Chap 36: Gastrointestinal Disorders

This set covers vocabulary and key concepts for gastrointestinal disorders, including constipation, diarrhea types, cancers, gastritis, ulcers, dysphagia types, GERD, IBD, and other related conditions.

Acute Constipation

Short periods of difficult, infrequent, or incomplete bowel movements lasting less than 3 months.

Chronic Constipation

Short periods of difficult, infrequent, or incomplete bowel movements lasting more than 3 months.

Osmotic Diarrhea

Diarrhea due to increased amounts of poorly absorbed solutes in the intestine, such as in lactose intolerance.

Secretory Diarrhea

Diarrhea caused by toxins that stimulate intestinal fluid secretion, commonly due to bacterial or viral infections.

Exudative Diarrhea

Diarrhea containing mucus, blood, and protein that results from inflammatory processes.

Warning Signs for cancer of the GI tract

color, shape, and/or pattern changes (black, bloody, or pencil-shaped stool and a change in bowel habits), weight loss, anemia/unexplained fatigue

RISK FACTORS: low-fiber, high-fat diet, polyps, and chronic irritation or inflammation

Esophageal Cancer Risk Factors

Genetics, diet high in nitrosamine content, chronic severe reflux (Barrett’s esophagus), smoking, and alcohol; most common in men; prognosis is poor due to high degree of metastasis

Gastritis

Inflammation of the stomach lining.

Acute Gastritis

Inflammation precipitated by infection or irritating substances like alcohol, aspirin, or NSAIDs, viral/bacterial/autoimmune; involving high HCL production and low protection.

Chronic Gastritis

Inflammation often caused by Helicobacter pylori infection, NSAIDs, or alcohol, leading to decreased acid and intrinsic factor.

Helicobacter pylori (H. pylori)

A bacterium that is a major cause of chronic gastritis and is a risk factor for peptic ulcer disease + gastric adenocarcinoma.

Peptic Ulcer Disease Risk Factors + Diagnosis + Treatment

Disorders of the upper GI tract caused by the action of acid and pepsin;

Risk factors include H. pylori, NSAIDs, stress (cortisol), smoking, genetics, and alcohol.

Diagnosis: endoscopy, upper GI barium contrast, test for H.pylori

Treatment: Encourage healing of the injured mucosa by reducing gastric acidity;

H.pylori antibiotics, H2 Antagonists, PPI, Sucralfate.

AVOID smoking, ASA, NSAIDS, stress, irritating foods

Duodenal Ulcers

The most common type of peptic ulcer where pain is relieved by meals and occurs 2-3 hours after eating; often associated with dark stool (melena).

Gastric Ulcers

A less common type of peptic ulcer where pain is increased by meals (occurs 20-30 mins after), often accompanied by vomiting; gastric ulcers should be visualized with endoscopy and biopsied to rule out malignancy

Dysphagia

Difficulty in swallowing, characterized by the inability to initiate swallowing or the sensation that solids/liquids are “stuck” in the esophagus + pain with swallowing (odynophagia)

Type I Dysphagia

Problems in the delivery of food/fluid into the esophagus due to neuromuscular disorders; worse with liquids than solids→ cough and expel the ingested food/fluids

Type II Dysphagia

Problems with transport of bolus in the esophagus (diverticula, achalasia, neoplasms); characterized by a sensation of food being “stuck” behind the sternum.

Type III Dysphagia

Problems in bolus entry into the stomach due to lower esophageal dysfunction, causing pain in the substernal area during swallowing.

Gastroesophageal Reflux Disease (GERD) + Etio + S/S + Complications

The backflow of gastric contents into the esophagus through the LES, causing inflammation known as esophagitis.

Etio/Risk Factor: Any condition or agent that alters the closure strength of LES or increases abdominal pressure; fatty foods, caffeine, large amounts of alcohol, cigarette smoking, pregnancy.

S/S: heartburn, regurgitation, chest pain, dysphagia

Complications: Barrett’s esophagus, ulceration, fibrotic scarring, pulmonary

symptoms-> carries a significant risk for esophageal cancer

Treatment of GERD + Gastritis + Peptic Ulcers

Antacids, H. pylori antibiotics, proton pump inhibitor (PPI) , preventive tasks (smoking cessation, No NSAIDS, stress reduction, avoid irritating foods), Histamine (h2)-blocking medications (Occasional GERD)

Barrett’s esophagus

A complication of chronic GERD that carries a significant risk for esophageal cancer.

Crohn’s Disease

Inflammatory bowel disease affecting all layers of the intestinal wall (transmural— proximal portion of the colon or terminal ileum) with skipping/cobblestone histology, typically causing RLQ pain and melena; complications of arthritis, uveitis, kidney stones, gallstones

Ulcerative Colitis + Treatment

Chronic inflammatory disease of the mucosa of the rectum and colon with superficial, continuous histology, causing LLQ pain and bloody stool.

Treatment: corticosteroids, Broad spec. Antibio, Immunomodulating agents (azathioprine + mercaptopurine), IV + Oral Cyclosporine

complications of arthritis, uveitis, kidney stones, gallstones + COLON CANCER

Right-sided Colon Cancer

ileocecal place, ascending colon + RLQ pain

HISTOLOGY: outward growth -> invasion of neighborhood

STOOL: dark stool (melena), no constipation

COMPLICATION: anemia, bowel obstruction, metastasis

Left-sided Colon Cancer

descending colon, sigmoid, rectum + LLQ pain

HISTOLOGY: inward growth-> little invasion of neighborhood

STOOL: bloody stool, constipation, pencil-shaped stool;

COMPLICATION: anemia, bowel obstruction, metastasis

Colon Cancer Risk Factors

Increases after age 40, high-fat, low-fiber diet, polyps, chronic irritation or inflammation, hereditary

Diverticular Disease

The presence of herniations (diverticula) in the colon caused by low dietary fiber and high intraluminal pressure.

Appendicitis

Inflammation of the appendix characterized by periumbilical and RLQ pain (McBurney’s point), rebound tenderness, nausea, vomitting, diarrhea, and fever. Treat with immediate surgical removal + antibiotics w fluid/electrolyte replacement

Irritable Bowel Syndrome (IBS)

Also called spastic colitis or Irritable colon syndrome; alternating diarrhea and constipation with abdominal cramping and mucus in the stool without an identifiable pathologic process.

Pseudomembranous Enterocolitis

Also known as antibiotic-associated colitis; acute inflammation and necrosis of the large intestine caused by

Etio: C. diff.

S/S: History is critical ; Diarrhea (often bloody), abdominal pain, fever, leukocytosis, sepsis, colonic perforation (rare)

Treatment: Stop current antibiotic (if possible); Oral antibiotics (metronidazole or vancomycin)

Celiac Disease + Treatment

Familial intolerance of gluten-containing foods leading to inflammation and atrophy of the intestinal villi; Treat with gluten-free diet, iron, folate, B12, fat-soluble vitamins (A, D, E, K) + oral corticosteroids or immunomodulating agents