1. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 0

2. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Chapter 8 Diseases and Conditions of the Digestive System Copyright © 2005 by Elsevier Inc. All rights reserved.

3. Slide 2 Learning Objectives  Trace the process of normal digestion and absorption.  Discuss the importance of normal teeth and a normal bite.  Describe the presenting symptoms of temporomandibular joint (TMJ) syndrome.  Compare the etiology of herpes simplex to the etiology of thrush.  Name a serious complication of esophageal varices.

4. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 3 Learning Objectives (cont’d.)  Explain the clinical significance of Barrett’s esophagus.  Describe the pathology of peptic ulcers and identify the etiology.  Explain the diagnosis of gastric cancer.  Describe a hiatal hernia.  Distinguish the types of abdominal hernias.

5. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 4 Learning Objectives (cont’d.)  Explain the differences between the pathology of Crohn disease and that of ulcerative colitis.  Describe the etiology of gastroenteritis.  Explain the difference between a functional and a mechanical obstruction of the bowel.  Discuss the pathologic conditions that may result in intestinal obstruction.

6. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 5 Learning Objectives (cont’d.)  Distinguish between diverticulosis and diverticulitis.  Discuss the screening program for and the treatment of colorectal cancer.  Explain the relationship between broad- spectrum antibiotics and pseudomembranous enterocolitis.  List the causes of inflammation of the peritoneum.

7. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 6 Learning Objectives (cont’d.)  Explain the pathologic symptoms and signs of cirrhosis of the liver.  Name the most important etiologic factor for hepatocellular carcinoma and other additional risk factors.  Contrast the causes and preventive measures of hepatitis A and hepatitis C. Explain how health care providers are at special risk for hepatitis B.

8. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 7 Learning Objectives (cont’d.)  Name the most common bloodborne infection in the United States.  Describe the clinical picture of an individual with (a) biliary colic and (b) acute pancreatitis.  State the prognosis of pancreatic cancer.  Describe the clinical manifestations of malnutrition and malabsorption.

9. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 8 Learning Objectives (cont’d.)  Explain the diagnostic criteria for celiac disease.  List some ways one can lower the risk of food poisoning.  Distinguish between the clinical picture of the patient with anorexia and that of the patient with bulimia.  State the components of a successful weight-loss program

10. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 9 Chapter 8 Lesson 8.1

11. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 10 The Digestive System

12. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 11 The Oral Cavity and Jaw Diseases and Conditions  Missing teeth: permanent teeth are missing  Dental caries (tooth decay): infection resulting in erosion of tooth surface  Gingivitis: inflammation and swelling of the gums  Periodontitis: destructive gum and bone disease around one or more of the teeth

13. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 12 The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Malocclusion: specific angles of malposition and contact of the maxillary and mandibular teeth  Temporomandibular joint (TMJ) syndrome: a symptom complex related to inflammation, disease, or dysfunction of the temporomandibular joint

14. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 13 The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Herpes simplex (cold sores): a recurrent viral infection that affects the skin and mucous membranes.  Thrush: candidiasis of the oral mucosa, involving the mouth, tongue, palate, and gums.

15. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 14 Digestive Distress Signals  Hiccup  Indigestion  Heartburn  Nausea  Vomiting  Colic  Flatulence  Diarrhea  Constipation  Fecal incontinence

16. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 15 Diseases of the Gastrointestinal Tract Esophageal varices: varicose veins of the esophagus, resulting from pressure within the veins Esophagitis: inflammation and tissue injury of the esophagus Esophageal cancer: cancer of the esophagus

17. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 16 Diseases of the Gastrointestinal Tract (cont’d.) Gastroesophageal reflux disease (GERD): the clinical manifestations of regurgitation of stomach and duodenal contents into the esophagus Barrett’s esophagus: severe consequence of GERD that replaces normal striated squamous epithelium of the distal esophagus with abnormal columnar epithelium

18. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 17 Diseases of the Gastrointestinal Tract (cont’d.) Peptic ulcers: sores or lesions in the mucous membrane of the stomach or upper intestinal tract Duodenal ulcers: ulcers of the first part of the small intestine Gastric ulcers: ulceration of the gastric mucosa of the stomach that follows chronic gastritis

19. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 18 Acute Appendicitis  Inflammation of the appendix  Symptoms: pain in right lower quadrant of abdomen; nausea; vomiting; fever; diarrhea or constipation  Treatment: surgical removal

20. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 19 Diseases of the Gastrointestinal Tract (cont’d.) Hiatal hernia: a defect in the diaphragm that permits segment of stomach to slide into thoracic cavity  Symptoms: heartburn, chest pain, swallowing difficulty; some cases asymptomatic Abdominal hernia: a condition in which an organ protrudes through an abnormal opening in the abdominal wall  Symptoms: lump or bulge; groin pain

21. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 20 Chapter 8 Lesson 8.2

22. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 21 Diseases of the Gastrointestinal Tract (cont’d.) Crohn disease (ileitis): chronic inflammatory disease of the alimentary tract Ulcerative colitis: chronic inflammatory bowel disease affecting the mucosa and submucosa of the rectum and colon Gastroenteritis: acute inflammation of the stomach and intestines

23. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 22 Intestinal Obstruction  Mechanical or functional blockage of intestines; contents cannot move forward  Severe pain, nausea, vomiting, bloated abdomen without passage of stool or gas  Sudden or severe onset requires urgent care  Treatment: surgery for mechanical blockage; NPO, stomach tube for functional blockage

24. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 23 Diverticular Conditions  Diverticulosis: outpouches (diverticula) of mucosa penetrate weak points in muscular layer of large intestine Symptoms: mild discomfort, irregular bowels; may be asymptomatic  Diverticulitis: trapped fecal matter causes inflammation of diverticula Symptoms: fever, nausea, pain, changes in bowel function

25. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 24 Diseases of the Gastrointestinal Tract (cont’d.) Colorectal cancer: a cancer that arises in any part of the colon or rectum  Symptoms: abdominal pain, change in bowel habits, bloody stools, rectal bleeding, iron deficiency anemia  Treatment options: surgical resection; colostomy; chemotherapy; radiation

26. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 25 Diseases of the Gastrointestinal Tract (cont’d.) Pseudomembranous enterocolitis: acute inflammation with a plaque-like adhesion of necrotic debris and mucus adhered to the damaged superficial mucosa of the small and large intestine  Symptoms: fever, weakness, abdominal cramping and tenderness, nausea, vomiting, diarrhea

27. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 26 Diseases of the Gastrointestinal Tract (cont’d.) Peritonitis: inflammation of the peritoneum that can be acute or chronic, local or generalized  Symptoms: abdominal pain, nausea, vomiting, weakness, sweating, fever, distended abdomen, paralytic ileus

28. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 27 Diseases of the Liver, Biliary Tract, and Pancreas Cirrhosis of the liver: an irreversible chronic degenerative disease that results in the replacement of normal liver cells with hard, fibrous scar tissue  Symptoms: loss of appetite and weight, nausea, vomiting, indigestion, abdominal distention, edema, easier bleeding and bruising, jaundice, pruritis, spider nevi

29. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 28 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.) Viral hepatitis  Hepatitis A: highly contagious condition caused by the hepatitis A virus (HAV) causing mild damage to the liver.  Hepatitis B: inflammation of the liver caused by the hepatitis B virus (HBV).  Hepatitis C: chronic condition caused by the hepatitis C virus (HCV) resulting in gradual, insidious liver disease.

30. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 29 Chapter 8 Lesson 8.3

31. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 30 Cancer of the Liver Hepatocellular carcinoma: primary tumor of the liver; usually arises in chronic liver disease setting  Symptoms: same as liver disease– upper abdominal pain, weight loss, early satiety, palpable abdominal mass, ascites, splenomegaly, jaundice

32. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 31 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.) Cholelithiasis (gallstones): condition in which there is abnormal presence of calculi that form in the bile. Pancreatitis: acute or chronic inflammation of the pancreas with variable involvement of adjacent or remote organs.

33. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 32 Cholecystitis  Symptoms: acute, colicky pain, nausea, and vomiting  Causes: obstruction of biliary duct by gallstones  Treatment: dietary modification with elimination of fatty foods; in acute cases, intravenous feeding

34. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 33 Pancreatitis  Symptoms: sudden onset of severe abdominal pain radiating to the back, nausea, and vomiting  Causes: alcoholism, biliary disease, gallstones  Treatment: Acute pancreatitis may require emergency treatment of intravenous fluid and electrolyte replacement

35. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 34 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.)  Pancreatic cancer: A neoplasm, usually an adenocarcinoma, that occurs more often in the head of the pancreas.

36. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 35 Pancreatic Cancer  Symptoms: abdominal pain, weight loss, or jaundice  Causes: cigarette smoking, high intake of fat and/or meat, family history of pancreatitis or diabetes  Treatment: surgical resection

37. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 36 Diseases of Nutrient Intake and Absorption Malnutrition: a disorder of nutrition caused by primary deprivation of protein energy or secondary to deficiency diseases Malabsorption syndrome: a group of disorders in which intestinal absorption of dietary nutrients is impaired

38. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 37 Malnutrition  Symptoms: decreased or increased appetite; emaciation or obesity; loss of energy; diarrhea  Causes: deprivation of protein energy from eating disorders, chronic illnesses, etc.  Treatment: nutritional supplements, oral and intravenous feeding

39. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 38 Malabsorption Syndrome  Symptoms: impaired digestion, inability to absorb fat or other components of diet  Causes: defective mucosal cells in the small intestine  Treatment: high-protein, high-calorie diet

40. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 39 Obesity  34 million Americans are obese, defined as being 20% overweight; obesity can lead to severe health problems.  Contributing factors for obesity include low rate of energy expenditure, inactivity, and endocrine disorders.  Treatment options include exercise and control of food intake through behavior modification.

41. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 40 Diseases of Nutrient Intake and Absorption (cont’d.) Celiac disease (gluten enteropathy): a disease of the small intestine characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine

42. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 41 Celiac Disease  Symptoms: weight loss, anorexia, diarrhea, flatulence, abdominal distention  Causes: toxic or immunologic reaction to component of gluten (found in wheat, barley, and oats)  Treatment: gluten-free diet; if no improvement, corticosteroid drugs

43. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 42 Diseases of Nutrient Intake and Absorption (cont’d.)  Food poisoning: an illness resulting from the ingestion of foods that contain bacterial or toxic substances

44. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 43 Food Poisoning  Symptoms: sudden nausea, vomiting, and diarrhea  Causes: poisoning from mushrooms, shellfish, contaminated foods  Treatment: nutritional support and fluid replacements

45. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 44 Eating Disorders Anorexia nervosa: psychological disturbance in which self-imposed starvation and compulsion to be thin leads to denial of hunger Bulimia: behavioral disorder characterized by recurring episodes of binge eating followed by self- induced vomiting or purging