1. Digestive Diseases

2. GASTROENTEROLOGIST
A physician that specializes in disorders and diseases of the digestive system

3. REVIEW
Small intestine – where digestion is completed and absorption occurs
Here you have the addition of enzymes from pancreas and bile from liver/gallbladder

4. Absorption Absorption occurs when:
1. Carbohydrates are converted to glucose
2. Proteins broken down to amino acids
3. Fats changed to fatty acids and glycerol

5. GASTROENTERITIS
Inflammation of mucus membrane lining of stomach and intestine
Common causes – virus
Symptoms – diarrhea and vomiting for 24 – 36 hours
Complication - dehydration

6. REVIEW
Regulation of H2O balance by absorbing large quantities back into bloodstream
Also absorbs Vitamin B complex and K
Bacterial action on undigested food – decomposed products excreted through colon – bacteria form moderate amounts of B complex and Vitamin K

7. FECES
Is undigested semi-solid consisting of bacteria, waste products, mucous and cellulose
Defecation – when lg intestine fills, defecation reflex triggered – colon and rectal muscles contract while internal sphincter relaxes
E-Coli live in lg intestine and feed on undigested fiber in fecal material to help reduce amount of feces produced.
1/3 of feces excreted is made up of E-Coli bacteria

9. DIARRHEA
Loose, watery, frequent bowel movements when feces pass along colon too rapidly and not enough water is absorbed
Caused by infection, poor diet, nervousness, toxic substances or irritants in food
When the lg. Intestine is irritated and inflamed, the intestinal mucosa secretes large amounts of water and electrolytes in addition to mucus.

10. CONSTIPATION Slow movement of feces through the large intestine
Feces become dry and hard because of the increased fluid absorption during its extended time in the large intestine

11. CONSTIPATION
If passage of feces through lg intestine is prolonged beyond 5 days, the feces lose volume and become more solid
Causes include irregular defecation patterns, intestinal blockages, tumors, and diverticulitis

12. CONSTIPATION
Treatment includes diet with cereals, fruits, vegetables, (roughage), drinking plenty of fluids, exercise, and avoiding tension

13.                                              
Colon removed from
a man that did not
have a bowel
movement for 30
days.

14. HEMORRHOIDS or PILES
Enlarged or inflamed veins (varicose veins) that protrude from the anal lining
Cause – excessive straining during defecation or childbirth
Rx – remove pressure that causes the condition or in severe cases they can be removed surgically

15. FLATULENCE Gas formation (flatus) is from 1-3 pints per day
It passes through the rectum at least 14 times a day
Bacteria in the large intestine produce the gases (methane – CH4

16. COLITIS (Irritable Bowel Syndrome)
Any inflammatory condition of the lg intestine
Cause unknown – may be result of emotional stress or an autoimmune disease such as ulcerative colitis
Symptoms – alternating episodes of constipation or diarrhea and abdominal cramps
Rx – high fiber diet, relaxation, and antispasmodic drugs. If these don’t work – affected part can be surgically removed.

17. DIVERTICULOSIS Little sacs (diverticuli) develop in wall of colon
Most people over the age of 50 who eat low fiber foods have this
When the sacs become inflamed = DIVERTICULITIS
Symptoms – abdominal pain and swelling, diarrhea, constipation,gas, and rectal bleeding

18. APPENDICITIS
Inflammation of the appendix that usually occurs because of obstruction of the appendix
If it ruptures, bacteria from appendix can spread to the peritoneal cavity causing PERITONITIS
Symptoms – acute pain in RLQ, loss of appetite, nausea, vomiting, and mild fever
Rx – surgical removal

19. COLORECTAL CANCER
2nd leading cause of death from cancer in the United States
Occurs most frequently after age 50 and even more frequently after the age of 70
Risk factors – family history, inflammatory bowel disease, intestinal polyps, high saturated-fat intake diet, and increasing age
Symptoms – fecal blood, a change in bowel habits, decrease in stool diameter, weight loss, fatigue, and onset of abdominal pain

20. COLONOSCOPY
Early detection for colon cancer is critical – need a colonoscopy after age 50
Colonscope (flexible viewing tube) is passed through the anus into the colon
Can take pictures and obtain tissue samples

21. HEMOCCULT SLIDE Stool slide specimen to look for hidden (occult) blood
Hemoccult annual screening tests can reduce the risk of death from CRC by up to 33%
In the privacy of their home, they collect a small amount of stool specimen on 3 different days and return the test card to your doctor or laboratory

22. COLON CANCER Rx – surgical resection
May also require a COLOSTOMY – opening in abdomen, healthy bowel brought to skin after cancer removed
Pouch worn to collect waist

23. CIRRHOSIS Chronic progressive disease of the liver
Normal tissue is replaced by fibrous connective tissue
Symptoms – nausea, anorexia, gray-white stools, weakness, and pain

24. CIRRHOSIS
Causes – hepatitis, chronic alcohol abuse, malnutrition, or infection
75% caused by excessive alcohol consumption
Rx – Remove cause and put on high protein diet. Liver transplant may be needed for extensive damage

25. CIRRHOSIS OF THE LIVER
Ascites is an abnormal accumulation of fluid containing large amounts of protein and electrolytes – detectable when more than 500 ml of fluid has accumulated
Is a complication of cirrhosis
Rx – diet therapy and diuretic therapy

26. CIRRHOSIS
Jaundice – yellow color of skin and sclera when bile pigment gets in bloodstream
Best place to assess for jaundice is the hard palate
Is a symptom of liver disease and biliary obstruction

27. HEPATITIS A Known as infectious hepatitis Cause – virus
Spread through contaminated food and water
Occurs commonly in young people

28. HEPATITIS A
Symptoms – Makes you feel like you have the flu – tired, sick to your stomach, fever, anorexia, diarrhea, dark yellow urine (tea colored), gray stools, and jaundice
Rx – Bedrest and no alcohol
Can protect yourself by getting a Hepatitis A Vaccine. Also always wash your hands after using the bathroom and drink bottled water when you are in another country

29. HEPATITIS B (Serum Hepatitis
Caused by virus found in the blood
Transmitted by blood transfusion or being stuck with contaminated needles (drug addicts)
Can block the flow of blood through the liver, thus causing it to back up into the hepatic portal circulation.
This causes portal hypertension and to relieve the pressure – new veins that connect to the systemic veins are formed.

30. HEPATITIS B Health care workers at risk and should be vaccinated
Use standard precautions for prevention

31. CHOLELITHIASIS Condition of gallstones
Gallstones are solid clumps of material (mostly cholesterol)
Can block the bile duct causing pain and digestive disorders
Small ones may pass on their own, large ones surgically removed
Surgical removal of gallbladder - CHOLECYSTECTOMY

32. CHOLECYSTITIS (Gallbladder Inflammation
Often seen with gallstones
Risk factors for gallstone formation –severely obese people because the liver produces higher level of cholesterol and also people who have a significant weight loss in a
short amount of time

33. LAPAROSCOPIC CHOLECYSTECTOMY
Most common method of cholecystectomy
Small abdominal incisions allow insertion of surgical instruments and small video camera
Surgeon performs procedure by watching monitor and manipulating instruments
Stomach muscles are not cut, healing is quicker

34. LAPAROSCOPIC CHOLECYSTECTOMY

35. ULCERS
Craterlike sore or lesion that forms in the mucosal lining of the stomach
1 in 10 people in the US will suffer from an ulcer
Gastric ulcers in the stomach and duodenal ulcers in the duocenum
Cause – H. pylori (bacteria) is primary cause – burrows through the mucosa and impairs the lining’s ability to produce protective mucus

36. ULCERS Lifestyle factors that contribute: Cigarette smoking Alcohol
Stress
Certain Drugs
Symptoms – burning pain in abdomen, between meals and early morning, may be relieved by eating or taking antacid

37. ULCERS Diagnosis -X-ray and presence of H.pylori (bacteria)
The bacteria is diagnosed by biopsy, breath, or blood antibody tests
If not treated, these lesions may result in hemorrhage, perforation, widespread infection, scarring, and other serious medical complications
Rx – H2 blockers (drugs) that block release of histamine

38. PANCREAS REVIEW Lies behind stomach Both endocrine and exocrine gland
Pancreatic juice is the most important digestive juice
It contains enzymes that digest all three major kinds of foods
Pancreatic juice contains sodium bicarbonate, an alkaline substance that neutralizes the hydrochloric acid
Pancreatic juice enters the duodenum in the same place bile enters

39. PANCREATITIS Inflammation of pancreas
Acute pancreatitis usually results from blockage of the common bile duct – pancratic enzymes “back up” and digests it.
In some cases of stomach inflammation from excess alcohol consumption or in gallbladder disease, irritation may extend to the pancreas and cause abnormal activation of the pancreatic enzymes
½ of cases are fatal

40. PYLORIC STENOSIS
Normally stomach contents are moved through the pyloric sphincter within about 2 to 6 hours after eating
Narrowing of pyloric sphincter, often found in infants- more common in boys
Symptoms – projectile vomiting
Treatment – surgery to modify the muscle to food can pass from the stomach into the duodenum

41. GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Cardiac sphincter is weak and relaxes inappropriately
Esophagus is irritated by acid that comes up from the stomach
Also called “Acid Reflux”
Some people feel nothing
Symptoms – heartburn pain, a bitter taste in your mouth, coughing at night, hoarseness in the morning, or worsening asthma
Stomach acid in the esophagus can cause ulcers, stenosis, and cancer

42. GERD Dietary habits that improve GERD 1. Eat small portions
2. Avoid onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes
Avoid drinking citrus juices, alcohol, coffee, tea, soft drinks, and other caffeinated and carbonated drinks
Avoid eating or drinking for 3 hours before going to bed

43. GERD Lifestyle habits that improve GERD 1. Lose weight if overweight
2. Stop smoking
3. Avoid wearing tight fitting clothing or belts
4. Avoid lying down or prolonged bending over, especially after eating
5. Avoid straining and constipation
6. Elevate the HOB 6 to 8 inches
7. Avoid stress

44. GERD Additional treatments:
1. Over-the-counter antacids or non-prescription-strength acid-blocking medications called H2 receptor antagonists such as Tagamet, Zantac, or Pepcid
2. Severe cases require surgery

45. HIATAL HERNIA
When stomach protrudes above diaphragm through esophageal opening
More common in people over 50
GERD is a symptom for hiatal hernia

46. TO BE CONTINUED

47. Hepatitis part 1
Hepatitis A-fecal contamination of food or water ( improper food handling,raw shellfish,)
Hepatitis B- sexual contact blood transfusions or needle sticks
Hepatitis C –blood contact and dirty neeles( Tattoo parlors)Low incidence of this kind
Hep D- Only people who have B, get D
Hep E mainly in asia

48. Hepatitis part 2
Hepatitis E-mainly in Asia, Mexico,India and Africa. Also thru feces contaminated foods.Pregnant women often die with this form
Hepatitis F-Nonexistent in the US.In Far East only.It is non A,non B and non C types, so its called F
Hepatitis G- Not infectious,doesn’t cause sickness. Found in a MD in Chicago.Rx:rest