1. Essentials of Human Diseases and Conditions 4 th edition Margaret Schell Frazier Jeanette Wist Drzymkowski

2. Chapter 8 Diseases and Conditions of the Digestive System

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives  Trace the process of normal digestion and absorption.  Discuss the importance of normal teeth and a normal bite.  Describe the presenting symptoms of temporomandibular joint (TMJ) syndrome.  Compare the etiology of herpes simplex to the etiology of thrush.  Name a serious complication of esophageal varices.

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the clinical significance of Barrett’s esophagus.  Describe the pathology of peptic ulcers and identify the etiology.  Explain the diagnosis of gastric cancer.  Describe a hiatal hernia.  Distinguish the types of abdominal hernias.

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the differences between the pathology of Crohn disease and that of ulcerative colitis.  Describe the etiology of gastroenteritis.  Explain the difference between a functional and a mechanical obstruction of the bowel.  Discuss the pathologic conditions that may result in intestinal obstruction.

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Distinguish between diverticulosis and diverticulitis.  Discuss the screening program for and the treatment of colorectal cancer.  Explain the relationship between broad-spectrum antibiotics and pseudomembranous enterocolitis.  List the causes of inflammation of the peritoneum.

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the pathologic symptoms and signs of cirrhosis of the liver.  Name the most important etiologic factor for hepatocellular carcinoma and other additional risk factors.  Contrast the causes and preventive measures of hepatitis A and hepatitis C. Explain how health care providers are at special risk for hepatitis B.

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Name the most common bloodborne infection in the United States.  Describe the clinical picture of an individual with (a) biliary colic and (b) acute pancreatitis.  State the prognosis of pancreatic cancer.  Describe the clinical manifestations of malnutrition and malabsorption.

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the diagnostic criteria for celiac disease.  List some ways one can lower the risk of food poisoning.  Distinguish between the clinical picture of the patient with anorexia and that of the patient with bulimia.  State the components of a successful weight- loss program

10. Chapter 8 Lesson 8.1

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. The Digestive System

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. The Oral Cavity and Jaw Diseases and Conditions  Missing teeth: permanent teeth are missing  Dental caries (tooth decay): infection resulting in erosion of tooth surface  Gingivitis: inflammation and swelling of the gums  Gingivitis: inflammation and swelling of the gums  Periodontitis: destructive gum and bone disease around one or more of the teeth

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Malocclusion: specific angles of malposition and contact of the maxillary and mandibular teeth  Temporomandibular joint (TMJ) syndrome: a symptom complex related to inflammation, disease, or dysfunction of the temporomandibular joint

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Herpes simplex (cold sores): a recurrent viral infection that affects the skin and mucous membranes.  Thrush: candidiasis of the oral mucosa, involving the mouth, tongue, palate, and gums.

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Oral Cancer  Appears as white patchy lesion or oral ulcer that won’t heal  Pain occurs late in disease  Lip is most common site  Alcohol and smoking is multiplicative  Treatment depends on stage  Because of late diagnosis overall survival rate is about 51%

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Digestive Distress Signals  Hiccup  Indigestion  Heartburn  Nausea  Vomiting  Colic  Flatulence  Diarrhea  Constipation  Fecal incontinence

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Esophageal varices: are dilated submucosal veins that develop in patients with underlying portal hypertension and may result in serious upper gastrointestinal bleeding. Esophagitis: inflammation and tissue injury of the esophagus Esophageal cancer: cancer of the esophagus Diseases of the Gastrointestinal Tract

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Gastroesophageal reflux disease (GERD): the clinical manifestations of regurgitation of stomach and duodenal contents into the esophagus Barrett’s esophagus: severe consequence of GERD that replaces normal striated squamous epithelium of the distal esophagus with abnormal columnar epithelium Diseases of the Gastrointestinal Tract (cont’d.)

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peptic ulcers: sores or lesions in the mucous membrane of the stomach or upper intestinal tract Duodenal ulcers: ulcers of the first part of the small intestine Gastric ulcers: ulceration of the gastric mucosa of the stomach that follows chronic gastritis Diseases of the Gastrointestinal Tract (cont’d.)

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Appendicitis  Inflammation of the appendix  Symptoms: begins with vague abdominal discomfort that localizes as pain in right lower quadrant of abdomen; nausea; vomiting; fever; diarrhea or constipation  Treatment: surgical removal

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hiatal hernia: a defect in the diaphragm that permits segment of stomach to slide into thoracic cavity  Symptoms: heartburn, chest pain, swallowing difficulty; some cases asymptomatic Abdominal hernia: a condition in which an organ protrudes through an abnormal opening in the abdominal wall  Symptoms: lump or bulge; groin pain Diseases of the Gastrointestinal Tract (cont’d.)

22. Chapter 8 Lesson 8.2

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Crohn disease (ileitis): chronic inflammatory disorder of the gastrointestinal tract Ulcerative colitis: chronic inflammatory bowel disease affecting the mucosa and submucosa of the rectum and colon Gastroenteritis: acute inflammation of the stomach and intestines Diseases of the Gastrointestinal Tract (cont’d.)

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Intestinal Obstruction  Mechanical or functional blockage of intestines; contents cannot move forward  Severe pain, nausea, vomiting, bloated abdomen without passage of stool or gas  Sudden or severe onset requires urgent care  Treatment: surgery for mechanical blockage; NPO, stomach tube for functional blockage

25. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Diverticular Conditions  Diverticulosis: outpouches (diverticula) of mucosa penetrate weak points in muscular layer of large intestine Symptoms: mild discomfort, irregular bowels; may be asymptomatic  Diverticulitis: trapped fecal matter causes inflammation of diverticula Symptoms: fever, nausea, pain, changes in bowel function

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Colorectal cancer: a cancer that arises in any part of the colon or rectum  Symptoms: abdominal pain, change in bowel habits, bloody stools, weight loss, weakness, rectal bleeding, iron deficiency anemia  Serum level of tumor marker CEA is used to plan treatment and assess prognosis  Treatment options: surgical resection; colostomy; chemotherapy; radiation Diseases of the Gastrointestinal Tract (cont’d.)

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pseudomembranous enterocolitis: acute inflammation with a plaque-like adhesion of necrotic debris and mucus adhered to the damaged superficial mucosa of the small and large intestine  Symptoms: fever, weakness, abdominal cramping and tenderness, nausea, vomiting, diarrhea Diseases of the Gastrointestinal Tract (cont’d.)

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peritonitis: inflammation of the peritoneum that can be acute or chronic, local or generalized  Symptoms: abdominal pain, nausea, vomiting, weakness, sweating, fever, distended abdomen, paralytic ileus Diseases of the Gastrointestinal Tract (cont’d.)

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cirrhosis of the liver: an irreversible chronic degenerative disease that results in the replacement of normal liver cells with hard, fibrous scar tissue  Symptoms: loss of appetite and weight, nausea, vomiting, indigestion, abdominal distention, edema, easier bleeding and bruising, jaundice, pruritis, spider nevi Diseases of the Liver, Biliary Tract, and Pancreas

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Viral hepatitis  Hepatitis A: highly contagious condition caused by the hepatitis A virus (HAV) causing mild, acute liver infection.  Hepatitis B: inflammation of the liver caused by the hepatitis B virus (HBV).  Hepatitis C: chronic condition caused by the hepatitis C virus (HCV) resulting in gradual, insidious liver disease. Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.)

31. Chapter 8 Lesson 8.3

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cancer of the Liver Hepatocellular carcinoma: primary tumor of the liver; usually arises in chronic liver disease setting  Symptoms: same as liver disease–upper abdominal pain, weight loss, early satiety, palpable abdominal mass, ascites, hepatomegaly splenomegaly, jaundice

33. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cholelithiasis (gallstones): condition in which there is abnormal presence of calculi that form in the bile. Pancreatitis: acute or chronic inflammation of the pancreas with variable involvement of adjacent or remote organs. Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.)

34. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cholecystitis  Symptoms: acute, colicky pain, nausea, and vomiting  Causes: obstruction of biliary duct by gallstones  Treatment: dietary modification with elimination of fatty foods; in acute cases, intravenous feeding

35. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pancreatitis  Symptoms: sudden onset of severe abdominal pain radiating to the back, nausea, and vomiting  Causes: alcoholism, biliary disease, gallstones  Treatment: Acute pancreatitis may require emergency treatment of intravenous fluid and electrolyte replacement

36. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Pancreatic cancer: A neoplasm, usually an adenocarcinoma, that occurs more often in the head of the pancreas. Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.)

37. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pancreatic Cancer  Symptoms: abdominal pain, weight loss, or jaundice  Causes: cigarette smoking, obesity, family history of pancreatitis or diabetes  Treatment: surgical resection

38. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Malnutrition: a disorder of nutrition caused by primary deprivation of protein energy or secondary to deficiency diseases Malabsorption syndrome: a group of disorders in which intestinal absorption of dietary nutrients is impaired Diseases of Nutrient Intake and Absorption

39. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Malnutrition  Symptoms: decreased or increased appetite; emaciation or obesity; loss of energy; diarrhea  Causes: deprivation of protein energy from eating disorders, chronic illnesses, etc.  Treatment: nutritional supplements, oral and intravenous feeding

40. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Malabsorption Syndrome  Symptoms: impaired digestion, inability to absorb fat or other components of diet  Causes: defective mucosal cells in the small intestine  Treatment: high-protein, high-calorie diet

41. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Obesity  Obesity is defined by Body Mass Index  The study of obesity is called Bariatrics  35% of adult Americans are obese, defined as being 27% overweight; obesity can lead to severe health problems.  Contributing factors for obesity include low rate of energy expenditure, inactivity, and endocrine disorders.  Treatment options include exercise and control of food intake through behavior modification.

42. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Celiac disease (gluten enteropathy): a disease of the small intestine characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine The disease has multisystem effects Diseases of Nutrient Intake and Absorption (cont’d.)

43. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Celiac Disease  Symptoms: weight loss, anorexia, diarrhea, flatulence, abdominal distention  Causes: toxic or immunologic reaction to component of gluten (found in wheat, barley, and oats)  Treatment: gluten-free diet; if no improvement, corticosteroid drugs

44. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Food poisoning: an illness resulting from the ingestion of foods that contain bacterial or toxic substances Diseases of Nutrient Intake and Absorption (cont’d.)

45. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Food Poisoning  Symptoms: sudden nausea, vomiting, and diarrhea  Causes: poisoning from mushrooms, shellfish, contaminated foods  Treatment: nutritional support and fluid replacements

46. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Eating Disorders Anorexia nervosa: psychological disturbance in which self-imposed starvation and compulsion to be thin leads to denial of hunger Bulimia: behavioral disorder characterized by recurring episodes of binge eating followed by self-induced vomiting or purging