Gastrointestinal Digest This!

Gastrointestinal The alimentary canal is a long, muscular tube Structure – it is 25 to 30 feet in length Includes the mouth, pharynx, esophagus, stomach, small intestine, large intestine and anus

Digestion The mouth or buccal cavity chews food called mastication Saliva is produced by the parotid, sublingual, and submadibular glands Food is broken down by an enzyme called salivary amylase The mouth is not a sterile area

Digestion Food is swallowed in a bolus – and enters the pharynx This triggers the epiglottis to close The bolus continues down the esophagus to the stomach Esophagus and stomach are not sterile

Digestion Once food bolus is in the stomach, the cardiac sphincter closes to prevent food from flowing back into the esophagus Peristalsis(mixing, contracting)begins to mechanically digest the food, and HCL, pepsin, lipase are chemically breaking down food HCL – kills bacteria Pepsin – breaks down protein Lipase breaks down fat

Digestion Food dumps from the stomach to the small intestine into the duodenum This section is where bile from the gallbladder and liver and pancreatic juice enter through the ducts After this point the small intestine produces enzymes; maltase, sucrase, and lactase – these break down sugars into simple forms Peptidase – for protein Steapsin – digestion of fat

Seed question What would happen if we had something wrong with the pancreas, and we could not produce enzymes to break food down?

Digestion This is where nutrients asborb into the blood stream through the villi of the small intestine (duodenum, jejunum, ileum) What remains goes into the large intestine – also not sterile This is where water and nutrients like B complex and Vit K are asborbed

Seed question If your large intestine became swollen and irritable, what nutrients could you not absorb, and how would that effect you?

Digestion Rectum stores the indigestible food and waste Waste exits from the anus – also not sterile

Pathology of the GI System GERD – Gastroesophageal reflux disease It is the backwards flow of stomach contents into the esophagus Etiology – incompetent(weak) lower esophageal sphincter makes the stomach contents dump back into the esophagus

GI System Signs and symptoms of GERD Dyspepsia (heartburn) Coughing AM hoarseness Belching Chest pain Regurgitation Odynophagia – painful swallowing

GI Systems Teach patient Small meals Avoid spicy foods Elevate HOB 8-12” Sleep in left lateral position Stop smoking!!!!

GERD

Surgery

Seed question If you had to explain to a 6 year old how to treat GERD, how would you do it?

GI Systems Gastritis – inflammation of the gastric mucosa Two kinds No. 1 Acute gastritis (erosive) – can be caused by infection of the helicobacter pylori bacteria. This is normal to have in your stomach, but if you become stressed it can have an overgrowth, and cause an ulcer. It could also be caused by e.coli, or salmonella. Inflammation can also be “set off” by irritating foods, chronic aspirin use and alcohol.

GI Systems Signs and symptoms of Acute gastritis: Rapid onset of epigastric pain Vomiting blood – can look like coffee grounds Stomach pain anorexia

GI Systems Treatment: EGD (esophagogastroduodenoscopy) is an examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat. Antibiotics to help with h.pylori infection

GI Systems No. 2 Chronic gastritis (non erosive) – constant irritation without ulcers, develops gradually and is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no signs or symptoms at all.

GI Systems Chronic gastritis signs and symptoms – causes few symptoms: Vague epigastria pain – usually relieved with food Intolerance of spicy foods Anemia – can’t absorb your B12 from food – you need this for red blood cells to function

GI Systems Diagnosis is same as the Acute – EGD and antibiotics if needed

GI Systems Treatment for chronic gastritis: Remove the cause – don’t take too much aspirin, eat too much acidic/fatty/spicy foods, stop smoking Medications – antacids, H2 receptor antagonist, antibiotics, Pepto

GI Systems PUD – Peptic ulcerative Disease – lesions in the stomach – stress ulcers, h.pylori causes acid increase Usually located in the lower stomach, upper duodenum

h.pylori

GI Systems Complications of PUD: Bleeding Melena – blood in the stool is black and tarry, very smelly Perforation – ulcer wears through the bowel or stomach, and leaks into the peritoneal cavity – 2-3% of people perforate, and of this 67% die 4% have pyloric obstruction – valve is obstructed and patient has vomiting

GI Systems Test for PUD: EGD Blood chemistry (CBC) – checks for anemia Check of occult blood Urea breath test – check after midnight if h.pylori is present patient will have an increase in CO2 Surgery – goes in an stems bleeding

GI Systems IBS – Irritable Bowel Syndrome – 10-20% of U.S. citizens have this Chronic recurrent diarrhea, constipation and bloating, abdominal pain, flares up with certain foods or stress

GI Systems IBS can flare up with stress or anxiety, food allergies like lactose intolerance Can have exacerbation – flare up Can be in remission – no problems

IBS

GI Systems Teach: Avoid precipitating factors Patient may need fiber supplements for constipation or Lomotil for diarrhea Stress management May need antidepressants

GI Systems Hemorrhoids – swollen engorged veins in the anorectic area Caused by severe straining, childbirth, cancer, liver disease due to portal hypertension

GI Systems Two types of hemorrhoids External – swelling of the anus Internal – inflammation near the anus, and can swell to the outside – it is possible to have both at the same time Both cause pain and itching, sometimes bleeding can occur – will be bright red, unlike melena, which is black

GI Systems Thrombosed hemorrhoid – Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.

GI Systems Treatment of hemorrhoids: Topical creams – decreases inflammation, eases pain Diet high in fiber Avoid – nuts, spices, coffee, alcohol Avoid sitting for prolonged periods Avoid valsalva maneuver – no straining, lifting In case of thrombosed hemorrhoid – surgery is required to release the blood for the swollen vein – follow with cold pack

Thrombosed hemorrhoid

Thrombosed hemorrhoid

GI Systems Crohn’s disease – is a form of IBS because it causes inflammation of the lining of the digestive tract. Crohn’s can extend deep into the layers of the affected bowel tissue.

GI Systems Common signs and symptoms for Crohns: Diarrhea Cramping Bloody stools Ulcers – can be severe and perforate through the bowel Weight loss

GI Systems Other signs and symptoms People with severe Crohn’s disease may also experience: Fever Fatigue Arthritis Eye inflammation Skin disorders Inflammation of the liver or bile ducts Delayed growth or sexual development, in children See handout

GI Systems Diagnoses with a colonoscopy or barium enema allows an x-ray of the entire colon

Crohns

Ulcerative Colitis Also a form of IBS – Inflammation of the colon Can be severe and life threatening Difference in the Crohn’s and ulcerative is right side Crohn’s left side colitis Signs and symptoms can range from rectal bleeding, bloody diarrhea, cramps, pain, malnutrition, dehydration, shock and even death

GI Systems Treatment for both: Crohn’s and Ulcerative Colitis Steroids – reduce inflammation Diet Stop smoking No alcohol For people who do not respond to all of the above, they might try to suppress the immune system to stop the body’s allergic response