Gastric and Duodenal Disorders

• Management of Patients with Gastric and Duodenal Disorders covers: Gastritis, Gastric and Duodenal Ulcers, and Gastric Cancer.

Gastritis

• Gastritis is an inflammatory disorder of the gastric mucosa.
• Acute gastritis is associated with Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), drugs, and chemicals.
• Clinical manifestations of gastritis include vague abdominal discomfort, epigastric tenderness, and bleeding.
• Treatment for gastritis includes spontaneous healing within a few days, stopping NSAIDs, H2 receptor blockers, PPIs, and antibiotics if due to H. pylori.

Gastric Ulcer

• Gastric ulcers are caused by H. Pylori and overuse of NSAIDs.
• Symptoms of gastric ulcers include pain 1-2 hours after a meal, abdominal pain aggravated by eating, vomiting, weight loss, and hematemesis if hemorrhage occurs.
• Treatment for gastric ulcers includes treating H. Pylori infection with antibiotics and reducing stomach acid with H2-receptor blockers or proton pump inhibitors.

Duodenal Ulcer

• Duodenal ulcers are caused by H. Pylori and overuse of NSAIDs.
• Symptoms of duodenal ulcers include pain 2-4 hours after meals, food may relieve pain, weight gain, and melena if hemorrhage occurs.
• Treatment for duodenal ulcers includes treating H. Pylori infection with antibiotics and reducing stomach acid with H2-receptor blockers or proton pump inhibitors.

Abnormalities of Fecal Elimination - Constipation

• Constipation occurs when bowel movements become infrequent or difficult to pass, due to factors like dehydration, low fiber intake, lack of physical activity, or medications.
• Common causes include low fiber diet, dehydration, lack of exercise, ignoring the urge to go, stress and lifestyle changes, medications, and medical conditions like IBS, hypothyroidism, and diabetes.
• Relief and prevention include increasing fiber intake, drinking plenty of water, exercising regularly, trying probiotics, establishing a bathroom routine, using natural laxatives, and reducing processed foods.
• The advice is to seek medical help if constipation lasts more than 2 weeks, if having severe pain, blood in stool, or unexplained weight loss, and if over-the-counter treatments don't work.

Abnormalities of Fecal Elimination - Diarrhea

• Diarrhea is having loose, watery stools that happen more frequently than normal, which can be caused by infections, food, stress, or medical conditions.
• Diarrhea usually lasts a short time but can sometimes be a sign of a more serious issue.
• Causes include viral, bacterial, or parasitic infections; spoiled food, food allergies; antibiotics, laxatives, certain diabetes or blood pressure medications; IBS, Crohn's disease, ulcerative colitis; and stress & anxiety.
• Treatment includes hydration with water and electrolyte solutions, the BRAT diet (bananas, rice, applesauce, toast), probiotics, avoiding dairy, caffeine, alcohol, and fatty/spicy foods, and medications like loperamide or bismuth subsalicylate.
• Seek medical help if diarrhea lasts more than 2 days (for adults) or 24 hours (for infants/young children), severe dehydration, high fever (above 102°F), bloody or black stools, or severe stomach pain or cramping.

Fecal Incontinence

• Fecal incontinence is the inability to control bowel movements, leading to involuntary leakage of stool, ranging from occasional leakage to a complete loss of bowel control.
• Common causes include: muscle damage to the anal sphincter muscles (often from childbirth or surgery) and nerve damage affecting the rectum and anal sphincter (from diabetes, stroke, multiple sclerosis, or spinal cord injury).
• Other causes: chronic constipation leading to weakened rectal muscles and nerves over time, diarrhea, loose stool, and rectal prolapse where the rectum drops out of its normal position, affecting control.
• Symptoms include: unexpected leakage of stool, gas, or mucus; urgency to defecate with little warning; and difficulty controlling bowel movements, especially after diarrhea.
• Diagnosis involves medical history & physical exam, anorectal manometry, endoanal Ultrasound, and MRI defecography.
• Treatment options include: dietary changes, pelvic floor therapy, medications and medical procedures.
• Dietary change management - Increase fiber intake for constipation), avoid triggers like spicy foods, caffeine, and dairy.
• Pelvic floor therapy - Kegel exercises strengthen anal sphincter muscles, biofeedback helps retrain muscle control.
• Medications include anti-diarrheal drugs like loperamide and fiber supplements.
• Medical procedures involve: sacral nerve stimulation, injectable bulking agents, and surgery for sphincter repair or colostomy in severe cases.
• One should seek medical help if fecal incontinence is frequent, affecting quality of life, or linked to other symptoms (pain, weight loss, or bleeding).

Irritable Bowel Syndrome (IBS)

• IBS is a common digestive disorder affecting the large intestine, and it's a chronic condition that can cause a variety of symptoms.
• Symptoms: abdominal pain or cramping (often relieved after a bowel movement), bloating and gas, diarrhea (IBS-D), constipation (IBS-C), or both (IBS-M), mucus in the stool, and changes in stool appearance and frequency.
• Causes and triggers: gut-brain interaction issues, food sensitivities to dairy, gluten, caffeine, or high-FODMAP foods, stress and anxiety, hormonal changes (especially around menstruation), and changes in gut bacteria or infections.
• There is no specific test for IBS, but doctors diagnose it based on symptoms and ruling out other conditions like inflammatory bowel disease (IBD), celiac disease, or infections, and include: blood tests, stool tests, colonoscopy if needed, and bowel sounds.
• IBS treatment focuses on symptom relief through lifestyle changes, diet modifications, and sometimes medications.
• Dietary changes: Low-FODMAP diet (avoiding fermentable carbs that can cause gas and bloating), increase fiber intake (for IBS-C, soluble fiber like oats may help), avoid trigger foods like spicy foods, dairy, caffeine, and alcohol, and stay hydrated.
• Lifestyle changes: Regular exercise, stress management (meditation, yoga, therapy), and adequate sleep.
• Medications if needed: include antispasmodics, laxatives, antidiarrheal medications, probiotics, and antidepressants or gut-brain modulators in severe cases.

Conditions of Malabsorption

• Malabsorption is the impaired absorption of nutrients from the small intestine, that leads to deficiencies in essential nutrients and can result from conditions affecting digestion and absorption.
• Celiac Disease is an autoimmune disorder triggered by gluten exposure that leads to damage of the intestinal lining and impaired nutrient absorption. Symptoms: diarrhea, weight loss, bloating, fatigue, and anemia.
• Lactose Intolerance caused by a deficiency of lactase, where the enzyme needed to digest lactose and milk sugar. Symptoms: bloating, diarrhea, gas, and abdominal pain after consuming dairy products.
• Crohn's Disease, which is a type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, leading to chronic inflammation and malabsorption. Symptoms: abdominal pain, diarrhea, weight loss, and nutrient deficiencies.
• Chronic Pancreatitis is long-term inflammation of the pancreas that reduces enzyme production is necessary for digestion. Symptoms: fatty stools, weight loss, abdominal pain, and vitamin deficiencies.
• Cystic Fibrosis is a genetic disorder affecting mucus production that leads to thick mucus which blocks pancreatic enzyme secretion needed for digestion. Symptoms: poor growth, fatty stools, and respiratory issues.
• Diagnosis and management includes blood tests, stool tests, endoscopy, imaging, and breath tests, and depends on the underlying cause (dietary modifications, enzyme supplements, vitamin supplementation, and medications).

Acute Inflammatory Intestinal Disorders: Appendicitis

• Appendicitis is inflammation of the appendix.
• It is most common in older children/young adults (average 10 years old)
• Appendicitis assessment involves: pain in the RLQ, anorexia, increased temperature & WBCs, Nausea, and tenderness at McBurney's point.
• Treatment includes appendectomy, no heat (can aggravate inflamed appendix and cause rupture), position right side, low Fowler's for comfort, IV Fluids/Antibiotics, pain management, ensure NPO until return of bowel sounds, and wound care.

Diverticular Disease

• Diverticular Disease = Diverticula, divericulosis, diverticulitis
• Diverticula is the herniation of mucosa through the muscle layers of the colon wall.
• Diverticulosis is asymptomatic diverticular disease.
• Diverticulitis is the inflammatory stage of diverticulosis.
• Possible causes include: decreased dietary fiber, abnormal neuromuscular function, alterations in intestinal motility, and aged over 60 years of age
• Assessments include: rebound tenderness, cramping, diarrhea, vomiting, dehydration, weight loss, rectal bleeding, bloody stools, anemia, and fever.
• Treatment includes: low fiber diet, avoidance of cold/hot foods, no smoking, and taking antidiarrheals/antibiotics/steroids.
• In severe cases of Diverticular Disease, the affected portion of the intestines may end up surgically removed through ileostomy/colostomy.

Peritonitis

• Peritonitis is inflammation of the peritoneum, the thin layer of tissue lining the inner wall of the abdomen and covering the abdominal organs, which requires urgent treatment.
• Peritonitis can be caused by infections: bacteria/fungal (ruptured appendix, perforated stomach ulcer, perforated bowel, diverticulitis with rupture, Pancreatitis, Pelvic inflammatory disease (PID), Peritoneal dialysis), and chemical irritation (Leakage non-infectious substances into the abdominal cavity (stomach acid, bile, pancreatic enzymes)
• Symptoms include: Severe abdominal pain and tenderness, swelling or bloating in the abdomen, fever/chills, nausea/vomiting, rapid heartbeat, low blood pressure, reduced urine output, and difficulty passing gas or stool.
• Diagnosis involves a physical exam/blood tests/imaging, and paracentesis to test fluid for infection.
• Treatments for Peritonitis include: antibiotics to fight infection, surgery to repair the rupture, supportive care (IV fluids, pain management, oxygen therapy)
• Complications from Peritonitis include: sepsis, organ failure, and death.