The Gastrointestinal System

Anorexia

diminished appetite

Anorexia-cachexia

loss of appetite that leads to muscle wasting

Dysphagia

difficult swallowing

Achalasia

lower esophageal sphincter does not relax

Hematemesis

vomiting blood

Melania

Dark stools

Hematochezia

bright red blood in stool

What is Hiatal Hernia?

Define: esophageal hiatus above the diaphragm becomes enlarged and the stomach passes through the diaphragm

Who: 60% of people over 60

Symptoms: heart burn and reflux

Diagnosis: endoscopy, contrast barium swallow, esophageal manometry

Treatment: PPI

Precautions: avoid Valsalva and flat supine exercises

What is gastoesophageal reflux?

Define: reflux of gastric contents into the esophagus

Who: 10-20% of americans increasing with age

Symptoms: heart burn 30-60 minutes after eating, chest pain, acid regurgitation, belching, vomiting, asthma, cough, laryngitis

Risk Factors: caffeine, nicotine, CNS depressants, estrogen therapy, chocolate, peppermint, citrus

Treatment: PPI, Antacids or H2 Blockers, avoid aggravating foods

What is a red flag in GERD?

Barretts esophagus which is precancerous changes in the types of cells (squamous to columnar) and increasing the risk of adenocarcinoma

Differentiate PPI, Antacids and H2 blockers

What is esophageal cancer?

Define: squamous cells carcinoma and adenocarcinoma (usually adenocarcinoma)

Who: more likely in men

Symptoms: dysphagia and weight loss

Risk factors: GERD turning into barrettes esophagus and then the glandular cells turn into adenocarcinoma

Diagnosis: endoscopy and biopsy

Treatment: chemo and radiation with a 5 year survival, alcohol and smoking cessation

What is esophageal varicies?

Define: fragile and dilated veins in the lower 1/3 of the esophagus right beneath the mucosa in the presence of portal hypertension

Risk factors: cirrhosis can increase the pressure into the esophagus and the veins get backed up

What is esophageal atresia?

A congenital condition where there is no connection between the esophagus and the stomach

What is tracheoesophageal fistula?

the esophagus goes into the lung

What is peptic ulcer disease?

Define: a break in the lining of the stomach or duodenum greater than 5 cm

Symptoms: burning, gnawing or cramping near the xiphoid radiating in the back

Risk factors: NSAIDS, asprin, H. pylori, stress, alcohol, caffeine

Diagnosis: finding H. pylori under a microscope

Treatment: PPI and antibiotics to get rid of the H. pylori, smoking cessation and alcohol

What is gastric cancer?

Define: adenocarcinoma from glandular cells

Who: men>women over 65

Symptoms: weight loss and abdominal pain nausea and vomiting, rectal bleeding, gastric outlet obstruction,

Treatment: surgery, chemo, radiation

Survival: 31% 5 year survival

What is pyloric stenosis?

Define: obstruction at the pyloric sphincter

Who: the first born child, more often males and preterm infants

Symptoms: projectile vomiting, palpable nodule that is firm and about the size of an olive in the right upper quadrant

Treatment: local resection of the pylorus

What is celiac disease?

Define: immune mediated disorder triggered by exposure of the digestive system to gluten and then B cells inhibit the breakdown of gluten

Symptoms: diarrhea, bloating, indigestion, flatulence, weight loss, abdominal pain

Risk factors: autoimmune disease and genetic predisposition

Diagnosis: screening for IgA antibodies

What is Crohn's disease

Define: the whole GI system and can affect all layers get better and worse

Symptoms: abdominal pain, diarrhea, bloody stool, arthritis and arthralgia

Diagnosis: colonoscopy and biopsy of the colon and ileum

Treatment: glucorticoids and sulfasalzine

What is ulcerative colitis?

Define: inflammatory disorder of the rectum and not continuous in the entire colon

Samy symptoms as Crohns basically diarrhea and joint pain

What is inflammatory bowel disease?

Define: abdominal pain with altered bowel habits in the absence of structural inflammatory or biochemical abnormalities

Who: related to chronic pain syndromes

Symptoms: lower abdominal pain with constipation and diarrhea

Diagnosis: Rome IV criteria

Treatment: antispasmodisc and dietary changes

What is diverticulosis?

Define: Outpouchings of the wall of the colon or small intestine

Symptoms: bloating, cramping, irregular bowel movement, vomiting, fever, anorexia

Risk factors: constipation, physical inactivity, red mean, obesity, smoking and NSAIDS

Diagnosis: CT of the abdomen and elevated WBC

When does diverticulitis become diverticulosis?

When the outpouchings become inflamed or infected and there may be complications like perforation

What is adenocarcinoma of the colon?

- second leading cause of cancer death

Symptoms: occult blood loss, melena, hematochezia, abdominal pain, changes in bowel habits

Risk factors: increasing age, male, history of polyps, diets high in sugar

Diagnosis: colonoscopy

Treatment: surgery and chemi

When should colon cancer be screened?

every 10 years when over 50

Intessuception

the bowel telescopes on itself

Volvulus

the bowel gets twisted

inguinal hernia

hernia around the inguinal ligament

Femoral hernia

hernia through the femoral canal

ubilical hernia

Hernia through the belly button

What is appendicitis?

Define: inflammation of the veriform appendix

Who: 15-19 years mostly males

Diagnosis: pain at McBurney point, peritonitis, elevated WBC

What is a rectal or anal fissure?

an ulceration or tear of the lining in the anal canal that presents as sharp pain

What are hemorrhoids?

varicose veins just below the mucous membranes beneath the rectum and anus a symptom is red blood surrounding the stool