Digestive system disorder, chapter 11
Chemical peritonitis results in bacterial peritonitis -Septicemia may result -Adult respiratory distress syndrome and acute renal failure are possible complications •Etiology -Gallstones -Alcohol abuse -Sudden onset may follow intake of a large meal or a large amount of alcohol
Acute Pancreatitis
Diagnostic tests -Serum amylase: first rise, then fall after 48 hours -Serum lipid levels are elevated -Hypocalcemia -Leukocytosis •Treatment -Oral intake is stopped. -Treatment of shock and electrolyte imbalances -Analgesics for pain relief
Acute Pancreatitis
Inflammation of the pancreas -Results in autodigestion of the tissue •May be acute or chronic -Acute form is considered a medical emergency •Pancreas lacks a fibrous capsule -Destruction may progress into tissue surrounding the pancreas -Substances released by necrotic tissue lead to widespread inflammation •Hypovolemia and circulatory collapse may follow
Acute Pancreatitis
Severe epigastric or abdominal pain radiating to the back - primary symptoms •Signs of shock -Due to hypovolemia •Low-grade fever until infection develops -Then body temperature may rise significantly •Abdominal distention and decreased bowel sounds -Decreased peristalsis and paralytic ileus
Acute Pancreatitis - Signs and Symptoms
Cholecystitis
Acute or chronic inflammation causing distention of the gallbladder - it is usually associated with a gallstone impacted in the cystic duct. •Accounts for 10%-25% of gall bladder surgery. •The acute form is most common in middle aged women. •The chronic form is prevalent among elderly people
Signs and Symptoms •Abdominal Pain, which may become localized to the lower right quadrant. (McBurney's point) Palpate McBurney's point •Rebound tenderness •Anorexia after onset •Nausea or vomiting •With Rupture: Pain, Tenderness, Spams, with brief cessation of abdominal pain.
Apenditicitis
Bile is produced in the liver and stored in the gall bladder for release into the duodenum. •One component of bile is bilirubin, a product of the breakdown of old or damaged red blood cells. •When red blood cells breakdown, unconjugated ( indirect ) bilirubin forms in the circulation. •The liver conjugates this bilirubin, thus producing conjugated bilirubin. •The conjugated bilirubin is secreted into the bile. •Jaundice occurs due to increased levels of conjugated or unconjugated
Bile metabolism and causes of jaundice
Most malignancies develop from adenomatous polyps. •Early diagnosis is essential. •Cancer occurs primarily in persons over 50. •Risk factors -Familial multiple polyposis -Long-term ulcerative colitis -Genetic factors -Environmental factors •Diet low in fiber
COLORECTAL CANCER
Second most common visceral malignant neoplasm in the United States and Europe •Progresses slowly and remains localized for a long time •Incidence equal between men and women •Potentialy curable in 90 % of all cases if early diagnosis allows for resection
COLORECTAL CANCER
Weak esophageal sphincter •Increased inter abdominal pressure, as in obese or pregnant •Hiatal hernia •Medications •Alcohol, cigarette smoke •Pyloric surgery
Causes Of Gastroesophageal Reflux Disease
Unknown •PREDISPOSING FACTORS: •Heredity •Age •Infection •High fat diet •Sedentary lifestyle
Causes Of colonic polyps
Unknown •RISK FACTORS: •Low fiber, high fat, high calorie diet •Other diseases of the digestive tract •History of ulcerative colitis •Familiar polyposis •Alcohol abuse •AGE ALERT: over age of 40
Causes Of colorectal cancer
Heptotoxic chemicals, such as carbontetrchloride or vinal chloride •Heptotoxic drugs, such as acetaminophen •VIRAL HEPATITIS: •Hepatitis virus A, B, C, D, E, and G, or transfusioins
Causes Of hepatitis
Hepatitis •Alcoholism •Malnutrition •Diseases of the biliary tree •Hepatic vein obstruction •Right sided heart failure
Causes of cirrhosis
UNKNOWN: POSSIBLE CONTRIBUTING FACTORS: •Lymphatic obstruction •Allergies, immune disorders - Haptens- Genetically Modified Organisms •Infection •Genetic predisposition
Causes of crohn's Disease
Exact cause unknown •Diminished colon motility and increased intra-luminal- pressure •Low fiber diets •Defect in colon wall strength
Causes of diverticular disease
First signs appear when cereals are added -About 4 to 6 months of age •Manifestation -Steatorrhea, muscle wasting, failure to gain weight -Irritability and malaise common •Diagnosed by a series of blood tests •Gluten-free diet for treatment -Intestinal mucosa returns to normal after a few weeks without gluten intake.
Celiac Disease
Malabsorption syndrome •Primarily a childhood disorder -May occur in adults in middle age •Appears to have genetic link •Defect in intestinal enzyme -Prevents further digestion of gliadin (breakdown product of gluten) -Toxic effect on intestinal villi - atrophy of villi •Malabsorption and malnutrition result.
Celiac Disease
Characterized by atrophy of stomach mucosa -Loss of secretory glands -Reduced production of intrinsic factor •H. pylori infection is often present. •Signs may be vague. -Mild epigastric discomfort, anorexia, intolerance for certain foods •Increased risk of peptic ulcers and gastric carcinoma •Certain autoimmune disorders are associated with one type of chronic gastric atrophy.
Chronic Gastritis
Chronic disease characterized by diffuse destruction and fibrotic regeneration of hepatic cells. •Mortality is high; many patients die within 5 years of onset •As cirrhosis progresses, complications may occur: these include ascites, portal hypertension, jaundice, bleeding , esophageal varices, acute GI bleed, liver failure. •Age alert: Malnurished persons over 50 with chronic alcoholism, 2x more common in men.
Cirrhosis
Progressive destruction of the liver •Causes -Alcoholic liver disease -Biliary cirrhosis •Associated with immune disorders -Postnecrotic cirrhosis •Linked with chronic hepatitis or long-term exposure to toxic materials -Metabolic •Usually caused by genetic metabolic storage disorders
Cirrhosis
Small tumorlike growth that projects from a mucous membrane surface. •Types include: polypoid adenomas, villous adenomas, •Most are benign: however; villous and hereditary polyps tend to become malignant •Age Alert: under 10- Juvenile Polyps characterized by recal bleeding. Villious type are most prevalent in men over 55
Colonic Polyps
Initial signs depend largely on the location of the growth. •General signs -Change in bowel habits •Alternating diarrhea and constipation -Bleeding -Fatigue, weight loss, anemia •Treatment -Surgical removal with radiation and/or chemotherapy
Colorectal cancer
Gangrene •Perforation •Peritonitis •Fistula formation' •Pancreatitis
Complication of gallbladder disorder
Apenditicitis
Complications •Rupture of perforation •Peritonitis •Appendiceal abscess (нарыв)
Gastroesophageal Reflux •Esophagitis and esophageal ulcers •Hemorrhage •Signs and symptoms: •Heartburn after eating •Substernal pain •Feeling of fullness after eating •Feeling of breathlessness or suffocation
Complications Of Hiatal Hernia
AKA- regional enteritis- Inflammation in ANY part of the GI tract but usually the terminal ileum, extending through ALL layers of the intestinal wall, It may involve lymph nodes and the mesentery. •AGE ALERT: Adults- 20-40
Crohn's Disease
X-ray reveals gallstones if there is enough calcium to be radioopague, can also disclose porcelain gallbladder. Also Known as ( bag of Diamonds ) •Ultrasound can detect gallstones as small as 2mm •Blood chemistry may reveal elevated Alkaline phosphate
Diagnosis of gallstones
Digital rectal exam. Detects almost 15% of colorectal cancers •Fecal occult blood test can possibly show blood in stool •Barium enema studies can determine the location of lesions that are not normally detected manually or visually.
Diagnostic test results
Barium enema identifies polyps in the colon •Fecal blood test is positive : GUIAC Test •Blood studies may show decreased hemoglobin level and hematocrit •Scope of colon and rectal biobsy confirmation
Diagnostic test results Of colonic polyps
Upper GI series reveals diverticulosis of the esophagus and upper bowel •Barium enema reveals filling of diverticula, which confirms diagnosis •Biopsy reveals evidence of benign disease, ruling out cancer
Diagnostic test results Of diverticulosis
Scope allows visual examination of the lining of the esophagus to reveal the extent of the disease and confirm pathologic changes in the mucosa •Upper GI series may detect hiatal hernia as cause
Diagnostic test results of GERD
Hepititis profile- looking for specific viral antibodies •Blood chemisty testing •Serum bilirubin levels high, due to liver's inability to conjugate
Diagnostic testing and results
X-ray shows air shadow behind heart ina large hernia •Barium swallow can detect hiatal hernia and diaphragm abnormalities •Treatment: •Restrict activities that increase intra-abdominal pressure •Proton pump inhibitors •Diet modifications- small , frequent, bland meals, not eating 2 hours prior to lying down
Diagnostic tests and results Of Hiatal hernia
Liver biopsy- tissue destruction and fibrosis •Abdominal X-ray- enlarged liver, cysts, liver calcifications, and massive fluid accumulation •Esophagogastroduodenoscopy- bleeding esophageal varices, •Blood studies reveal elevated levels of liver enzymes, total serum bilirubin, and indirect bilirubin. ( conjugated, and unconjugated ) decreased serum albumin and protein, prolonged prothrombin time.
Diagnostic tests and results Of cirrhosis
Fecal occult blood test reveals minute amounts of blood •Small bowel x-ray show irregular mucosa, ulceration, and stiffening •Barium enema reveals string sign, ( segments of stricture separated by normal bowel) and possibly fissures and narrowing of bowel. •Scope reveals patchy areas of inflammation
Diagnostic tests and results Of crohn's disease
Form at gaps between muscle layers •Congenital weakness of wall may be a factor. •Weaker areas bulge when pressure increases. •Many cases are asymptomatic. •Diverticulitis stasis of material in diverticula leads to inflammation and infection. •Cramping, tenderness, nausea, vomiting •Slight fever and elevated white blood cell count •Treatment of diverticulitis •Antimicrobial drugs
Diverticular Disease
In diverticular disease, bulging pouches ( diverticula) in the GI wall push the mucosal lining through the surrounding muscle. •Although the common site for diverticula is in the sigmoid colon, they may develop anywhere, from the proximal end of the pharynx to the anus •Common sites include the duodenum, near the pancreatic border or ampulla of Vater, and the jejunum. •Diverticular disease of the ileum ( Merkel's diverticulum) is the most common congenital anomaly of the GI tract. •Diverticulosis- diverticula present but asymptomatic •Diverticulitis - inflammed diverticula, may cause potentially fatal obstruction , infection, or hemorrhage.
Diverticular disease
Control of gastric emptying is lost and gastric contents are "dumped" into the duodenum without complete digestion. •May follow gastric resection •Hyperosmolar chyme draws fluid from vascular compartment into intestine. -Intestinal distention -Increased intestinal motility -Decreased blood pressure → anxiety and syncope( обморок)
Dumping Syndrome
Occurs during or shortly after meals -Abdominal cramps, nausea, diarrhea •Hypoglycemia 2 to 3 hours after meal -High blood glucose levels in chyme stimulate increased insulin secretion → drop in blood glucose levels •May be resolved by dietary changes -Frequent small meals - high in protein, low in simple carbohydrates •Often resolves over time
Dumping Syndrome
Pathophysiology •With acute cases, inflammation of the gallbladder wall usually develops after a gall stone lodges in the cystic duct. •Gallstone usually develop when cholesterol or bile salt metabolism is abnormal •Changes in the composition of bile may cause gallstones •When gallstones block bile flow, the gallbladder becomes inflamed and distended. •Growth of bacteria, usually E. Coli may contribute to the inflammation and abscess formation .
Gallbladder
Gallstones vary in size and shape. •Form in bile ducts, gallbladder, or cystic duct •May consist of -Cholesterol or bile pigment -Mixed content with calcium salts •Small stones -May be silent and excreted in bile •Larger stones -Obstruct flow of bile in cystic or common bile ducts - causing severe pain, which is often referred to subscapular area
Gallbladder Disorders
Acute abdominal pain in the upper right hand quadrant that may radiate to the back, between the shoulders, or to the front of the chest; typically occurs after a fatty meal. •Colic •Nausea and vomiting •Chills, low-grade fever •Jaundice
Galledbladder disorder( gallstones)
Causes of cholecystisis
Gallstones Poor or absent blood flow to the gallbladder Abnormal metabolism of cholesterol and bile salts
Gastric mucosa is inflamed. •May be ulcerated and bleeding •May result from -Infection by microorganisms -Allergies to foods -Spicy or irritating foods -Excessive alcohol intake -Ingestion of aspirin or other NSAIDs -Ingestion of corrosive or toxic substances -Radiation or chemotherapy
Gastritis - Acute Gastritis
AKA: Heartburn. Backflow of gastric or dueodenal contents or both into the esophagus and past the lower esophageal sphincter, without associated belching or vomiting. •The reflux of gastric contents causes acute epigastric pain, usually after a meal. •The pain may radiate to the chest or arms •Occurs frequently in pregnant and obese persons, lying down after a meal may also contribute or exacerbate condition.
Gastroesophageal Reflux Disease
Inflammation of the liver that usually results from exposure to certain chemicals or drugs •Most patient recover from this illness, although a few develop fulminating hepatitis, hepatic failure, or cirrhosis •VIRAL HEPATITIS is a common infection, resulting in hepatic cell destruction, necrosis, and autolysis. •Hepatic cells usually regenerate with little or no residual damage
Hepatitis
A defect in the diaphragm that permits a portion of the stomach to pass through the diaphragmatic opening into the chest •Treatment can prevent complications
Hiatal Hernia
Food may lodge in pouch of the hernia -Causes inflammation of the mucosa -Reflux of food up the esophagus -May cause chronic esophagitis •Signs -Heartburn or pyrosis -Frequent belching -Increased discomfort when laying down -Substernal pain that may radiate to shoulder and jaw
Hiatal Hernia
Part of the stomach protrudes into the thoracic cavity. •Sliding hernia -More common type -Portion and part of stomach and gastroesophageal junction slide up above the diaphragm •Rolling or paraesophageal hernia -Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become trapped.
Hiatal Hernia
Appendicitis
Inflammation and obstruction of the vermiform appendix. •With the advent of antibiotics , the incidence and the death rate of appendicitis have declined; if untreated, the disease is fatal •AGE ALERT: can occur at any age but the majority of cases occur between 11 and 20. Affects both sexes equally; however, between puberty and age 25, it is more prevalent in men.
Gases and fluids accumulate proximal to blockage, distending the intestine. •Increasingly strong contractions of proximal intestine -Effort to move contents along •Pressure increases in lumen. -More secretions enter the intestine. -Compression of veins in wall •Intestinal wall becomes edematous. •Prevention of absorption
Intestinal Obstruction
Intestinal distention leads to persistent vomiting. -Additional loss of fluid and electrolytes -Hypovolemia(decreased volume of circulating blood in the body.) can result. •Intestinal wall becomes ischemic and necrotic. -If obstruction is not removed, gangrene ensues. •Ischemia and necrosis → decreased innervation and cessation of peristalsis •Paralytic ileus occurs if it is not a cause to begin with.
Intestinal Obstruction
Lack of movement of intestinal contents through the intestine -More common in small intestine •Mechanical obstructions -Result from tumors, adhesions, hernias, other tangible obstructions •Functional or adynamic obstructions -Result from impairment of peristalsis •Spinal cord injury •Paralytic ileus due to toxins or electrolyte imbalance
Intestinal Obstruction
Mechanical obstruction from -Adhesions that twist or constrict intestine -Hernias -Strictures caused by scar tissue -Masses - tumors or foreign bodies -Intussusception -Volvulus -Hirschsprung disease -Gradual obstruction from chronic inflammatory conditions
Intestinal Obstruction
Mechanical obstruction of small intestine -Severe colicky abdominal pain -Intermittent bowel sounds can be heard. •Paralytic ileus -Pain is steady. -Bowel sounds decrease or are absent. •Vomiting and abdominal distention -Occurs quickly with obstruction of small intestine -Vomiting is recurrent - eventually with bile-stained content •Obstruction of the small intestine is a medical emergency!
Intestinal Obstruction
Obstruction of large intestine -Develops slowly with mild signs -Constipation -Mild abdominal pain, followed by abdominal distention -Anorexia, vomiting, more severe pain •Treatment -Treatment of underlying cause -Fluid and electrolyte replacement -Surgery and antimicrobial therapy
Intestinal Obstruction
Obstruction promotes rapid reproduction of intestinal bacteria. -Some produce endotoxins. -Affected wall becomes necrotic and more permeable. -Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia). •Perforation of the necrotic segment may occur. -Generalized peritonitis and septic shock
Intestinal Obstruction
•Functional obstructions or paralytic ileus from -After abdominal surgery -Spinal shock following spinal cord injuries -Inflammation related to severe ischemia -Pancreatitis, peritonitis, infection in the abdominal cavity -Hypokalemia -Mesenteric thrombosis -Toxemia
Intestinal Obstruction
Gases and fluids accumulate proximal to blockage, distending the intestine. •Increasingly strong contractions of proximal intestine -Effort to move contents along •Pressure increases in lumen. -More secretions enter the intestine. -Compression of veins in wall •Intestinal wall becomes edematous. •Prevention of absorption
Intestinal obstruction
Intestinal distention leads to persistent vomiting. -Additional loss of fluid and electrolytes -Hypovolemia can result. •Intestinal wall becomes ischemic and necrotic. -If obstruction is not removed, gangrene ensues. •Ischemia and necrosis → decreased innervation and cessation of peristalsis •Paralytic ileus occurs if it is not a cause to begin with.
Intestinal obstruction
Lack of movement of intestinal contents through the intestine -More common in small intestine •Mechanical obstructions -Result from tumors, adhesions, hernias, other tangible obstructions •Functional or adynamic obstructions -Result from impairment of peristalsis •Spinal cord injury •Paralytic ileus due to toxins or electrolyte imbalance
Intestinal obstruction
Obstruction promotes rapid reproduction of intestinal bacteria. -Some produce endotoxins. -Affected wall becomes necrotic and more permeable. -Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia). •Perforation of the necrotic segment may occur. -Generalized peritonitis and septic shock
Intestinal obstruction
casauses of appendicitis
Mucosal Ulceration •Fecal mass ( fecalith) •Stricture •Viral Infection •Neoplasm •Foreign body
Diverticulum
Outpouching (herniation) of the mucosa through the muscular layer of the colon
The initial event is Hepatic scarring or fibrosis •Hepatocyte function is impacted as the matrix chages •Fat-storing cells are believed to be the source of the extracellulary changes •Cellular changes produce bands of scar tissue and disrupt lobar structure: •Complications: Portal hypertension, esophageal varices, ascites(the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.), liver failure, and death.
Pathophisiology of cirrhosis
Pathophysiology •Inflammation spreads slowly and progressively •Enlarged lymph nodes block lymph flow to submucosa, •Lymphatic obstruction leads to edema, fissures, and abscesses •Skip lesions- mucosal ulcerations, that are not continuous, like in ulcerative colitis •Thickening of bowel wall causes stenosis (сужение) •Complications: anal fistula, perineal abscess, fistulas to the bladder, vagina, or skin, intestinal obstruction, nutritional deficiencies, and peritonitis.
Pathophisiology of crohn's disease
Non-Viral- after exposure to heptotoxic substance, hepatic cells necros, scarring forms, Kupffer cell Hyperplasia, and infiltration by Mononuclear phagocytes occurs. •Can be drug induced- manifests 2 - 5 weeks after therapy. •Viral- Virus causes hepatocyte injury and death by either directly killing cell or through the inflammatory reponse. •Later direct antibody attacj against viral antigens causes further destruction of the infected cells. Edema and swelling lead to collapse of capillary beds , decreased blood flow, tissue hypoxia, scarring , and fibrosis. •Complications: chronic persistant hepatitis, chrrhoisi, heptic failure and death,
Pathophisiology of hepatitis
Colonic polyps are masses of tissue resulting from unrestrained cell growth in the upper epithelium that rise above the mucosal membrane and protrude into the GI tract. •They may be described by their appearance : pedunculated- attached to a stalk, of sessile- attached to the wall with broad base. •Complications: slow bleed, bowel obstruction, large rectal bleeding, intussusception, colorectal cancer.
Pathophisiology oh colnic polyps
Apenditicitis
Pathophysiology •Mucosal ulceration triggers inflammation, which temporarily obstructs the appendix. •This obstruction blocks mucus outflow. Pressure in the now distended appendix increases, and the appendix contracts. •Bacteria multiply, and inflammation and pressure continue to increase. •This restricts blood flow to the organ which causes severe abdominal pain. •Inflammation can lead to infection, clotting, and tissue decay.
Lower esophageal spinctor does not maintain enough pressure to close and prevent backflow or reflux. •Typically the sphincter relaxes after each swallow to allow food into the stomach, In GERD, the sphincter doesn't remain closed and stomach contents flow into the esophagus. •The high acidity of the stomach contents causes pain and irritation in the esophagus, and stricture or ulceration may occur: •Complications: Reflux esophagitis- esophageal stricture- esophageal ulcer- Metaplasia- normal squamous epithelium is replaced with columnar epithelium ( Barrett's esophagus)- Pulmonary problems with reflux
Pathophysiology Of Gastroesophageal Reflux Disease
Hernias typically result when an organ protrudes through an abnormal opening in the muscle wall of the cavity that surrounds it. •In Hiatal hernias, a portion of the stomach protrudes through the diaphragm. •Three types of hiatal hernia can occur: •Sliding •Paraesophageal ( rolling) •Mixed
Pathophysiology Of Hiatal Hernia
Most are due to H. pylori infection. •Occur most commonly in the proximal duodenum (duodenal ulcers) •Also found in the antrum of the stomach (gastric ulcers) •Development begins with breakdown of mucosal barrier. -Decreased mucosal defense -More common in gastric ulcer development -Increased acid secretion predominant factor in duodenal ulcers
Peptic Ulcer - Gastric and Duodenal Ulcers
Women twice as likely to develop stones -High cholesterol in bile -High cholesterol intake -Obesity -Multiparity -Use of oral contraceptives or estrogen supplements -Hemolytic anemia -Alcoholic cirrhosis -Biliary tract infection
Risk factors for gallstones
Anorexia, nausea and vomiting, diarrhea •Dull abdominal ache- due to swelling of the liver capsule •Respiratory problems -due to pleural effusion, impaired gas exchange •Hematologic- bleeding tendency, anemia, splenomegaly, portal hypertension •Skin-severe pruritus palmar erythema, extreme dryness •Hepatic- jaundice, heptomegaly, ascites, and edema of lower extremities.
Signs an symptoms of cirrhosis
Usually asymptomatic; discovered incidentally during a digital exam or rectosigmoidoscopy •Rectal bleeding- with high polyps streak of blood on stool- with lower polyps bleed freely •Painful defication •Diarrhea
Signs and Symptoms of polyp
Steady colicky pain •Cramping and tenderness •Weight loss •Diarrhea, steatorrhea, bloody stools •Anal \fistula •Perineal abscess
Signs and symptoms Of crohn's disease
Diverticulosis- is asymptomatic •Mild Diverticulitis- Moderate left lower abdominal pain. Low grade fever, nausea and vomiting •Severe Diverticulitis- nausea and vomiting- left lower quadrant pain, abdominal rigidity. Microscopic to massive hemorrhage •Chronic Diverticulitis Constipation, ribbon like stools, intermittent diarrhea, abdominal distention •Abdominal rigidity and pain, diminished or absent bowel sounds, nausea, and vomiting
Signs and symptoms Of diverticulosis
Burning epigastric pain, can radiate to arms and chest, usually after a meal or when laying down. •Chronic cough •Layngitis and morning hoarseness •Wheezing •Nausea and vomiting
Signs and symptoms of Gastroesophageal Reflux Disease
Anorexia, nausea , vomiting •Jaundice, dark urine, clay-colored stool •Heptamegaly •Pruritus •Viral, Prodromal Phase •Easy fatigue, malaise •Arthralgia(pain in joints), myalgia(pain in a muscle or group of muscles)•Nausea/vomiting •Right upper quadrant pain
Signs and symptoms of hepatitis
Change in bowel habits, bleeding •Symptoms of local obstruction •If in RIGHT Colon; Black tarry stools0 abdominal aching or pressure- dull cramps, possible vomiting •If in LEFT Colon: Rectal bleeding, dark or bright red blood or mucus in stools •Abdominal fullness or cramping •Rectal pressure • constipation •Diarrhea
Signs and sysmptoms Of colorectal cancer
Liquid or bland diet, stool softeners, occasional doses of mineral oil\antibiotics •Exercise to increase intestinal emptying •Colon resection with removal of involved segment •Temporary colostomy if necessary
Treatment Of Diverticulosis
Polyectomy- less than 1cm in size •Abdominoperineal resection if over 4cms
Treatment Of colonic polyp
Non-viral- corticosteroids •Viral--- •rest •Avoidance of any hepatoxic drugs or substances •Liver transplantation
Treatment Of hepatitis
Vitamin and nutritional supplementation •Portosystemic shunts •Esophageal balloon tamponade
Treatment for cirrhossis
•Surgery to remove tumor plus adjacent tissues and any nodes •Radiation therapy for tumor mass reduction, done prior to surgery •High fiber diet.
Treatment of colorectal cancer
Corticosteroids, immunosuppressants •Antidiarrheals •Avoidance of fruits and vetables: high -fiber, spicy, or fatty foods; dairy products, carbonated or caffeine - containing beverages, or anything that stimulates intestinal activity •Surgery if needed
Treatment of crohn's disease
Cholecystectomy •Lithotripsy(дробление) •Low fat diet •antibiotics
Treatment of gallstones
Decreased detoxification reactions, resulting in accumulation of toxic substances in the blood, which can lead to heptic pathology. •Decrease in gluconeogenesis, which can cause fasting hypoglycemia. •Decrease in protein production, increasing the risk of bleeding. •Failure of the liver to secrete conjugated bilirubin or failure to conjugate it, which can cause jaundice.
What would happen if the liver failed?
The heptic portal vein drains the gut's venous system, carrying absorbed nutrients to the liver. •The liver performs many metabolic functions •Provides glucose during fasting ( via gluconeogenesis and glycogenesis) •Detoxifies various substances, •Stores glycogen, produces bile, as well as various proteins and lipids.
liver function
Likeyl results from high intra-luminal pressure on an area of weakness in the GI wall where blood vessels enter. •Diet may contribute due to decreased fiber consumption reduces fecal residue, narrows luman, and leads to increased need of higher pressure for defecation. • In diverticulitis, undigested food and bacteria accumulate in the diverticular sac. This hard mass cuts off the blood supply to the thin walls of the sac, making them more susceptible to attack by colonic bacteria •Complications - rectal hemorrhage, fistulas, obstruction, perforation, abcess, peritonitis
pathophisiology of diverticular disease
Frequent small meals, avoidance of eating just prior to bed •Sitting up during and afer meals, sleeping with head elevated •Proton pump inhibitors •Avoidance of foods that irritate the sphincter; caffeine, mint, and chocolate
treatment Of GERD
Diverticulosis
•Asymptomatic diverticular disease
Diverticulitis
•Inflammation of the diverticula
Complication of appenditicitis
•Rupture of perforation •Peritonitis •Appendiceal abscess