CH 36 (P2) - GI Disorders

disorders involving alterations in the integrity of the gastrointestinal tract wall

• gastritis

• gastroenteritis

• peptic ulcer disease

gastritis

inflammation of the stomach lining

acute gastritis

caused by

• ingestion of irritating substances (alcohol; aspirin; tobacco; NSAIDs)

• infections (viral; bacterial)

• autoimmune diseases

chronic (superficial) gastritis

caused by Heliocobacter pylori

mode of transmission of H. pylori

• person to person (primary)

• fecal-oral route

• reservoir in water sources

clinical manifestations of gastritis

• asymptomatic

• anorexia

• nausea/vomiting

• postprandial (post eating) discomfort

• hematemesis (vomiting up blood)

treatment for gastritis

• remove offending agent

• manage & treat causative infection

complications of gastritis

• peptic ulcer disease

• atrophic gastritis

• gastric adenocarcinoma

• mucosa-associated lymphoid tissue lymphoma

• decreased acid & intrinsic factor (= pernicious anemia)

gastroenteritis

inflammation of stomach & small intestine (usually resolves on its own)

acute gastroenteritis

caused by:

• direct infection of GI tract lining by pathogenic bacteria

• bacterial toxin

• imbalance in normal bacterial flora of GI tract

chronic gastroenteritis

usually the result of another (inflammatory) GI disorder (ex: Crohn’s disease)

clinical manifestation of (acute) gastroenteritis

• (secretory) diarrhea

• abdominal discomfort & pain

• nausea

• vomiting

• fever

• malaise

treatment for gastroenteritis

replace fluid & electrolytes (especially elderly & children) ex: oral rehydration solution or gatorade (SOLELY WATER = WORSE)

peptic ulcer disease (PUD) refers to disorders of

the upper GI tract caused by action of acid & pepsin

peptic ulcer disease (PUD)

• characterized by injury to the mucosa of the esophagus, stomach or duodenum

• may range from slight mucosal injury to severe ulceration

complications of peptic ulcer disease

perforation; bleeding

gastric PUD

caused by breakdown of protective mucous layer that normally prevents diffusion of acids into gastric epithelia b/c of chronic irritations

duodenal PUD

inappropriate excess secretion of acid

• increased basal activity of vagus nerve

result of increased activity of vagus nerve in duodenal PUD

• stimulation of pyloric antrum cells to release gastric to act on gastric parietal cells to release HCl

• high level of HCl

causes of PUD

• key role: H. pylori

• NSAIDs

• stress (glucocorticoids)

• smoking

• genetics

H. pylori relation in promoting gastric & duodenal ulcer formation

• thrives in acidic conditions

• slows rate of ulcer healing

• high rate of recurrence

clinical manifestations of gastroenteritis

• epigastric burning pain

• pain of gastric ulcers on empty stomach or after meal

• pain of duodenal ulcer 2-3 hrs after meal which is relieved by ingesting more food

diagnosis of gastroenteritis

• endoscopy (tube insertion)

• testing for H. pylori (breath test, fecal Ag test, serology test)

treatment of gastroenteritis

H. pylori antibiotics; H2 antagonists; proton pump inhibitors; sucralfate; smoking cessation; avoidance of ASA & NSAIDs; stress reduction; avoiding irritating foods

inflammatory bowel disease (IBD) refers to

the two separate disease entities of UC & CD

IBD risks

• onsets in childhood or young adulthood

• possible 2nd peak btwn 50-80 yrs

• CD: more females

• UC: more males

• Jewish & white

• western diet

IBD is typically characterized by

exacerbations (sudden worsening) & remissions (significant reduction)

causes of IBD not confirmed but factors involved are

genetic, environmental, & immunologic

ulcerative colitis (UC)

inflammatory disease of the mucosa of the rectum & colon

UC characterization & risks

• inflammation @ base of crypts of Lieberkuhn

• large ulcerations in epithelium

• 7-10+ yrs = associated w/ increased cancer risks

hallmark clinical manifestations of UC

• bloody (exudative) diarrhea

• lower abdominal pain

• rectal bleeding

treatment for UC

• mainstay for acute: corticosteroids

• antibiotics

• salicylate

• immunomodulating agents

• cut out infected parts

crohn disease (aka regional enteritis or granulomatous colitis)

inflammation of the GI tract that extends through all layers of the intestinal wall

characterization of crohn disease

• affects proximal portion of colon or terminal ileum

• transmural

• blockage & inflammation of lymphatic vessels

• RLQ mass

clinical manifestations of CD

• ulcerations

• strictures

• fibrosis

• fistulas (abnormal openings)

• constant abdominal pain

• possibly bloody stool

treatment of CD

• no cure

• can’t cut out infected parts

• smoking cessation

• drugs similar to UC

enterocolitis (appendicitis)

inflammation of the vermiform appendix b/c of obstruction by lumps of feces

clinical manifestations of appendicitis

• periumbilical pain

• RLQ pain & tenderness (McBurney’s point)

• nausea/vomiting

• fever

• systemic signs of inflammation

treatment for appendicitis

• immediate surgical removal (best)

• antibiotics w/ fluid & electrolyte replacement

• localized abscesses may be managed w/ tube drainage

untreated appendicitis may result in

rupture of the appendix & subsequent peritonitis

irritable bowel syndrome (aka spastic colitis; irritable colon syndrome) [motility disorder]

• alternating diarrhea & constipation

• abdominal cramping

• no identifiable pathologic process

• mucus in stool

• nausea

causes of irritable bowel syndrome

unclear but slow wave activity of bowel is increased

treatment of irritable bowel syndrome

• antidiarrheal agents

• antispasmodic meds

• high fiber diet

• support groups

• therapies

malabsorption disorders of GI

failure of small intestine to absorb or normally digest one or more dietary constituents

causes of malabsorption disorders in GI system

• enzyme abnormalities

• infection

• radiation enteritis

• mucosal dysfunction (crohn, celiac, tropical sprue)

• post surgical intervention (dumping, short-bowel)

clinical manifestations of malabsorption disorder

diarrhea; passage of inappropriately processed intestinal contents; abdominal pain

celiac disease (malabsorption disorder)

• aka celiac sprue

• characterized by intolerance of gluten (protein in wheat (products))

celiac disease leads to

• inflammation & atrophy of the intestinal villi

• decrease in the activity & amt of surface epithelial enzymes

• malabsorption of ingested nutrients = malnutrition

treatment for celiac disease

• gluten-free diet

• supplemental iron, folate, B12, fat-soluble vitamins

• oral corticosteroids or other agents for refractory

colon cancer

second cause of cancer deaths; risks:

• increases after age 40

• high-fat, low-fiber diet

• polyps

• chronic irritation or inflammation

• hereditary

clinical manifestations of right side colon cancer

black, tarry stools

clinical manifestations of left side colon cancer

• intermittent abdominal cramping & fullness

• ribbon or pencil shaped stools

• blood or mucus in stool

clinical manifestations of rectum colon cancer

• constipation & diarrhea

• sensation of rectal fullness

• dull ache in rectum/sacral region

treatment for colon cancer

surgical removal; colostomy; chemotherapy, radiation or both