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digestive disorders 1.docx

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Health Science
HLSC 2461U
Otto Sanchez

Digestive Disorders 1 Common Disorders of the Esophagus GERD (Gastroesophageal Reflux Disease)  Stomach has HCl, mucosa is protected in the stomach but the stratified squamous epithelium in the esophagus doesn’t have the same protection from the mucous  when the sphincter doesn’t work well, there can be reflex (heartburn, GERD)  continuous exposure of acid will cause changes in the mucosa (erosive esophagitis)  esophageal stricture can be produced when esophagitis is chronic and causes the formation of scars  when our cardius doesn’t work well, there can be reflux  chronically, this is called GERD  can form ulcers in the esophagus, commonly caused by GERD and be aware that in some parts of the world there is esophageal  esophageal ulcers could also be cancer so they should be removed and biopsied  most esophageal cancers are in the lower third of the esophagus which is where ulcers also caused by GERD may also be Hiatal Hernia  Some people with GERD all the time  Reason may be anatomical (hernia through the hiatus which is a hole in the diaphragm)  esophagus communicates with the stomach through this hole  stomach slides upward over diaphragm Sliding: part of the fundus of the stomach slides upwards so that cardias (sphincter is above the diaphragm=reflux all of the time, ischemia of the stomach wall) Paraesophageal: small portion of the stomach is herniated = ischemic  Clinically manifests as GERD…needs to be surgically corrected Common Disorders of the Stomach and Duodenum Gastritis  inflammation of the mucosa of the stomach  left is the normal mucosa of the stomach  upper right corner = a lot of inflammation (acute gastritis), erythema, mucosa still continues (no alteration), pain, increased mucous and gastric acid production = reflux  lower right corner = beginning of hemorrhages/ulcers, chronic, ulcer = mucosa discontinues, mucosa dies  causes pain and an increased production of mucus and gastric acid  can also cause a bit if reflux  once it gets worse you will start to see little hemorrhages  formation of ulcers  ulcer is when this mucosa discontinues Ulcers  almost like a crater/hole in the mucosa  mucosa around the hole is inflamed (folds disappear), also no mucosa in the actual hole  depending how deep the ulcer is, symptoms differ (submucosa = veins and ulcers)  ulcer can be very deep  remember the different layers of the stomach: mucosa, submucosa, muscle, serosa  depending on how deep the ulcer is there will be different symptoms  submucosa: they will bleed because there are many veins/arteries  may have GI bleeding/hematemesis (throwing up blood)  inflammation can go so deep it can start to destroy the muscle/serosa  can perforate and communicate internal stomach peritoneal cavity = perontonitis (chemical), or pneumoperitoneum (some air in the stomach gets into peritoneum) Duodenal Ulcers  can be caused by the same thing as gastric ulcers  ulcer has interrupted the mucosa, forming a crater  compromise submucosa and muscle  if this keeps going, can cause perforation/hemorrhage  ulcers are benign  if you compare gastric & duodenal ulcers, duodenal bleeds easier because the wall of the duodenum is thinner & close to bigger arteries The process that leads to ulceration  commonly caused by things that produce inflammation in the stomach (alcohol)  aspirin (antiinflammatories produce chemical irration of the stomach = gastririts)  bile salts (liver secreted in duodenum), normally no bile in the stomach unless we get reflux = gastritis  ischemia, once in a while the stomach gets this, causes gastritis (car accident, bleed a lot, ischemia everywhere)  In gastritis, the stomach produces a lot more pepsin, acid and histamine (acids)  causes mucosa to erode  vasodilation  all of these increase the ability to the mucosa to evade injury  bacteria H pylori Stomach Cancer  most commonly adenocarcinoma (glands of the mucosa of the stomach)  preferred locations: lower part of the stomach  east asians most likely related to diet  less chemicals in food = less stomach
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