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.
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,
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
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
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
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
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
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
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.
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.