Gastrointestinal Disorders Overview

Gastrointestinal Disorders

• Gastrointestinal disorders can affect the upper and lower GI tract.

Esophagus

• GERD is caused by reflux of gastric secretions into the esophagus.
• An incompetent lower esophageal sphincter and hiatal hernia can contribute to GERD.
• Decreased gastric emptying can increase the risk of reflux.
• GERD can cause complications like scar tissue, Barrett's esophagus, and pneumonia.
• Hiatal hernia occurs when the upper part of the stomach protrudes through the diaphragm.
• There are two types of hiatal hernias: sliding and rolling.

Stomach/Duodenum

• Peptic ulcer disease (PUD) involves a break or ulceration in the GI mucosa.
• Risk factors for PUD include smoking, NSAID use, alcohol consumption, caffeine intake, chronic diseases, and Helicobacter pylori (H. pylori) infection.
• 80% of peptic ulcers are linked to H. pylori infection.

Inflammatory Bowel Disease

• Chronic inflammation of the intestinal tract
• Etiology: autoimmune, environmental factors & genetic predisposition
• Types: Ulcerative Colitis & Crohn's Disease

Ulcerative Colitis

• Ulceration of the colon and rectum, distal and continuous
• Inflammation and edema lead to abscess development, ulcerations, destruction of the epithelium, decreased surface area, and increased fluid loss
• Repeated attacks result in scar tissue formation

Ulcerative Colitis (Clinical)

• Diarrhea, abdominal pain, fever, weight loss, increased heart rate, dehydration and anemia
• Complications: hemorrhage, toxic megacolon and colon cancer

Crohn's Disease

• Can affect any part of the gastrointestinal tract, skip lesions (separated segments)
• Affected areas are edematous, swollen with ulcerations, and deeper than ulcerative colitis, leading to a "cobblestone" appearance
• All layers are affected

Crohn's Disease (Clinical)

• Diarrhea, fatigue, abdominal pain and weight loss
• Complications: strictures, obstructions and fistulas

Inflammatory Bowel Disease (Diagnostic & Treatment)

• Diagnostic tests include stool studies, barium enemas, sigmoidoscopy and colonoscopy
• Treatment options include medications such as sulfasalazine, steroids and antibiotics, and surgery

Diverticular Disease

• Diverticula are saclike outpouchings of the mucosal layer of the colon through the muscle layer
• Diverticulosis is asymptomatic diverticular disease, while diverticulitis is inflammation of the diverticula
• Etiology: low fiber diet, decreased physical activity, aging

Diverticular Disease (Pathophysiology)

• Diverticuli form at weak points in the wall
• Smooth muscle thickens, decreasing diameter and increasing pressure, leading to more diverticuli
• Decreased bulk in stool and decreased diameter can cause diverticulitis due to trapped stool or rupture

Diverticular Disease (Clinical)

• Fever, chills, increased white blood cell count, and left lower quadrant pain

Diverticular Disease (Diagnostic & Treatment)

• Diagnostic tests include sigmoidoscopy and barium enema
• Treatment options: Uncomplicated disease - diet, fluid; Acute - NPO, fluids, and antibiotics

Appendicitis

• Inflammation of the appendix
• Etiology: lumen obstruction with fecalith
• Obstructed lumen prevents drainage of the appendix
• Mucosal secretions continue, increasing pressure and decreasing blood flow, leading to mucosal ulceration, further inflammation, gangrene and perforation

Appendicitis (Clinical)

• Abdominal pain, rebound tenderness, fever, nausea and vomiting

Appendicitis (Complications)

• Perforation, peritonitis and sepsis

Appendicitis (Diagnostic & Treatment)

• Diagnostic tests include white blood cell count, abdominal X-ray and CT scan
• Treatment options: Early - antibiotics and fluids, Appendectomy

Cholelithiasis

• Gallstones in the gallbladder
• Risk factors: obesity, sedentary lifestyle, family history

Cholelithiasis (Pathophysiology)

• Bile supersaturated with cholesterol causes the cholesterol to precipitate out and form stones

This quiz covers essential aspects of gastrointestinal disorders, focusing on conditions such as GERD and peptic ulcer disease. It explores key factors, complications, and the role of Helicobacter pylori in peptic ulcers. Test your understanding of the upper and lower GI tract conditions and their implications.