1. Digest This!

2.  The alimentary canal is a long, muscular tube  Structure – it is 25 to 30 feet in length  Includes the mouth, pharynx, esophagus, stomach, small intestine, large intestine and anus

3.  The mouth or buccal cavity chews food called mastication  Saliva is produced by the parotid, sublingual, and submadibular glands  Food is broken down by an enzyme called salivary amylase  The mouth is not a sterile area

4.  Food is swallowed in a bolus – and enters the pharynx  This triggers the epiglottis to close  The bolus continues down the esophagus to the stomach  Esophagus and stomach are not sterile

5.  Once food bolus is in the stomach, the cardiac sphincter closes to prevent food from flowing back into the esophagus  Peristalsis(mixing, contracting)begins to mechanically digest the food, and HCL, pepsin, lipase are chemically breaking down food  HCL – kills bacteria  Pepsin – breaks down protein  Lipase breaks down fat

6.  Food dumps from the stomach to the small intestine into the duodenum  This section is where bile from the gallbladder and liver and pancreatic juice enter through the ducts  After this point the small intestine produces enzymes; maltase, sucrase, and lactase – these break down sugars into simple forms  Peptidase – for protein  Steapsin – digestion of fat

7.  What would happen if we had something wrong with the pancreas, and we could not produce enzymes to break food down?

8.  This is where nutrients asborb into the blood stream through the villi of the small intestine  (duodenum, jejunum, ileum)  What remains goes into the large intestine – also not sterile  This is where water and nutrients like B complex and Vit K are asborbed

9.  If your large intestine became swollen and irritable, what nutrients could you not absorb, and how would that effect you?

10.  Rectum stores the indigestible food and waste  Waste exits from the anus – also not sterile

11.  GERD – Gastroesophageal reflux disease  It is the backwards flow of stomach contents into the esophagus  Etiology – incompetent(weak) lower esophageal sphincter makes the stomach contents dump back into the esophagus

12.  Signs and symptoms of GERD  Dyspepsia (heartburn)  Coughing  AM hoarseness  Belching  Chest pain  Regurgitation  Odynophagia – painful swallowing

13.  Teach patient ◦ Small meals ◦ Avoid spicy foods ◦ Elevate HOB 8-12” ◦ Sleep in left lateral position ◦ Stop smoking!!!!

16.  If you had to explain to a 6 year old how to treat GERD, how would you do it?

17.  Gastritis – inflammation of the gastric mucosa  Two kinds ◦ No. 1 Acute gastritis (erosive) – can be caused by infection of the helicobacter pylori bacteria. This is normal to have in your stomach, but if you become stressed it can have an overgrowth, and cause an ulcer. It could also be caused by e.coli, or salmonella. ◦ Inflammation can also be “set off” by irritating foods, chronic aspirin use and alcohol.

18.  Signs and symptoms of Acute gastritis: ◦ Rapid onset of epigastric pain ◦ Vomiting blood – can look like coffee grounds ◦ Stomach pain ◦ anorexia

19.  Treatment: ◦ EGD (esophagogastroduodenoscopy) is an examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat. ◦ Antibiotics to help with h.pylori infection

20.  No. 2 Chronic gastritis (non erosive) – constant irritation without ulcers, develops gradually and is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no signs or symptoms at all.

21.  Chronic gastritis signs and symptoms – causes few symptoms: ◦ Vague epigastria pain – usually relieved with food ◦ Intolerance of spicy foods ◦ Anemia – can’t absorb your B12 from food – you need this for red blood cells to function

22.  Diagnosis is same as the Acute – EGD and antibiotics if needed

23.  Treatment for chronic gastritis: ◦ Remove the cause – don’t take too much aspirin, eat too much acidic/fatty/spicy foods, stop smoking ◦ Medications – antacids, H2 receptor antagonist, antibiotics, Pepto

24.  PUD – Peptic ulcerative Disease – lesions in the stomach – stress ulcers, h.pylori causes acid increase  Usually located in the lower stomach, upper duodenum

25. h.pylori

26.  Complications of PUD: ◦ Bleeding ◦ Melena – blood in the stool is black and tarry, very smelly ◦ Perforation – ulcer wears through the bowel or stomach, and leaks into the peritoneal cavity – 2-3% of people perforate, and of this 67% die ◦ 4% have pyloric obstruction – valve is obstructed and patient has vomiting

27.  Test for PUD: ◦ EGD ◦ Blood chemistry (CBC) – checks for anemia ◦ Check of occult blood ◦ Urea breath test – check after midnight if h.pylori is present patient will have an increase in CO2 ◦ Surgery – goes in an stems bleeding

29.  IBS – Irritable Bowel Syndrome – 10-20% of U.S. citizens have this  Chronic recurrent diarrhea, constipation and bloating, abdominal pain, flares up with certain foods or stress

30.  IBS can flare up with stress or anxiety, food allergies like lactose intolerance  Can have exacerbation – flare up  Can be in remission – no problems

31. IBS

32.  Teach: ◦ Avoid precipitating factors ◦ Patient may need fiber supplements for constipation or Lomotil for diarrhea ◦ Stress management ◦ May need antidepressants

33.  Hemorrhoids – swollen engorged veins in the anorectic area  Caused by severe straining, childbirth, cancer, liver disease due to portal hypertension

34.  Two types of hemorrhoids ◦ External – swelling of the anus ◦ Internal – inflammation near the anus, and can swell to the outside – it is possible to have both at the same time  Both cause pain and itching, sometimes bleeding can occur – will be bright red, unlike melena, which is black

35.  Thrombosed hemorrhoid – Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.

36.  Treatment of hemorrhoids: ◦ Topical creams – decreases inflammation, eases pain ◦ Diet high in fiber ◦ Avoid – nuts, spices, coffee, alcohol ◦ Avoid sitting for prolonged periods ◦ Avoid valsalva maneuver – no straining, lifting ◦ In case of thrombosed hemorrhoid – surgery is required to release the blood for the swollen vein – follow with cold pack

39.  Crohn’s disease – is a form of IBS because it causes inflammation of the lining of the digestive tract. Crohn’s can extend deep into the layers of the affected bowel tissue.

40.  Common signs and symptoms for Crohns: ◦ Diarrhea ◦ Cramping ◦ Bloody stools ◦ Ulcers – can be severe and perforate through the bowel ◦ Weight loss

41.  Other signs and symptoms  People with severe Crohn’s disease may also experience: ◦ Fever ◦ Fatigue ◦ Arthritis ◦ Eye inflammation ◦ Skin disorders ◦ Inflammation of the liver or bile ducts ◦ Delayed growth or sexual development, in children ◦ See handout

42.  Diagnoses with a colonoscopy or barium enema allows an x-ray of the entire colon

44.  Also a form of IBS – Inflammation of the colon  Can be severe and life threatening  Difference in the Crohn’s and ulcerative is right side Crohn’s left side colitis  Signs and symptoms can range from rectal bleeding, bloody diarrhea, cramps, pain, malnutrition, dehydration, shock and even death

46.  Treatment for both: Crohn’s and Ulcerative Colitis ◦ Steroids – reduce inflammation ◦ Diet ◦ Stop smoking ◦ No alcohol ◦ For people who do not respond to all of the above, they might try to suppress the immune system to stop the body’s allergic response