HS 3150 - Chapter 8, 11, & 15

Chapters 8: Diseases of Digestive system & Chapter 11: Diseases of Urinary system

Digestive system

digestive tract processes and transports the products of digestion

• accessory organs manufacture and secrete endocrine and exocrine enzymes essential to digestive functions

Diseases of GI tract can

affect health and threaten life; interfere with:

• ingestion and digestion of food

• absorption of nutrients for metabolism

• elimination of wastes

General categories of diseases

erosion of tissue, inflammation, and infection; benign/malignant tumors, obstruction, malnutrition, and malabsorption syndrome

diseases of oral cavity and jaws

function of teeth is to breakdown food into easily digestible pieces; decrease in saliva production can adversely affect the digestive process; there can be a connection between oral infections and cardiovascular diseases, respiratory diseases and diabetes

Xerostomia

dried mouth

Missing teeth (malocclusion)

can alter the bite (occlusion); malocclusion eventually leads to jaw pain called temporomandibular joint disease (TMD)

• can lead to digestive disturbances and loss of nutrients

• bolting: inadequate chewing

four main causes of malocclusion

• dental decay

• dental injury

• congenitally missing

• impacted

Impacted 3rd molar

• wisdom tooth can become impacted and cause pain

• usually no symptoms until they begin to emerge

• decay much more often than other teeth

• become impacted when they do not have enough room to erupt

Dental caries (cavities)

• first appear as white spots (infection) on the tooth surface

• major symptoms in the early stage is mild toothache, with hypersensitivity to sweets and extreme temps

• eventually pulp of gums becomes inflamed, and pain is persistent; if untreated leaves bad taste in mouth, bad breath and affect taste of food

• avoid this by brushing teeth and flossing, mouthwash

• sugars can lead to cavities

Discolored teeth

• colors range from a slight yellow to brown and gray

• age causes yellowing, and smoking turns teeth brown

• certain drugs can cause discoloration of enamel

• things that can cause discoloration in teeth: blueberries, certain drugs, mouthwashes, coffee, tea, red wine

Treatment for discolored teeth

superficial treatment: polishing machine (on surface)

deep treatment: bleaching

Gingivitis

• inflammation and swelling of the gums

• gums are normally pale, pink and firm but become red, soft, and shiny…as well as bleed easily

• can lead to periodontitis: destruction of gums and bone disease

• Common cause is plaque {inflamed/swollen causes pocket formation}

Periodontitis

• end result of gingivitis

• Pockets form between the teeth and gums, gradually deepen and expose roots

• Plaque develops and causes unpleasant tastes in the mouth, “offensive breath”

• Tooth or teeth become extremely sensitive to extreme temperatures

Malocclusion (faulty bite)

• signs include a protrusion or a recession of the jaw; teeth that are turned or twisted out of position because of crowding

• generally results from genetics; crowing can result from the early loss of primary teeth or oral habits

• keep fingers out of mouth

Temporomandibular joint disorder (TMD or TMJ)

• when joints are inflamed or dieseased; jaw movement is markedly limited

• patient reports hearing clicking sounds during chewing; experiences severe pain or aching in or around the ears and jaw joints made worse by chewing

• pain and limitation are usually bilateral

Tooth Abscesses

a tooth abscess is a pus-filled sac that develops in the tissue surrounding the base or root

• persistent ache or throbbing and can be extremely painful when biting/chewing food

• forms when a tooth is decayed or dying or when tooth structure loss exposes the nerve to bacteria

mouth ulcers (2 most common types)

a ulcer in the mouth is a lesion on mucous membrane, exposing underlying sensitive tissue

• can appear as pale-yellow spots with red borders

• types: aphthous ulcer and traumatic ulcer

aphthous ulcer

also known as a canker sore; caused by stress, certain acidic foods, candy, illness

traumatic ulcer

caused by: injuries (braces, hot food, toothbrush, dentures)

• should heal in 10 days; go to doctor if still present; not viral

• treatment: mouthwash or salt water rinse

Herpes Simplex

a contagious, recurrent viral infection that affects the skin and mucous membranes

• these blisters can develop on the lips and inside the mouth, producing painful ulcers

• ulcers can form on the gums, causing them to become red and swollen

• the types are based off the area located

herpes simplex type 1

generally in the mouth

herpes simplex type 2

generally genitals area

Thrush

• candidiasis of oral mucosa, involving the mouth, tongue, palate, and gums; can happen to babies, elders, immunocompromised people

• produces sore, slightly raised, pale yellow patches in the mouth sometimes the throat

• fungus candida albicans causes mot cases of thrush; extended use of antibiotics can cause this

Gastroesophageal reflux disease (GRED)

• Clinical manifestations of regurgitation of stomach and duodenal contents into the esophagus

• patient typically experiences belching with a burning sensation in the chest and mouth

• chronic and frequent GERD:

  1. difficulty swallowing and inflamed esophagus along with bleeding

• causes: overeating, pregnancy, weight gain

Esophageal varices

superficial veins lining esophagus become dilated and twisted at the distal end

-maybe asymptomatic until a rupture

-result from increased pressure within the veins, develops when venous return to liver is obstructed

esophagitis

inflammation and tissue injury of the esophagus

• main symptom is burning chest pain, which can make the patient believe that he or she is having a heart attack; onset of pain typically follows eating or drinking

corrosive esophagitis

severe inflammation resulting from the ingestion of a burning chemical

• treatment: no hot, spicy foods, bland diet

Gastric ulcer

patient is asymptomatic, especially if caused by NSAID ingestion

• some patient experience pain or a feeling of uncomfortable fullness after eating

• common cause is helicovacter pylori infection

Duodenal ulcer

symptoms vary from subtle mid-epigastric pain and heartburn to intense pain in the upper abdomen

• common cause is helicovacter pylori infection

Gastritis

stomach lining becomes inflamed the patient experiences epigastric pain, indigestion, and a feeling of fullness; when gastric mucosa is inflamed and swollen, it can bleed;

• main cause is H. pylori, but alcohol, smoking, aspirin, & other anti-inflammatory drugs, & stress can lead to this

Acute appendicitis

• Inflammation of the appendix

• classic symptoms: abdominal pain, vague discomfort around the navel that localizes in the right side lower quadrant

• obstruction of the narrow lumen initiates the clinical illness

• surgical removal of the appendix is treatment & performed

Hiatal Hernia

defect in the diaphragm that permits a segment of the stomach to slide into the thoracic cavity

• Symptoms: heartburn, chest pain, swallowing, difficulty swallowing

• can be caused by a congenital defect in the diaphragm or a weakness due to old age, trauma, and obesity

Abdominal hernia

• the condition in which an organ protrudes through an abnormal opening in abdominal wall

• signs/symptoms: vary with size and location of the hernia

• severe pain because hernia is trapped or strangulated

types of abdominal hernias (locations)

• incisional: organ protrudes at site of previous surgery

• umbilical: from belly button

• indirect inguinal: at opening of inguinal ring

• direct inguinal: near the opening of inguinal canal

• epigastric: upper midline

• Femoral: located on femoral canal

Crohn’s Disease

a chronic inflammatory disorder of the GI tract

• all layers of the bowel wall are inflamed with edema

• patients are accompanied with chronic diarrhea, or abdominal pain

• any portion of the GI tract from mouth to anus can be affected

• cause unknown

Ulcerative Colitis

a chronic inflammatory bowel disease affecting mucosa and submucosa of the rectum and colon; cause unknown

• symptoms: intermittent episodes of bloody diarrhea, abdominal cramping, urgency to defecate, and stools with mucus

• stools become looser and more frequent with cramping and rectal pressure

Gastroenteritis

Acute inflammation of the lining of the stomach, and intestines

• stomach and intestines remain protected by normal bacteria flora and acid secretions and the motility of the GI tract

• cause: can be result of infection, chronic consumption of acidic, caffeine, alcohol, spicy food, aspirin

• Symptoms: increased motility, rapid fluid loss (aka travelers diarrhea

Intestinal Obstruction

mechanical or functional blockage of intestines

• occurs when contents of the intestines cannot move because of partial or complete bowel blockage

• sign: severe pain, nausea, vomiting, blocked abdomen without passage of stool/gas

• functional blockage treatment is IV feed

Mechanical blockage vs functional blockage

mechanical is fecal impaction or tumor and functional is when muscles don’t work normally

Diverticulosis

diverticula (out pouches) of the mucosa that penetrate weak points in the muscular layer of the large intestine

• characterized by defects in the muscular layer of large intestines

• usually causes no symptoms

Diverticulitis

the inflammation of diverticula

Pseudomembranous Enterocolitis

in small and large intestine, you have dead tissue and plaque is sticking to dead tissue

• marked by severe greenish, foul-smelling watery diarrhea

• cause is long term use of antibiotics

Short bowel syndrome

insufficient function of the small bowel to absorb nutrients, fluid, vitamins, and minerals.

• significant signs of malnutrition is noted and develops when the length of the small bowel has been altered by disease or surgery

• diarrhea and abnormal stools occur

Irritable bowel syndrome (IBS)

Chronic abdominal pain, bloating, and discomfort and erratic dysfunction of bowel habits; cause unknown

• classic symptoms include episodes of cramping or aching abdominal pain

Peritonitis

when irritated or infected, the peritoneum becomes hyperemic, meaning the fluid accumulates (edema)

• Symptoms include: abdominal pain, nausea, vomiting, weakness, and sweating

• inflammatory process of peritonitis has potential to cause abscesses and adhesions

Hemorrhoids

Lump in rectal and anal area, could be painful or painless, if painful it may indicate thrombosis of external hemorrhoid

• when symptomatic patient may experience rectal pain, itching, protrusion, or bleeding

• veins in rectal and anal area become varicose, swollen, and tender as a result of blockage

• caused by childbirth or straining due to constipation

Cirrhosis of the Liver

Chronic degenerative disease that is irreversible and involves slow deterioration of the liver, resulting in the replacement of normal liver cells with hard fibrous scar tissue; early stages of disease symptoms are vague

• COMMON causes are alcoholism and exposure to chemicals

Wilson’s disease

the uncommon cause of cirrhosis of the liver; genetic disorder cause copper to build up in body which leads to cirrhosis of liver

Viral Hepatitis

most cases are by one of several viral agents

• treatment is symptomatic in acute cases; some chronic cases respond to antiviral agents

Hepatitis A

common cause fecal to oral transmission; poor hygiene; highly contagious

Hepatitis B

blood/fluid borne; most common worldwide

Hepatitis C & D

blood/fluid borne

Hepatitis E

contaminated food and water

Cholelithiasis

Abnormal gallstones that form in bile, which lead to inflammation

• may be asymptomatic until bile duct become obstructed by the stones; nausea and vomiting accompany the pain

Cholecystitis

acute or chronic inflammation of the gallbladder due to obstruction of the cystic duct

• the patient can experience acute colicky pain localizes in upper right quadrant

Acute and Chronic Pancreatitis

can range from mild and self self-limiting to chronic, fatal destruction of pancreatic tissue

• sudden onset of severe abdominal pain, which radiates to the back, along with nausea and vomiting

• causes can include: alcoholism, trauma, infection, elevated calcium levels, structural anomalies, hemorrhage, hyperlipidemia

COMPONENTS OF A SUCCESSFUL WEIGHT LOSS PROGRAM

• Patient self-control

• Supportive Physician

• Reduced-calorie diet

• Nutritionally adequate diet

• Increased physical activity

• Do not focus on portion control alone

Malnutrition

Disrupts the body's metabolic processes, disturbing physical structure and biological function

• Symptoms: decreased or increased appetite, loss of energy, diarrhea, skin lesions, hair loss, poor nails, edema

• Causes: depriving yourself of food energy

• not everyone who is slender is malnourished and weight/size does not determine malnourishment

Hypervitaminosis

Condition of toxicity resulting from an excess of any vitamin

• four fat soluble vitamins: A, D, E, K

• TOXICITY: Vitamins A,D,E,K,C

Facts of obesity

• Overweight and obesity are identified objectively using BMI

• A major correlation has been made between greater energy intake and output

• Obesity and the regional distribution of fat have a strong genetic component

Malabsorption Syndrome

A group of disorders in which intestinal absorption of dietary nutrients is impaired; main cause of malabsorption syndrome is defective mucosal cells in the small intestine

• symptoms: impaired digestion, inability to absorb fat or other components of diet

Celiac Disease

Disease of the small intestine that is characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine

• Symptoms: weight loss, anorexia, abdominal cramping and distention, diarrhea, intestinal bleeding

• Cause may be a toxic or immunologic reaction to a component of gluten

Anorexia Nervosa

restriction of food intake leading to low body weight

Bulimia

eating or bingeing and then throwing up

Urinary system

• is responsible for producing, storing, and excreting urine

• responsible for also cleansing blood of waste products

• regulating the water, salts, and acids in the body fluids ensures homeostasis

The kidneys

enable reabsorption of necessary nutrients, water and electrolytes

• three regions: cortex, renal pelvis, and medulla

• blood enters kidney by way of renal arteries and leaves through renal veins

Nephrons

• each kidney is composed of about 1 million nephrons

• urine transports from nephron to renal pelvis and then ureters

• composed of: bowman’s capsule (glomerulus) and loop of Henle which are responsible for filtration, reabsorption and secretion of urine

Urea

waste product that passed through glomerulus

Types of disturbances in renal function

• infection

• scarring

• toxic necrosis

• trauma

• congenital or acquired structural defects

Urinalysis

looking at the characteristics and constituent compounds of urine

• color & clarity (normal is pale to dark yellow)

• chemical nature (pH should be 6.5/slightly acidic)

• odor (no fowl or fruity smell)

• specific gravity (measurement of urine concentration)

constituent compounds & how much should be found in urine

• glucose and ketones should not be present (if present is a sign of diabetes)

• protein is acceptable from none to a trace (high level means kidney not functioning properly)

• bile and bilirubin (should have no trace; if present something wrong with liver or gallbladder)

• casts are particles in urine made of white/red blood cells or fat (should have none to small trace)

• nitrogenous waste or urea

• crystals are a result of minerals and salts in urine (none to very small trace)

• fat droplets (none)

Culture and sensitivity of Urine

• culture: urine specimen places in/on culture medium to identify pathogens

• sensitivity: testing the pathogens against antibiotics to determine effective treatment

Renal Diagnostic Tests

• clearance test: look at glomerulus filtration rate

• concentration and dilution test: look at ability of renal tubes to retain and eliminate water

• serum creatine and BUN: tells us how well protein is being metabolized

• Protein in Urine Test: tells us how the glomerulus membranes are filtering and are they normal

Symptoms of urinary disease

• Nausea and loss of appetite

• fever

• headache

• edema

• flank or lower back pain

• decreased urinary output

• hypertension

• pruritus (itchy skin)

Acute glomerulonephritis

• can be primary disease of kidneys or develop due to systemic disease

• marked by proteinuria, edema, and decreased urine output

• can be idiopathic or result from an immune trapping antibodies

• Treatment: antibiotics, diuretic, steroid, limit salt intake

Chronic glomerulonephritis (CGN)

a progressive, non-infectious disease that leads to irreversible renal damage and eventually kidney failure

• results in inflammation followed by progressive destruction of the glomeruli

• leads to hypertension, hematuria, proteinuria, oliguria (decreased output) and edema

• immune mechanisms suspected to be a major cause of CGN

Dialysis

filters out unwanted elements from the blood by diffusion across a semipermeable

• the proper fluids, electrolytes, and acid-base balances are maintained in the body

Hemodialysis

removes impurities or wastes from patients blood by using an artificial kidney

Peritoneal dialysis

uses a dialysate solution and peritoneal membrane to filter out harmful toxins and excessive fluids

• two types: CAPD or CCPD

CAPD (continuous ambulatory peritoneal dialysis)

uses gravity to aid dialysate solution in filtering process, thereby draining waste into bag worn around the waist

• takes about 15 minutes per session; repeated 3 too 4 times per day and once at night

CCPD (continuous cycling peritoneal dialysis)

uses a machine that continuous cycles the dialysate and extracts the waste; typically at night

Kidney Transplantation

surgical placement of a donor kidney into a patient with irreversible renal failure

• immunosuppressive agents are used to prevent or treat rejection syndrome

• evaluation of donor and the recipient to find good match offers the best chance for a good prognosis

Nephrotic syndrome (nephrosis)

a kidney disorder causing excessive protein (mainly albumin) loss in urine, leading to swelling due to retained water and sodium

• sometimes referred to as protein-losing kidney

• no cure; treatment is prevent further damage

• caused by damage to glomeruli such as diabetes or an autoimmune disease

Nephrotoxic agents

• solvents (chemicals)

• heavy metals

• pesticides

• antibiotics

• nonsteroidal anti-inflammatory drugs

• iodinated radiographic contrast media

• antineoplastic agents (cancer meds)

• poisonous mushrooms

Acute renal failure (ARF)

sudden and severe reduction in renal function; is reversible with quick treatment

• symptoms: decreased urine output, gastrointestinal disturbances, headache, drowsiness

• causes are classified: results is diminished blood flow to kidney; involve intrarenal damage or disease; result from mechanical obstruction of urine flow

Chronic renal failure (CRF)

results from the gradual and progressive loss of nephrons

• patient feels tired and weak; retention of water causes hypertension and edema

• The underlying cause must be treated

• Treatment is dialysis and kidney transplant

Stages of CRF (glomerulus filtration rate)

1: 90 and up (eGFR) (normal function)

2: 60-89 (mild)

3a: 45-59 (mild to moderate)

3b: 30-44 (moderate to severe)

4: 15-29 (severe)

5: 15 and lower (kidneys are not working)

Pyelonephritis (Most common type of renal disease)

usually is caused by infection, pregnancy, or renal calculi

• Pus collects in the renal pelvis, with the formation of abscess

• Patient experiences rapid onset of fever, chills, nausea vomiting, and flank pain

• Bacteria that ascend from the lower urinary tract to the kidneys usually cause pyelonephritis

• Inflammation of the renal pelvis or 1 or both kidneys

• Signs: fowl smelling urine

• prevention: drink water

Hydronephrosis

abnormal dilation of the renal pelvis

• usually chronic condition, with destruction of the kidneys without pain or symptoms

• caused by buildup of pressure in the kidney because of an obstruction

• treatment: depends on underlying cause of obstruction (cancer, calculi)

Renal Calculi

Kidney stones can be solitary or multiple and vary in size; Patient's symptoms vary with the degree of obstruction

• With infection or blockage:

  1. Patient experiences renal colic

  2. Urinary urgency and other urinary symptoms

  3. Nausea and vomiting, hematuria, fever, chills, and abdominal distention

Infection cystitis and Urethritis

Inflammation and infection usually caused by an ascending bacterial invasion of the urinary tract

• Causes urinary urgency, and frequency, dysuria, and even incontinence

• Treatment consists of organism-specific antibiotics or urinary antiseptic therapy

• antibiotics kill bacteria but antiseptic prevents growth of bacteria

Diabetic Nephropathy

Clinical manifestations include urinary retention, hypertension, nausea, and protein in the urine

• Diabetic glomerulosclerosis is a complication of diabetes mellitus

  1. Lesions of the glomeruli eventually cause the filtration rate to decrease

• Treatment plan must be individualized

• Blood pressure control and the prolongation of proper kidney function

Polycystic Kidney disease

Slowly progressive and irreversible disorder in which normal tissue is replaced by grape-like cysts

• Condition is bilateral, with cysts that form from dilated nephrons and collecting ducts

• The kidneys become grossly enlarged, with compression of surrounding tissue leading to impaired renal function and renal failure

• Patient experiences lumbar pain, abdominal pain and tenderness, hematuria, and systemic hypertension

• two types: 1 is inherited and the 2 is someone who had CKD and long term dialysis

Urinary catherization

Involves the insertion of a catheter into the urinary bladder through the urethra for the withdrawal of urine for irrigation of the bladder with a therapeutic solution

• Strict sterile technique is necessary to prevent cystitis

Neurogenic bladder

insult to brain, spinal cord. or the nerves supplying the lower urinary tract may result in the ability to empty the bladder of urine or to maintain continence

• treatment: prevention of UTI and attempts to restore normal function

Classification of Neurogenic bladder (5 classifications )

1. Spastic (involuntary contractions, frequent urination, muscles become stiff)

2. Flaccid (weakening of bladder muscles)

3. Reflex (involuntary bladder contractions, frequent urinations)

4. Atonic (loss of muscle tone, bladder get distended)

5. Mixed (combination of above)

Urinary Incontinence

partial or total loss of voluntary control of the bladder with inability to retain urine

• is sometimes experienced temporarily after childbirth due to stretching

• neurologic damage may result in permeant incontinence

5 main types of incontinence

• Stress incontinence: uncontrollable leakage of urine from the urinary bladder; occurs during physical exertion; caused by weakening of pelvic floor muscles; hormonal aging and menopause

• Urge incontinence: sudden feeling to urinate but cant hold

• Overflow Incontinence: bladder not completely empty

• Functional incontinence: physical or mental disability

• Mixed Incontinence: mix of multiple

Overactive Bladder

the uncontrollable urge can result in urinary incontinence with the accidental loss or leakage of small amounts of urine

• the individual with this symptoms can never be sure when they will occur

• the muscles transmit false signals to the brain before bladder is full

Trauma

• causes: accidental, self-inflicted, violence

• Effects:

  • Interfere with body to functions

  • Alter homeostasis of body