Question

CHAPTER 36: GASTROINTESTINAL DISORDERS General Manifestations - dysphagia: definition, types/causes, clinical manifestations - esophageal pain: - heartburn: cause, clinical manifestations - chest pain: causes, clinical manifestations -abdominal pain: visceral, somatic, referred, acute, chronic descriptions - vomiting: definition, causes - constipation: definition, causes, complications - diarrhea: definition, acute vs chronic, complications Esophageal Disorders - gastroesophageal reflux disease (GERD): description, causes, clinical manifestations, complications Inflammation of the Stomach and Intestines - gastritis:description, acute vs chronic (causes, clinical manifestations, complications) - gastroenteritis: description, acute vs chronic, clinical manifestations - peptic ulcer disease: causes, gastric vs duodenal, clinical manifestations, complications Inflammatory Bowel Disease - ulcerative colitis: description, appearance, location, clinical manifestations - Crohn disease: description, appearance, location, clinical manifestations USD Enterocolitis - appendicitis: description, location, clinical manifestations, complications Neoplasms of the GI Tract - warning signs - risk factors - colon cancer: polyps (description), risk factors, hereditary condition, clinical manifestations, prognosis CHAPTER 37: ALTERATIONS IN FUNCTION OF THE GALLBLADDER AND EXOCRINE PANCREAS Overview - review normal anatomy and physiology of the gallbladder and pancreas (including their secretions) Gallbladder Disorders - cholesterol gallstones: phases, risk factors, black vs brown pigment stones - cholelithiasis: description, etiology, adults vs children - chronic/biliary colic: description, cause, clinical manifestations - acute cholecystitis: description, etiology, complications, clinical manifestations Pancreatic Disorders acute pancreatitis: description, predisposing factors, clinical manifestations, severe complications

Answer 1

GASTROINTESTINAL DISORDERS

DYSPHAGIA :

• Definition -Dysphagia refers to a difficulty in swallowing - it takes more effort than normal to move food from the mouth to the stomach.
• Causes - Possible causes of dysphagia include: Amyotrophic lateral sclerosis, Achalasia, Diffuse spasm, Stroke, Eosinophilic esophagitis, Multiple sclerosis, Myasthenia gravis (Goldflam disease), Parkinson's disease and Parkinsonism syndromes, Cleft lip and palate ,Scleroderma, Esophageal cancer, Esophageal stricture, Xerostomia (dry mouth)

• Types - There are three general types of dysphagia: Oral dysphagia (high dysphagia), Pharyngeal dysphagia & Esophageal dysphagia (low dysphagia)

• Clinical Menifestations - Symptoms linked to dysphagia include: Choking when eating, Coughing or gagging when swallowing, Drooling, Food or stomach acid backing up into the throat, Hoarseness, Sensation of food getting stuck in the throat or chest, or behind the breastbone, Unexplained weight loss, Bringing food back up (regurgitation), Inability to control saliva in the mouth

ESOPHAGEAL PAIN

- HEARTBURN :

• Cause - Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (esophagus). The acid backup may be worse when you're bent over or lying down.
• Clinical Manifestations - Symptoms of heartburn include: A burning pain in the chest that usually occurs after eating and may occur at night, Pain that worsens when lying down or bending over, Bitter or acidic taste in the mouth

-CHEST PAIN :

• Causes of esophageal chest pain result from an underlying disturbed nerve sensation and muscle and mucosal dysfunction.
• Clinical Manifestations -
• Squeezing pain in your chest. The pain is often intense, and you might mistake it for heart pain (angina).

ABDOMINAL PAIN

• Visceral - Visceral pain resulting from stretch of smooth muscle is localized in one of the three midline zones of the abdomen: epigastric, midabdominal, and lower abdominal. This midline zone pain, the sum of pain from the right and left splachnic pathways, is poorly localized, covers several body segments and, depending on its cause, varies from dull, aching, constant pain to cramping pain. Nausea, vomiting, pallor, and sweating are commonly associated with visceral pain.
• Somatic - Somatic pain is well localized. It is located asymmetrically and is intensified by jarring, deep inspiration or pressure on the abdominal wall.
• Referred - Referred pain is pain perceived at a location other than the site of the painful stimulus/ origin. It's the result of a network of interconnecting sensory nerves.
• Acute - The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting. Most patients with an acute abdomen appear ill.
• Chronic - Chronic abdominal pain is pain that is present for more than 3 months. It may be present all the time (chronic) or come and go (recurring).

VOMITING

• Definition - Vomiting is the forcible voluntary or involuntary emptying ("throwing up") of stomach contents through the mouth.
• Causes - Nausea and vomiting are not diseases, but they are symptoms of many conditions such as:Motion sickness or seasickness, Early stages of pregnancy (nausea occurs in approximately 50%-90% of all pregnancies; vomiting in 25%-55%, Medication-induced vomiting, Intense pain, Food poisonin, Infections (such as the "stomach flu", Overeating, A reaction to certain smells or odors, Heart attack, Concussion or brain injury, Brain tumor, Ulcers, Some forms of cancer, Bulimia or other psychological illnesses, Gastroparesis or slow stomach emptying (a condition that can be seen in people with diabetes), Ingestion of toxins or excessive amounts of alcohol, Bowel obstruction ,Appendicitis

CONSTIPATION

• Definition - Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a condition of the digestive system where an individual has hard feces that are difficult to expel.
• Causes - Lack of fiber in the diet, Physical inactivity, Medications,  Irritable bowel syndrome, Pregnancy, Aging, Not going to the toilet when needed, Not drinking enough water, scar tissue, diverticulosis, and abnormal narrowing of the colon or rectum, known as colorectal stricture, etc
• Complications - Constipation on its own can be uncomfortable but not life-threatening. However, severe constipation can develop into more serious conditions, including: rectal bleeding after continually straining to pass stools; anal fissure, or a small tear around the anal opening; hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum; faecal impaction, in which dried stools collect in the rectum, leading to an obstruction in the path stool would take to leave the body

DIARRHEA

• Definition - Diarrhea is characterized by abnormally loose or watery stools. Loose, watery bowel movements that may occur frequently and with a sense of urgency.
• Acute Diarrhea - Acute diarrhea occurs when the condition lasts for one to two days. One might experience diarrhea as a result of a viral or bacterial infection. Other times, it could be due to food poisoning. There’s even a condition known as traveler’s diarrhea, which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.
• Chronic Diarrhea - Chronic diarrhea refers to diarrhea that lasts for at least four weeks. It’s usually the result of an intestinal disease or disorder, such as celiac disease or Crohn’s disease.
• Complications - Complications may result from diarrhea of any etiology. Fluid loss with consequent dehydration, electrolyte loss (sodium, potassium, magnesium, chloride), and even vascular collapse sometimes occur. Collapse can develop rapidly in patients who have severe diarrhea (eg, patients with cholera) or are very young, very old, or debilitated. Bicarbonate loss can cause metabolic acidosis. Hypokalemia can occur when patients have severe or chronic diarrhea or if the stool contains excess mucus. Hypomagnesemia after prolonged diarrhea can cause tetany.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

• Description - Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the return of the stomach's contents back up into the esophagus.
• Causes - Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia.
• Clinical Manifestations - A burning sensation in your chest (heartburn), usually after eating, which might be worse at night, Chest pain, Difficulty swallowing, Regurgitation of food or sour liquid, Sensation of a lump in your throat
• Complications - Over time, chronic inflammation in your esophagus can cause: Narrowing of the esophagus (esophageal stricture), An open sore in the esophagus (esophageal ulcer), Precancerous changes to the esophagus (Barrett's esophagus)

GASTRITIS

• Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).
• Acute Gastritis - Acute gastritis is a sudden inflammation or swelling in the lining of the stomach. Causes -  injury, bacteria, viruses, stress, or ingesting irritants such as alcohol, NSAIDs, steroids, or spicy food. Clinical Manifestations - It can cause severe and nagging pain. However, the pain is temporary and usually lasts for short bursts at a time. Acute gastritis comes on suddenly. It is often only temporary. Complications of acute gastritis include Bleeding from an erosion or ulcer
• Chronic Gastritis - Chronic gastritis is a long-term condition in which the mucus lined layer of the stomach, also known as the gastric mucosa, is inflamed or irritated over a longer period of time. Cause - Helicobacter pylori (H. pylori) infection, Bile reflux, and Infections caused by bacteria and viruses Clinical Manifestations -  most people with chronic gastritis experience a variety of symptoms, including: indigestion, a burning or gnawing feeling in the stomach, the sensation of being full after eating a small amount, nausea and vomiting, belching, unintentional weight loss, bloating, loss of appetite, upper abdominal pain or discomfort, bleeding, usually only in erosive gastritis. Gastritis is termed "erosive" if the stomach lining has been worn away, exposing the tissue to stomach acids.   Complications - Erosive gastritis can cause peptic ulcers. Once an ulcer has formed, they can progressively degrade the surrounding tissues, widening and enlarging themselves. Severe ulcers may eventually cause internal bleeding, which can be life-threatening if left untreated. Other possible complications of chronic gastritis include: anemia caused by iron deficiency, anemia caused by internal bleeding, vitamin B-12 deficiency, abnormal stomach growths, such as polyps and tumors

GASTROENTERITIS

• Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—the stomach and small intestine.

• Signs and symptoms- Gastroenteritis usually involves both diarrhea and vomiting. Sometimes, only one or the other is present. This may be accompanied by abdominal cramps. Signs and symptoms usually begin 12–72 hours after contracting the infectious agent. If due to a virus, the condition usually resolves within one week. Some viral infections also involve fever, fatigue, headache and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections cause severe abdominal pain and may persist for several weeks. Children infected with rotavirus usually make a full recovery within three to eight days. However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common. Dehydration is a common complication of diarrhea. Severe dehydration in children may be recognized if the skin color and position returns slowly when pressed. This is called "prolonged capillary refill" and "poor skin turgor". Abnormal breathing is another sign of severe dehydration.Repeat infections are typically seen in areas with poor sanitation, and malnutrition. Stunted growth and long-term cognitive delays can result.