Disorders of Gastrointestinal Tract PDF

Disorders of Gastrointestinal Tract Marina Gharibian PhD, RN NURS 210A Fall 2024-20245  Terms to Remember Hematemesis Blood in the vomitus Blood in the stomach is irritating and causes vomiting. May be bright red in...

Disorders of Gastrointestinal Tract Marina Gharibian PhD, RN NURS 210A Fall 2024-20245  Terms to Remember Hematemesis Blood in the vomitus Blood in the stomach is irritating and causes vomiting. May be bright red in color or may have coffee ground appearance. Hematochezia Bright red blood through rectum Melena Blood in the stool resulting in black- tarry color. Dysphasia Difficulty in Swallowing Odynophagia Painful swallowing Signs and Symptoms Common to most GI Disorders Anorexia Nausea Vomiting Dysphagia Abdominal Diarrhea/ Gastrointestin Pain Constipation al Bleeding Gastroesophageal Reflux Disease (GERD)  Definition Pathophysiology A weak or incompetent Is the lower esophageal persistent sphincter allows reflux of reflux of gastric contents into the gastric esophagus. contents into The irritant effects of the the esophagus refluxate causes heartburn.  Heart Burn occurs 30 to 60 minutes after a meal; has an evening onset. Causes pain in epigastric area that radiates to throat, shoulder, or back. Avoid large meals; alcohol use and smoking, recumbent position several hours after a meal, and bending for long GERD periods. Sleep with the head elevated, lose weight if overweight, and remain upright after meals. Because of GERD the patient may develop Esophageal mucosal injury which is related to the destructive nature of the refluxate and the amount of time it is in contact with mucosa. Acidic gastric fluids (pH < 4.0) are particularly damaging. Acid reflux or Heartburn Disorders of the Stomach Gastritis  The stomach is protected by a mucosal barrier that prevents gastric secretions from injuring the epithelial and deeper layers of the stomach wall.   Transient inflammation of the gastric mucosa Acute  Associated with local irritants such as bacterial endotoxins, alcohol, and aspirin. Gastrit is  Characterized by chronic Chron inflammatory changes.  Leads to atrophy of the stomach ic glandular epithelium.  1) Aspirin and Nonsteroidal anti- inflammatory drugs Causes of Irritate the gastric mucosa and inhibit Gastric prostaglandin synthesis. Prostaglandins can have healing effects, especially in the stomach. They decrease stomach acid production while Irritation also stimulating the release of protective mucus in the GI tract. Prostaglandins are hormones and Ulcer secreted by cells during a chemical reaction at 2)the Infection site wherewith Helicobacter an injury occurs. pylori (H. Formationpylori) thrives in acid environment of the stomach disrupting the mucosal barrier of the stomach that protects it from digestive enzymes. Gastritis caused by H. Pylori A type of chronic gastritis Pathophysiology H-pylori This produces enzymes This leads to gastric and toxins that have the colonizes mucus- capacity to interfere with atrophy and peptic ulcer and is associated secreting the local protection of the with increased risk of gastric mucosa against epithelial cells of acid leading to intense gastric the stomach. inflammation. adenocarcinoma. H. Pylori inside the Stomach Gastritis Peptic Ulcer Ulcerative disorders that occur in areas of the upper GI tract that are exposed to acid- pepsin secretions. Spontaneous remissions and exacerbations are common. Causes: H. pylori, Aspirin, Age, or Smoking. Formation of an Ulcer Stomach Ulcer  Hemorrhage: Caused by bleeding from erosion of an ulcer into an artery or vein. Complicatio ns of Peptic Ulcer Perforation: Occurs when an ulcer erodes through all the layers of the stomach or duodenum wall.  Other Types of Ulcers: Stress Ulcers Curling Ulcer Cushing Ulcers GI ulcerations that may  Consists of gastric, develop in relation to duodenal, and major physiologic stress: esophageal ulcers  Large-surface-area arising in persons with burns; Trauma; Sepsis intracranial injury, or  Acute respiratory operations. distress syndrome  Severe liver failure; and major surgical procedures Disorders of the Large Intestines Inflammatory Bowel Disease Ulcerative Crohn’s Disease Colitis  Inflammatory Bowel Disease Crohn’s Disease Ulcerative Colitis  bn A recurrent, granulomatous type A nonspecific of inflammatory disease that can inflammatory affect any area of condition the gastrointestinal confined to the tract from the rectum and colon mouth to the anus.  A granuloma is a structure formed during inflammation that is found in many diseases. It is a collection of immune cells (WBCs). Granulomas form when the immune system attempts to wall off substances it Granulom perceives as foreign but is unable to eliminate. a: Meaning A granuloma can be found in the lungs, head, skin or other parts of the body. Granulomas are not cancerous. They form as a reaction to infections, inflammation, irritants or foreign objects. Granuloma Macrophage Granulomas — immune cell aggregates formed in response to chronic inflammatory stimuli such as infection — contain a range of macrophage morphologies, including multinuclear giant cells. Pyogenic Granuloma Crohn’s Disease  The mucosal surface of the colon displays a “cobblestone” appearance owing to the presence of linear ulcerations and edema and inflammation of the intervening tissue.  Periods of exacerbations and remissions: Intermittent diarrhea; Colicky pain; Weight loss; and Fluid and Electrolyte Cobblestone Appearance  Cobblestone Appearance in the Colon of a 24-year-old man Crohn’s Disease Ulcerative Colitis  Prominent erythema and ulceration of the colon begin in the ascending colon and are most severe in the recto sigmoid area. Ulcerative Colitis  Crohn’s Ulcerative disease Colitis Type of inflammation Granulomatous Ulcerative, Exudative Level of involvement Submucosal Mucosal Extent of involvement Skip lesions Continuous Areas of involvement Ileum, colon Rectum, colon Diarrhea Common Common Rectal bleeding Rare Common Development of Increased risk Common cancer  Although the cause of cancer of the colon and rectum is largely unknown, most cases begin as adenomatous polyps. Its incidence increases with age; Colorectalapproximately 80% of persons who develop this form of cancer are older than Cancer 50 years of age. Its incidence also is increased among persons with a family history of cancer, persons with IBDs. Polyps in the Colon Removal of the polyp Colon Cancer Colon Cancer Layers of the Bowel Wall Stages of Colon Cancer Attention has focused on dietary fat, refined sugar, and fiber intake as well as the adequacy of such protective micronutrients as vitamins A, C, and E in the diet. It has been hypothesized that a high level of fat in the diet increases the synthesis of bile acids in the liver, which may be converted to potential carcinogens by the bacterial flora in the colon. Dietary fiber is thought to increase stool bulk and thereby dilute and remove potential carcinogens. Reports indicate that aspirin may protect against colorectal cancer (?)