1. Overview – March 7  Clinical Applications  Sjogren’s Syndrome  Acid Reflux Disease  GERD: Gastroesophageal Reflux Disease  Gall Bladder Disease  Crohn’s Disease  Appendicitis

2. Digestive System: Overview Figure 23.1

3. Sjogren’s Disease  Dry eyes and dry mouth  Autoimmune disease  Inflammation of glands of body  Glands that produce tears  Glands that produce saliva  Cause is unknown  Genetic associations  90% of patients are females

4. Salivary Glands Figure 23.9a

5. Symptoms  Mouth dryness  Difficulty in swallowing  Mouth sores and tooth and gum disease  Saliva crystals and infection of parotid glands  Heartburn from acid reflux

6. Treatment  No cure is available  Drink plenty of fluids  Humidify air  Sucking on sugarless lemon drops  Drugs: saliva stimulants  Artificial saliva  Diligent dental care

7. Acid Reflux Disease  Stomach is filled with acids to help digest foods  Very strong acids in stomach  Acid backup into esophagus  Heartburn  Heartburn 2 or more days per week for at least 3 mos  Acid reflux disease  Valve separating the esophagus from the stomach does not close properly (esophageal sphincter)  Chronic heartburn  Can lead to more serious medical complications  Erode lining of esophagus

8. Microscopic View of the Lining of the Digestive Tract

9. Esophageal Sphincter Normal GERD

10. Lifestyle Treatments  Diet – avoid:  Fatty and fried foods  Chocolate  Peppermint  Citrus fruits  Tomato juice  Alcohol  Coffee  Cold or spicy foods

11. Lifestyle Treatments (con’t)  Avoid tight clothes and tight belts  Raise head about 6-9 inches when supine  Avoid excessive bending, lifting and stooping

12. Treatment  Medications  Antacid  Neutralizes acid that backs up into esophagus  Salts of magnesium, calcium, and aluminum bicarbonate  Turn off acid pumps in stomach (Nexium – ‘the purple pill’, Pepcid)  Can also heal esophageal erosion

13. Swallow pill and view digestive tract camera transmitter Alternative to endoscopy Pill moves through digestive tract by peristalisis Eliminated from body 12-24 hrs later Pillcam

14. Gall Bladder Disease  Includes inflammation, infection, gall stones, gall bladder obstruction  Trapped bile  Becomes more concentrated  Causes irritation, infection, perforation  Conditions which slow or obstruct flow of bile out of gall bladder  Cholescyctitis (inflammation of gall bladder)  Gall stones

15. Gall Bladder Position

16. Gallbladder and Associated Ducts Figure 23.20

17. Symptoms  Abdominal fullness or gas  Abdominal pain –right side or upper middle abdomen  Occurs after meals; particularly after fatty food intake  Worse during intake of deep breath  Pain under sternum  Fever and chills  Nausea and vomiting  Heartburn

18. Treatment  Gall bladder removal  Open surgery – large abdominal cut through abdominal muscles  Laparoscopic surgery  4 tiny incisions in abdomen

19. Gall Bladder Laparoscopic Surgery

20. Crohn’s Disease  Chronic inflammation of digestive tract (type of inflammatory bowel disease)  Most commonly affects lower small intestine (ileum)  ileitis  Swelling deep into lining of wall of affected area  Severe pain  Severe diarrhea  Higher rates among Jewish people  African Americans at lower risk for disease

21. Digestive System: Overview Figure 23.1

22. Causes of Crohn’s Disease  Several theories  Autoimmune disease  Own body’s immune system attacks digestive system  Accumulation of white blood cells in intestinal lining  Causes chronic inflammation

23. Treatment  65-75% of patients with Crohn’s disease need surgery  Relief of symptoms  Correct complications  Blockages  Perforation (tear in intestinal lining)  Bleeding  Remove part of small intestine  Large intestine  Need colectomy – remove large intestine  Ileum (base of small intestine) is brought to surface and pouch is attached to collect waste

24. Crohn’s Disease Normal ileum Ileum with Crohn’s disease

25. Diet, Drug Therapy and Crohn’s Disease  Decreased appetite  Diarrhea and poor absorption of nutrients  Nutritional supplements  High calorie liquid supplements  Intravenous feeding  Reduce fiber, alcohol, milk, spices  Drugs  Antibiotics  Steriods  Immune system suppressors  Anti-diarrheal and fluid/electrolyte replacements

26. Appendicitis  Appendix attached to cecum (large intestine)  Produces mucus and antibodies  Delivered to colon  When opening from appendix to colon is blocked  Excessive mucus or stool  Bacteria invade wall of appendix  Inflammation  Surgery to remove appendix

27. Digestive System: Overview Figure 23.1

28. Inflamed Appendix