Digestive System Disorders

Overview

• Gingivitis • Heartburn (GERD) • Hemorrhoids • Cholera • Gastric Ulcer • Cirrhosis • Emesis • Gallstones • Inflammatory Bowel Disease • Proctitis

Gingivitis

• Gingivitis is a very common and mild form of gum (periodontal) disease that causes swelling (inflammation) of your gums.

Common Manifestations — Anorexia, Nausea, Vomiting • Digestive system disorders or sign of other problems • Nausea and vomiting common indicators of GI disorder – Anorexia precedes the above • Nausea – General unpleasant, subjective feeling • Vomiting – Forceful expulsion of irritant – Medulla coordinates reflex

Steps of Vomiting

Anorexia, Nausea, Vomiting

• Retching before vomiting • Characteristics of vomitus – “coffee grounds” • Blood • Partial digestion in stomach of protein in blood – Yellowish-green • Contains bile (from duodenum) – Deeper brown • Content from lower intestine

Common Manifestations —Diarrhea • Excessive freq of stools – Usually loose and watery – Acute or chronic • Accomp by cramps and pain • Severe, prolonged may lead to – Dehydration, electrolyte imbalance, acidosis, malnutrition

Esophagitis

•

Reflux esophagitis Infections

• Crohn disease, acute graft versus host disease • Prolonged gastric intubation • Ingestion of irritant substance • Chemotherapy and irradiation

Esophageal carcinoma

• Squamous cell carcinoma – More prevalent worldwide – Risk factors: long-standing esophagitis, achalasia, smoking, alcohol, diet (low vitamins and zinc), genetics – 50% in middle 1/3

Esophageal carcinoma

• Adenocarcinoma – More common in USA – Occurs on top of Barrett esophagus – More in distal 1/3

Gastroesophageal Reflux Disease (GERD) • In conjunction with hiatal hernia • Severity depends on lower esophageal sphincter (LES) • Freq episodes at night • Eliminate factors that decrease LES pressure • Avoid spicy foods, take antacids

GERD

Upper Gastrointestinal Tract Disorders —Hiatal Hernia • Part of stomach elevated, protrudes thru hiatus of diaphragm into thoracic cavity • 2 types – Sliding hernia • More common – Rolling (paraesophageal) hernia • Fundus moves up thru enlarged or weak hiatus in diaphragm

Peptic Ulcers: Gastric and Duodenal Ulcers —Pathophysiology • Proximal duodenum most common • Also found in antrum of stomach or lower esophagus • Usually appear as single, small, round cavities – Smooth margins; penetrate submucosa • Once acid or pepsin penetrate mucosal barrier tissues exposed to continuous damage – Acid diffuses into gastric wall • May erode deeply into musculature and eventually perforate wall – Inflammation surrounds crater

Gastric and Duodenal Ulcers — Pathophysiology • Erosion invades bv wall, bleeding occurs – Persistent loss of small amt of blood – Or massive hemorrhage • Development begins w/ break down of mucosal barrier • Decreased resistance of mucosa or increase HCl or pepsin secretion – Impaired mucosal defenses (gastric ulcer) – Increased acid secretion (duodenal ulcer) • Most have

H. pylori

present

Disorders of the Liver and Pancreas —Gallbladder Disorders • Gallstones – Cholelithiasis • Formation • Masses of solid material (calculi) that form in bile

Gallstones —Pathophysiology

• Vary in shape, size – Small stones “silent” – Lg can obstruct flow of bile • Initially form in bile ducts, gallbladder, cystic ducts • May consist primarily of cholesterol (white), bilirubin (black), or both • Tend to form when bile contains high concentration of component or when bile salts low – Stone grows as more deposits

Hepatitis

• Inflammation of the liver • May result from local infection (viral), infection elsewhere (mono) or from chem/drug toxicity • Mild inflammation and necrosis – Obstruction of blood and bile flow in liver – Decrease liver cell function • Damage to liver cells – b/c of function of liver – But good b/c functional reserve and excellent regeneration

The points to remember

Hepatitis A Hepatitis B Hepatitis C Transmission

Oral-fecal

Parenteral Carrier state

None

Present Parenteral Present Chronic hepatitis Fulminant hepatitis Carcinoma None 0.1% No

5-10% 0.1-1.0% Yes >70%

Rare

Yes

Jaundice

• Accumulation of bilirubin in tissue leading to yellow discoloration of skin and sclera (icterus) • Normal serum level: 0.3-1.2 mg/dl; jaundice appears with levels above 2.0-2.5 mg/dl • Source of bilirubin: the breakdown of senescent red blood cells in the spleen releases heme that changes into bilirubin by specific enzymes.

Helicobacter pylori and Gastric Ulcers H. pylori

Gastric ulcer

• Gastritis (chronic and acute), peptic (gastric and duodenal) ulcers • Gastric adenocarcinoma, intestinal type • Gastric lymphoma

Macroscopic growth patterns of gastric adenocarcinoma

Mass Lintis plastica Ulcer

Clinical picture: asymptomatic or abdominal discomfort, weight loss, anemia

Meckel diverticulum

Meckel diverticulum

• A blind pouch located in distal small bowel • The most common congenital anomaly of the small intestine; results from failure of the involution of the omphalomesenteric (vitelline) duct • The rule of 2’s: – 2% of the population, 2 inches in length, 2 feet proximal to the ileocecal valve, 2 types of heterotopic tissue (pancreas and stomach); 2% are symptomatic.

• Symptoms are rare: – Overgrowth of bacteria that depletes vitamin B12 leading to anemia – “Peptic” ulcer and bleeding

Colonoscopy

Polyps

Colonic adenocarcinoma

Exophytic tumor leading to partial obstruction

• Clinical picture: Asymptomatic or fatigue, weakness and iron deficiency anemia in tumors of right side. Left sided tumors may produce bleeding, change in bowel habits and crampy pain

Hemorrhoids

• The term hemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed.

• Hemorrhoids may result from straining to move stool. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal intercourse.

• Hemorrhoids are either inside the anus anus —external.

—internal—or under the skin around the

Proctitis

• Proctitis is inflammation of the lining of the rectum, called the rectal mucosa.

• Proctitis can be short term (acute) or long term (chronic). • It may be a side effect of medical treatments like radiation therapy or antibiotics. • Gonorrhea, herpes, and chlamydia may also cause proctitis.