1. DIGESTIVE ISSUES: Diseases, Disorders, and Dysfunctions

2. 5 This powerpoint contains images that some students may find disgusting. (www.teclasap.com.br)www.teclasap.com.br

3. Swallowing and NOT Choking Make note of the steps in swallowing! 1. Mastication (chewing)= mechanical digestion 2. Addition of salivary amylase= chemical digestion 3. Tongue pushes food to back of mouth 4. Swallow- read the diagrams! 5. Peristalsis is the wave of muscle contraction behind the bolus (ball of food) that moves the food through the entire digestive tract- mouth to anus.

4. Choking  the mechanical obstruction (food!) of the flow of air from the environment into the lungs  can be partial (allowing inadequate flow of air into the lungs) or complete  prolonged or complete choking results in asphyxia (look it up!) and it is potentially fatal  oxygen stores in the blood and lungs keep the victim alive for several minutes after breathing is stopped completely

5. Gastroesophageal Reflux Disease Normal: Closed LES (lower esophageal sphincter)Open LES LES Acid reflux

6. 5 Gross image next. (www.teclasap.com.br)www.teclasap.com.br

7. GERD  gastroesophageal reflux disease (GERD) is also called gastric reflux disease or acid reflux disease  chronic symptoms of mucosal damage caused by stomach acid coming up from the stomach into the esophagus  a typical symptom is heartburn

8. GERD Treatments 1. eating smaller meals earlier in the evening 2. avoiding things that affect the LES (caffeine, smoking, chocolate, fatty foods, spicy foods, peppermint, alcohol consumption) 3. taking antacids and LOTS water! 4. prescription pharmaceuticals to reduce acid production or increase motility 5. surgery to rebuild the lower esophageal sphincter 6. endoscopic treatments to tighten the LES (by suturing or applying radio-frequency waves to create scar tissue)

9. Ulcers Gastric Ulcer Esophageal Ulcer Duodenal Ulcer An ulcer is a small erosion (hole) in the gastrointestinal tract. The most common type, duodenal, occurs in the first 12 inches of small intestine beyond the stomach. Ulcers that form in the stomach are called gastric ulcers.

10. 5 Gross. Ulcers. (www.teclasap.com.br)www.teclasap.com.br

11. Gastric Ulcer  mainly associated with Helicobacter pylori  also caused by prolonged use of anti-inflammatory drugs, such as Ibuprofen and aspirin, which damage the stomach lining  severe complications include bleeding or perforations = complete hole into abdomen (can cause death due to contamination)!

12. Ulcer: Treatment  Symptoms: burning pain- feels worse when stomach is empty, but pain returns a couple of hours after eating, black blood in stools  Diagnosis: series of x-rays, endoscopy, tissue sample to identify bacteria  Treatment: antibiotic to kill H. pylori  Meds to reduce HCl secretion (rest stomach) no smoking, no alcohol, decrease NSAID use e.g. ibubuprofen

13. Recall the location of the gall bladder?  No? It’s the storage sac tucked under the liver  Purpose? Stores bile until needed for digestion

14. Gallstones Small calculi (stones)Big calculiBig calculi with cholecystitis (inflammation)

15. Gallstones  an accumulation of hardened cholesterol and/or calcium deposits in the gallbladder  can be as small as a grain of sand or as large as a golf ball  can either be “passed” (OUCH!!) or surgically removed

16. Gallstone Treatment  New treatment: extracorporeal lithotripsy  Shockwave is used to break up gallstones  Used with ERCP- endoscopy with fluoresence to make sure all the big stones are broken up  Pain immediately follows the treatment  Look up the meaning of endoscopy!

17. Diarrhea  a gastrointestinal disturbance characterized by decreased water absorption and increased peristaltic activity of the large intestine  this results in increased, multiple, watery feces  this condition may result in severe dehydration, especially in infants & elderly

18. Constipation  a condition in which the large intestine is emptied infrequently and/or with difficulty  too much water is reabsorbed in the colon  the solid waste hardens and is difficult to pass  greater fluid intake, more fibre, and increased exercise are recommended

19. Hemorrhoids Internal hemorrhoids External hemorrhoids Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. About 75 percent of people will have hemorrhoids at some point in their lives. Hemorrhoids are most common among adults ages 45 to 65 and in pregnant women. rectum anus

20. Hemorrhoids treatment  Increase dietary fibre  Moderate exercise  Drink more fluids  Cleanliness!  May be related to stress = mindfulness, yoga

21. Inflammatory Bowel Disease (IBD) Healthy colonCrohn’s disease inflammation

22. Inflammatory Bowel Disease  Crohn’s disease is one of a group of disorders categorized as inflammatory bowel disease (IBD), which also includes ulcerative colitis  intestines become inflamed (red and swollen) and develop sores  causes pain, cramps, intestinal bleeding, weight loss, diarrhea  diagnosed based on symptoms and results of a sigmoidoscopy or a colonoscopy, as well as x-rays

23. Endoscopy

24. 5 This powerpoint contains images that some students may find disgusting. (www.teclasap.com.br)www.teclasap.com.br

25. Crohn’s and IBD  Severity of the disease varies, but occasionally leads to complete obstruction, which sometimes requires surgery

26. IBD Treatment  goal of treatment is to reduce inflammation and suppress the immune system response  When all medications have been tried and the patient is still suffering, a fecal transplant is the penultimate option  if ulcerative colitis becomes so severe that all treatment is unsuccessful, it may be necessary to surgically remove part or all of the colon (resulting in a colostomy or ileostomy)

27. Ostomy

28. 5 Gross. Polyps. (www.teclasap.com.br)www.teclasap.com.br

29. Intestinal Polyps Peduncular polyp Sessile polyp Polyps are abnormal growths arising from the inside lining of the colon or rectum. They protrude into the intestinal canal. Some are flat (sessile) while others are on a stalk (peduncular).

30. Diagnosis of polyps? Sigmoidoscopy or colonoscopy Tissue samples may be removed using a snare (wire loop) and checked to see if they are benign or malignant More gross pictures follow.

31. More pictures of polyps

32. Intestinal Polyps  Polyps are very common, occurring in 15-20% of the adult population  Although most polyps are benign (not cancerous) some can change into cancer  Colonoscopy is used to identify and remove polyps  Regular screening begins at age 50

33. Colon cancer

34. Colon Cancer Stage I Stage IIStage III

35. Colon Cancer

36. Appendicitis  an inflammation of the appendix due to infection  common treatments involve antibiotics and removal of the appendix (appendectomy)  if untreated, appendix can burst causing infection (peritonitis) and death

37. Appendicitis

38. Appendectomy  the surgical (open) or laparoscopic (minimally invasive) removal of the appendix  laparoscopy involves tiny incisions where a camera and surgical instruments are inserted

39. Clostridium difficile Infection  anaerobic, endospore-forming bacteria found in hospitals and other long-term care facilities (look it up!)  causes severe diarrhea and other intestinal diseases when competing bacteria in the gut flora have been wiped out by antibiotics  can be life-threatening, especially among the elderly  Bleach wipes, hand-washing with soap and water, and gloves are effective and reducing infection  Alcohol-based hand sanitizers are not effective at killing the spores

40.  Polyp Removal Polyp Removal  Stomach Ulcer Stomach Ulcer  Gallbladder stones Gallbladder stones

41. THE END! HW: Eat well, exercise, eat more fibre and rest… Unit Test Thursday! Learn the vocab!!! The second long answer question on your unit test will be to describe the path of a bite of food (containing fat, protein and carbohydrates e.g. steak and potatoes) from mouth to toilet Include in your answer: 1.All the structures the food/bolus/chyme passes 2.Location of mechanical digestion 2. Location of chemical digestion 3. 4. Any diseases associated with each structure 5. All the enzymes- for fat, carbs and proteins- their origin of production, where they are active, what the digestive product is etc. 60 points = 30 marks