digestive diseases introduction to human diseases chapter 10
TRANSCRIPT
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Digestive Diseases
Introduction to Human Diseases
Chapter 10
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Gastrointestinal System Anatomy
OropharynxEsophagusStomachSmall intestineLarge intestineRectumOther digestive organs: liver, gall bladder, pancreas
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Stomatitis
Inflammation of the oral mucosaEtiology: Herpetic stomatitis (cold sores, HSV 1) Aphthous stomatitis (canker sores) Temporary immunosuppression involve in both
S/S: painful blisters or ulcersTreatment: topical anesthetics & rinses, antiviral meds for herpes (1 day of meds)
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Gastroesophageal Reflux Disease(GERD)
Backup (reflux) of gastric & duodenal contents (food & acid) past the incompetent lower esophageal sphincter into the esophagusMore GERD in people over 40 YOAStats: 7% of US population have daily heartburn 20-40% with heartburn have GERD
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GERD
Usually involves the following: Functional/mechanical problem with LES Certain foods, meds, hormones
Coffee, etoh, b-or Ca channel blockers, nitrates, progesterone
Obesity (contributing factor)
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GERD
S/S: Heartburn, regurgitation, dysphagia, cough, chest pain,
wheezing
Treatment: Antacids, H2 blockers, PPI, prokinetic agents 80% GERD is controlled with meds, 20% need surgery
Other issues: 50% GERD get esophagitis 8-15% GERD have Barrett’s esophagus (stricture)
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Gastritis
Acute or chronic inflammation & erosion of the gastric mucosaEtiology: idiopathic frequently, may be due to foods, meds, alcohol, caffeineS/S: epigastric pain, nausea & vomiting, belching, full feeling in epigastriumTreatment: avoidance of irritants, H2 blockers or antacids
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Gastroenteritis
Inflammation of the stomach & small intestine Some types: traveler’s diarrhea, food poisoning
Etiology: commonly infectious (viral, bacterial, protozoal, parasitic), also meds and toxinsDiagnosis: history, stool culture for bacteria or stool exam for parasitesTreatment: varies with etiology Meds for parasitic, helminthic, protozoal Antiemetics, sometimes antidiarrheals Avoids of fatty or dairy foods, increased fluid intake
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Hiatal Hernia
Protrusion of part of the stomach through the diaphragmatic opening into the thoraxTypes: Sliding (most common) GE jct + stomach slide upwards
into thorax Paraesophageal (rolling) GE jct remains fixed
More common in: women, obesity, trauma,older age Etiology: unknown Suspected: high intra-abdominal pressure or weakness of
gastroesophageal junction, trauma
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Hiatal Hernia (HH)
S/S: 50% asymptomatic Heartburn, chest pain, dysphagia, reflux
Diagnosis: CXR, endoscopy
Treatment: Diet, meds for reflux, change in activities,
surgery
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Peptic Ulcers
Well-defined lesion (ulcers) in the mucosa of the lower esophagus, stomach, pylorus, or duodenumEtiology: Gastric acid hypersecretion conditions, Helicobacter
pylori infection, mucosal damage from aspirin, NSAID’s, alcohol, tobacco
More common in: Middle-aged and older males, smokers, alcohol and
NSAID users, Type A blood type (gastric) and type O blood type (duodenal)
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Peptic Ulcers
S/S: heartburn, epigastric pain, nausea, vomiting, GI bleeding, symptoms within/about 2 hours post-prandial
Diagnosis: endoscopy
Treatment: H. pylori: antibiotics, bismuth Same as reflux, also possible endoscopic
surgery (cautery) or routine surgical resection
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Infantile Colic
Paroxysmal abdominal pain or crampingFirst 3 months of lifeEtiology: Excessive fermentation & gas production, overeating,
air swallowing, rapid feeding, inadequate burping
S/S: crying, drawing up legsDiagnostics: Rule of Three’s (1st 3 months of life, crying 3 hrs/day, 3 days/week, at least 3 weeks.)Treatment: calming child, feeding techniques, etc.
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Lower GI Tract Diseases
Celiac Disease/ Gluten Induced EnteropathyMalabsorption due to immunologic reaction to part of gluten (wheat), gluten intolerance, and mucosal damage to intestineInherited, female to male = 2 to 1S/S: abdominal distention, diarrhea (large, greasy, grey-yellow), poor absorption of B12 & folate, weight loss,
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Celiac Disease
Testing: small intestinal biopsy (villi destruction) and improvement on gluten-free diet
Treatment: Dietary avoidance of wheat products,
supplements if needed of folate, etc.
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Irritable Bowel Syndrome
GI symptom complex with no known organic cause: Alternating constipation & diarrhea Some change in colon motility
A diagnosis of exclusionMost frequent GI disorder in USEtiology: unknownDisorder of adults
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IBS
Treatment: Variable, avoidance of foods or other factors
that provoke episodes No single successful treatment
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Crohn’s Disease/ Regional Enteritis
Chronic inflammatory disease of unknown etiology that primarily involves the ileum Transmural thickening of bowel wall Patchy or segmental areas of this Thickening of wall, narrowing of lumen
S/S: abdominal pain, diarrhea, anorexia & weight loss, anal or other fissures, fistulas
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Crohn’s Disease
Diagnosis Colonoscopy & biopsy
Treatment: Immunosuppressives, anti-inflammatories,
surgery (colectomy, ileostomy)
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Ulcerative Colitis
Inflammation & ulceration of the colon, beginning in rectum or sigmoid and extending proximallyOnly mucosa is involvedUniform involvement of the area, no segments or patches of healthy tissueEtiology, diagnostic test, treatment: like Crohn’s Disease
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Diverticular Disease
Diverticulosis Outpouching of colonic mucosa that bulge
through wall into peritoneum
Diverticulitis Infection of diverticuli
Etiology: obstruction of diverticuli by matter (particulate material in stool, fecalith, etc) and subsequent infection
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Diverticular Disease
S/S LLQ pain, fever, nausea, diarrhea
Diagnostics Blood tests nondiagnostic, CT scan
Treatment Dietary changes (high fiber), antibiotics for
flare-up, surgery if needed
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Acute Appendicitis
Inflammation & infection of appendix, often due to obstruction by fecalith
S/S: RLQ pain (McBurney’s Point), anorexia, low-grade fever, nausea, possible peritonitis if rupture occurs
Treatment: appendectomy
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Hemorrhoids
Dilated, tortuous veins of anus or rectum Internal or external
S/S: itching, bleeding, pain
Etiology: high intraabdominal pressure conditions
Treatment: antiinflammatories, hemorrhoidectomy
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Abdominal Hernias
Protrusion of an internal organ through an abnormal opening in the abdominal wall Umbilical (ventral), femoral, or inguinal (most
common type)
Etiology: congenital or acquired weakness in part of abdominal wall Lifting, pregnancy, obesity = predispositions
S/S: visible or palpable bulge is most common, sometimes pain, nausea, vomiting
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Hernias
Incarcerated vs. strangulated hernia
Treatment: Surgery (herniorraphy)
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Colorectal Cancer
Adenocarcinoma almost alwaysDisease of adults (over 40 YOA)Risk factors: High meat, low fiber diets, IBS, polyposis
S/S: often asymptomatic, occult lower GI bleeding, change in bowel habitsDiagnosis: sigmoidoscopy or colonoscopy and biopsy, routine screening after age 50
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Colorectal Cancer
Treatment: Surgery if early Chemotherapy/radiation if mets
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Diarrhea
Frequent passage of feces, often increased in volume and fluidity
Is this itself a disease?
Sign or symptom?
Etiology: numerous
Testing: stool cultures, examination for WBC, RBC, parasites, etc
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Helminths
Worms living as parasites in human GI tract
Types: Roundworms
Ingestion of larvae deposited by dogs/cats Usually children ingest dirt
Pinworms Egg deposition around anus Nocturnal pruritis
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Pancreatitis
Inflammation of pancreas Autodigestion due to leaking pancreatic
digestive enzymes
Acute or chronicMild or life-threateningEtiology: associated with alcoholism, biliary disease, trauma, severe hyperlipidemias
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Pancreatitis
S/S: Upper abdominal pain, vomiting
Diagnosis: blood tests helpful
Treatment: IV hydration, treatment of vomiting, no oral foods (GI rest)
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Biliary Diseases
Cholelithiasis Gallstones, mostly cholesterol in US Mostly middle-ages or older females May are asymptomatic
Cholecystitis Inflammation of GB wall Often occurs due to obstruction of cystic duct
by gallstone
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Biliary Diseases
S/S: Severe RUQ pain, often spasmic, nausea,
vomiting, intolerance of fatty foods
Diagnosis: ultrasound, blood tests
Treatment: If mild: dietary avoidance If severe: laparoscopic cholecystectomy
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Cirrhosis
Chronic, irreversible degenerative liver disease, like scarring with regrowth of abnormal liver cells
Due to repeated trauma of many etiologies: Toxins, infections, metabolic, circulatory
Liver failure (hepatic insufficiency) often occurs
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Cirrhosis
Etiologies: Alcoholic is most common etiology Also biliary diseases, hemochromotosis,
idiopathic
S/S: jaundice, firm, enlarged palpable liver, weight loss, pruritis, increased bleeding,ascites, edema of legs and abd wall, esophageal varices
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Hepatitis
Acute viral etiology is most common Hepatitis A: infectious hepatitis Hepatitis B: via human secretions or feces Hepatitis C: less common, often becomes
chronic, quiescent for decades Hepatitis D: delta hepatitis Hepatitis E: rare in US, feces-contaminated
water Hepatitis G: blood-borne illness
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Hepatitis
Diagnosis: blood testing for antibodies and antigens, liver function tests
S/S: RUQ pain, nausea, fatigue, jaundice, loss of appetite, fever
Treatment: Usually supportive, immunoglobulin
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Pancreatic Cancer
Usually adenocarcinoma
Often head of the pancreas
Geriatric disease (60-70 YOA)
Remains asymptomatic until late Great majority of patients have advanced
disease at time of diagnosis