Manifestations of GI tract disorders

Dysphagia

Esophageal Pain

Abdominal Pain

Vomiting

Intestinal Gas

Alternations in Bowel Patterns:

Constipation

Diarrhea

Gastroesophageal Reflux

(GERD)

Backflow of gastric contents into esophagus through LES.

Etiology: Pregnancy, Obesity, Smoking, Fatty foods, ETOH, caffeine, chocolate, hiatal hernia, medications

S/S: heartburn, regurgitation, CP, belching, reflux esophagitis

Tx: Inc. LES closing pressure, improve gastric emptying, dec. gastric acidity

Lose weight, sm meals (not before bed) elevate HOB, antacids

Potential Complication: Barrett esophagus: histological changes.

Peptic Ulcer Disease

Disorders of GI tract caused by acid and pepsin

Usually in stomach or duodenum.

Etiologies: breakdown of gastric mucosal barrier, excess secretion of acid (duodenal), H pylori.

S/S: epigastric pain that goes away with eating, hematemesis, melena, hemoptysis

Tx: Reduce gastric acidity, eradicate H pylori w/ antibiotics

Avoid smoking, NSAIDS, stress, ETOH, caffeine

Ulcerative Colitis

Inflammatory disease of colon and rectum.

Btwn 15-30 yrs and 50-70 yrs.

Smoking dec. risk of developing UC

Starts in rectum and moves up.

Disease of the mucosa of unknown origin

Inflam. of crypts of Lieberkuhn, invasion of leukocytes, abscesses form, ulceration develops.

S/S: abdom. pain, diarrhea, rectal bleeding

65-75% experience exacerbations and remissions

Tx: corticosteroids, broad spectrum antibiotics.

Crohn Disease

Inflammatory disease extending through all layers of intest. wall

Age: >30 yrs.

Most commonly affects proximal colon and terminal ileum.

Results from a blockage of lymphatic structures.

S/S: perianal fissures, fistulae, abscesses, RLQ abdom pain, diarrhea, vomiting, wt loss, dec H+H

Tx: reduce and alleviate inflammation. Antibiotic metronidazone is paticularly useful.

Smoking inc. risk

Potential complication: perforation peritonitis.

Appendicitis

Etiology: unknown. Most likely blockage of appendiceal lumen.

S/S: waves of periumbilical pain, nausea, pain becomes steady, rebound tenderness, guarding.

Tx: appendectomy.

Diverticula

Herniation of mucosa and submucosa into the colon wall.

Diverticulosis

Presence of diverticula in the colon.

Etiology: low fiber diet.

80% of 80 year olds have this.

Asymptomatic.

Develop in areas of high intralumen pressure.

Tx: high fiber diet, bran, bulk laxatives.

Diverticulitis

Inflammation of the diverticula

Can lead to abscesses in the bowel wall, peritonitis and intestinal obstruction.

S/S: LLQ abdom. pain, fever, leukocytosis, constipation common, anorexia, flatus, mucus or blood in stools.

Tx: rest bowel, NPO, NGT to sxn, IV fluids and antibiotics, surgery

Intestinal Obstruction

Partial or complete blockage of the lumen of the sm/lg intestine.

Mechanical: adhesions, hernia, tumor, inflam, impacted feces

Functional: loss of propulsive ability by the bowel.

S/S: reverse peristalsis, dehydration, pain, constipation, gas distention, electrolyte imbalance, raised diaphragm

Tx: decompress the bowel: insertion of intestinal tube, surgery for mechanical. For functional, rest the bowel, prevent distention w/ gastric suction.

Intussusception

Telescoping or invagination of a portion of the bowel into an adjacent distal portion.

Most common in infants.

Has been linked to viral infections.

As a bowel segment undergoes intussusception, peristalsis acts to pull more bowel along w/ it.

Tx: surgery.

Cholelithiasis

Gall stones in the gall bladder

Chloledocholithiasis

Stones in the common bile duct

Cholangitis

Inflammation of the common bile duct

Acute Cholecystitis

Inflammation of the gall bladder wall.

Risk factors: cholelithiasis, age, female, obese, rapid wt loss, pregnancy, Native American, spinal cord injury

Cystic duct clogs, bile stasis in gall bladder occurs, inflammation escalates, gall bladder may rupture.

S/S: RUQ pain, may radiate back, abdom. tenderness and fever, jaundice if CBD is blocked.

Tx: laparoscopic cholecystectomy, lithotripsy, antibiotics.

Acute Pancreatitis

Etiology: ETOH abuse, gallstone obstruction, infections, toxins, heredity, structure abnormality, ischemia, pregnancy

Obstruction of pancreatic duct by stone or other cause w/ release of digestive enzymes within the parenchyma, followed by enzyme activation and autodigestion of pancreas.

S/S: steady, boring pain in the epigastrium or LUQ, gradully inc. in intensity, N/V, exquisite tenderness, fever, ascites, anxious

Tx: NPO, NGt to sxn, opioids, TPN, calcium, antibiotics, supportive care, ERCP.

Acute Viral Hepatitis

Inflammation of the liver parenchyma

Liver inflam leads to necrosis and dec liver fxn.

S/S: jaundice, lethargy, malaise, myalgia, arthalgia, anorexia, N/V, abdom pain, diarrhea, constipation, fever, itching from bile salt accumulation.

Tx: Rest, nutrition.

Hepatitis A

RNA virus spread by fecal-oral route.

S/S: often asymptomatic, malaise, anorexia, nausea, fever, RUQ pain, jaundice (sometimes absent in kids)

Tx: supportive, rest, nutrition avoid ETOH, NSAIDS, vaccination recommended for risk groups (foreign travelers, chronic active HBV or HCV, institutionalized persons)

Hepatitis B

Partially double-stranded DNA virus highly prevalent worldwide.

Spread by parenteral contact with infected blood or blood products,  and sexual contact.

Incubation period: 2-6 months.

S/S: rashes, urticaria, joint pain, malaise, anorexia, nausea, fever, RUQ pain, jaundice

Tx: liver transplant, supportive.

Prevention: HBV vaccine.

Hepatitis C

Single-stranded RNA virus.

Mode of transmission resembles HBV, sexual less likely. Mainly infected by IV drug use or blood transfusions.

Acute HCV usually asymptomatic. Mild if appear.

One of the most common causes of end stage liver disease.

Tx: supportive

Pts should be vaccinated against HAV and HBV.

Cirrhosis

Widespread progressive fibrosis and nodule formation in liver.

Destruction of hepatocytes, scarring, dec liver fxn.

S/S: ascites, hematemesis, bleeding tendancy, prominent abdom. wall veins, internal hemorrhoids, confusion, irritability, infection, asterixis, inc in AST, ALT, LDH. dec in albumin.

Tx: nutritious diet w/ adequate calories and protein, vit supp, adequate rest. prevent infections, liver transplant.