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    MEAS 242 Chapter14 MEAS 242 Chapter14 Presentation Transcript

    • Lecture Notes 14 Digestive System Diseases and DisordersClassroom Activity to AccompanyDiseases of the Human BodyFifth EditionCarol D. Tamparo Marcia A. Lewis
    • Copyright © 2011 by F.A. Davis Company. All rightsreserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise— without written permission from the publisher.
    • An apple a day keeps everyone away if your aim is good enough. —Maxine 3
    • Common Signs and Symptoms of DigestiveSystem Diseases and Disorders• Loss of appetite, weight loss• Nausea, vomiting• Dehydration• Any change in bowel habits• Hemoptysis, hematemesis• Blood, mucus in stool• Pain in GI tract• Heartburn, indigestion, dysphagia, reflux• Malaise, loss of strength, fatigability• Jaundice• Fever 4
    • Gastroesophageal RefluxDisease (GERD)• Description • Backup of gastric or duodenal contents into esophagus, past the lower esophageal sphincter (LES) without belching or vomiting 5
    • Gastroesophageal Reflux Disease (GERD)• Etiology • Weak contraction of the LES • Abnormal relaxation of the LES • Predisposing factors include pyloric surgery, long-term nasogastric (NG) intubation, some foods, drugs, alcohol, smoking • Hiatal hernia and intra-abdominal pressure 6
    • Gastroesophageal RefluxDisease (GERD)• Signs and symptoms • There may be no symptoms • Heartburn, regurgitation, and nausea relieved with antacids, sitting upright • Worsens with vigorous exercise, bending, lying down 7
    • Gastroesophageal RefluxDisease (GERD)• Diagnostic procedures • History and physical examination • Medications to suppress acid • Esophageal probe and manometry • Esophagoscopy • Bernstein test (acid perfusion) 8
    • Gastroesophageal RefluxDisease (GERD)• Treatment • Eat low-fat, high-fiber foods • Avoid caffeine, tobacco, alcohol, chocolate, peppermint, carbonated drinks • Elevate head of bed • Antacids, proton pump inhibitors, GI stimulants • Surgery 9
    • Gastroesophageal RefluxDisease (GERD) Complementary therapy • Avoid trigger foods • Drink warm water with a meal • Chew gum after a meal Client communication • Eat nothing 2 hours before bedtime; eat smaller meals • Avoid tight clothing • Maintain normal body weight 10
    • Gastroesophageal RefluxDisease (GERD)• Prognosis • Varies with underlying cause • Chronic condition creates risk for Barrett esophagus• Prevention • Avoid offending foods • Reduce fat, increase fiber in diet • Do not eat before bed 11
    • Gastroesophageal RefluxDisease (GERD)• GERD occurs due to _______ or abnormal relaxation of the LES. 1. blockage 2. weak contraction 3. stenosis 4. over contraction 12
    • Peptic Ulcers• Description • Circumscribed lesions in mucous membranes most likely found in stomach and duodenum • Gastric peptic ulcers occur mostly in women older than age 60 • Duodenal peptic ulcers found in men between ages 20 and 50; tend to be chronic, recurrent 13
    • Peptic Ulcers• Etiology • Infection with Helicobacter pylori • Use of NSAIDs • Increase of gastric acid • Irritants likely accelerate • Predisposing factors include blood type • Gastric ulcers = type A blood; duodenal ulcers = type O blood NSAIDs = nonsteroidal anti-inflammatory drugs. 14
    • Peptic Ulcers• Signs and symptoms • Persistent heartburn, indigestion • Nagging stomach pain • GI bleeding • Nausea, vomiting • Weight loss • Hematochezia • Sensation of hot water bubbling in back of throat • Occurs 2 hours after eating 15
    • Peptic Ulcers• Diagnostic procedures • EGD • UGI barium swallow • Occult blood in stools • Serologic tests • Gastric analysis • Carbon 13 urea breath test EGD = esophagogastroduodenoscopy; UGI = upper gastrointestinal. 16
    • Peptic Ulcers• Treatment • Treat at least once with antibiotics to eradicate H. pylori infection • Medication to reduce gastric secretion • Surgery if perforation 17
    • Peptic Ulcers Complementary therapy • Eliminate irritating foods • Reduce stress • Herbal medicines may be considered Client communication • Prompt treatment to prevent complications • Avoid foods that cause increase in stomach acid 18
    • Peptic Ulcers• Prognosis • Varies • Tends to be chronic with remissions, exacerbations • Complications include hemorrhage, perforation• Prevention • None known but risk can be lowered: no smoking, no NSAIDs, and limit alcohol 19
    • Gastroenteritis• Description • Inflammation of the stomach and small intestine • Also known as intestinal flu, traveler’s diarrhea, or food poisoning 20
    • Celiac Disease (Gluten-InducedEnteropathy)• Description • Disease of the small intestine • Marked by malabsorption, gluten intolerance, and damage to the mucosal lining of the intestine • Sometimes called gluten-induced enteropathy 21
    • Irritable Bowel Syndrome• Description • Complex symptoms of abdominal pain, altered bowel function; constipation, diarrhea • Chronic, lasting intermittently for years • Most frequently occurring GI disorder in the United States 22
    • Irritable Bowel Syndrome• Etiology • Unknown • Associated with change in colonic motility, stress seems to precipitate an attack, intolerance of some foods 23
    • Irritable Bowel Syndrome• Signs and symptoms • Abdominal pain with constipation or constipation alternating with diarrhea • Heartburn • Abdominal distention • Faintness • Acute attacks subside within 1 day, then exacerbations 24
    • Irritable Bowel Syndrome• Diagnostic procedures • Rule out other GI diseases • History and physical examination • CBC • Stool exam • Sigmoidoscopy • Colonoscopy • Barium enema • Rectal biopsy CBC = complete blood count. 25
    • Irritable Bowel Syndrome• Treatment • Dietary modifications, adding fiber • Adequate sleep, exercise; eliminate as much stress as possible • Antispasmodic drugs 26
    • Irritable Bowel Syndrome Complementary therapy • Herbal remedies or probiotics may help • Eat meals at regular intervals, chew foods slowly • Drink eight glasses of water/day • Biofeedback, acupuncture, hypnosis Client communication • Recommend regular check-ups • Educate about chronicity and possible complications • May need immediate use of bathroom 27
    • Irritable Bowel Syndrome• Prognosis • Varies with how successful symptoms can be controlled• Prevention • None known 28
    • Crohn Disease• Description • Serious, chronic inflammation of ileum, or any portion of GI tract • Extends through all layers of intestinal wall, causing thickening, toughening of wall with narrowing of intestinal lumen 29
    • Crohn Disease• Etiology • Suspect immunologic interaction with bacteria or virus • Genetic susceptibility, environmental trigger, weakened or damaged intestinal wall 30
    • Crohn Disease• Signs and symptoms • Intermittent or steady abdominal pain in RLQ • Diarrhea • Lack of appetite, weight loss • Fissures or fistulas may appear in anal area RLQ = right lower quadrant. 31
    • Crohn Disease• Diagnostic procedures • Rule out other bowel diseases • History and physical examination • Barium enema • Sigmoidoscopy • Colonoscopy • Biopsy 32
    • Crohn Disease• Treatment • Symptomatic, supportive • Mesalamine, sulfasalazine, corticosteroid drugs • Surgery for complications or extensive disease 33
    • Crohn Disease Complementary therapy • Probiotics Client communication • Support through acute attacks • Teach prevention of complications • Adequate nutritional intake, fluid balance 34
    • Crohn Disease• Prognosis • Depends on severity • Worsens over time • Complications include intestinal obstruction, fistula• Prevention • None 35
    • Crohn Disease• Crohn disease most commonly is inflammation of the 1. duodenum 2. esophagus 3. ileum 4. colon 36
    • Ulcerative Colitis• Description • Chronic inflammation and ulceration of the colon • Begins at the rectum or sigmoid colon and continues upward into the entire colon • With Crohn disease, often referred to as inflammatory bowel disease (IBD) – together affect about 2 million persons in the United States 37
    • Diverticular Disease(Diverticulosis and Diverticulitis)• Description • Bulging pouches in the GI tract wall push mucosal lining through surrounding muscle • Diverticulitis: the acute inflammation of the pouch-like herniations in the intestinal wall • Diverticulosis: the presence of the pouches or diverticula; usually causing no symptoms 38
    • Diverticular Disease(Diverticulosis and Diverticulitis) • Etiology • Colon walls thicken with age and increased pressure to eliminate feces • Fecal matter sometimes forms a fecalith and bacteria accumulate around it and attack the lining of the diverticulum • Inflammation may lead to perforation 39
    • Diverticular Disease(Diverticulosis and Diverticulitis)• Signs and symptoms • Diverticulosis is usually asymptomatic • If diverticulitis occurs it is characterized by fever, lower left quadrant pain that is relieved by bowel movement or flatulence • Alternating constipation and diarrhea 40
    • Diverticular Disease(Diverticulosis and Diverticulitis) • Diagnostic procedures • Abdominal x-rays • CT scan • Stool specimen examination • Barium enema and colonoscopy, but not when disease is active CT = computed tomography. 41
    • Diverticular Disease(Diverticulosis and Diverticulitis)• Treatment • Bran and bulk additives to the diet • Stool softeners • Antibiotics or anticholinergics • Colon resection with temporary colostomy 42
    • Diverticular Disease(Diverticulosis and Diverticulitis) Complementary therapy • Whole foods, high-fiber diet with soluble fibers Client communication • Explain connection between dietary habits and the disease • Refer to a dietitian 43
    • Diverticular Disease(Diverticulosis and Diverticulitis)• Prognosis • Less favorable with age • Proper diet can forestall acute episodes • Perforation of the wall can lead to acute peritonitis, sepsis, and shock• Prevention • None, except high-fiber diet can prevent further formation or worsening of the condition 44
    • Acute Appendicitis• Description • Inflammation of vermiform appendix due to obstruction• Etiology • Obstruction by fecalith, stricture, foreign body, viral infection, or ulceration of mucosal lining • Bacteria multiply, invade appendix wall; necrosis, gangrene, perforation may occur 45
    • Acute Appendicitis• Signs and symptoms • Generalized abdominal pain, then settles over McBurney point with board-like rigidity • Increased tenderness • Abdominal spasms • Fever 46
    • Acute Appendicitis• Diagnostic procedures • History and physical examination • Characteristic symptoms • Leukocytosis and pyuria • CT scan• Treatment • Appendectomy 47
    • Acute Appendicitis Complementary therapy • None Client communication • Advise about postoperative care 48
    • Acute Appendicitis• Prognosis • With early diagnosis and treatment, prognosis good • If appendix ruptures, peritonitis may occur, greatly increasing serious complications• Prevention • None 49
    • Acute Appendicitis• Appendicitis is inflammation of the appendix due to a(n) 1. ulceration 2. obstruction 3. perforation 4. fistula 50
    • Hemorrhoids• Description • Dilated, tortuous veins in the mucous membrane of the anus or rectum • Insignificant unless they cause bleeding or pain • External hemorrhoids: veins below the anorectal line • Internal hemorrhoids: veins above the anorectal line 51
    • Hiatal Hernia• Description • Protrusion of some portion of stomach into thoracic cavity • Two major types • Sliding (most common) • Paraesophageal or rolling 52
    • Hiatal Hernia• Etiology • Unclear • Intra-abdominal pressure, or weakening of gastroesophageal junction caused by trauma or loss of muscle tone • Incidence increases with age; higher in women; obesity 53
    • Hiatal Hernia• Signs and symptoms • Asymptomatic • Heartburn, aggravated by reclining • Chest pain • Dysphagia • Esophageal reflux 54
    • Hiatal Hernia• Diagnostic procedures • Chest x-ray • Barium x-ray • Endoscopy and biopsy • pH studies of reflux 55
    • Hiatal Hernia• Treatment • Alleviate symptoms • Modify diet • Medication to strengthen LES • Restrict activities • Antacids, proton pump inhibitors • Stool softeners, laxatives • Surgery, if all else fails 56
    • Hiatal Hernia Complementary therapy • Avoid spicy, fried foods; caffeine; carbonated drinks; alcohol; peppermint • Avoid overeating • Deep breathing to strengthen diaphragm, expand lungs Client communication • Explain tests and treatments • Describe dietary and activity restrictions 57
    • Hiatal Hernia• Prognosis • Good with proper treatment • Complications include stricture, significant bleeding, pulmonary aspiration, strangulation• Prevention • None 58
    • Abdominal Hernias• Description • Protrusion of an internal organ, typically a portion of the intestine, through an abnormal opening in the musculature of the abdominal wall • Can be umbilical, inguinal, or femoral 59
    • Pancreatitis• Description • Inflammation of the pancreas • Pancreatic enzymes, normally inactive until reaching the duodenum, start digesting pancreatic tissue • Causes edema, swelling, tissue necrosis, and hemorrhage 60
    • Cholelithiasis andCholecystitis• Description • Cholelithiasis: formation or presence of gallstones within gallbladder or bile ducts • Cholecystitis: severe inflammation of interior wall of gallbladder 61
    • Cholelithiasis andCholecystitis• Etiology: Cholelithiasis • Obesity, high-calorie diet • Certain drugs, oral contraceptives • Multiple pregnancies • Increasing age • Genetic 62
    • Cholelithiasis andCholecystitis• Etiology: Acute cholecystitis • Consequence of obstructing gallstones in bile ducts • Accumulating bile increases pressure in gallbladder • Chemical changes in bile erodes tissue • Secondary infection • Obstruction of bile ducts can result from other causes, too 63
    • Cholelithiasis andCholecystitis• Signs and symptoms: Cholelithiasis • Asymptomatic; gallbladder attack when obstructed • Acute URQ abdominal pain radiating to shoulder, back • Nausea, vomiting • Flatulence, belching, heartburn; especially after eating fatty foods URQ = upper right quadrant. 64
    • Cholelithiasis andCholecystitis• Signs and symptoms: Acute cholecystitis • Gradual onset of URQ pain; remains localized and persists • Anorexia • Nausea, vomiting • Low-grade fever • Chills 65
    • Cholelithiasis andCholecystitis• Diagnostic procedures • Biliary colic pain suggests gallstones • Ultrasound • Oral cholecystogram • IV cholangiogram • Abdominal x-ray, CT, or MRI • Elevated serum bilirubin IV = intravenous; MRI = magnetic resonance imaging. 66
    • Cholelithiasis andCholecystitis• Treatment • If symptoms persist, surgery • Nonsurgical treatment with catheter insertion using basket to trap stone • Extracorporeal shock wave lithotripsy • Bile acid therapy to dissolve certain stones 67
    • Cholelithiasis andCholecystitis Complementary therapy • Identify food allergies • Reduce fat, refined carbohydrates • Eat frequent, smaller meals; avoid overeating • Increase dietary fiber Client communication • Provide pre- and postoperative care, including any complications 68
    • Cholelithiasis andCholecystitis• Prognosis • Generally good, with prompt treatment • Complications include infection, peritonitis• Prevention • None; avoid high-fat diet 69
    • Cirrhosis• Description • Chronic, irreversible, degenerative liver disease • Normal liver cells replaced with fibrous scar tissue • Necrosis, hepatic insufficiency results 70
    • Cirrhosis• Etiology • Common causes are portal, nutritional, and alcoholic • Other causes include • Chronic hepatitis B, C, & D • CHF, some toxins, and genetics • Abuse of acetaminophen • Also, idiopathic CHF = congestive heart failure. 71
    • Cirrhosis• Signs and symptoms • Asymptomatic or vague and unspecific • Nausea, vomiting • Anorexia • Dull abdominal ache • Weakness, fatigability • Weight loss • Pruritus • Peripheral neuritis • Edema, ascites 72
    • Cirrhosis• Diagnostic procedures • Enlarged, firm liver on palpation • CT scan, MRI, ultrasound • Lab results may reveal anemia, folate deficiency, blood loss • Liver enzymes (ALT and AST) are checked ALT = alanine transaminase; AST = aspartate transaminase. 73
    • Cirrhosis• Treatment • Aimed at cause; prevent further damage • Adequate rest, diet • Restrict alcohol • Vitamin, mineral supplements • Liver transplantation for end-stage liver disease 74
    • Cirrhosis Complementary therapy • Whole-foods diet avoiding processed fats • No alcohol • Careful use of drugs and herbals Client communication • Encourage regular check-ups • Refer for alcohol treatment if indicated 75
    • Cirrhosis• Prognosis • Poor in advanced cirrhosis • Complications include portal hypertension, esophageal varices, hepatic failure, death• Prevention • None • When alcohol is contributing factor, treat alcoholism • Warn about abuse of acetaminophen 76
    • Cirrhosis• Cirrhosis is characterized by the replacement of normal liver cells with 1. adenocarcinoma 2. adipose 3. sclerotic tissue 4. scar tissue 77
    • Acute Viral Hepatitis• Description • Infection with subsequent inflammation of liver, caused by one of several viruses • Hepatitis viruses A, B, C, D, E, G 78
    • Acute Viral Hepatitis• Etiology • Six types • Type A (HAV): formerly called infectious; highly contagious through oral-fecal or parenteral transmission • Type B (HBV): spread by blood or serum from contaminated needles; health-care professionals frequently exposed; may become chronic 79
    • Acute Viral Hepatitis• Etiology (cont.) • Six types (cont.) • Type C (HCV): less common, spread is similar to HBV; often damages liver for 20 years before symptoms appear • Type D (HDV): delta; needs HBV to exist and can occur together; hemophiliacs and IV drug users at risk 80
    • Acute Viral Hepatitis• Etiology (cont.) • Six types (cont.) • Type E (HEV): rarely seen in United States; transmitted by feces-contaminated water • Type G (HGV): little is known; more common with injection-drug users; frequent co-infections with HBV, HCV, and HIV 81
    • Acute Viral Hepatitis• Signs and symptoms • Flulike • Malaise, fatigue • Anorexia • Myalgia • Fever • Dark-colored urine, clay-colored stools • Rashes, hives • Abdominal pain or tenderness • Pruritus • Jaundice 82
    • Acute Viral Hepatitis• Diagnostic procedures • Specific blood tests show antibody-antigen type • History and physical examination • Liver biopsy helps to confirm • Lab tests show proteinuria, bilirubinuria, increased liver enzymes, gamma globulin 83
    • Acute Viral Hepatitis• Treatment • Rest, adequate diet, fluid intake • Antiemetics • Medications specific to type of hepatitis • Recovery can take up to 4 months 84
    • Acute Viral Hepatitis Complementary therapy • Whole foods diet in small meals • Avoid refined sugars, alcohol, caffeine • Drink fresh lemon juice in water followed by vegetable juice • Vitamin supplements Client communication • Practice proper hygiene, especially when handling needles for injection or human secretions 85
    • Acute Viral Hepatitis• Prognosis • Depends on extent of liver damage • Chronic active hepatitis can result• Prevention • When exposed to HAV, IgG may be administered for prevention • Vaccines available for A, B; none for C, D, E IgG = immunoglobulin G. 86
    • Colorectal Cancer• Description • Collective designation for a variety of malignant neoplasms that may arise in either the colon or the rectum • Almost always an adenocarcinoma 87
    • Colorectal Cancer• Etiology • Cause is unknown • Higher incidence in high-fat, low-fiber diets • Predisposing factors: diseases of the digestive tract, a history of IBS, familial polyposis • Incidence increases after age 40 88
    • Colorectal Cancer• Signs and symptoms • Rectal bleeding or blood in the stool • Pallor, ascites • Cachexia • Lymphadenopathy, hepatomegaly • May metastasize to adjacent organs 89
    • Colorectal Cancer• Diagnostic procedures • Tumor biopsy to verify • Digital rectal exam • Fecal occult blood test • Sigmoidoscopy • Colonoscopy • CT scan 90
    • Colorectal Cancer• Treatment • Surgery to remove tumor, adjacent tissues, and lymph nodes • Chemotherapy • Radiation therapy • Carcinoembryonic antigen testing to detect metastasis or recurrence 91
    • Colorectal Cancer Complementary therapy • Acupuncture, relaxation, and meditation to reduce symptoms Client communication • Provide information on postoperative procedures and expected adverse effects of chemotherapy and radiation 92
    • Colorectal Cancer• Prognosis • Prognosis varies • If diagnosed early and is localized, potentially curable in 90% of cases• Prevention • High-fiber, low-fat diet may reduce the risk 93
    • Pancreatic Cancer• Description • Adenocarcinoma that occurs most frequently in the head of the pancreas • Highest incidence in people ages 60 to 70 94
    • Pancreatic Cancer• Etiology • Not known • Linked to inhalation or absorption of carcinogens • Associated with smoking, high-fat diet, exposure to occupational chemicals • Chronic pancreatitis and family history 95
    • Pancreatic Cancer• Signs and symptoms • Abdominal pain that radiates to the back • Anorexia, jaundice • Fatigue, weakness • Nausea and vomiting • Insulin deficiency • Glucosuria, hypergylcemia 96
    • Pancreatic Cancer• Diagnostic procedures • Percutaneous needle aspiration biopsy • Ultrasonography, MRI, CT scan • Endoscopic retrograde cholangiopancreatography • Blood tests 97
    • Pancreatic Cancer• Treatment • Dependent on the stage and location of the cancer • Often palliative if diagnosed after metastasis • Surgery, chemotherapy, and radiation • Pain management 98
    • Pancreatic Cancer Complementary therapy • Increase intake of antioxidants Client communication • Reinforce the need for small frequent meals • Instruct clients to notify their primary care provider if jaundice, weight loss, or bowel obstruction occurs 99
    • Pancreatic Cancer• Prognosis • Poor due to metastasis at diagnosis• Prevention • None, other than avoid known carcinogens and reduce amount of dietary fat 100
    • Pancreatic Cancer• Pancreatic cancer is linked to _____ of carcinogens. 1. malabsorption 2. inhalation 3. digestion 4. ingestion 101
    • Credits Publisher: Margaret Biblis Acquisitions Editor: Andy McPhee Developmental Editor: Yvonne Gillam, Julie Munden Backgrounds: Joseph John Clark, Jr. Production Manager: Sam Rondinelli Manager of Electronic Product Development: Kirk Pedrick Electronic Publishing: Frank Musick The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation. 102