GI TRACT DISORDERS

these are all the GI tract disorders and their manifestations, etiology and pathogenesis.

What is “GERD”.

Gastroesophageal Reflex Disease

What causes GERD?

The back flow of acidic contents from the stomach into the esophagus.

What is the etiology of GERD?

Anything that may alter the strength of the LES. (Lower Esophageal Sprinter)

examples are:

• Increase in abdominal pressure ( Pregnancy, Obesity )

• Diet ( too much fatty foods, caffeine or alc )

• Over eating ( it relaxes your LES )

• Cig Smoking

• Congenital Defects ( Hiatal Hernia )

What is the pathogenesis of GERD?

When the pressure in the stomach overrides the LES refluxing into the esophagus.

What are the manifestations of GERD?

• Dysphagia… feeling of lump in throat

• (Dyspepsia) Heart Burn

• Regurgitation

• Chest pain

• Pulmonary symptoms from acidic being high enough… (cough, asthma, laryngitis)

What is a Hiatal Hernia?

When a portion of the stomach slips above the diaphragm.

What causes a Hiatal Hernia to occur?

This occurs because the diaphragm aids in LES by helping support it and keep it closed. When you get that hernia or weakness in the diaphragm it causes the stomach to slip up there. This makes you look the strength from the outside that keeps the LES tight.

What is the etiology of Hiatal Hernia?

• Pregnancy, Obesity, aging

• Tight clothing, straining

• Sudden Physical exertion ( lifting weights )

• abdominal surgery

Hiatal hernia Manifestations

same as GERD

• Chest pain

• Dysphagia

• Heart Burn

What is gastritis?

it is the inflammation of stomach lining which irritates the stomach lining causing irritation and pain.

What is acute gastritis and what causes it?

It is just a temporary stomach ache caused by what you eat or if you take ibuprofen on an empty stomach.

What is chronic gastritis?

It is when you just cant get over that inflammation.

• anything that causes atrophy or thinning of the stomach lining.

What does chronic gastritis eventually lead to?

it eventually leads to a decrease of hydrochloric acid and intrinsic factor.

Why is the irritation occurring in gastritis so bad?

When your stomach is irritated it alters the amount of acid your stomach mucosa can make.

What does gastritis feel like?

it feels like your stomach is on fire.

What are the manifestations of gastritis?

• anorexia ( not interested in eating )

• diarrhea

• vomiting ( of blood )

• hematosis ( blood formation )

• abdominal pain

• anemia ( from all the blood loss/loss of intrinsic factor )

What is PUD?

Pepticular Ulcer disease

What is pepticular ulcer disease?

it is when the stomach lining erodes from pepsin or acid causing an ulcer in that lining. ( usually after ongoing gastritis )

What happens when there is that irritation in the mucosa lining?

It erodes and gets thinner and breaks through gaining access to the other layers ( submucosa and muscular layer ) which are not strong enough for that acid or pepsin causing bleeding and pain.

What is the etiology of PUD?

it usually caused by excessive nsaid use or h pylori. ( any trauma to the lining)

What is H pylori?

A bacteria that causes ulcers

What two locations do PUD occur in?

Gastric and Duodenal

What happens with PUD in the gastric location?

This is when the protective mucosa layer is broken down allowing the acid to irritate the other layers.

What causes acid in that gastric location? (PUD)

This is caused by NSAIDS, alcohol, bile acids and aspirins.

What happens with PUD in the duodenal location?

This when an inappropriate excessive secretion of acid occurs and the activity of the vagus nerve increases.

What happens in both locations during PUD?

An H pylori infection which manifests a slow healing of ulcer.

What are the manifestations of PUD?

• pain: gnawing, burning, cramp-like ( happens when stomach is empty, in between meals or at night )

• pain relieved by eating

• pain relieved by antacids

• epigastric tenderness

What is appendicitis?

Inflammation of the appendix.

What causes appendicitis?

When food or stool or anything else gets caught in the appendix causing pressure is ischemia ( reduced blood flow), causing necrosis ( death of body tissue )

What are manifestations of appendicitis?

• pain around belly button area.

• pain in right lower quadrant (mc burneys point)

• rebound tenderness ( extreme pain after touch is removed)

• malaise ( feeling of discomfort )

• fever or other systemic signs of inflammation ( elevated WBC )

Where is the appendix located?

in the right lower quadrant and it is a small pouch connected to the large intestine.

What is “IBS”?

Irritated Bowel Syndrome

What is the etiology of IBS?

it is unknown.

What is the pathophysiology of IBS?

It is a functional disease that causes alternating diarrhea, constipation and cramping.

How does IBS happen?

spasms that occur in the bowel and the colon related to stress or food. it is usually relieved when you defecate.

What are the manifestations of IBS?

it is a syndrome which means a collection of symptoms.

• abdominal pain

• diarrhea

• cramping

• constipation

• bloating

• relief with defection

What is “IBD”?

Inflammatory bowel disease

What is inflammatory bowel disease?

It is when the bowel itself is inflammed.

What is Crohns disease?

It is when the whole bowel wall is inflamed. ( anywhere along the gi tract) and it develops slowly.

What does this look like in Crohns disease?

It has a cobblestone appearance (bumpy) and skip lesions.

What are skip lesions?

It is when the fissures, fistulas and accesses skip around the bowel and they are present in some places and absent in some.

What usually causes IBD?

The cause is unknown but it is usually genetic or environmental.

Is crohns immune related or autoimmune?

it is immune related because the immune system is over active but not attacking itself.

What causes IBD symptoms?

There are caused when the bowel is inflamed and that inflammation causes a blockage of the lymph vessel manifesting symptoms.

What does the inflammation in IBD eventually lead to?

It eventually leads to painful, bleeding and mucuos in the stool.

What are the manifestations of IBD?

related to inability of bowel to absorb contents adequately

• pain in the RLQ

• intermittent 5-10 stools per day ( mucosy, blood streaks )

• fluid and electrolyte imbalance

• fever, elevated wbc (systemic from inflammation )

• iron deficiency anemia

• hypoalbunemia, wt loss, malnutrition

• mucous, blood in stool

What does the malabsorption in Crohns eventually lead to?

It eventually leads to malnutrition because the bowel is not absorbing the nutrients it needs to correctly.

Is Crohns chronic or acute?

Chronic

Is Ulcerative colitis Chronic or acute?

Chronic