretions or the part that makes insulin and other hormones. It occurs when cells in the pancreas grow, divide and spread uncontrollably, forming a malignant tumor. Smoking is the major risk factor for pancreatic cancer; it roughly doubles the risk. Pancreatic cancer is treated in several ways, alone or in combination: surgery, chemotherapy, radiation therapy and palliative care.
Barrett’s esophagus is a serious complication of GERD in which the normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine. There are no specific symptoms associated with Barrett’s disease, however symptoms related to GERD may occur. It does, though, increase the risk of developing esophageal adenocarcinoma (cancer of the esophagus). One of the major goals of treatment is to prevent or slow the development of Barrett’s esophagus by treating and controlling acid reflux.
The main symptoms of Crohn’s Disease are abdominal pain, diarrhea, loss of appetite, fever, weight loss and anemia. The cause of Crohn’s disease is unknown, but it may result from an abnormal response by the body’s immune system to normal intestinal bacteria. Disease-causing bacteria and viruses also may play a role. The main treatment is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery.

54. Common Diseases Pancreatitis Appendicitis Gastroenteritis Pancreatitis
Pancreatitis is inflammation of the pancreas. Most cases of pancreatitis are caused by gallstones or alcohol abuse. If pancreatic enzymes leak into the endocrine parts of the pancreas, they can irritate it and cause pain and swelling. The main symptom of pancreatitis is medium to severe pain in the upper belly that may spread to the back. Most attacks of pancreatitis need treatment in the hospital. Pain medication and fluids will be administered through an IV until the pain and swelling subside. Surgery to remove the gallbladder or part of the pancreas may be necessary. (In figure, the pancreas is enlarged highlighted by blue arrow, there is pancreatic fluid in the abdominal cavity highlighted by red arrow and peripancreatic infiltration of the surrounding fat highlighted by black arrow)
Appendicitis is the result of infection and inflammation of the appendix. The exact cause of appendicitis is not yet known, but it is believed to occur when a small object (such as a piece of feces) blocks the opening to the appendix and bacteria is allowed to grow. The main symptoms are belly pain, fever and nausea. The only treatment for appendicitis is surgery to remove it. If this is not done in time, the appendix can burst causing major complications from the bacteria released into the abdominal cavity.
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines. An infection may be caused by bacteria, viruses or parasites in spoiled food or unclean water. Gastroenteritis may affect both the stomach and intestines, resulting in one or more of the following symptoms: low grade fever, nausea with or without vomiting, diarrhea, cramps, bloating.

55. Common Diseases Tonsillitis Hemorrhoids Laryngitis Tonsillitis
Tonsillitis is an infection or inflammation of the tonsils. Most often, tonsillitis is spread through the air droplets when an infected person breathes, coughs, or sneezes. The main symptoms of tonsillitis is a sore throat. The throat and tonsils usually look red and swollen. The tonsils may have spots on them or pus that covers them completely or in patches. Fever is also common. Tonsillitis caused by a virus will usually go away on its own and that called by strep will be treated by antibiotics. Surgery may be necessary if there are recurring or long lasting infections.
Hemmorhoids are swollen veins in the anal canal. Veins can swell inside the anal canal to form internal hemmorhoids or near the opening of the anus to form external hemorrhoids. Too much pressure on the veins in the pelvic and rectal area causes hemorrhoids. Normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch. The most common symptoms of both internal and external hemorrhoids include: bleeding during bowel movements, itching and rectal pain. Treatment for external hemorrhoids include slowly adding fiber to the diet, drinking more water, taking stool softeners and using ointments to stop the itching. If internal hemorrhoids are severe, they may be tied off with rubber bands to reduce the blood supply to the hemorrhoids so they shrink or go away. Surgery may be necessary if other treatments fail.
Laryngitis is an inflammation of the larynx that causes a patients voice to become raspy or hoarse. Laryngitis can be caused by colds or flu, acid reflux, overuse of voice or irritation from smoke or allergies. Treatment for laryngitis is to rest the voice, add moisture to the air at home with a humidifier and drink plenty of fluids. Surgery may be necessary if the vocal cords are damaged, such as by sores or polyps.

56. Endoscopy with Ulcers

57. Colonoscopy of Patient with Rectal Cancer with Hemerroids