1. Lecture Notes 14
Digestive System
Diseases and Disorders
Classroom Activity to Accompany
Diseases of the Human Body
Fifth Edition
Carol D. Tamparo Marcia A. Lewis
3. An apple a day keeps everyone away if
your aim is good enough.
—Maxine
3
4. Common Signs and Symptoms of Digestive
System Diseases and Disorders
• Loss of appetite, weight loss
• Nausea, vomiting
• Dehydration
• Any change in bowel habits
• Hemoptysis, hematemesis
• Blood, mucus in stool
• Pain in GI tract
• Heartburn, indigestion, dysphagia, reflux
• Malaise, loss of strength, fatigability
• Jaundice
• Fever
4
5. Gastroesophageal Reflux
Disease (GERD)
• Description
• Backup of gastric or duodenal contents into
esophagus, past the lower esophageal
sphincter (LES) without belching or vomiting
5
6. Gastroesophageal Reflux
Disease (GERD)
• Etiology
• Weak contraction of the LES
• Abnormal relaxation of the LES
• Predisposing factors include pyloric surgery, long-term
nasogastric (NG) intubation, some foods, drugs, alcohol,
smoking
• Hiatal hernia and intra-abdominal pressure
6
7. Gastroesophageal Reflux
Disease (GERD)
• Signs and symptoms
• There may be no symptoms
• Heartburn, regurgitation, and nausea
relieved with antacids, sitting upright
• Worsens with vigorous exercise, bending,
lying down
7
8. Gastroesophageal Reflux
Disease (GERD)
• Diagnostic procedures
• History and physical examination
• Medications to suppress acid
• Esophageal probe and manometry
• Esophagoscopy
• Bernstein test (acid perfusion)
8
9. Gastroesophageal Reflux
Disease (GERD)
• Treatment
• Eat low-fat, high-fiber foods
• Avoid caffeine, tobacco, alcohol, chocolate,
peppermint, carbonated drinks
• Elevate head of bed
• Antacids, proton pump inhibitors, GI
stimulants
• Surgery
9
10. Gastroesophageal Reflux
Disease (GERD)
Complementary therapy
• Avoid trigger foods
• Drink warm water with a meal
• Chew gum after a meal
Client communication
• Eat nothing 2 hours before bedtime; eat smaller
meals
• Avoid tight clothing
• Maintain normal body weight
10
11. Gastroesophageal Reflux
Disease (GERD)
• Prognosis
• Varies with underlying cause
• Chronic condition creates risk for Barrett
esophagus
• Prevention
• Avoid offending foods
• Reduce fat, increase fiber in diet
• Do not eat before bed
11
12. Gastroesophageal Reflux
Disease (GERD)
• GERD occurs due to _______ or
abnormal relaxation of the LES.
1. blockage
2. weak contraction
3. stenosis
4. over contraction
12
13. Peptic Ulcers
• Description
• Circumscribed lesions in mucous
membranes most likely found in stomach
and duodenum
• Gastric peptic ulcers occur mostly in women older
than age 60
• Duodenal peptic ulcers found in men between
ages 20 and 50; tend to be chronic, recurrent
13
14. Peptic Ulcers
• Etiology
• Infection with Helicobacter pylori
• Use of NSAIDs
• Increase of gastric acid
• Irritants likely accelerate
• Predisposing factors include blood type
• Gastric ulcers = type A blood; duodenal ulcers = type O
blood
NSAIDs = nonsteroidal anti-inflammatory drugs.
14
15. Peptic Ulcers
• Signs and symptoms
• Persistent heartburn, indigestion
• Nagging stomach pain
• GI bleeding
• Nausea, vomiting
• Weight loss
• Hematochezia
• Sensation of hot water bubbling in back of throat
• Occurs 2 hours after eating
15
16. Peptic Ulcers
• Diagnostic procedures
• EGD
• UGI barium swallow
• Occult blood in stools
• Serologic tests
• Gastric analysis
• Carbon 13 urea breath test
EGD = esophagogastroduodenoscopy; UGI = upper gastrointestinal.
16
17. Peptic Ulcers
• Treatment
• Treat at least once with antibiotics to
eradicate H. pylori infection
• Medication to reduce gastric secretion
• Surgery if perforation
17
18. Peptic Ulcers
Complementary therapy
• Eliminate irritating foods
• Reduce stress
• Herbal medicines may be considered
Client communication
• Prompt treatment to prevent complications
• Avoid foods that cause increase in stomach acid
18
19. Peptic Ulcers
• Prognosis
• Varies
• Tends to be chronic with remissions, exacerbations
• Complications include hemorrhage, perforation
• Prevention
• None known but risk can be lowered: no smoking,
no NSAIDs, and limit alcohol
19
20. Gastroenteritis
• Description
• Inflammation of the stomach and small
intestine
• Also known as intestinal flu, traveler’s
diarrhea, or food poisoning
20
21. Celiac Disease (Gluten-Induced
Enteropathy)
• Description
• Disease of the small intestine
• Marked by malabsorption, gluten intolerance,
and damage to the mucosal lining of the
intestine
• Sometimes called gluten-induced
enteropathy
21
22. Irritable Bowel Syndrome
• Description
• Complex symptoms of abdominal pain,
altered bowel function; constipation, diarrhea
• Chronic, lasting intermittently for years
• Most frequently occurring GI disorder in the
United States
22
23. Irritable Bowel Syndrome
• Etiology
• Unknown
• Associated with change in colonic motility,
stress seems to precipitate an attack,
intolerance of some foods
23
24. Irritable Bowel Syndrome
• Signs and symptoms
• Abdominal pain with constipation or
constipation alternating with diarrhea
• Heartburn
• Abdominal distention
• Faintness
• Acute attacks subside within 1 day, then
exacerbations
24
25. Irritable Bowel Syndrome
• Diagnostic procedures
• Rule out other GI diseases
• History and physical examination
• CBC
• Stool exam
• Sigmoidoscopy
• Colonoscopy
• Barium enema
• Rectal biopsy CBC = complete blood count.
25
26. Irritable Bowel Syndrome
• Treatment
• Dietary modifications, adding fiber
• Adequate sleep, exercise; eliminate as much
stress as possible
• Antispasmodic drugs
26
27. Irritable Bowel Syndrome
Complementary therapy
• Herbal remedies or probiotics may help
• Eat meals at regular intervals, chew foods slowly
• Drink eight glasses of water/day
• Biofeedback, acupuncture, hypnosis
Client communication
• Recommend regular check-ups
• Educate about chronicity and possible complications
• May need immediate use of bathroom
27
28. Irritable Bowel Syndrome
• Prognosis
• Varies with how successful symptoms can
be controlled
• Prevention
• None known
28
29. Crohn Disease
• Description
• Serious, chronic inflammation of ileum, or
any portion of GI tract
• Extends through all layers of intestinal wall,
causing thickening, toughening of wall with
narrowing of intestinal lumen
29
30. Crohn Disease
• Etiology
• Suspect immunologic interaction with
bacteria or virus
• Genetic susceptibility, environmental trigger,
weakened or damaged intestinal wall
30
31. Crohn Disease
• Signs and symptoms
• Intermittent or steady abdominal pain in RLQ
• Diarrhea
• Lack of appetite, weight loss
• Fissures or fistulas may appear in anal area
RLQ = right lower quadrant.
31
32. Crohn Disease
• Diagnostic procedures
• Rule out other bowel diseases
• History and physical examination
• Barium enema
• Sigmoidoscopy
• Colonoscopy
• Biopsy
32
33. Crohn Disease
• Treatment
• Symptomatic, supportive
• Mesalamine, sulfasalazine, corticosteroid
drugs
• Surgery for complications or extensive
disease
33
34. Crohn Disease
Complementary therapy
• Probiotics
Client communication
• Support through acute attacks
• Teach prevention of complications
• Adequate nutritional intake, fluid balance
34
35. Crohn Disease
• Prognosis
• Depends on severity
• Worsens over time
• Complications include intestinal obstruction,
fistula
• Prevention
• None
35
36. Crohn Disease
• Crohn disease most commonly is
inflammation of the
1. duodenum
2. esophagus
3. ileum
4. colon
36
37. Ulcerative Colitis
• Description
• Chronic inflammation and ulceration of the colon
• Begins at the rectum or sigmoid colon and continues
upward into the entire colon
• With Crohn disease, often referred to as
inflammatory bowel disease (IBD) – together affect
about 2 million persons in the United States
37
38. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Description
• Bulging pouches in the GI tract wall push
mucosal lining through surrounding muscle
• Diverticulitis: the acute inflammation of the
pouch-like herniations in the intestinal wall
• Diverticulosis: the presence of the pouches or
diverticula; usually causing no symptoms
38
39. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Etiology
• Colon walls thicken with age and increased
pressure to eliminate feces
• Fecal matter sometimes forms a fecalith and
bacteria accumulate around it and attack the
lining of the diverticulum
• Inflammation may lead to perforation
39
40. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Signs and symptoms
• Diverticulosis is usually asymptomatic
• If diverticulitis occurs it is characterized by
fever, lower left quadrant pain that is relieved
by bowel movement or flatulence
• Alternating constipation and diarrhea
40
41. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Diagnostic procedures
• Abdominal x-rays
• CT scan
• Stool specimen examination
• Barium enema and colonoscopy, but not
when disease is active
CT = computed tomography.
41
42. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Treatment
• Bran and bulk additives to the diet
• Stool softeners
• Antibiotics or anticholinergics
• Colon resection with temporary colostomy
42
43. Diverticular Disease
(Diverticulosis and Diverticulitis)
Complementary therapy
• Whole foods, high-fiber diet with soluble fibers
Client communication
• Explain connection between dietary habits and
the disease
• Refer to a dietitian
43
44. Diverticular Disease
(Diverticulosis and Diverticulitis)
• Prognosis
• Less favorable with age
• Proper diet can forestall acute episodes
• Perforation of the wall can lead to acute peritonitis,
sepsis, and shock
• Prevention
• None, except high-fiber diet can prevent further
formation or worsening of the condition
44
45. Acute Appendicitis
• Description
• Inflammation of vermiform appendix due to
obstruction
• Etiology
• Obstruction by fecalith, stricture, foreign body, viral
infection, or ulceration of mucosal lining
• Bacteria multiply, invade appendix wall; necrosis,
gangrene, perforation may occur
45
46. Acute Appendicitis
• Signs and symptoms
• Generalized abdominal pain, then settles
over McBurney point with board-like rigidity
• Increased tenderness
• Abdominal spasms
• Fever
46
47. Acute Appendicitis
• Diagnostic procedures
• History and physical examination
• Characteristic symptoms
• Leukocytosis and pyuria
• CT scan
• Treatment
• Appendectomy
47
48. Acute Appendicitis
Complementary therapy
• None
Client communication
• Advise about postoperative care
48
49. Acute Appendicitis
• Prognosis
• With early diagnosis and treatment, prognosis good
• If appendix ruptures, peritonitis may occur, greatly
increasing serious complications
• Prevention
• None
49
50. Acute Appendicitis
• Appendicitis is inflammation of the
appendix due to a(n)
1. ulceration
2. obstruction
3. perforation
4. fistula
50
51. Hemorrhoids
• Description
• Dilated, tortuous veins in the mucous
membrane of the anus or rectum
• Insignificant unless they cause bleeding or
pain
• External hemorrhoids: veins below the anorectal line
• Internal hemorrhoids: veins above the anorectal line
51
52. Hiatal Hernia
• Description
• Protrusion of some portion of stomach into
thoracic cavity
• Two major types
• Sliding (most common)
• Paraesophageal or rolling
52
53. Hiatal Hernia
• Etiology
• Unclear
• Intra-abdominal pressure, or weakening of
gastroesophageal junction caused by trauma
or loss of muscle tone
• Incidence increases with age; higher in
women; obesity
53
56. Hiatal Hernia
• Treatment
• Alleviate symptoms
• Modify diet
• Medication to strengthen LES
• Restrict activities
• Antacids, proton pump inhibitors
• Stool softeners, laxatives
• Surgery, if all else fails
56
57. Hiatal Hernia
Complementary therapy
• Avoid spicy, fried foods; caffeine; carbonated drinks;
alcohol; peppermint
• Avoid overeating
• Deep breathing to strengthen diaphragm, expand lungs
Client communication
• Explain tests and treatments
• Describe dietary and activity restrictions
57
58. Hiatal Hernia
• Prognosis
• Good with proper treatment
• Complications include stricture, significant
bleeding, pulmonary aspiration, strangulation
• Prevention
• None
58
59. Abdominal Hernias
• Description
• Protrusion of an internal organ, typically a
portion of the intestine, through an abnormal
opening in the musculature of the abdominal
wall
• Can be umbilical, inguinal, or femoral
59
60. Pancreatitis
• Description
• Inflammation of the pancreas
• Pancreatic enzymes, normally inactive until
reaching the duodenum, start digesting
pancreatic tissue
• Causes edema, swelling, tissue necrosis,
and hemorrhage
60
61. Cholelithiasis and
Cholecystitis
• Description
• Cholelithiasis: formation or presence of
gallstones within gallbladder or bile ducts
• Cholecystitis: severe inflammation of interior
wall of gallbladder
61
62. Cholelithiasis and
Cholecystitis
• Etiology: Cholelithiasis
• Obesity, high-calorie diet
• Certain drugs, oral contraceptives
• Multiple pregnancies
• Increasing age
• Genetic
62
63. Cholelithiasis and
Cholecystitis
• Etiology: Acute cholecystitis
• Consequence of obstructing gallstones in bile
ducts
• Accumulating bile increases pressure in
gallbladder
• Chemical changes in bile erodes tissue
• Secondary infection
• Obstruction of bile ducts can result from other
causes, too
63
64. Cholelithiasis and
Cholecystitis
• Signs and symptoms: Cholelithiasis
• Asymptomatic; gallbladder attack when obstructed
• Acute URQ abdominal pain radiating to shoulder,
back
• Nausea, vomiting
• Flatulence, belching, heartburn; especially after
eating fatty foods
URQ = upper right quadrant.
64
65. Cholelithiasis and
Cholecystitis
• Signs and symptoms:
Acute cholecystitis
• Gradual onset of URQ pain; remains localized
and persists
• Anorexia
• Nausea, vomiting
• Low-grade fever
• Chills
65
66. Cholelithiasis and
Cholecystitis
• Diagnostic procedures
• Biliary colic pain suggests gallstones
• Ultrasound
• Oral cholecystogram
• IV cholangiogram
• Abdominal x-ray, CT, or MRI
• Elevated serum bilirubin
IV = intravenous; MRI = magnetic resonance imaging.
66
67. Cholelithiasis and
Cholecystitis
• Treatment
• If symptoms persist, surgery
• Nonsurgical treatment with catheter insertion using
basket to trap stone
• Extracorporeal shock wave lithotripsy
• Bile acid therapy to dissolve certain stones
67
68. Cholelithiasis and
Cholecystitis
Complementary therapy
• Identify food allergies
• Reduce fat, refined carbohydrates
• Eat frequent, smaller meals; avoid overeating
• Increase dietary fiber
Client communication
• Provide pre- and postoperative care, including
any complications
68
71. Cirrhosis
• Etiology
• Common causes are portal, nutritional, and
alcoholic
• Other causes include
• Chronic hepatitis B, C, & D
• CHF, some toxins, and genetics
• Abuse of acetaminophen
• Also, idiopathic
CHF = congestive heart failure.
71
72. Cirrhosis
• Signs and symptoms
• Asymptomatic or vague and unspecific
• Nausea, vomiting
• Anorexia
• Dull abdominal ache
• Weakness, fatigability
• Weight loss
• Pruritus
• Peripheral neuritis
• Edema, ascites
72
73. Cirrhosis
• Diagnostic procedures
• Enlarged, firm liver on palpation
• CT scan, MRI, ultrasound
• Lab results may reveal anemia, folate
deficiency, blood loss
• Liver enzymes (ALT and AST) are checked
ALT = alanine transaminase; AST = aspartate transaminase.
73
74. Cirrhosis
• Treatment
• Aimed at cause; prevent further damage
• Adequate rest, diet
• Restrict alcohol
• Vitamin, mineral supplements
• Liver transplantation for end-stage liver
disease
74
75. Cirrhosis
Complementary therapy
• Whole-foods diet avoiding processed fats
• No alcohol
• Careful use of drugs and herbals
Client communication
• Encourage regular check-ups
• Refer for alcohol treatment if indicated
75
76. Cirrhosis
• Prognosis
• Poor in advanced cirrhosis
• Complications include portal hypertension,
esophageal varices, hepatic failure, death
• Prevention
• None
• When alcohol is contributing factor, treat alcoholism
• Warn about abuse of acetaminophen
76
77. Cirrhosis
• Cirrhosis is characterized by the
replacement of normal liver cells with
1. adenocarcinoma
2. adipose
3. sclerotic tissue
4. scar tissue
77
78. Acute Viral Hepatitis
• Description
• Infection with subsequent inflammation of
liver, caused by one of several viruses
• Hepatitis viruses A, B, C, D, E, G
78
79. Acute Viral Hepatitis
• Etiology
• Six types
• Type A (HAV): formerly called infectious; highly
contagious through oral-fecal or parenteral
transmission
• Type B (HBV): spread by blood or serum from
contaminated needles; health-care professionals
frequently exposed; may become chronic
79
80. Acute Viral Hepatitis
• Etiology (cont.)
• Six types (cont.)
• Type C (HCV): less common, spread is similar to
HBV; often damages liver for 20 years before
symptoms appear
• Type D (HDV): delta; needs HBV to exist and can
occur together; hemophiliacs and IV drug users at
risk
80
81. Acute Viral Hepatitis
• Etiology (cont.)
• Six types (cont.)
• Type E (HEV): rarely seen in United States;
transmitted by feces-contaminated water
• Type G (HGV): little is known; more common with
injection-drug users; frequent co-infections with
HBV, HCV, and HIV
81
83. Acute Viral Hepatitis
• Diagnostic procedures
• Specific blood tests show antibody-antigen
type
• History and physical examination
• Liver biopsy helps to confirm
• Lab tests show proteinuria, bilirubinuria,
increased liver enzymes, gamma globulin
83
84. Acute Viral Hepatitis
• Treatment
• Rest, adequate diet, fluid intake
• Antiemetics
• Medications specific to type of hepatitis
• Recovery can take up to 4 months
84
85. Acute Viral Hepatitis
Complementary therapy
• Whole foods diet in small meals
• Avoid refined sugars, alcohol, caffeine
• Drink fresh lemon juice in water followed by
vegetable juice
• Vitamin supplements
Client communication
• Practice proper hygiene, especially when
handling needles for injection or human
secretions
85
86. Acute Viral Hepatitis
• Prognosis
• Depends on extent of liver damage
• Chronic active hepatitis can result
• Prevention
• When exposed to HAV, IgG may be
administered for prevention
• Vaccines available for A, B; none for C, D, E
IgG = immunoglobulin G.
86
87. Colorectal Cancer
• Description
• Collective designation for a variety of
malignant neoplasms that may arise in either
the colon or the rectum
• Almost always an adenocarcinoma
87
88. Colorectal Cancer
• Etiology
• Cause is unknown
• Higher incidence in high-fat, low-fiber diets
• Predisposing factors: diseases of the
digestive tract, a history of IBS, familial
polyposis
• Incidence increases after age 40
88
89. Colorectal Cancer
• Signs and symptoms
• Rectal bleeding or blood in the stool
• Pallor, ascites
• Cachexia
• Lymphadenopathy, hepatomegaly
• May metastasize to adjacent organs
89
90. Colorectal Cancer
• Diagnostic procedures
• Tumor biopsy to verify
• Digital rectal exam
• Fecal occult blood test
• Sigmoidoscopy
• Colonoscopy
• CT scan
90
91. Colorectal Cancer
• Treatment
• Surgery to remove tumor, adjacent tissues,
and lymph nodes
• Chemotherapy
• Radiation therapy
• Carcinoembryonic antigen testing to detect
metastasis or recurrence
91
92. Colorectal Cancer
Complementary therapy
• Acupuncture, relaxation, and meditation to reduce
symptoms
Client communication
• Provide information on postoperative procedures
and expected adverse effects of chemotherapy
and radiation
92
93. Colorectal Cancer
• Prognosis
• Prognosis varies
• If diagnosed early and is localized,
potentially curable in 90% of cases
• Prevention
• High-fiber, low-fat diet may reduce the risk
93
94. Pancreatic Cancer
• Description
• Adenocarcinoma that occurs most frequently
in the head of the pancreas
• Highest incidence in people ages 60 to 70
94
95. Pancreatic Cancer
• Etiology
• Not known
• Linked to inhalation or absorption of
carcinogens
• Associated with smoking, high-fat diet,
exposure to occupational chemicals
• Chronic pancreatitis and family history
95
96. Pancreatic Cancer
• Signs and symptoms
• Abdominal pain that radiates to the back
• Anorexia, jaundice
• Fatigue, weakness
• Nausea and vomiting
• Insulin deficiency
• Glucosuria, hypergylcemia
96
98. Pancreatic Cancer
• Treatment
• Dependent on the stage and location of the
cancer
• Often palliative if diagnosed after metastasis
• Surgery, chemotherapy, and radiation
• Pain management
98
99. Pancreatic Cancer
Complementary therapy
• Increase intake of antioxidants
Client communication
• Reinforce the need for small frequent meals
• Instruct clients to notify their primary care
provider if jaundice, weight loss, or bowel
obstruction occurs
99
100. Pancreatic Cancer
• Prognosis
• Poor due to metastasis at diagnosis
• Prevention
• None, other than avoid known carcinogens
and reduce amount of dietary fat
100
101. Pancreatic Cancer
• Pancreatic cancer is linked to _____ of
carcinogens.
1. malabsorption
2. inhalation
3. digestion
4. ingestion
101
102. Credits
Publisher: Margaret Biblis
Acquisitions Editor: Andy McPhee
Developmental Editor: Yvonne Gillam, Julie Munden
Backgrounds: Joseph John Clark, Jr.
Production Manager: Sam Rondinelli
Manager of Electronic Product Development: Kirk Pedrick
Electronic Publishing: Frank Musick
The publisher is not responsible for errors of omission or for consequences from application of information in this
presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this
presentation should be applied by the reader in accordance with professional standards of care used with regard to the
unique circumstances that may apply in each situation.
102
