15-Gastrointestinal

Liver Disorders: Ascites

Ascites is the buildup of an abnormal amount of fluid inside the belly. This is a common problem in patients with cirrhosis (scarring) of the liver. Ascites is treated by lowering salt in the diet and taking water pills. Ascites occurs when portal hypertension develops. The kidneys cannot rid the body of enough sodium (salt) through urine. Not being able to rid the body of salt causes fluids to build up in the abdomen, resulting in ascites. SS: Most people who develop ascites develop a large belly and experience a rapid gain in weight. Some people also develop swelling of the ankles and shortness of breath. Complications · Abdominal pain, discomfort and difficulty breathing: This may limit a patient's ability to eat, walk and perform daily activities. · Infection · Fluid in the lungs · Kidney failure Tx: Limit the amount of salt in diet. Often, patients will require diuretics ("water pills") to treat ascites. Take these pills as prescribed. Other, increasingly more aggressive treatments include: · Paracentesis as a treatment · Surgery Liver transplant:This approach is reserved for patients with very severe cirrhosis whose livers are failing.

GI Tests

Barium A barium swallow test is a special type of imaging test that uses barium and X-rays to create images of the upper gastrointestinal (GI) tract. Upper GI series (Barium swallow) Lower GI series (barium enema) Blood and Fluid Tissue Tests -CBC -Bilirubin Test -Prothrombin Time (PT) -Parcial thromoplastin Time (PPT) -Tissue biopsy -Stool sample Colonoscopy A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. Sigmoidoscopy - up into sigmoid colon Endoscopy Endoscopy is a nonsurgical procedure used to examine a person's digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, the doctor can view pictures of the digestive tract on a color TV monitor. In through the throat. Exploratory Laparotomy (Ex Lap) An exploratory laparotomy (also known as an ex-lap) is a surgical operation where the abdomen is opened and the abdominal organs examined for injury or disease. Digital Rectal Exam a test for both men and women. It allows a doctor to check the lower rectum, pelvis, and lower belly for cancer and other health problems, including: Prostate cancer in men. Blood in the stool or an abnormal mass in the anus or rectum. During a digital rectal exam, the doctor inserts a gloved, lubricated finger into the rectum and feels the back wall of the prostate gland for enlargement, tenderness, lumps or hard spots. Esophageal acidity testing X-rays and imaging Tests New technique: swallowing a capsule containing a tiny video camera that transmits images to a computer

Liver Disorders: Cirrhosis

Chronic degenerative disease that is irreversible - also known as end-stage liver disease Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The cirrhotic liver appears to be covered in nodules. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed. SS: · Fatigue · Easily bleeding or bruising · Loss of appetite · Nausea · Swelling in your legs, feet or ankles (edema) · Weight loss · Itchy skin · Yellow discoloration in the skin and eyes (jaundice) · Fluid accumulation in your abdomen (ascites) · Spiderlike blood vessels on your skin · Redness in the palms of the hands · For women, absent or loss of periods not related to menopause · For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy · Confusion, drowsiness and slurred speech (hepatic encephalopathy) · Portal hypertension: blood backs into stomach, esophagus, umbilicus and rectum o Causes gastroesophageal varices, engorged vessels can bleed and cause melena or hematemesis · Splenomegaly · GI hemorrhage: caused by thrombocytopenia and the liver's inability to secrete blood proteins for clotting · Altered sex hormone metabolism - males may develop characteristics related to excessive estrogen Causes · Chronic alcohol abuse · Chronic viral hepatitis (hepatitis B, C and D) · Fat accumulating in the liver (nonalcoholic fatty liver disease) · Iron buildup in the body (hemochromatosis) · Cystic fibrosis · Copper accumulated in the liver (Wilson's disease) · Poorly formed bile ducts (biliary atresia) · Alpha-1 antitrypsin deficiency · Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease) · Genetic digestive disorder (Alagille syndrome) · Liver disease caused by your body's immune system (autoimmune hepatitis) · Destruction of the bile ducts (primary biliary cirrhosis) · Hardening and scarring of the bile ducts (primary sclerosing cholangitis · Infection, such as syphilis or brucellosis · Medications, including methotrexate or isoniazid Complications · High blood pressure in the veins that supply the liver (portal hypertension) · Swelling in the legs and abdomen · Enlargement of the spleen (splenomegaly) · Bleeding · Infections. · Malnutrition. · Buildup of toxins in the brain (hepatic encephalopathy) · Jaundice · Bone disease · Increased risk of liver cancer · Acute-on-chronic cirrhosis Tx: Treatment for the underlying cause of cirrhosis In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause. The options include: · Treatment for alcohol dependency. · Weight loss. · Rest, vitamins, minerals and diuretics · Medications to control hepatitis. Medications to control other causes and symptoms of cirrhosis.

Pancreas Disorders: Diabetes Mellitus

Diabetes mellitus refers to a group of diseases that affect how the body uses glucose, specifically it can lead to excess sugar in the blood and result in serious health problems. The underlying cause of diabetes varies by type. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. SS: · Increased thirst · Frequent urination · Extreme hunger · Unexplained weight loss · Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) · Fatigue · Irritability · Blurred vision · Slow-healing sores · Frequent infections, such as gums or skin infections and vaginal infections Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40. Causes of type 1 diabetes The exact cause of type 1 diabetes is unknown. What is known is that the immune system attacks and destroys insulin-producing cells in the pancreas. This leaves little or no insulin. Instead of being transported into cells, sugar builds up in the bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes. Causes of prediabetes and type 2 diabetes In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, cells become resistant to the action of insulin, and the pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into cells where it's needed for energy, sugar builds up in the bloodstream. Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight. Causes of gestational diabetes During pregnancy, the placenta produces hormones to sustain the pregnancy. These hormones make cells more resistant to insulin. Normally, the pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes the pancreas can't keep up. When this happens, too little glucose gets into cells and too much stays in the blood, resulting in gestational diabetes. Risk factors for type 1 diabetes Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include: · Family history · Environmental factors · The presence of damaging immune system cells (autoantibodies) · Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes. Risk factors for prediabetes and type 2 diabetes Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including: · Weight. The more fatty tissue you have, the more resistant your cells become to insulin. · Inactivity · Family history · Race. Although it's unclear why, people of certain races — including black people, Hispanics, American Indians and Asian-Americans — are at higher risk. · Age. Your risk increases as you get older. · Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. · Polycystic ovary syndrome · High blood pressure · Abnormal cholesterol and triglyceride levels Risk factors for gestational diabetes Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include: · Age. Women older than age 25 are at increased risk. · Family or personal history · Weight · Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes. Treatments for all types of diabetes An important part of managing diabetes — as well as your overall health — is maintaining a healthy weight through a healthy diet and exercise plan: · Healthy eating. · Physical activity. Treatments for type 1 and type 2 diabetes Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or both. · Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. · Bariatric surgery. Treatment for prediabetes If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome. In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you're at high risk. However, healthy lifestyle choices remain key.

Large Intestine Disorders: Diverticulosis/Diverticulitis

Diverticulosis: Sm pouches (diverticula) develop in the colon (usually the sigmoid portion) Aka Diverticular disease Diverticula are small, bulging pouches that can form in the lining of the digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. It may be asymptomatic until the pouches are packed with fecal material, causing irritation Once they become inflamed or infected, the condition is called diverticulitis Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery. It occurs more with increased age and is linked to lack of physical activity, poor bowel habits, and poor dietary habits • Diverticulosis is the presence of abnormal, saclike outpouchings of the intestinal wall called diverticula. Diverticulitis is characterized by pain, tenderness, and fever. SS: · Pain, which may be constant and persist for several days. The lower left side of the abdomen is the usual site of the pain. Sometimes, however, the right side of the abdomen is more painful, especially in people of Asian descent. · Nausea and vomiting. · Fever. · Abdominal tenderness. · Constipation or, less commonly, diarrhea. Causes Diverticula usually develop when naturally weak places in the colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. Diverticulitis occurs when diverticula tear, resulting in inflammation or infection or both. Risk factors · Aging. · Obesity. · Smoking. · Lack of exercise. · Diet high in animal fat and low in fiber. · Certain medications Several drugs are associated with an increased risk of diverticulitis, including steroids, opioids and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Complications About 25 percent of people with acute diverticulitis develop complications, which may include: · An abscess, which occurs when pus collects in the pouch. · A blockage in your colon or small intestine caused by scarring. · An abnormal passageway (fistula) between sections of bowel or the bowel and bladder. · Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care. Tx: increasing dietary fiber and if acute, the use of antibiotics, surgery for severe cases or complications

Esophageal Disorders: GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus through the lower esophageal sphincter. This backwash (acid reflux) can cause inflammation of the tissue lining at the distal end of the esophagus. Causes a burning sensation in epigastric area - heartburn 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. Risk factors: pregnancy, obesity, scleroderma, hiatal hernia SS: • 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 If you have nighttime acid reflux, you might also experience: • Chronic cough • Laryngitis • New or worsening asthma • Disrupted sleep Complications • Narrowing of the esophagus (esophageal stricture) due to scar tissue formation. • An open sore in the esophagus (esophageal ulcer). • Precancerous changes to the esophagus (Barrett's esophagus). Tx: Proton pump inhibitor meds (acid reducers) Avoiding large meals, alcohol, chocolate, mint, spicy foods, caffeine, and tight clothing; raise head of bed, smoking cessation

Liver Disorders: Hepatic Encephalopathy

Hepatic Encephalopathy, sometimes referred to as portosystemic encephalopathy or PSE, is a condition that causes temporary worsening of brain function (confusion & forgetfulness) in people with advanced liver disease. When your liver is damaged it can no longer remove toxic substances from your blood. These toxins build up and can travel through your body until they reach your brain, causing mental and physical symptoms of HE. · With time, hepatic encephalopathy can progress to unresponsiveness or coma. SS: · Mental o Mild confusion o Short attention span o Forgetfulness o Mood swings o Personality changes o Inappropriate behavior o Difficulty doing basic math · Physical o Change in sleep patterns (like sleeping during the day and staying up at night) o Difficulty writing or doing other small hand movements o Breath that smells musty or sweet o Slurred speech More severe symptoms of HE may include these mental and physical changes: · Mental o Marked confusion o Severe anxiety or fearfulness o Disorientation regarding time and place o Inability to perform mental tasks such as doing basic math · Physical o Extreme sleepiness o Slowed or sluggish movement o Shaking of hands or arms (called "flapping") o Jumbled, slurred speech that can't be understood In the most severe form of HE, people can become unresponsive, unconscious and enter a coma. Tx: treatment is aimed at lowering the level of ammonia and other toxins in your blood. Since these toxins originally arise in your gastrointestinal or GI system, therapies are aimed at your gut to eliminate or reduce the production of toxins. The two types of medications used to do this are lactulose, a man-made sugar, and antibiotics.

Liver Disorders: Hepatitis

Hepatitis refers to an inflammatory condition of the liver. It's commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue. Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis. Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women. Hepatitis A Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A. Hepatitis B - can lead to cirrhosis Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B. It's estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease. Hepatitis C - can lead to cirrhosis (85%) Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection. Hepatitis D Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can't multiply without the presence of hepatitis B. It's very uncommon in the United States. Hepatitis E Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC. SS: · fatigue · flu-like symptoms · dark urine · pale stool · abdominal pain · loss of appetite · unexplained weight loss · yellow skin and eyes, which may be signs of jaundice Tx: Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic. Hepatitis A Hepatitis A usually doesn't require treatment because it's a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. The hepatitis A vaccine is available to prevent this infection. Hepatitis B Acute hepatitis B doesn't require specific treatment. Chronic hepatitis B is treated with antiviral medications. Hepatitis B can be prevented with vaccination. Hepatitis C Antiviral medications are used to treat both acute and chronic forms of hepatitis C. Hepatitis D No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people. Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop. Hepatitis E Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care. Autoimmune hepatitis Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They're effective in about 80 percent of people with this condition. Azothioprine (Imuran), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids. Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.

Stomach Disorders: Gastroenteritis

Inflammation of stomach and intestines Caused by bacteria, toxins, parasites, viruses, tainted food, allergic reactions, stress, and lactose intolerance Viral gastroenteritis is the second most common illness in the U.S. The cause is often a norovirus infection. It spreads through contaminated food or water or by contact with an infected person. Viral SS: Although it's commonly called stomach flu, gastroenteritis isn't the same as influenza. Real flu (influenza) affects only the respiratory system — nose, throat and lungs. Gastroenteritis, on the other hand, attacks the intestines, causing signs and symptoms, such as: · Watery, usually nonbloody diarrhea (leading to fluid/electrolyte loss) · Abdominal cramps and pain · Stomach rumbling · Nausea, vomiting or both · Occasional muscle aches or headache · Low-grade fever · Malaise SS occur quickly Depending on the cause, viral gastroenteritis symptoms may appear within one to three days after you're infected and can range from mild to severe. Symptoms usually last just a day or two, but occasionally they may persist as long as 10 days. Because the symptoms are similar, it's easy to confuse viral diarrhea with diarrhea caused by bacteria, such as Clostridium difficile, salmonella and E. coli, or parasites, such as giardia. Causes A number of viruses can cause gastroenteritis, including: · Noroviruses. · Rotavirus. Worldwide, this is the most common cause of viral gastroenteritis in children, who are usually infected when they put their fingers or other objects contaminated with the virus into their mouths. Risk Factors · Young children · Older adults · Schoolchildren, churchgoers or dormitory residents. Anywhere that groups of people come together in close quarters can be an environment for an intestinal infection to get passed. · Anyone with a weakened immune system Dx: via stool Tx: depends on cause meds to treat nausea, antidiarrheals, antibiotics, fluid support, nutritional support, stress management There's often no specific medical treatment for viral gastroenteritis. Treatment initially consists of self-care measures.

Gallbladder Disorders: Cholecystitis

Inflammation of the gallbladder, often caused by a gallstone obstructing bile flow. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections. May be prevented by maintaining healthy body weight and high fiber diet If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often involves gallbladder removal. SS: · Severe pain in upper right or center abdomen · Pain that spreads to right shoulder or back · Tenderness over abdomen when it's touched · Nausea · Vomiting · Fever · Excessive flatulence Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty one. Causes Cholecystitis occurs when your gallbladder becomes inflamed. Gallbladder inflammation can be caused by: · Gallstones. · Tumor · Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis. · Infection. AIDS and certain viral infections can trigger gallbladder inflammation. · Blood vessel problems. Risk factors Having gallstones is the main risk factor for developing cholecystitis. Dx: Confirmed by US, cholecystogram and x-rays Tx: · Fasting: take stress off your inflamed gallbladder. · Fluids through a vein in your arm · Antibiotics to fight infection · Pain medications · Procedure to remove stones or gallbladder (cholecystectomy)

Pancreas Disorders: Pancreatitis

Inflammation of the pancreas Mild cases may go away without treatment, but severe cases can cause life-threatening complications. Can be acute or chronic. The pancreas becomes inflamed, edematous, hemorrhagic and necrotic SS: Acute pancreatitis signs and symptoms include: · Upper abdominal pain · Abdominal pain that radiates to your back · Abdominal pain that feels worse after eating · Fever · Rapid pulse · Nausea · Vomiting · Sweating · Tenderness when touching the abdomen Chronic pancreatitis signs and symptoms include: · Upper abdominal pain · Losing weight without trying · Oily, smelly stools (steatorrhea) Causes · Abdominal surgery · Alcoholism · Certain medications · Cystic fibrosis · Gallstones · High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism) · High triglyceride levels in the blood (hypertriglyceridemia) · Infection · Injury to the abdomen · Obesity · Pancreatic cancer Tx: · Fasting in order to give pancreas a chance to recover. · Pain medications · Intravenous (IV) fluids · Procedures to remove bile duct obstructions A procedure called endoscopic retrograde cholangiopancreatography (ERCP) can aid in diagnosing problems in the bile duct and pancreatic duct and in making repairs. Gallbladder surgery Pancreas surgery Treatment for alcohol dependence Additional treatments for chronic pancreatitis · Pain management. · Enzymes to improve digestion Changes to diet

Large Intestine Disorders: Peritonitis

Inflammation of the peritoneum - it can be local, generalized, acute, and or chronic Usually due to a bacterial or fungal infection. Peritonitis can result from any perforation in the abdomen, or as a complication of other medical conditions. The fluid accumulation in the peritoneal space often results in abscesses and adhesions. SS: · Sharp, severe abdominal pain or tenderness or spasms · Bloating or a feeling of fullness (distention) in your abdomen · Ascites (abnormal buildup of fluid in the abdomen) · Fever · Nausea and vomiting · Loss of appetite · Diarrhea · Low urine output · Thirst · Inability to pass stool or gas · Fatigue · Joint Pain Causes Causes: organisms from the blood or genital tract or may be secondary because of contamination by GI secretions from perforation of the GI tract or nearby organs Infection of the peritoneum can happen for a variety of reasons. In most cases, the cause is a perforation within the abdominal wall. Common causes of ruptures that lead to peritonitis include: · Medical procedures, such as peritoneal dialysis, a ruptured appendix, stomach ulcer or perforated colon, pancreatitis, diverticulitis, trauma Spontaneous peritonitis is usually a complication of liver disease, such as cirrhosis which causes fluid buildup susceptible to bacterial infection. Complications · A bloodstream infection (bacteremia). · An infection throughout your body (sepsis). Tx: antibiotics, surgery

Stomach Disorders: Gastritis

Inflammation of the stomach lining - may be acute or chronic Erosive vs nonerosive It usually causes abdominal pain, and may also cause belching, nausea and vomiting In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment. Causes: most often the result of infection with the same bacterium that causes most stomach ulcers (such as H.Pylori) but use of NSAIDS, and alcohol consumption can also cause gastritis SS: • Gnawing or burning ache or pain (indigestion) in upper abdomen that may become either worse or better with eating • Nausea • Vomiting • A feeling of fullness in your upper abdomen after eating Tx: meds (antibiotics, acid blockers, antacids) and lifestyle changes

Small Intestine Disorders: Appendicitis

Inflammation of the vermiform appendix Pain begins throughout the abdomen, then shifts to the lower right quadrant. (McBurneys point) If the appendix ruptures, pain may decrease, but peritonitis (which can be fatal if not treated with antibiotics) may develop Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix. SS: · Sudden pain that begins on the RLQ · Sudden pain that begins around navel and often shifts to LRQ · Pain that worsens if coughing, walking or making jarring movements · Nausea and vomiting · Loss of appetite · Low-grade fever that may worsen as the illness progresses · Leukocytosis · Constipation or diarrhea · Abdominal bloating · Flatulence Mimics the symptoms of kidney stones, pelvic inflammatory disease and pancreatitis Causes A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. Complications Appendicitis can cause serious complications, such as: · A ruptured appendix. A rupture spreads infection throughout the abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean the abdominal cavity. · A pocket of pus that forms in the abdomen. If the appendix bursts, it's possible to develop a pocket of infection (abscess). Tx: Surgery to remove the appendix (appendectomy)

Large Intestine Disorders: Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of the digestive tract. Types of IBD include: Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum. Crohn's disease. This type of IBD is characterized by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues. Both ulcerative colitis and Crohn's disease usually involve severe diarrhea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications.

Liver Disorders: Jaundice

Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment. Jaundice has many causes, including hepatitis, gallstones and tumors. In adults, jaundice usually does not need to be treated. Causes Jaundice can be caused by a problem in any of the three phases in bilirubin production. Before the production of bilirubin, you may have what is called unconjugated jaundice due to increased levels of bilirubin caused by: · Reabsorption of a large hematoma · Hemolytic anemias During production of bilirubin, jaundice can be caused by: · Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis) · Alcohol · Autoimmune disorders · Rare genetic metabolic defects · Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (Thorazine®) and estrogenic or anabolic steroids After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from: · Gallstones · Inflammation (swelling) of the gallbladder · Gallbladder cancer · Pancreatic tumor SS: · Fever · Chills · Abdominal pain · Flu-like symptoms · Change in skin color · Dark-colored urine and/or clay-colored stool

GI Signs & Symptoms

Nausea/ Vomiting Hemorrhage/ GI Bleed all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool. Hematemesis: blood in vomit Melena: dark tarry stool Abdominal pain, can be severe Altered motility Diarrhea Constipation Anorexia loss of appetite or inability to eat (not the same as anorexia nervosa the psychological condition) Perforation/tear When a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to a number of different diseases, including appendicitis and diverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. A perforation may also occur in the gallbladder. This can have symptoms that are similar to the symptoms of a gastrointestinal perforation. A hole in the gastrointestinal system or gallbladder can lead to peritonitis. Peritonitis is inflammation of the membrane that lines the abdominal cavity, digestive contents spill into abdominal cavity and contaminate it - corrosive, acidic. Severe pain. Infection can lead to septicemia

Small Intestine Disorders: Ileus/Small Bowel Obstruction

Obstruction of the sm intestine that keeps food or liquid from passing through the small intestine or large intestine Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery, an inflamed intestine (Crohn's disease), infected pouches in your intestine (diverticulitis), twisting of the colon (volvulus), impacted feces, hernias and colon cancer. Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated. Paralytic ileus - nerve injury due to SCI, trauma, meds Loss of peristalsis SS: · Fever · Tachycardia · Severe crampy abdominal pain that comes and goes · Loss of appetite · Constipation/Diarrhea · Vomiting · Inability to have a bowel movement or pass gas · Swelling of the abdomen (distension) · Bad breath odor Infection and gangrene can occur Pseudo-obstruction Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but doesn't involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system. Paralytic ileus can affect any part of the intestine. Causes can include: · Abdominal or pelvic surgery · Infection · Certain medications that affect muscles and nerves, including tricyclic antidepressants, such as amitriptyline and imipramine (Tofranil), and opioid pain medications, such as those containing hydrocodone (Vicodin) and oxycodone (Oxycontin) · Muscle and nerve disorders, such as Parkinson's disease Risk factors Diseases and conditions that can increase your risk of intestinal obstruction include: · Abdominal or pelvic surgery, which often causes adhesions — a common intestinal obstruction · Crohn's disease, which can cause the intestine's walls to thicken, narrowing the passageway · Cancer in your abdomen, especially if you've had surgery to remove an abdominal tumor or radiation therapy Complications Untreated, intestinal obstruction can cause serious, life-threatening complications, including: · Tissue death. Intestinal obstruction can cut off the blood supply to part of your intestine. Lack of blood causes the intestinal wall to die. Tissue death can result in a tear (perforation) in the intestinal wall, which can lead to infection. · Infection. Peritonitis is the medical term for infection in the abdominal cavity. It's a life-threatening condition that requires immediate medical and often surgical attention. Tx: nasogastric (NG) tube to relieve pressure; antimicrobials, analgesics, and antimetic meds; surgery

Small Intestine Disorders: Inguinal Hernia

Occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. (i.e. a pouching of the sm. intestine and peritoneum into the groin) more common in males An inguinal hernia isn't necessarily dangerous. It doesn't improve on its own, however, and can lead to life-threatening complications. SS: · A bulge in the area on either side of the pubic bone, which becomes more obvious when upright, especially when coughing or straining · A burning or aching sensation at the bulge · Pain or discomfort in your groin, especially when bending over, coughing or lifting, but is relieved by lying down · A heavy or dragging sensation in your groin · Weakness or pressure in your groin · Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum If the hernia isn't able to be pushed in, the contents of the hernia may be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated. Signs and symptoms of a strangulated hernia include: · Nausea, vomiting or both · Fever · Sudden pain that quickly intensifies · A hernia bulge that turns red, purple or dark · Inability to move your bowels or pass gas Causes Some inguinal hernias have no apparent cause. Others might occur as a result of: · Increased pressure within the abdomen · A pre-existing weak spot in the abdominal wall · Congenital conditions · Straining during bowel movements or urination · Strenuous activity · Pregnancy · Chronic coughing or sneezing Risk Factors Factors that contribute to developing an inguinal hernia include: · Being male. Men are eight times more likely to develop an inguinal hernia than are women. · Being older. Muscles weaken as you age. · Being white. · Family history. You have a close relative, such as a parent or sibling, who has the condition. · Chronic cough, such as from smoking. · Chronic constipation. Constipation causes straining during bowel movements. · Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen. · Premature birth and low birth weight. · Previous inguinal hernia or hernia repair DX: via pt history, physical exam, ultrasound, and CT scan Tx: Exercises my be utilized to relieve pain Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications such as tissue death. There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Stomach Disorders: Peptic Ulcer Disease

Peptic ulcers are open sores where tissue has eroded on the inside lining of the stomach and the upper portion of your small intestine leaving a crater-like appearance. The most common symptom of a peptic ulcer is stomach pain which comes from HCL acid irritating the ulcerated area. Gastric ulcer - stomach Duodenal ulcer - duodenum May be caused by the action of pepsin - digestive enzyme Most are associated with H.Pylori and long-term use of aspirin and NSAIDS. SS: · Burning stomach pain · Feeling of fullness, bloating or belching · Fatty food intolerance · Heartburn · Nausea Complications Left untreated, peptic ulcers can result in: · Internal bleeding · Infection · Obstruction Dx is based on symptoms and gastroscopy Tx: reduction of gastric acidity, antibiotics, antacids, and surgery

Liver Disorders: Portal Hypertension

Portal hypertension is an increase in the pressure within the portal vein, which carries blood from the digestive organs to the liver. The most common cause is cirrhosis of the liver, but thrombosis (clotting) might also be the cause. The increase in pressure is caused by a blockage in the blood flow through the liver. Increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to get around the blockage. The varices become fragile and can bleed easily. SS: · Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and bleeding from varices. · Ascites: An accumulation of fluid in the abdomen. · Encephalopathy: Confusion and forgetfulness caused by poor liver function and the diversion of blood flow away from your liver. · Reduced levels of platelets or decreased white blood cell count. Tx: diet, medications (beta blockers or nitrates), endoscopic therapy (sclerotherapy or banding), surgery, or radiology (Transjugular intrahepatic portosystemic shunt (TIPS), Distal splenorenal shunt (DSRS)) · Liver transplant is done in cases of end-stage liver disease. · Devascularization is a surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt is not possible or is unsuccessful in controlling the bleeding. The accumulation of fluid in the abdomen (called ascites) sometimes needs to be directly removed. This procedure is called paracentesis.

Gallbladder Disorders: Cholelithiasis

Presence of gallstones - hardened deposits of digestive fluid Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time. Affect women more than men, with nearly 600,000 people in the US have them removed each year (female, fat, fertile, 40+, fair complexion - 5 fs) They usually cause symptoms because they are blocking the outflow of the gallbladder or its ducts SS: · Sudden and rapidly intensifying pain in the upper right portion of abdomen · Sudden and rapidly intensifying pain in the center of abdomen, just below breastbone · Back pain between shoulder blades · Pain in right shoulder · Nausea or vomiting Gallstone pain may last several minutes to a few hours. Causes It's not clear what causes gallstones to form. Doctors think gallstones may result when: · Bile contains too much cholesterol or bilirubin · Gallbladder doesn't empty correctly Risk factors · Being female · Being age 40 or older · Being a Native American, Mexican American · Being overweight or obese · Being sedentary · Being pregnant · Eating a high-fat diet, high-cholesterol, low-fiber diet · Having a family history of gallstones · Having diabetes · Having certain blood disorders, such as sickle cell anemia or leukemia · Losing weight very quickly · Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs · Having liver disease Tx: · Surgery to remove the gallbladder (cholecystectomy) · ESWL (lithotripsy) to break up stones · Medications to dissolve gallstones Sometimes medications don't work. Medications for gallstones aren't commonly used and are reserved for people who can't undergo surgery.

Liver Disorders: Common SS

SS: · GI symptoms · Ascites · Dark urine · Light colored feces · RUQ pain · Skin changes - jaundice, palmer erythema · Neuro changes

Large Intestine Disorders: Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in the digestive tract. Ulcerative colitis affects the innermost lining of the large intestine and rectum. Symptoms usually develop over time, rather than suddenly. SS: · Diarrhea, often with blood or pus · Abdominal pain and cramping · Rectal pain · Rectal bleeding — passing small amount of blood with stool · Urgency to defecate · Inability to defecate despite urgency · Weight loss · Fatigue · Fever · In children, failure to grow Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include: · Ulcerative proctitis. Inflammation is confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest. · Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon (lower end of the colon). Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus). · Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. · Pancolitis. Pancolitis often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss. · Acute severe ulcerative colitis. This rare form of colitis affects the entire colon and causes severe pain, profuse diarrhea, bleeding, fever and inability to eat. Causes The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause ulcerative colitis. It appears to be related to autoimmune disorders and heredity, and may increase the risk of developing colon cancer Risk factors Ulcerative colitis affects about the same number of women and men. Risk factors may include: · Age. Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60. · Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher. · Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. Complications · Severe bleeding · A hole in the colon (perforated colon) · Severe dehydration · Liver disease (rare) · Bone loss (osteoporosis) · Inflammation of your skin, joints and eyes · An increased risk of colon cancer · A rapidly swelling colon (toxic megacolon) · Increased risk of blood clots in veins and arteries Dx: blood tests, stool samples, CT scan, and colonoscopy Tx: Can be treated with a limited diet, mild sedatives, anti-inflammatories, immunosuppressants, biologics, stress reduction and surgery Surgery often involves a temporary or permanent colostomy

Large Intestine Disorders: Crohn's Disease

a chronic inflammatory bowel disease (IBD) characterized by periods of remission and exacerbation that affect the intestinal wall. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people. The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue causing inflammation and ulceration of the bowel mucosa with marked thickening and scarring of the bowel wall. Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications. SS: mild to severe, gradual or sudden onset The most common areas affected by Crohn's disease are the last part of the small intestine and the colon. When the disease is active, signs and symptoms may include: · Diarrhea/Constipation · Flatulence · Fever · Fatigue · Abdominal pain and cramping · Blood in your stool · Mouth sores · Reduced appetite and weight loss · Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula) Causes The exact cause of Crohn's disease remains unknown. It appears to be genetically linked, infectious, immunologic and related to stress Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause Crohn's disease. Risk factors · Age. Crohn's disease can occur at any age, but you're likely to develop the condition when you're young. Most people who develop Crohn's disease are diagnosed before they're around 30 years old. · Ethnicity. Although Crohn's disease can affect any ethnic group, whites have the highest risk, including people of Eastern European (Ashkenazi) Jewish descent. However, the incidence of Crohn's disease is increasing among blacks who live in North America and the United Kingdom. · Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease. · Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Smoking also leads to more-severe disease and a greater risk of having surgery. If you smoke, it's important to stop. · Nonsteroidal anti-inflammatory medications. · Where you live. If you live in an urban area or in an industrialized country, you're more likely to develop Crohn's disease. This suggests that environmental factors, including a diet high in fat or refined foods, may play a role in Crohn's disease. Complications · Bowel obstruction. · Ulcers. · Fistulas. Fistulas near or around the anal area (perianal) are most common. · Anal fissure. · Malnutrition. · Colon cancer. · Other health problems. Crohn's disease can cause problems in other parts of the body. Among these problems are anemia, skin disorders, osteoporosis, arthritis, and gallbladder or liver disease. · Medication risks. Certain Crohn's disease drugs that act by blocking functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase risk of infection. Dx: via blood tests, upper GI series, CT scans, colonoscopy, and video capsule endoscopy Tx: While there's no known cure for Crohn's disease, therapies can greatly reduce its signs and symptoms and even bring about long-term remission. With treatment, many people with Crohn's disease are able to function well. The goal of medical treatment is to reduce the inflammation that triggers signs and symptoms: -dietary changes -meds to control symptoms: corticosteroids, immunosuppressants,, antibiotics, anti-diarrheals, pain relievers, iron supplements, vitamin B-12 shots, calcium and vitamin D supplements -if perforation or obstruction occurs, surgical resection Nearly half of those with Crohn's disease will require at least one surgery

Esophageal Disorders: Hiatal Hernia

occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity through the hiatus where the esophagus passes often due to weakening of the sphincter. A small hiatal hernia usually doesn't cause problems. But a large hiatal hernia can allow food and acid to back up into the esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms. A very large hiatal hernia might require surgery. Risk factors • Age 50 or older • Obese Hiatal hernias are diagnosed via upper GI x-rays SS: • Heartburn • Regurgitation of food or liquids into the mouth • Backflow of stomach acid into the esophagus (acid reflux) • Difficulty swallowing • Chest or abdominal pain • Shortness of breath • Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding Tx: meds that block acid production, treat infections, and reduce pain, as well as corticosteroids, IV nutrition, endoscopy, and surgery

Large Intestine Disorders: Irritable Bowel Syndrome (IBS)

the most common disorder of the intestines and is often confused with IBD. IBS is a chronic condition that you'll need to manage long term. IBS doesn't cause changes in bowel tissue or increase your risk of colorectal cancer. It is also known as spastic colon SS: · Abdominal pain, cramping or bloating that is typically relieved or partially relieved by passing a bowel movement · Excess gas · Diarrhea or constipation — sometimes alternating bouts of diarrhea and constipation · Mucus in the stool Causes The precise cause of IBS isn't known. Factors that appear to play a role include: · Muscle contractions in the intestine. Contractions that are stronger and last longer than normal can cause gas, bloating and diarrhea. Weak intestinal contractions can slow food passage and lead to hard, dry stools. · Nervous system. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that normally occur in the digestive process, resulting in pain, diarrhea or constipation. · Inflammation in the intestines. Some people with IBS have an increased number of immune-system cells in their intestines. · Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth). · Changes in bacteria in the gut (microflora). Microflora are the "good" bacteria that reside in the intestines and play a key role in health. Research indicates that microflora in people with IBS might differ from microflora in healthy people. Triggers · Food. Many people have worse IBS symptoms when they eat or drink certain foods or beverages, including wheat, dairy products, citrus fruits, beans, cabbage, milk, carbonated drinks, spicy food, alcohol, caffeine, and certain food seasonings · Stress. Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn't cause them. · Hormones. Women are twice as likely to have IBS, which might indicate that hormonal changes play a role. Many women find that signs and symptoms are worse during or around their menstrual periods. Risk factors Many people have occasional signs and symptoms of IBS. But you're more likely to have the syndrome if you: · Are young. IBS occurs more frequently in people under age 50. · Are female. In the United States, IBS is more common among women. Estrogen therapy before or after menopause also is a risk factor for IBS. · Have a family history of IBS. Genes may play a role, as may shared factors in a family's environment or a combination of genes and environment. · Have a mental health problem. Anxiety, depression and other mental health issues are associated with IBS. A history of sexual, physical or emotional abuse also might be a risk factor. Complications Chronic constipation or diarrhea can cause hemorrhoids. In addition, IBS is associated with: · Poor quality of life. · Mood disorders. Dx: stool samples, blood tests, endoscopy, x-rays, and colonoscopy Tx: focuses on relieving symptoms Mild signs and symptoms can often be controlled by managing stress and by making changes in diet and lifestyle. Avoid foods that trigger your symptoms · Eat high-fiber foods · Drink plenty of fluids · Exercise regularly · Get enough sleep If problems are moderate or severe, doctor might suggest counseling — especially if depression or stress tends to worsen symptoms. Stress Reduction Techniques: biofeedback, counseling, regular exercise, meditation, deep breathing, hypnosis, and yoga Meds: In addition, based on your symptoms your doctor might suggest medications such as: · Fiber supplements · Laxatives · Anti-diarrheal medications · Anticholinergic medications · Tricyclic antidepressants · SSRI antidepressants · Pain medications