1. Digestive System Disorders

2. Overview Gingivitis Heartburn (GERD) Hemorrhoids Cholera Gastric Ulcer Cirrhosis Emesis Gallstones Inflammatory Bowel Disease Proctitis

3. Gingivitis Gingivitis is a very common and mild form of gum (periodontal) disease that causes swelling (inflammation) of your gums.

4. Common Manifestations— Anorexia, Nausea, Vomiting Digestive system disorders or sign of other problems Nausea and vomiting common indicators of GI disorder –Anorexia precedes the above Nausea –General unpleasant, subjective feeling Vomiting –Forceful expulsion of irritant –Medulla coordinates reflex

5. Steps of Vomiting

6. Anorexia, Nausea, Vomiting Retching before vomiting Characteristics of vomitus –“coffee grounds” Blood Partial digestion in stomach of protein in blood –Yellowish-green Contains bile (from duodenum) –Deeper brown Content from lower intestine

7. Common Manifestations—Diarrhea Excessive freq of stools –Usually loose and watery –Acute or chronic Accomp by cramps and pain Severe, prolonged may lead to –Dehydration, electrolyte imbalance, acidosis, malnutrition

8. Esophagitis Reflux esophagitis Infections Crohn disease, acute graft versus host disease Prolonged gastric intubation Ingestion of irritant substance Chemotherapy and irradiation

9. Esophageal carcinoma Squamous cell carcinoma –More prevalent worldwide –Risk factors: long-standing esophagitis, achalasia, smoking, alcohol, diet (low vitamins and zinc), genetics –50% in middle 1/3

10. Esophageal carcinoma Adenocarcinoma –More common in USA –Occurs on top of Barrett esophagus –More in distal 1/3

11. Gastroesophageal Reflux Disease (GERD) In conjunction with hiatal hernia Severity depends on lower esophageal sphincter (LES) Freq episodes at night Eliminate factors that decrease LES pressure Avoid spicy foods, take antacids

12. GERD

13. Upper Gastrointestinal Tract Disorders—Hiatal Hernia Part of stomach elevated, protrudes thru hiatus of diaphragm into thoracic cavity 2 types –Sliding hernia More common –Rolling (paraesophageal) hernia Fundus moves up thru enlarged or weak hiatus in diaphragm

15. Peptic Ulcers: Gastric and Duodenal Ulcers—Pathophysiology Proximal duodenum most common Also found in antrum of stomach or lower esophagus Usually appear as single, small, round cavities –Smooth margins; penetrate submucosa Once acid or pepsin penetrate mucosal barrier tissues exposed to continuous damage –Acid diffuses into gastric wall May erode deeply into musculature and eventually perforate wall –Inflammation surrounds crater

17. Gastric and Duodenal Ulcers— Pathophysiology Erosion invades bv wall, bleeding occurs –Persistent loss of small amt of blood –Or massive hemorrhage Development begins w/ break down of mucosal barrier Decreased resistance of mucosa or increase HCl or pepsin secretion –Impaired mucosal defenses (gastric ulcer) –Increased acid secretion (duodenal ulcer) Most have H. pylori present

20. Disorders of the Liver and Pancreas—Gallbladder Disorders Gallstones –Cholelithiasis Formation Masses of solid material (calculi) that form in bile

21. Gallstones—Pathophysiology Vary in shape, size –Small stones “silent” –Lg can obstruct flow of bile Initially form in bile ducts, gallbladder, cystic ducts May consist primarily of cholesterol (white), bilirubin (black), or both Tend to form when bile contains high concentration of component or when bile salts low –Stone grows as more deposits

23. Hepatitis Inflammation of the liver May result from local infection (viral), infection elsewhere (mono) or from chem/drug toxicity Mild inflammation and necrosis –Obstruction of blood and bile flow in liver –Decrease liver cell function Damage to liver cells –b/c of function of liver –But good b/c functional reserve and excellent regeneration

25. The points to remember Hepatitis AHepatitis BHepatitis C TransmissionOral-fecalParenteral Carrier stateNonePresent Chronic hepatitis None5-10%>70% Fulminant hepatitis 0.1%0.1-1.0%Rare CarcinomaNoYes

26. Jaundice Accumulation of bilirubin in tissue leading to yellow discoloration of skin and sclera (icterus) Normal serum level: 0.3-1.2 mg/dl; jaundice appears with levels above 2.0-2.5 mg/dl Source of bilirubin: the breakdown of senescent red blood cells in the spleen releases heme that changes into bilirubin by specific enzymes.

27. Helicobacter pylori and Gastric Ulcers Gastritis (chronic and acute), peptic (gastric and duodenal) ulcers Gastric adenocarcinoma, intestinal type Gastric lymphoma H. pyloriGastric ulcer

28. Macroscopic growth patterns of gastric adenocarcinoma Mass Ulcer Lintis plastica Clinical picture: asymptomatic or abdominal discomfort, weight loss, anemia

29. Meckel diverticulum A blind pouch located in distal small bowel The most common congenital anomaly of the small intestine; results from failure of the involution of the omphalomesenteric (vitelline) duct The rule of 2’s: –2% of the population, 2 inches in length, 2 feet proximal to the ileocecal valve, 2 types of heterotopic tissue (pancreas and stomach); 2% are symptomatic. Symptoms are rare: –Overgrowth of bacteria that depletes vitamin B12 leading to anemia –“Peptic” ulcer and bleeding Meckel diverticulum

30. Colonoscopy

31. Polyps

32. Colonic adenocarcinoma Clinical picture: Asymptomatic or fatigue, weakness and iron deficiency anemia in tumors of right side. Left sided tumors may produce bleeding, change in bowel habits and crampy pain Exophytic tumor leading to partial obstruction

33. Hemorrhoids The term hemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed. Hemorrhoids may result from straining to move stool. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal intercourse. Hemorrhoids are either inside the anus—internal—or under the skin around the anus—external.

34. Proctitis Proctitis is inflammation of the lining of the rectum, called the rectal mucosa. Proctitis can be short term (acute) or long term (chronic). It may be a side effect of medical treatments like radiation therapy or antibiotics. Gonorrhea, herpes, and chlamydia may also cause proctitis.