Gastrointestinal Tract

Anatomy
 mouth
 liver
•teeth
•tongue  gallbladder
•salivary glands
 pancreas
 esophagus

 pharynx

 stomach

 small intestine

 colon
 Functions
1. Ingestion: eating
2. Secretion: release of water, enzymes & buffers
3. Mixing & propulsion: movement along GI tract
4. Digestion: mechanical and chemical breakdown of foods
5. Absorption: getting it into the body
6. Defecation: dumping waste products = defecation
Digestion
Proteins
Carbohydrates
Fats
Fig. 16.9
Fig. 16.2
Diagnostic techniques
 CBC

 Upper GI series

 Barium enema

 UTZ

 CT scan
Disorders of the
Digestive System
 Reflux esophagitis

 gastritis

 peptic ulcers

 irritable bowel syndrome

 neoplasms
Reflux Esophagitis
 LES

 Heartburn

 Barret’s Esophagus

 Antacids

 H2-receptor blockers
 Gastritis
 Inflammation of the lining of the stomach

 The stomach lining may be "eaten away," leading to sores (peptic ulcers) in the
stomach or first part of the small intestine.
 Left untreated, these ulcers may bleed

 Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis).

Signs and Symptoms:

most common - stomach upset and pain

Other symptoms of gastritis:

* Indigestion (also called dyspepsia)
* Heartburn
* Abdominal pain
* Hiccups
* Loss of appetite
* Nausea
* Vomiting, possibly of blood (called hematemesis) or material
that looks like coffee-grounds
* Dark stools
Causes

• infection,
• irritation,
• autoimmune disorders (disorders caused by the body's
immune response against its own tissues), or
• backflow of bile into the stomach (bile reflux)

Infections can be any of the following types:

* Bacterial (usually Helicobacter pylori )

* Viral (including herpes simplex virus)
* Parasitic
* Fungal
Irritation can be caused by a number of things, such as the following:

* Long-term medication use (for example, aspirin, ibuprofen or

other anti-inflammatory drugs [called NSAIDS])
* Alcohol use
* Cigarette smoking
* Chronic vomiting
* Coffee and acidic beverages
* Excess gastric acid secretion (such as from stress)
* Eating or drinking caustic or corrosive substances (such as
poisons)
* Trauma (for example, radiation treatments or having swallowed a
foreign object)
Helicobactor pylori- a common bacterial cause of gastritis and ulcers
Treated with a combination of drugs.
antibiotics, a bismuth compound, and a proton pump inhibitor. (Proton pump inhibitors
reduce stomach acid secretion.)
taken for at least 14 days.

In addition to the medications used for Helicobacter pylori infection, other medications that may
be used to relieve symptoms of gastritis include those that reduce stomach acid secretion:

* Antacids such as calcium carbonate and magnesium hydroxide with aluminum salts
* H2 blockers such as ranitidine, cimetidine, nizatidine, and famotidine
* Proton pump inhibitors such as omeprazole and lansoprazole

Drugs that reduce stomach acid secretion help protect against or treat ulcers. Other drugs used
for ulcers include:

* Misoprostol – protects against the major intestinal toxicity of NSAIDS, and can reduce the
formation of ulcers
* Sucralfate – helps to heal ulcers in the stomach
Peptic ulcers
 stomach and proximal duodenum

 smoking, NSAIDS, steroid, alcohol, family history

 duodenal - benign; gastric - malignant

 H. pylori

 endoscopy and biopsy

 antacids with antibiotic

Diarrhea
 increased volume and liquidity of stool
 secretory
 osmotic

 fluid replacement
Constipation
 less than 3 bowel movements per week

 low fiber diet or a disease process

Appendicitis
 abdominal pain

 RLQ

 surgery
Acute Pancreatitis
 acute inflammation of the pancreas with edema,
autodigestion, necrosis and hge.
 alcohol ingestion & biliary tract dse.

 nausea & vomiting usually not present

 IV fluid replacement and pain relievers

 NGT suction
Acute cholecystitis
 inflammation of the gall bladder

 obstruction of the cystic duct

 crampy epigastric or RUQ postprandial pain

 fever, nausea and vomiting

 jaundice

 surgery
Cholelithiasis
 gallstone in the common bile duct

 fever, jaundice, RUQ pain (Charcot’s triad)

 antibiotics

 surgical - Cholecystectomy
Cholelithiasis
Cholesterol stones
 radiolucent with 10-20% opaque (calcifications)
 associated with Obesity

Pigment stones
 radiopaque
 alcoholic cirrhosis and biliary infection

Mixed stones
 radiolucent
 most common type
Viral Hepatitis
 HAV, HBV, HCV

 jaundice, hepatomegaly, tender

 HAV - fecal-oral

 HBV - parenteral

 HCV - parenteral

 vitamin K

 no specific therapy
Viral Hepatitis
 HBsAg - infected

 HBsAb - treated/immune/vaccinated

 HBeAg - infectious

 HBeAb - non-infectious

 HBcAg – chronic/carrier

Alcoholic Liver Dse.

 leads to Liver cirrhosis
Cirrhosis (Portal Hypertension)
diffuse fibrosis of liver, destroys normal
architecture
Nodular regeneration
Micronodular
<3mm
uniform size
due to metabolic insult (alcohol)
Cirrhosis (Portal Hypertension)
 Macronodular
 >3mm
 varied size
 due to significant liver injury leading to hepatic necrosis
(postinfectious or drug induced hepatitis)
 Increased risk of hepatocellular carcinoma
Cirrhosis (Portal Hypertension)
 esophageal varices
 hematemesis
 Melena
 peptic ulcer
 Splenomegaly
 Caput medusae/Spider angioma
 Ascites
 Hemorrhoids
GI Bleed
 Hematemesis

 Melena

 Hematochezia
Peutz-Jeghers Syndrome (PJS)
an autosomal dominant inherited disorder
characterized by intestinal hamartomatous polyps in
association with mucocutaneous melanocytic macules.
15-fold increased risk of developing intestinal cancer
includes gastrointestinal and extraintestinal sites.
Inflammatory Bowel Diseases
Ulcerative Colitis
 idiopathic chronic inflammatory disorder limited to the colon
 lifelong illness that has a profound emotional and social
impact on patients who are affected.
 rectum (>95% of cases), extends proximally from the anal
verge in an uninterrupted pattern to involve part or all of the
colon.
Ulcerative Colitis
 * Frequent episodes of rectal bleeding occur, with
or without mucus. The characteristic feature is blood
in each bowel movement.
 * Urgency and tenesmus
 * Abdominal cramps
 * Weight loss in severe cases
Crohn's Disease
 form of inflammatory bowel disease (IBD)
 usually affects the ILEUM, but may occur anywhere from the
mouth to the end of the rectum (anus).
 Causes: autoimmune disorder
 ongoing (chronic) inflammation of the GIT --> healthy
patches of tissue between diseased areas --> causes the
intestinal wall to become thick.
 A person's genes and environmental factors seem to play a
role in the development of Crohn's disease. The body may be
overreacting to normal bacteria in the intestines.
Crohn's Disease
 5 different types of Crohn's disease:
 * Ileocolitis is the most common form. It affects the lowest
part of the small intestine (ileum) and the large intestine
(colon).
 * Ileitis affects the ileum.
 * Gastroduodenal Crohn's disease causes inflammation in
the stomach and the duodenum.
 * Jejunoileitis causes spotty patches of inflammation in the
jejunum.
 * Crohn's (granulomatous) colitis only affects the large
intestine.
 INCREASED RISK OF DEVELOPING CANCER
 The main symptoms of Crohn's disease are:
 * Crampy abdominal (belly area) pain
 * Fever
 * Fatigue
 * Loss of appetite
 * Pain with passing stool (tenesmus)
 * Persistent, watery diarrhea
 * Unintentional weight loss
 Other symptoms may include:
 * Constipation
 * Eye inflammation
 * Fistulas (usually around the rectal area, may cause
draining of pus, mucus, or stools)
 * Joint pain
 * Liver inflammation
 * Mouth ulcers
 * Rectal bleeding and bloody stools
 * Skin rash
 * Swollen gums
END