ALU 201: Intermediate Medical Life Insurance Writing PDF

THE GASTROINTESTINAL SYSTEM Introduction is covered in the next chapter. The alimentary tract is one continuous tube, beginning at the mouth and progressing through the esophagus, stomach, small intestine, large intestine, and ending with appearance. Page 1 ALU 201: Intermediate Medical Life Insuran...

THE GASTROINTESTINAL SYSTEM Introduction is covered in the next chapter. The alimentary tract is one continuous tube, beginning at the mouth and progressing through the esophagus, stomach, small intestine, large intestine, and ending with appearance. Page 1 ALU 201: Intermediate Medical Life Insurance Writing produced in the liver, empty into the duodenum through a common opening known as the ampulla The residual solution that is not absorbed by the small intestine passes through the ileocecal Page 2 Oral Diseases As mentioned earlier, the gastrointestinal tract can be subject to many pathologic processes. The cell carcinoma, which tends to recur and has a high mortality rate. Many systemic diseases have Esophageal Disease the underlying etiology. When a primary motor disorder (e.g., esophageal spasm) is diagnosed ® ), or ® treated with endoscopic balloon dilatation or surgery. Achalasia is associated with an increased Page 3 ALU 201: Intermediate Medical Life Insurance Writing glandular gastric mucosa. Further changes to the mucosa (i.e., metaplasia) causing it to resemble intestinal cells (i.e., intestinalization) is Barrett’s esophagus. Barrett’s can be detected visually using upper endoscopy. The instrument can be passed through the mouth to the duodenum allowing done microscopically on a biopsy specimen. causing bronchospasm and, in severe cases, pneumonia. 1. 2. 3. 4. weight loss. Esophageal Squamous Cell Cancer alcohol abuse and esophageal squamous cell carcinoma. In the past, SCC was the most common common. All esophageal cancers have a high mortality rate. As mentioned earlier, the stomach normally lies in the abdominal cavity with the gastroesophageal Page 4 hernias. With this hernia, the gastroesophageal junction stays below the diaphragm. Strangulation genetic predisposition to ulcer disease. Stress has not been proven to induce or exacerbate ulcers. ® , Advil® ® , Aleve®). Alcohol is Page 5 ALU 201: Intermediate Medical Life Insurance Writing These medications include liquid or tablet antacids (Maalox®, Mylanta® blockers (cimetidine/ 2 ® ® ® Tagamet ), and proton pump inhibitors (omeprazole/ ® ® Prilosec , pantoprazole/Protonix®, lansoprazole/Prevacid®, rabeprazole/ ® Aciphex pylori. detected indirectly through serum antibody testing, stool testing, or biopsy testing to detect urea Pancreatic Disorders Pancreatitis pancreatitis, can be acute or chronic. It can be caused by alcohol, blockage by gallstones (gallstone levels >1000, and idiopathically. Acute pancreatitis has a high mortality rate. The diagnosis is based on elevated serum amylase and lipase levels and imaging studies (e.g., Page 6 inadequate insulin production (diabetes) and inadequate digestive enzyme production (pancreatic ® , Pancrease®). Pancreatic Tumors Solid Lesions adenocarcinoma, which has a very high mortality rate. 1. ulcers 2. insulinomas that cause precipitous low blood sugar (hypoglycemia) 3. vasoactive intestinal peptide producing tumors (VIPomas) that cause watery diarrhea 4. glucagonomas that cause hyperglycemia, diabetes, necrolytic migratory erythema and thromboembolic complications. Cystic Lesions include size > 3 cm, any solid component, dilated pancreatic duct and rapid growth. Cysts with Page 7 ALU 201: Intermediate Medical Life Insurance Writing potential Pseudocyst Congenital cyst Endometrial cyst Cystic lymphangioma Cavernous hemangioma Serous cystic adenoma Malignant potential Malignant Intraductal papillary mucinous neoplasm Cystic ductal adenocarcinoma Cystic neuroendocrine tumor Mucinous cystic neoplasm Solid pseudopapillary neoplasm Intraductal tubular tumor Cystic pancreatoblastoma Cystic acinar cystadenocarcinoma lactose intolerance). bloating, diarrhea, weight loss, abdominal pain, anemia, low serum albumin, osteoporosis, and in rare cases, steroids can be needed. Page 8 beyond the colon when Crohn’s disease is suspected. Beyond the initial diagnosis, small bowel radiation. giant cells). This does not occur in ulcerative colitis. centimeters) have a small, increased cancer risk. Page 9 ALU 201: Intermediate Medical Life Insurance Writing with antibiotics, steroids (e.g., prednisone, budesonide/Entocort EC®), immunosuppressive agents ® (e.g., 6 mercaptopurine or 6MP, azathioprine/Imuran® prevent relapse. Dipentum®, balsalazide/Colazal®, mesalamine/Pentasa®, Asacol® ® (Simponi® ® and Canasa® ), Certolizumab pegol (Cimzia® ® ), Vedolizumab (Entyvio® ® ® ® From an underwriting perspective, Crohn’s disease mortality is associated with bleeding, Both Crohn’s disease and ulcerative colitis are associated with extraintestinal complications including ankylosing spondylitis, arthritis, iritis, pyoderma gangrenosum, and erythema nodosum. Page 10 Crohn’s Disease Common Abdominal Pain Almost 100% Stricture, obstruction Perianal, perirectal abscesses Continuous Mucosa & submucosa Common 50% Common Common Common Discontinuous (skip areas) Transmural Small bowel involvement Moderately increased There is almost never any weight loss and symptoms usually do not occur during sleep. It is potential. Serrated polyps or serrated adenomas are other premalignant polyps. Benign polyps with Page 11 ALU 201: Intermediate Medical Life Insurance Writing polyposis syndromes are outlined in Table 2. Polyp type/ Familial Adenomatous Adenoma/Colon Polyposis (FAP) and Attenuated FAP Adenoma/Colon FAP plus other lesions Turcot Syndrome – Adenoma/Colon FAP plus brain tumors Adenoma, serrated/ Colon Adenoma/Colon Polyposis Colon Syndrome intestine Other intestinal lesions Extraintestinal lesions Turcot Syndrome Turcot Syndrome tumors Small intestinal tumors Congenital hypertrophy See above Mesenteric desmoid tumors Brain tumors Duodenal cancer papillary thyroid cancer. Sebaceous gland tumors thyroid nodules. ? Stomach, small intestine, and biliary cancer and endometrial cancer. Endometrial, ovarian, prostate, ureter, and kidney cancer bronchus, gall bladder, nasal passages, bladder, and ureter. breast, and ovary, cervix Dark spots on lips, Juvenile Polyposis Page 12 Pancreas become routine. The American Cancer Society recently changed their guidelines to recommend current recommendation is a repeat colonoscopy in eight to ten years. cancer screening. It is not as reliable as standard colonoscopy and still requires a colonoscopy to ® cards, FIT testing), barium hemorrhage or diverticulitis. spontaneously but can require surgery or an angiographic embolization procedure. Gastrointestinal Bleeding Page 13 ALU 201: Intermediate Medical Life Insurance Writing ® cards. The clinician ® cards. Attributing cause slow blood loss. Clinically, acute gastrointestinal bleeding is divided into upper and lower gastrointestinal sites. 1. esophageal varices (distended veins secondary to portal hypertension) 2. ulcers 3. severe gastritis 4. 1. diverticulosis 2. 3. polyps 4. cancers. Mortality is associated with the underlying cause, the acute complications associated with rapid the bleeding is the key to determining the mortality risk. In older age groups, colon cancer is the 1. 2. 3. bowel and obstruction Page 14 4. 5. and even intussusception can resolve on their own with “bowel rest” – gastric suction and not to gradual narrowing due to atherosclerosis, a clot due to a hypercoagulable condition, or an acute on its own with bowel rest but can require surgery. Bariatric Surgery the intestine. This causes intended partial malabsorption. A sleeve gastrectomy involves removing Page 15 ALU 201: Intermediate Medical Life Insurance Writing intestinal obstruction. mortality improves 40% by 7 years and persists up to 20 years when compared to those who did not have surgery. Page 16