1. Chapter 29 Disorders of Gastrointestinal Function
Essentials of Pathophysiology
Chapter 29 Disorders of Gastrointestinal Function

2. Pre lecture Quiz true/false
Two of the major causes of gastric irritation and ulcer formation are aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori.
A peptic ulcer affects only a single layer of the stomach or duodenum.
Clostridium difficile and Escherichia coli are two types of viral infections that affect the gastrointestinal system.
Small-volume diarrhea is usually painless and watery and without blood or pus in the stool. 
Appendicitis, a condition in which the appendix becomes inflamed, swollen, and gangrenous, is very uncommon. T F

3. Pre lecture Quiz __________ refers to difficulty in swallowing.
Crohn disease and ulcerative colitis are two related intestinal disorders that fit under the category of __________ bowel disease.
__________ is a condition that occurs primarily in the sigmoid colon, in which the mucosal layer of the colon herniates through the muscular layer.
__________ disease is an immune-mediated disorder triggered by ingestion of gluten- containing grains (including wheat, barley, and rye).
__________ is a common characteristic of both ulcerative colitis and Crohn disease.
Celiac
Diarrhea
Diverticulosis
Dysphagia
inflammatory

4. The Job of the Bowel
To digest food: involves a corrosive solution and potentially pathogenic bacteria
To absorb the food into the blood while keeping the corrosive substances and the bacteria inside the gut
To keep the solution moving down the bowel at the right rate for digestion and absorption

5. Inflammation and Damage to the Bowel Wall
Hemorrhage  anemia
Perforation  peritonitis
Decreased mucosal function  malabsorption
Decreased bacterial containment  sepsis

6. Hemorrhage Hemorrhage above the stomach: frank hematemesis
Hemorrhage into the stomach with partial digestion of blood: coffee-grounds vomitus
Hemorrhage in the intestine with blood mixing into stools: occult blood
Hemorrhage into the intestine with large volumes of blood: melena
Hemorrhage in the rectum: red blood coating stools

7. The Vicious Circle: One Kind of Bowel Problem Can Cause Another
Reflex paralysis
Inflammation
and cell damage
Obstruction
Distension, ischemia
Food does not pass through bowel at correct rate
Decreased
bowel
function
Malabsorption

8. Which symptom accompanies hemorrhage into the stomach? Hematemesis-
Question
Which symptom accompanies hemorrhage into the stomach?
Hematemesis-
Occult blood –
Coffee-grounds vomitus –
Melena -
the vomiting of blood
blood in the stool
blood mixed w/ chime
black, tarry, bloody stools, usually resulting from a hemorrhage in the alimentary tract.

9. Answer
Coffee-grounds vomitus
Rationale: Coffee-grounds vomitus is a classic symptom of blood in the stomach (it mixes with chyme to give it the coffee-grounds color and consistency). Hematemesis occurs in hemorrhage above the stomach; occult blood is the result of blood mixing with stool in the small intestine; and melena occurs with large-volume hemorrhages in the intestine.

10. Disorders of the Esophagus
Dysphagia -
Achalasia -
Esophageal diverticulum -
Gastroesophageal reflux disease
Cancer of the esophagus -
difficulty in swallowing
inability of a circular muscle to relax, resulting in widening of the structure above the muscular constriction
mucosal layer herniated through the muscularis layer
a chronic condition in which acid from the stomach flows back into the lower esophagus, causing pain or tissue damage
malignant neoplasm

11. Disorders of the Stomach
Acute gastritis
Chronic gastritis
Ulcer disease
Peptic ulcer
Zollinger-Ellison syndrome
Stress ulcers
Cancer of the stomach
inflammation of the stomach, especially of
the mucous membrane of the stomach
erosion of the mucous membrane caused in part by the corrosive action of the gastric juice
a condition in which a gastrin-secreting tumor of the pancreas or small intestine causes excessive secretion of gastric juice, leading to intractable peptic ulcers
Acute peptic ulcers occurring in association with various other pathologic conditions

12. Author: Please add title.

13. Scenario Mrs. D. has pain in her stomach at night and vomits up blood.
She is pale and weak
The doctor finds that her hematocrit is low
Her blood contains large, pale erythrocytes and some reticulocytes
Bilirubin levels are normal
Question:
Explain her symptoms

14. Helicobacter pylori The major cause of ulcers
Second most common cause is NSAIDs
pylori
damages
stomach
lining
repair and
ULCER
healing
increased risk of
gastric cancer

15. Helicobacter Pylori

16. Helicobacter Pylori
“In the US: The frequency of HP infection may be linked to race. White persons account for 29% of cases, and Hispanic persons account for 60% of cases.”
“Internationally: … At least half of all people are infected … HP may be detected in approximately 90% of individuals with peptic ulcer disease...”
(Santacroce, L., and Miragliotta, G Helicobacter pylori infection. eMedicine.
Retrieved April 2005 from

17. Inflammations of the Small and Large Intestines
Infectious enterocolitis
Viral infections
Bacterial infections
Inflammatory bowel disease
Crohn disease
Ulcerative colitis
Diverticular disease
Appendicitis
Crohn’s disease – an autoimmune condition-
a chronic inflammatory bowel disease that causes scarring and thickening of the intestinal walls and frequently leads to obstruction.

18. Discussion Think back to the last time you had enterocolitis.
Questions:
List the things that happened to you
Which of them were systemic signs of inflammation?
Which of them were caused by your sympathetic system?
Which of them helped you get over the disease?
Which of them could have caused serious complications?
Why?

19. Question
Which intestinal disorder is an autoimmune disease?
Enterocolitis
Crohn disease
Ulcerative colitis
Diverticulitis

20. Answer
b. Crohn disease Rationale: Crohn disease is an autoimmune disorder that affects the mucous membrane lining of the bowel (it gets thicker and doesn’t function as it should), causing chronic malabsorption.

21. The bowel attempts to get rid of the infectious agent
Enterocolitis
The bowel attempts to get rid of the infectious agent
Exudate to dilute toxins
Hypermotility
Vomiting
Decreased intestinal function
Food not absorbed
Osmosis draws water into the bowel
Osmotic (or explosive) diarrhea

22. Inflammations That Cannot Be Expelled
Pain and sympathetic nervous stimulation cause the bowel to freeze in position
Reflex paralysis or paralytic ileus
Muscles of the abdominal wall tighten to protect the inflamed bowel
Board-like abdomen
Diaphragm and accessory breathing muscle movements decrease
Shallow breathing

23. One Kind of Bowel Problem Can Cause Another
Reflex paralysis
Inflammation
and cell damage
Obstruction
Distension, ischemia

24. Intestinal Obstruction
Mechanical
Severe, colicky pain
Borborygmus
Audible, high-pitched peristalsis; peristaltic rushes
Awareness of intestinal movements
Paralytic
Continuous pain
Silent abdomen

25. Results of Obstruction
Vomiting  fluid and electrolyte loss
Fluids move into intestinal contents
Gas accumulates
Distension of bowel
Compartment syndrome  ischemia, necrosis
Anaerobic bacteria produce endotoxin  toxemia

26. Question
Tell whether the following statement is true or false. Paralytic intestinal obstruction causes audible paralysis.

27. Answer
False Rationale: Mechanical obstruction results in high-pitched peristalsis (bowel sounds); in paralytic obstruction, bowel sounds are inaudible (silent abdomen).

28. Bowel Distension and Compartment Syndrome
The blood vessels on the surface of the gut are covered and held in place by the inflexible peritoneum
When the gut lumen distends, it crushes the blood vessels between the gut wall and the peritoneum
Peritoneum = Serosa

29. Compartment Syndrome
An organ expands inside a membrane that will not expand
The blood vessels feeding the organ are crushed between the organ and the membrane
Blood supply is cut off

30. Scenario Mrs. K. presents with acute abdominal pain.
She has a distended, board-like abdomen with no bowel sounds. Blood pressure is low and heart rate elevated. Her skin is pale and cool with cold sweat. She is very restless and complains of acute abdominal pain.
The pain came on over the last 8 hours. WBC count is elevated. Now she complains of nausea and begins throwing up, but there is no blood in her vomitus. She has had no bowel movements or urine production.
Question:
What adaptive responses and counterattacks are evident?

31. Scenario (cont.) Mrs. K. has begun to run a fever
Her skin is now flushed and warm, and her abdomen is further distended
Her blood pressure has decreased further
The doctor has ordered nasogastric suction and an isotonic IV
Question:
Why are you taking fluids out of her GI tract and putting them into her veins?