CLO5 Disorders of GI Tract 2020 PDF

CLO5- Disorders of the Gastrointestinal System and its Accessory Organs Dr. Riaz Akseer HIM 2113  C Define and explain pathogenesis of the L Gastrointestinal System and its O Accessory Organs. 5 2  The Digestive System Review 3 Copyright © 200...

CLO5- Disorders of the Gastrointestinal System and its Accessory Organs Dr. Riaz Akseer HIM 2113  C Define and explain pathogenesis of the L Gastrointestinal System and its O Accessory Organs. 5 2  The Digestive System Review 3 Copyright © 2007 Lippincott Williams & Wilkins.  Mouth Pharynx Esophagus Stomach Small Intestine Appendix Large Intestine Gall bladder Liver Pancreas 4  THE ORAL CAVITY 5  THE SALIVAR Y GLANDS 6  SWALLOWING 7  PERISTALSIS 8  Esophagus the tube that connects your mouth and your stomach 9  Stomach A stretchy bag that holds your food after you eat It mixes the food with gastric juices (acid) that helps to break food into smaller pieces 10 11  STOMACH WALL 12  GASTRIC GLANDS [PITS] 13  Small Intestine Tube that is 6m long. Receives broken down food from the stomach and starts to digest and absorbs nutrients with the help of pancreatic enzymes Food stays in your small intestine for 4 to 8 hours Nucleus Medical Media (2020). The small intestines [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/the-small-intestines/view-item?ItemID=8573 14  THE SMALL INTESTINE [MOSTLY] 15  GROSS STRUCTURE OF THE SMALL INTESTINE 16  HISTOLOGY OF THE SMALL INTESTINE 17  Large Intestine Tube that is 1.5m long Absorbs water Gets waste from small intestine Waste stays for 10 to 12 hours 18 THE LARGE INTESTINE 19  LARGE INTESTINE WALL 20  ACCESSORY ORGANS OF DIGESTION 21  Gall Bladder For bile (a greenish-yellow liquid) that helps Storage tank your body for bile (a greenish-yellow liquid) that break down helps your body break down and use fats and use fats Located under your liver Shaped like a pear 22  THE GALLBLADDER 23  Gall Bladder 24  Liver Factory for antibodies and bile Functions also as a detoxification device Stores vitamins and sugars until your body needs them 25  Liver 26 27 28  HEPATIC FUNCTIONS METABOLISM FAT STORAGE SYNTHESIS OF SERUM FIBRINOGEN , PROTHROMBIN , ALBUMIN VITAMIN STORAGE DETOXIFICATION OF LIPID SOLUABLE DRUGS SYNTHESIS OF BILE CONVER SION OF SUBSTANCES INTO ACTIVE FORMS T 4 T 3 STORAGE & PRODUCTION OF BLOOD FILTRATION OF FOREIGN PARTICLES i.e.. bacteria 29  Pancreas Produces enzymes which help you digest food Produces Insulin 30  Gastritis Inflammation of the stomach mucosa 31  Gastritis Pathophysiology & Etiology: Acute or Chronic Causes: –Irritants (alcohol, drugs like NSAIDs) –Bacterial or viral infections (Salmonella, E.coli) –Peptic ulcer disease (Helicobacter pylori infection) –Bile acid reflux 32  Signs and Symptoms: Abdominal pain (mild to severe) Nausea, vomiting, diarrhea (dehydration) Intolerance of spicy foods Gastric ulceration Investigations: Complete blood count (CBC) Stool test (for infection/presence of blood) Gastroscopy 33  Treatment Avoidance of irritating substances/foods – Alcohol – NSAIDs (Aspirin, ibuprofen and others) – Spicy foods – Caffeine Medications: – Antacids – Anti-emetics – Antibiotics 34  Complications: Atrophy (destruction) of gastric glands Achlorhydria=decreased production of acid Gastric mucosal erosion hemorrhage (hematemesis or melana) Damage of parietal cells that produce intrinsic factor needed for vitamin B 12 absorption Vitamin B12 deficiency and anemia 35  Peptic Ulcer Disease Ulceration of Duodenum Gastric mucosa Lower esophagus or jejunum (less common) Usually chronic Can be acute due to medical or surgical stress (Stress ulcer) FIG 51-4 Gastric ulcer 36  Peptic Ulcer Disease 37  Peptic Ulcer Disease Pathophysiology and Etiology –Infection with H. pylori –Family history –Smoking tobacco –NSAIDs, steroids –Stress –Increased acid production –Chronic gastric inflammation –Development of ulcers 38  Peptic Ulcer Disease Signs & Symptoms –Abdominal pain and back pain –Bleeding hematemesis and melena Investigations (Diagnostic tests) – Carbon 13 urea breath test for H. pylori activity –Esophagogastroduodenoscopy –Stool for occult blood –CBC - Low Hemoglobin 39  Medical and Surgical Management Antibiotic combination to get rid of H. pylori Antacids and proton pump inhibitors (decrease acid production) Gastrectomy (rarely done) 40  Appendicitis Bacterial infection of the Appendix The most common intestinal infection Requires prompt surgical intervention Often caused by trapped feces in the appendix 41  Appendicitis Signs & Symptoms Fever Abdominal pain – RLQ (Mc Burney’s point) Anorexia Nausea, vomiting Elevated WBC count 42  Appendicitis Diagnostic Tests Measure temperature Mc Burney’s Sign Blood test (WBC) Ultrasound Complications Rupture Peritonitis Development of abscess 43  Treatment NPO (non per oral) IV fluids Appendectomy 44  Disorders of Small & Large Intestine Colorectal Cancer Cancer of colon or rectum – “intestinal cancer” The 2nd most common cancer Often runs in the family Higher risk with low fiber, high fat diet Grows slowly, may spread metastasize Symptoms when tumor is large 45  Colorectal Cancer Symptoms: – Rectal bleeding or occult (hidden) blood in feces – Change in stool shape (flat or ribbon shape) – Progressive constipation – Anemia – Anorexia, nausea, weight loss – Abdominal distension and pain Complication: – Intestinal obstruction 46  Colorectal Cancer Nucleus Medical Media (2020). Colorectal cancer - distal rectal carcinoma [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/col orectal-cancer-distal-rectal-carcinoma/view-item?ItemID =10992 47  Diagnostic tests: Tumor biopsy Digital rectal exam Colonoscopy Stool for occult blood Treatment: Surgery to remove the tumor Radiation 48  Disease of the Liver Hepatitis Different types based on cause: – Toxic (chemicals, medications, alcohol) – Viral (Hepatitis A, B, C, D, E, etc.) Similar pathophysiology, signs and symptoms: – Exposure to causative agent – Inflammation of the liver – Damage of liver cells – Bile channels get blocked Jaundice – Liver cells regenerate – starting in 48 hours, up to 3 months 49  Hepatitis Signs & Symptoms: Fever, malaise, anorexia, nausea, rash & jaundice Enlarged and tender liver Investigation: Hepatitis profile (blood test) – Measures antibodies to specific viruses – Measures different parts of the virus (antigens) in the blood 50  Viral Hepatitis A & E From contaminated food and water Symptomatic treatment – Rest for about 1-2 weeks – Medications for fever, nausea & vomiting Enteric precautions to prevent spread 51  Viral Hepatitis B Transmitted through blood & body fluids Incubation time of 40-180 days Treatment – Alpha-interferon – Antiviral drugs Prevention - Vaccines May become chronic hepatitis and lead to liver cirrhosis and liver cancer 52  Viral Hepatitis C Transmitted in high risk groups through body fluids (e.g. drug addicts, sex workers, dialysis patients) Incubation time is 5-9 weeks Symptoms are similar to Hepatitis A&B Prevention/control is similar to Hepatitis B May become chronic hepatitis and lead to liver cirrhosis and liver cancer 53  Liver Cirrhosis Chronic, irreversible liver disease Liver tissue is replaced by fibrosis and scars Pathophysiology classic triad: – Necrosis (death) of liver cells – Repair by fibrosis – Regeneration of liver cells causing nodules to form all the liver 54  Liver Cirrhosis Causes –Alcoholism –Bile duct disease –Chronic hepatitis 55  Liver cirrhosis Signs & Symptoms Damjanov Page 273 Figure 11-11 56  Diseases of the Gall Bladder Gallstones and blocked bile duct 57  Gallstones and blocked bile duct A common cause for hospitalization Remember gall stones are most common in –“Fat, –Fertile, –Forty, –Females!” Often asymptomatic, until stones enter and block ducts Sharp pain may occur triggered by fatty food Treatment - usually cholecystectomy 58  Gall stones are often referred to as cholecystitis Etiology Obesity Rapid weight loss Middle-aged women Oral contraceptives High dietary cholesterol. Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition. 59  Gallstones Nucleus Medical Media (2020). Choledocholithiasis - gallstones [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/choledocholithiasis-gallstones/view-item?ItemID=4244 60  Acute Pancreatitis Acute inflammation of pancreas caused by pancreatic digestive enzymes (auto-digestion) (Hughes, 2004) It is a sterile chemical inflammation Often caused by obstruction of the main pancreatic duct (20%) Or by chronic alcohol ingestion (80%) 61 62  Aetiology Alcohol, biliary and gastric disease, trauma, metabolic abnormalities Infection – mumps, viral hepatitis Drugs – thiazide diuretics, furosemide, oestrogens, tetracycline, salicylates, corticosteroids, immunosuppressive Activation of enzymes Metabolic disorders Hyperlipidaemia Hyperparathyroidism, Renal failure Hypercalcaemia ∎Trauma ∎Tumours ∎Pregnancy – third trimester ∎Surgery Hereditary pancreatitis Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition. 63  Pathology Spontaneous, obstruction, bile, reflux, duodenal reflux Oedema, vascular damage, rupture of pancreatic ducts Activation of enzymes Autodigestion 64  Nucleus Medical Media (2020). Normal pancreas, pancreatitis, and severe necrotizing pancreatitis [Digital image]. Retrieved from https://ebsco-smartimagebase-com.ezproxy.hct.ac.ae/normal-pancreas-pancreatitis-and-severe-necrotizing-pancreatitis/view-item?ItemI D=76498 65  Acute Pancreatitis Signs & Symptoms Severe abdominal pain (LUQ, back) Nausea, vomiting High WBC High serum amylase and lipase (pancreatic enzymes spill into the blood) High glucose level (hyperglycemia) Abdominal X-ray Dilated small bowel Calcification of pancreas 66  Treatment NPO IV fluids Analgesics (pain killers) Treat underlying cause –(e.g. pancreatic duct obstruction, alcoholism) Mortality rate at about 20% 67  OVERVIEW 68  References (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition. Damjanov, I (2011) Pathology for the Health Professions 4th edition Lippincott Williams & Wilkins. (2009). Professional guide to diseases (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Martini, F., & Nath, J. L. (2015). Fundamentals of anatomy & physiology. San Francisco: Pearson/Benjamin Cummings. Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition 69 69  Any Questions ? 70