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NRS 215 (1)

Alterations of Digestive Function.docx

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NRS 215
Danillo Viana

Alterations of Digestive Function 1) Anorexia – lack of desire to eat, associated with abdominal pain, diarrhea, nausea 2) Vomiting – result of reverse peristalsis in duodenum, stomach. Initiated by varius drugs, trauma, activation of medullary centre 3) Constipation – difficult/ infrequent defication d/t personal habits , disorders, drugs decreased fluid intake, muscle weakness 4) Diarrhea - in frequency of defecation and fluidity/volume of feces d/t excessive water or secretions in intestines, if prolonged = dehydration electrolyte imbalance, weight loss 5) Abdominal Pain = Parietal – more localized and intense Visceral – usually diffuse, vauge, closely connected to ANS = sweating, nausea, vomiting Referred – sense and feel it somewhere else 6) GI Bleeding – Hematemesis = Bloody vomit (fresh bright or coffee ground) Melena – tarry foul smelling stool (d/t digested blood) Hematochesia – fresh bright red blood from rectum Occult Blood – Trace amounts in stool or gastric secretions Blood accumulation in GI tract  vomiting and diarrhea. Esophagus Disorder Description Dysphagia Difficulty swallowing d/t lack of salivary secretions, obstruction, motility, neuro/muscular disorders. Achalasia = severely impaired lower esophageal peristalsis and sphincter f’n Hiatal Hernia Protrusion of the upper part of the stomach into thoracic cavity through esophageal hiatus  GER, esophaaitid, dysphagia, regurgitation Gastroesophageal Regurgitation of chyme into esophagus  heartburn, upper Reflux (GER) abdominal pain. Symptoms worsened by lying down or increase intra abdominal pressure. Rarely an issue may increase risk of esophagitis, cancer, asthmatic attack, strictures, esophageal spasm, decrease esophageal motility. Stomach Disorder Description Acute Gastritis Inflammation of the gastric mucosa (typically superficial erosions). Usually result of mucosal injury d/t drugs, chemicals, or bacterial toxin  vague abdominal discomfort, epigastric tenderness, bleeding Chronic Usually result in elderly, the thinning degeneration of the stomach Gastritis wall (gastric bleeding, anorexia, nausea, pain) Type A – fundal and most severe. Excessive mucosal degeneration in body and fundus  gastric atrophy  minimal secretions Type B – Antral is 4X more common, usually caused by H.pylori may lead to atrophy and peptic ulcer (risk of cancer) Peptic Ulcer Break or ulceration in mucosa (from pepsin and acid) lower Disease esophagus, stomach, duodenum. Exposes submucosa to gastric secretions  autodigestion. May be acute chronic, superficial, deep. Superficial ulcerations (called erosions) erode mucosa but don’t penetrate muscularis mucosae. True Ulcers extend through muscularis mucosae, damage blood vessels Complications: 1) Bleeding if ulcer penetrates to submucosa or deeper. Slow bleeding  iron deficiency 2) Perforation if ulcer extends through wall (usually duodenum) gastric juice enters peritoneal caviy  peritonitis Peptic Ulcer Ulcers of the stomach wall (usually antrum) occur equally in males Disease - and females. Age 55 -65 yr. Major causes: H.Pylori, NSAIDS, chronic Gastric gastrics. Manifestations: Chronic intermittent pain (burning gnawing shortly after meals. Relived by antacids may be asymptomatic. Usually heals by fibrosis in 6-8 weeks but reoccur in months. Episodic condition (remission and relapse). Tend to be chronic ulcerations. More anorexia, vomiting, weight loss then duodenal ulcers. Peptic Ulcer More common than other locations, and in males. Age usually 30-60 Disease - years. Major causes H.Pylori, NSAIDS, chemicals (caffeine, smoke) Duodenal Manifestations: similar to gastric, less anorexia, vomiting, weightloss. Peptic Ulcer Acute peptic ulcer that accompanies Severe illness ie sig. burns, Disease – Stress trauma, sepsis, liver failure, major surgery. Decreased mucosal blood Ulcer flow, hyper secretions of acid. May present with multiple lesions in stomach, duodenum  usually leads to bleeding Small Intestine/Large Intestine Disorder Description Inflammatory 1) Ulcerative Colitis – chronic inflammation of the colon mucosa Bowl Disease typically in rectum, sigmoid colon. Cause unknown. Mainly young adults 20-25 years. More common in NA and western countries. Small erosions form  merge and form ulcers. Abscess forms, necrosis, ragged ulceration separated by normal mucosa called speudopolyps (growth from mucosa to lumen). Bleeding cramping pain, diarrhea. Risk of colon cancer increased. Manifest as: frequent diarrhea with passage of small amount of blood and purulent mucus. Episodic may last weeks/ months/days. Mild forms involve less mucosa, minimal pain, bleeding, frequency of BM. Severe forms may involve entire colon, fever, increase pulse rate, urgency, frequent bloody Diarrhea. Treatment: depends on severity. Avoid caffeine, lactose, spiced foods, gas forming foods, high fibre. Antibiotics (if bacterial), anti inflammatory, imunouppresive drugs. Surgical resection if all fails 2) Crohns Disease – primarily affects distal 10-20 cm of lium rarely rectum. Recurrent granulomatous inflammation rht begins in the submucosa, may spread to all layers( Transmural – entire wall). Manifestations: more persistent but still episodic. Several years only sign could be irritable bowel (diarrhea). Weight loss, lower abdominal pain (continuous). Anemia if ilium involved (malabsorption of vitamin B12) – although less hemmorhagin. Increase risk of colon cancer. Diagnosis and treatment similar to UC Infectious Infection of the small/large intestine that leads to inflammation Enterocolitis (manifests with low fever, vomiting, and watery diarrhea. Mostly through oral/fecal route (possibly through contaminated food or water) Can be: viral (rotavirus), bacterial more severe. Clostridium difficile Colitis (C. difficile) – use of broad spec antibiotics allow it to colonize. Produced toxins that damage mucosa causing hemorrhage and necrosis (diarrhea) Escherichia Coli (E.coli) – usually found in beef and other meats infection result from under cooking. Produces toxins that lead to local inflammation (diarrhea) but can damage kidneys and other structures if systematic. Diverticular Inflammation of a diverticulum (pouch in lower wall of intestine), esp. Disease in the colon, causing pain and disturbance of bowel function. Multiple herniations (outpouchings) of mucosa. Protrude through muscular wall anywhere along the GI tract (prime sigmoid colon). Common in western society. Most common in elderly but also young ppl with low dietary fibre. Initial site is at weak point in the wall. Inflammation of diverticula usually d/t infection (accumulation of fecal matter in pouches). Manifest: usually asymptomatic, cramping, diarrhea, constipation, distension. If inflamed: abdominal pain, rectal bleeding, severe complication are rare (ie fistula rupturing) Acute Inflammation of the appendix. Generally occurs age 20-30. May be a Appendicitis result of fecalith (hardened fecal mass), tumor, or foreign body obstructing lumen of appendix resulting in bacterial infection, or torsion. Manifest: gastric/periumbilitcal pain increasing in intensity, nausea vomiting diarrhea. Complications: abscess formation, gangrene  perforation  peritonitis. Treatment: visualized with ultrasound or CT, appendectomy Intestinal Caused by any condition that prevents the normal flow o chyme through Obstruction intestinal lumen. May be: Simple (mechanical blockage) or functional (failure of motility), acute or chronic (progressive), intrinsic (within lumen – foreign bodies, hemorrhage) or extrinsic (torsion tumor hernia) Four major causes: 1) herniation of a segment in the umbilical or inguinal regions, 2) adhesion between intestinal loops 3) intussception 4) volvulus Volvulus – twisting loop if bowel usually involving occlusion of blood supply. Commonly involves cecum or sigmoid colon Intussusception – telescoping of bowel segment into another. Infants = excessive peristalsis in adults certain tumors Manifest: intermittent pain (waves), sweating ,nausea/vomiting, constipation, anxiety, abdominal distention. Malabsorption Interefers with nutrient absorption in small intestine. Can be pancreatic, Syndrome lactase or bile salt insufficiency Pancreatic Deficient production of pancreatic enzymes. Affects of digestion of all Insufficiency nutrients, but fat digestion is the main problem. Statorrhea = high fat content of stool, weakness, weight loss, abdominal pain ,cramps Lactase absense of lactase d/t congenital defecr of the small intestine brush Deficiency border disaccharidase. Most common in blacks doesn’t deveop until adulthood. Indigested lactose stays in the intestine. Gas d/t bacterial fermentation (adds pressure to GI tract pushing things through, diarrhea Bile Salt d/t conditions that decrease production, secretion of bile to duodenum Deficiency (advanced liver disease, bile duct obstruction) poor absorption of fat (steatorra, diarrhea). Poor absorption of fat soluble vitamins. Nutrition Disorder Description Obesity Typically involves an imbalance b/w energy intake and expenditure. BMI > 30. Manifest: coronary artery disease (23%), hypertension(45%), type II diabetes (39%) some forms of cancer, pulmonary, joint problems. Anorexia Psychological/ physiological disease characterized by: body weigh Nervosa 15% less that normal d/t excessive dieting and possibly exercise, fear of weight gain, distorted body image, loss of menstrual periods.
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