Digestive Disorders

Anorexia

A lack of a desire to eat

- Can be pathological or physiological

Nausea

subjective feeling of unwellness

Vomiting

The forceful emptying of the stomach and intestinal contents through the mouth

Another word for vomiting

Emesis

What is Retching?

Non Productive vomitting

What is vomiting blood called ?

Hematemesis

What is Constipation

Less frequent bowel movements

What comes with constipation?

- Straining with defecation

- Lumpy hard stool

- Sensation that you didn't completely empty bowels

- Less than 3x a week

What is primary condition for constipation ?

○ Normal transit

○ Slow transit

○ Pelvic floor dysfunction

What is secondary condition for Constipation?

○ Diet

○ Medication

○ Hypothyroidism

○ Aging

What is Treatment for Constipation?

Manage underlying disease

- Increase fluid and fibers

- Enemas

- Stool softener and Laxative

What is Diarrhea

increased frequency of bowel movements

Things that is associated for Diarrhea

- Poop 3-4x a day

- Loose watery stool

What are the two types of Diarrhea

Acute and Chronic

What is the cause for Acute Diarrhea

Caused by Infection

What is the cause for chronic diarrhea

inflammation

What are the three different types that cause Diarrhea?

Osmotic

- Lactose intolerance

Secretory

- Infectious

Motility

- Drugs & hyperthyroidism

Signs and Symptoms of Diarrhea

- Dehydration

- Electrolyte imbalance

- Rapid weight loss

- Lose base → causes acidotic state

Treatment for Diarrhea

- Fluid

- Antimotility

- Causal factors

What is something you should never give to an infectious diarrhea ?

Antimotility medication because you want to get rid of the infection rather than store it in your body

What are the types of Abdominal Pain

Visceral pain

- Stretching of organ

- Poorly localized pain

- Dull, cramping, aching, burning sensation

Parietal pain

- Irritation of nerve fibers innervating the parietal peritoneum

- Localized to the sire of painful stimulus

- Sharp pain

Referred Pain

- Pain or discomfort identified as coming from one region like the shoulder when its coming from a different region like the diaphragm

Gastrointestinal Bleeding anatomical

Upper and lower gastrointestinal bleeding

What are the rates of blood loss for Gastrointestinal bleeding

Acute- Visible blood to the eyes

Occult

- Bleeding not visible to the eye; positive fecal occult blood test

- Can cause iron deficiency anemia

What is Hematochezia

blood in stool

Melena

dark/black tarry stool

What is Gastroesophageal Reflux Disease: GERD

- Periodic symptomatic reflux of gastric contents into the esophagus, causing erosion and inflammation

Pathogenesis of GERD

- Resting tone of the lower esophageal sphincter tends to be lower than normal

- Incompetent LES is another name for above statement

- LES opens more frequently and longer resulting reflux’

Symptoms of GERD

- Heartburn: burning feeling in the lower chest along with a sour or bitter taste

- Indigestion: discomfort in your upper abdomen or a feeling of fullness soon after eating

- Globus: sensation of something in the back of your throat

- Dysphagia: difficulty or pain on swallowing

What is Barrett Esophagus

Caused by Chronic GERD

- A condition that occurs when the cells lining the lower esophagus change to resemble those of the stomach and intestines(stratified squamous → metaplastic columnar cells)

- Increased risk of esophageal adenocarcinoma

Risk factors for GERD

- Increased abdominal pressure

- Obesity, pregnancy, hiatal hernia

- Delayed gastric emptying(gastroparesis)

- Calcium channel blockers

- Helicobacter pylori

What is the significance with GERD ?

- Occurs 30-90 mins after a meal

- Patients sleep with incline to prevent backflow

- Worsens with reclining

- Improves with antacids, sitting, or standing

Diagnosis for GERD

Upper endoscopy with biopsy

Treatment for GERD

- Weight loss

- Head elevation

- Avoidance of meals 2-3 hours before bed

- Trigger foods eliminated from diet

- Medication: proton pump inhibitor, H-2 antagonist, Antacid

- Surgery: laparoscopic fundoplication- for hiatal hernia

What is Peptic Ulcer Disease

Results from damage to or break in the mucosal barrier of the stomach and duodenum

Pathogenesis for Peptic Ulcer Disease

Inadequate blood supply

- Vasoconstriction→ interferes with rapid regeneration of epithelium

Excessive glucocorticoid secretion or medication

Ulcerogenic substances breakdown the mucus layer

- Aspirin, NSAIDs, alcohol

Atrophy of gastric mucosa

- Chronic gastritis

What are the two causes of Peptic Ulcer Disease

- NSAIDs

- Helicobacter Pylori

Pathophysiology of NSAIDs for Peptic Ulcer Disease

Systemic antiprostaglandin effects

-Lose cytoprotection decreases with prostaglandin

- Minimize mucosal secretion

- Stop bicarbonate

- Less blood flow

Pathophysiology of Helicobacter Pylori

- Gram negative rod

- Only found in gastric epithelium

- Produce ammonia

To decrease acid production

- Produce protease to allow bacteria to burrow into the mucosa

- Produce autoantibodies

Peptic Ulcer Disease Complications

Hemorrhage

- Erosion of blood vessels

- May be the first sign of a peptic ulcer

Perforation

- Ulcer erodes through the wall →

Obstruction

- May result later from the formation of scar tissue

Treatment for Helicobacter Pylori

- Antibiotics

- Omeprazole

- Clarithromycin

- Amoxicillin

How to diagnose Peptic Ulcer Disease

- Fiberoptic endoscopy with biopsy

- Barium x-ray

Treatment for Peptic Ulcer

Determine the cause and reduce the causing factors

- Antimicrobial + proton pump inhibitor for H. pylori

Signs and symptoms Peptic Ulcer Disease

- Epigastric burning or localized pain after stomach emptying

Two types of Peptic Ulcer Disease

Duodenal ulcer and Gastric Ulcer

What is pathognesis of Gastric Ulcer

- Increased mucosal permeability to acid

- Gastric secretion usually normal

History of Gastric Ulcer

- Food causes PAIN (Immediately)

- Antacid → minimal relief

What is Pathogenesis of Duodenal Ulcer

- Use of NSAIDS

- Helicobcacter pylori

What is a sign of Duodenal Ulcer

Intermittent pain in the epigastric area

- Relieved rapidly by ingestion of food or antacids

- Pain 2-3 hours after meal

- Pain at nigh

What is the big difference between Duodenal Ulcer and Gastric Ulcer

Food relives pain for Duodenal

Food causes pain for Gastric

What is the most common Peptic Ulcer

Duodenal Ulcer

Inflammatory Bowel Diseases

Chronic Gastrointestinal tract inflammatory bowel disease due to autoimmune Reactions

Pathogenesis of Inflammatory Bowel Diseases

- Alteration of the epithelial barrier functions

- Altered immune reactions to the intestinal flora

- Genetics

What are the two types of Inflammatory Bowel Diseases

Ulcerative Colitis and Crohn’s Disease

What is Ulcerative Colitis

Chronic inflammatory disease that causes ulceration of the mucosal layer of the sigmoid colon and rectum

-Begins at the rectum and then goes to colon

- Intermittent periods of remission and exacerbation

- Lesion: continuous & limited to the mucosa; NO skipping

Symptoms of Ulcerative Colitis

- Diarrhea

- Urgency

- Bloody stool

- Mucus in stool

- Cramping

- Malabsorption and malnutrition usually not common

What is Crohn’s Disease

Crohn’s disease

- Idiopathic

- Granulomatous

- Inflammatory

- Transmural: existing or occurring across the entire wall of an organ or blood vessel.

- Affects any part of the GI; mouth to anus

- Skips lesions

- Prolonged diarrhea

- Abdominal pain and fatigue

- One side of intestinal wall could be effects but not the other

- Interference with digestion and absorption

- Hypoproteinemia, malnutrition, steatorrhea

- Anemia→ malabsorption of b12 and folic acid

Complications for Crohn’s Disease

- Adhesions

- Fissures: small tears

- Fistulas: abnormal opening between two structures

What is the treatment for IBD

- Achieve remission

- Prevention of flare ups

- Anti-inflammatory medication: Sulfasalazine and Glucocorticoids

- Immunotherapeutic agents

- Antimotility agents

- Antimicrobials

- Diet, lifestyle, and nutritional

Surgical resection: last option

- Ileostomy or colostomy

What is Clostridioides Difficile

- Most common nosocomial diarrhea

- Also called pseudomembranous colitis

- Normal gut flora is altered by broad spectrum antibiotics → C. diff will flourish within colon

What is Important to know for Colorectal Cancer

- 3rd most common cancer diagnosis & mortality among cancers

Risk Factors for Colorectal Cancer

- Personal family history increases risk factors

- Type 2 diabetes

- Risk goes up with age

- Ulcerative colitis are more prone to colon cancer

Diagnostics for Colorectal Cancer

- FIT test annually

- Colonoscopy every 10 years starting at age 50

Start at age 40 if someone in family has history of colon cancer

- Every 5 years at age 40 or every 5 years starting 10 years before their diagnosis

Preventions of Colon Cacer

- Healthy Diet

- BMI normal

- Activity that involves exercise

- Healthy lifestyle

What is Portal Hypertension

High blood pressure in the portal venous circuit

- Causes varicose veins

- Splenomegaly

- Vomiting of blood from esophageal varices is the common sign

What is Ascites

- Accumulation of fluid in the peritoneal cavity

- Cirrhosis is the most common cause

Abdominal distention and increased girth

- Weight gain

Diagnostics

serum-ascites albumin gradient

Treatment

-paracentesis

What is Hepatic Encephalopathy

Spectrum of neuropsychiatric abnormalities in patients with liver dysfunction after exclusion of brain disease

Signs and symptoms of Hepatic Encepholathy

- Personality change

- Intellectual impairment and memory loss

- Lower level of consciousness

- Tremor of the hands

- Stupor, coma, death

Pathogenesis of Hepatic Encephalaopathy

- Astrocyte dysfunction

- Excess plasma ammonia

What is Hepanorenal Syndrome

Functional renal failure that develops as a complication of liver disease

Manifestations of Hepanorenal Syndrome

- Oliguria

- Hypotension

- Peripheral vasodilation

All associated with advanced liver disease

What is significant Hepanorenal Syndrome

Acute or gradual onset

What is Jaundice cause by

hyperbilirubinemia

Types of Jaundice

Prehepatic

- Before liver; blood vessel

- Transfusion reaction, sickle cell anemia, autoimmune disease

Intrahepatic

- Liver

- Hepatitis, cancer, cirrhosis, drugs

Extrahepatic

- After liver

- Gallstones, Inflammation, or tumor that block the flow of bile in the intestines

Alcoholic Liver Cirrhosis

- Irreversible inflammatory fibrotic liver disease

- Biliary channels becomes obstructed and cause portal hypertension

What is the causes of Cirrhosis

-Chronic hepatitis B or C

-Alcoholic Liver Disease

-Genetic Disorder

-Biliary disorder

-Autoimmune hepatitis

What is Initial stage of alcoholic liver cirrhosis

Fatty liver (Steatosis)

- Enlargement of liver

- Asymptomatic and reversible with reduced alcohol intake

What is second stage for Alcohol Liver Cirrhosis

Hepatitis

- Inflammation and cell necrosis

- Fibrous tissue formation → irreversible change

What is the third stage for Liver Cirrhosis

Cirrhosis

- Fibrotic tissue replaces normal tissue

- Little normal function remain

Signs for early Alcoholic Liver Cirrhosis

- Fatigue

- Anorexia

- Anemia

- Diarrhea

- Dull aching pain in right upper quadrant

Signs for Advanced Cirrhosis

- Ascites and peripheral edema

- Increased bruising

- Esophageal varices may rupture

- Jaundice

- Encephalopathy

Treatment for Alcoholic Liver Cirrhosis

- Avoidance of alcohol

- Paracentesis

- No dietary restriction

- Liver transplant

Cholelithiasis

gallstones

Cholecystitis

inflammation of the gallbladder from obstruction of the cystic duct

Choledocholithiasis

gallstone obstructing the biliary tract, i.e., the common bile duct

Cholangitis

bacterial infection superimposed on an obstruction of the biliary tree

What is the pathogenesis of Gallstones

- Impaired metabolism of cholesterol, bilirubin, and bile acids

- Hypomotility

- Supersaturation of bile with cholesterol

What are the two types of Gallstones

Cholesterol: most common

- Bile that is saturated with cholesterol

Pigmented

- Brown: infected bile

- Black: parenteral nutrition or chronic liver disease and hemolytic disease

Risk Factors for Gallstones

- Fat (obese)

- Forty(middle age)

- Female

- Fertile (has children)

- Oral contraceptive use

- Rapid weight loss

- Native american ancestry

What is Acute Cholecytitis

Gallstone lodged in the cystic duct

Intolerance to Fatty foods

What is a sign and symptoms of Acute Cholecystitis

Pain in the right upper quadrant or epigastric area

- Abdominal muscle guarding

Positive Murphy Sign

Vomitting

Jaundice

Diagnosis of Acute Cholecystitis

- CBC

- SMA7(metabolic panel)

- Liver panel

- Amylase

- Lipase

- Ultrasound- Best Choice

Treatment for Acute Cholecysitis

Surgery to remove gallbladder

-Laparoscopic

-Transluminal endoscopic

-Endoscopic retrograde

Medication to dissolve stones(short term)

What is Acute Pancreatitis

Inflammation resulting in autodigestion of the tissue

What are the main causes of Acute Pancreatitis

- Alcoholism

- Gallstones

What is to consider for Acute Pancreatitis

Can be acute or chronic

- Acute considered a medical emergency

Pathogenesis for Acute Pancreatitis

Obstruction of pancreatic flow

Pathophysiology for Acute Pancreatitis

Injury or damage to pancreatic cells and ducts→ leakage of pancreatic enzymes into the pancreatic tissue → cause autodigestion of pancreatic tissue and leak into the

bloodstream → leading to injury to blood vessels and other organs

- Hypovolemia and circulatory collapse may follow

Signs and Symptoms of Acute Pancreatitis

- Fever

- Nausea and vomiting

- Severe epigastric or mid-abdominal pain

- Pain radiating to the back

- Signs of shock

- Low grade fever till infection develops

- Abdominal distention

Diagnsotic Test for Acute Pancreatitis

- Serum amylase levels; initially elevated then fall after 48 hours

- Serum lipase levels elevated

- Liver panel

- CBC

- SMA7

What is treatment for Acute Pancreatitis

- IV fluids

- NPO

- NG tube for insertion and suction

- Treatment of shock and electrolyte imbalances

- Analgesic for pain relief