Chapter029

Chapter 29
Disorders of Gastrointestinal
Function
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Job of the Bowel
• To digest food: involves a corrosive solution
and potentially pathogenic bacteria
• To absorb the food into the blood while
keeping the corrosive substances and the
bacteria inside the gut
• To keep the solution moving down the bowel
at the right rate for digestion and absorption

Inflammation and Damage to the Bowel
Wall
• Hemorrhage  anemia
• Perforation  peritonitis
• Decreased mucosal function  malabsorption
• Decreased bacterial containment  sepsis

Hemorrhage
• Hemorrhage above the stomach: frank
hematemesis
• Hemorrhage into the stomach with partial
digestion of blood: coffee-ground vomitus
• Hemorrhage in the intestine with blood mixing
into stools: occult blood
• Hemorrhage into the intestines with large
volumes of blood: melena
• Hemorrhage in the rectum: red blood coating
stools

The Vicious Circle: One Kind of Bowel
Problem Can Cause Another
Reflex paralysis
Distension, ischemia
Inflammation
and cell damage
Obstruction
Malabsorption
Decreased
bowel
function
Food does not
pass through
bowel at correct
rate

Question
Which symptom accompanies hemorrhage into the
stomach?
a. Hematemesis
b. Occult blood
c. Coffee-ground vomitus
d. Melena

Answer
c. Coffee-ground vomitus
Coffee-ground vomitus is a classic symptom of blood in the
stomach (it mixes with chyme to give it the coffee-ground
color and consistency). Hematemesis occurs in
hemorrhage above the stomach; occult blood is the
result of blood mixing with stool in the small intestine;
and melena occurs with large-volume hemorrhages in
the intestine.

Disorders of the Esophagus
• Dysphagia
• Achalasia
• Esophageal diverticulum
• Gastroesophageal reflux disease
• Cancer of the esophagus

Disorders of the Stomach
• Acute gastritis
• Chronic gastritis
• Ulcer disease
– Peptic ulcer
– Zollinger-Ellison syndrome
– Stress ulcers
• Cancer of the stomach

Scenario
Mrs. D has pain in her stomach at night and vomits up
blood…
• She is pale and weak
• The doctor finds that her hematocrit is low
• Her blood contains large, pale erythrocytes and
some reticulocytes
• Bilirubin levels are normal
Question:
• Explain her symptoms

Helicobacter pylori
• The major
cause of
ulcers
• Second most
common
cause is
NSAIDs
H.
pylori
damages
stomach
lining
ULCER repair and
healing
increased risk of
gastric cancer

“In the US: The frequency of HP infection may
be linked to race. White persons account for
29% of cases, and Hispanic persons account for
60% of cases.
“Internationally: … At least half of all people
are infected … HP may be detected in
approximately 90% of individuals with peptic
ulcer disease...”
(Santacroce, L., and Miragliotta, G. 2005. Helicobacter pylori infection. eMedicine.
Retrieved April 2005 from http://www.emedicine.com/ med/topic962.htm#top.)

Inflammations of the Small and Large
Intestines
• Infectious enterocolitis
– Viral infections
– Bacterial infections
• Inflammatory bowel disease
– Crohn disease
– Ulcerative colitis
• Diverticular disease
• Appendicitis

Discussion
Think back to the last time you had enterocolitis
Question:
• List the things that happened to you
• Which of them were systemic signs of
inflammation?
• Which of them were caused by your
sympathetic system?
• Which of them helped you get over the
disease?
• Which of them could have caused serious
complications? Why?

Question
Which intestinal disorder is an autoimmune disease?
a. Enterocolitis
b. Crohn disease
c. Ulcerative colitis
d. Diverticulitis

Answer
b. Crohn disease
Crohn disease is an autoimmune disorder that affects the
mucous membrane lining of the bowel (it gets thicker
and does not function as it should), causing chronic
malabsorption.

Enterocolitis
• The bowel attempts to get rid of the infectious agent
– Exudate to dilute toxins
– Hypermotility
• Vomiting
• Decreased intestinal function
– Food not absorbed
º Osmosis draws water into the bowel
º Osmotic (or explosive) diarrhea

Inflammations That Cannot Be Expelled
• Pain and sympathetic nervous stimulation cause the
bowel to freeze in position
– Reflex paralysis or paralytic ileus
• Muscles of the abdominal wall tighten to protect the
inflamed bowel
– Board-like abdomen
• Diaphragm and accessory breathing muscle
movements decrease
– Shallow breathing

One Kind of Bowel Problem Can Cause
Another
Inflammation
and cell damage
Obstruction
Reflex paralysis
Distension, ischemia

Intestinal Obstruction
• Mechanical
– Severe, colicky pain
– Borborygmus
– Audible, high-pitched peristalsis; peristaltic rushes
– Awareness of intestinal movements
• Paralytic
– Continuous pain
– Silent abdomen

Results of Obstruction:
• Vomiting  fluid and
electrolyte loss
• Fluids move into intestinal
contents
• Gas accumulates
• Distension of bowel
• Compartment syndrome 
ischemia, necrosis
• Anaerobic bacteria produce
endotoxin  toxemia

Question
Tell whether the following statement is true or false:
Paralytic intestinal obstruction causes audible paralysis.

Answer
False
Mechanical obstruction results in high-pitched peristalsis
(bowel sounds); in paralytic obstruction, bowel sounds
are inaudible (silent abdomen).

Bowel Distension and Compartment
Syndrome
• The blood vessels on the surface of the gut are covered and
held in place by the inflexible mesentery
• When the gut lumen distends, it crushes the blood vessels
between the gut wall and the mesentery

Compartment Syndrome
• An organ expands inside a membrane that
will not expand
• The blood vessels feeding the organ are
crushed between the organ and the
membrane
• Blood supply is cut off

Scenario
Mrs. K presents with acute abdominal pain…
• She has a distended, board-like abdomen with no bowel
sounds. Blood pressure is low and heart rate elevated.
Her skin is pale and cool with cold sweat. She is very
restless and complains of acute abdominal pain.
• The pain came on over the last 8 hours. WBC count is
elevated. Now she complains of nausea and begins
throwing up, but there is no blood in her vomitus. She
has had no bowel movements or urine production.
Question
• What adaptive responses and counterattacks are evident?

Scenario (cont.)
• Mrs. K has begun to run a fever
• Her skin is now flushed and warm, and her
abdomen is further distended
• Her blood pressure has decreased further
• The doctor has ordered nasogastric suction and
an isotonic IV
Question
• Why are you taking fluids out of her GI tract
and putting them into her veins?

Alterations in Intestinal Absorption
– Malabsorption syndrome
– Celiac disease

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