Digestive System Disorders: Symptoms and Treatments

Posted on Dec 10, 2024 in Medicine & Health

Gastroesophageal Reflux Disorder (GERD)

Definition: Reflux occurring two or more times a week
Erosive Esophagitis: Inflammation due to acidity
Signs and Symptoms: Regurgitation, pyrosis (heartburn), pain
Causes: Increased intra-abdominal pressure, high alcohol/fat/chocolate intake
Complications: Esophageal stricture (narrowing due to scarring), Barrett’s metaplasia (precancerous change with mucous cells)
Treatment: Medications (antacids, proton-pump inhibitors, histamine blockers), lifestyle changes

Achalasia

Definition: Incomplete relaxation of the lower esophageal sphincter, producing an obstruction
Signs and Symptoms: Regurgitation, coughing, chest pain, weight loss
Cause: Unknown (possibly damage to the myenteric plexus)
Diagnosis: Barium swallow showing a narrowed lower esophagus (“bird-beak” or “rat’s tail” appearance)
Treatment: Pneumatic dilation or endoscopic myotomy

Mallory-Weiss Syndrome

Definition: Lacerations of the mucous membrane lining the gastroesophageal junction
Signs and Symptoms: Pain, hematemesis (vomiting blood), melena (tar-like, bloody stool)
Cause: Increased intra-abdominal pressure forces stomach contents into the esophagus, resulting in tears
Diagnosis: Endoscopic examination (visualizing tears)
Treatment: Usually heals on its own within a week

Hiatal Hernia

Definition: Protrusion of the stomach through the esophageal hiatus of the diaphragm
Types: Sliding (axial) or paraesophageal (non-axial)
Signs and Symptoms: Large hernias may cause chest pain, acid reflux, and pyrosis
Cause: Increased intra-abdominal pressure, widened esophageal hiatus
Treatment: Medications (antacids, proton-pump inhibitors, histamine blockers), surgery

Helicobacter pylori Gastritis

Prevalence: Present in two-thirds of the population, with only 20% showing signs and symptoms
Cause: Infection with a flagellated, S-shaped, Gram-negative bacterium spread by vomit, saliva, or feces
Diagnosis: Urea breath test
Treatment: Combination therapy (antibiotics and proton-pump inhibitors)

Esophagitis

Definition: Inflammation of the esophagus
Signs and Symptoms: Dysphagia (difficulty swallowing), chest pain, pyrosis
Causes: Infection, acid reflux into the esophagus, medications
Diagnosis: Endoscopic examination
Treatment: Addressing the underlying cause

Esophageal Diverticula

Definition: Sacs along the esophageal wall, pushing out the mucosa through the muscularis externa
Signs and Symptoms: Halitosis (bad breath), regurgitation
Cause: Unknown (possibly increased esophageal pressure)
Diagnosis: Barium swallow (X-rays reveal pouches)
Treatment: Surgery

Types of Esophageal Diverticula

Zenker’s Diverticulum: Develops in the upper esophagus
Midthoracic Diverticulum: Develops in the middle esophagus
Epiphrenic Diverticulum: Develops in the lower esophagus

Acute Gastritis

Definition: Acute inflammation of the gastric mucosa with the presence of grossly visible erosion
Signs and Symptoms: Pyrosis, abdominal pain, nausea, and vomiting
Causes: High alcohol or spicy food intake, medications
Diagnosis: Endoscopic examination (visualizing inflammation)
Treatment: Medications for acid, addressing the underlying cause

Chronic Gastritis

Definition: Chronic inflammation of the gastric mucosa with the absence of grossly visible erosion
Signs and Symptoms: Early satiety, abdominal pain, nausea, vomiting
Types: Helicobacter pylori gastritis, autoimmune atrophic gastritis, and reactive (chemical) gastropathy

Esophageal Cancer

Prevalence: More common in men aged 65 and older
Signs and Symptoms: Dysphagia, loss of appetite, weight loss, odynophagia (painful swallowing)
Causes: High alcohol intake, smoking, Barrett’s metaplasia
Diagnosis: Endoscopic examination
Treatment: Chemotherapy, radiation, surgery

Pathogenesis of Helicobacter pylori Gastritis

H. pylori colonizes gastric mucous cells and withstands the stomach’s acidic environment by producing and secreting urease.

Urease: Converts stomach urea into CO2 and ammonia (buffering acidity)

Autoimmune Atrophic Gastritis

Cause: Autoantibody formation to gastric mucosa in the stomach
Result: Parietal cell atrophy, causing decreased intrinsic factor and leading to decreased vitamin B12 absorption and megaloblastic anemia
Signs and Symptoms: Glossitis – “beefy,” fiery, red, and sore tongue

Peptic Ulcer Disease (PUD)

Definition: Ulcers in the gastric or duodenal mucosa exposed to acidic secretions (can affect multiple layers)
Signs and Symptoms: Pyrosis, epigastric pain
Causes: High aspirin/alcohol/smoking/stress intake, H. pylori infection
Complications: Internal bleeding, ulcer perforation
Diagnosis: Endoscopic examination, urea breath test, fecal occult blood test
Treatment: Combination therapy (antibiotics and proton-pump inhibitors)

Refractory Ulcers

Peptic ulcers that do not heal after 8-12 weeks of treatment

Greater than 5mm in diameter
Results from antibiotic resistance, poor medical adherence
Treat with antibiotics and addressing factors hindering healing

Types of Refractory Ulcers

Curling Ulcers: Develop after severe burns (burn surface area greater than 30%)
Cushing Ulcers: Associated with increased intracranial pressure, causing increased HCl production

Zollinger-Ellison Syndrome

Definition: Condition characterized by gastrin-secreting tumors (gastrinomas) in the duodenum or stomach
Cause: Increased gastrin leads to increased HCl secretion by parietal cells, causing peptic ulcers
Signs and Symptoms: Pyrosis, epigastric pain, nausea, vomiting
Diagnosis: Blood test for elevated gastrin levels
Treatment: Acid control medications, chemotherapy, or surgery

Stress Ulcers

Definition: Acute gastric mucosal lesions that develop after significant stress or trauma
Causes: Sudden decrease in gastric blood flow or increased acid production
Signs and Symptoms: Pyrosis, epigastric pain, variable response to food
Complications: Internal bleeding, ulcer perforation leading to peritonitis
Diagnosis: Endoscopic examination (visualizing ulcers)
Treatment: Acid control medications

Stomach Cancer

Definition: Malignant tumor in the stomach lining
Causes: Family history, H. pylori infection, carcinogenic preservatives, high alcohol intake, men aged 60 and older
Signs and Symptoms: Later symptoms include appetite loss, weight loss, fatigue, weakness
Diagnosis: Endoscopic examination (visualizing tumor)
Treatment: Surgery

Acute Diarrhea

Definition: Loose, watery stools lasting less than 2 weeks
Causes: Bacterial toxins leading to increased secretion of water/electrolytes; viral damage leading to decreased absorption
Signs and Symptoms: Frequent loose stools, abdominal cramping, fever
Treatment: Oral rehydration solution

Chronic Diarrhea

Definition: Persistent loose stools lasting 4 weeks or longer
Causes: Protozoal infections, chronic inflammation, hyperosmotic contents
Signs and Symptoms: Continuous loose stools, bloating, weight loss, fatigue
Treatment: Addressing the underlying cause

Factitious Diarrhea

Definition: Intentional creation of symptoms, often related to laxative misuse
Prevalence: Over 90% in women, healthcare workers
Causes: Laxative abuse
Signs and Symptoms: Persistent diarrhea, nausea, cramping, fatigue
Diagnosis: Stool tests checking for laxatives
Treatment: Replacing fluids/electrolytes; mental health referral

Constipation

Definition: Infrequent or difficult bowel movements
Causes: Decreased dietary fiber/fluid intake, inactivity, medications, congenital absence of neurons (Hirschsprung disease)
Signs and Symptoms: Straining, hard stools, bloating, discomfort
Treatment: Addressing the underlying cause

Intestinal Obstruction

Definition: Prevention of movement through the intestines
Signs and Symptoms: Vomiting, constipation, abdominal pain, borborygmi (rumbling or gurgling noise made by the movement of fluid and gas in the intestines)
Diagnosis: Abdominal X-ray (distended gas-filled loops)
Treatment: Addressing the underlying cause

Types of Intestinal Obstruction

Mechanical: Tumors or foreign bodies
- Intussusception
- Volvulus
- Inguinal hernia
Non-mechanical: Decreased peristalsis due to impaired blood flow
- Paralytic ileus: Intestinal muscle paralysis caused by nerve damage

Irritable Bowel Syndrome (IBS)

Definition: Gastrointestinal disorder without structural abnormalities
Signs and Symptoms: Bloating, flatulence, diarrhea/constipation, nausea, appetite loss, intermittent cramping relieved by defecation
Causes: Stress, certain dietary factors
Treatment: Dietary changes, stress management, anti-diarrheal medications/laxatives

Inflammatory Bowel Disease (IBD)

Definition: Chronic inflammatory conditions of the GI tract
Signs and Symptoms: Abdominal pain, diarrhea, increased colorectal cancer risk, systemic manifestations (e.g., arthritis)
Skin Lesion Flare: Erythema nodosum
Types:
- Crohn’s Disease (Cobblestone Appearance): Can affect any segment of the GI tract
- Ulcerative Colitis (Inflammation): Starts in the rectum
Diagnosis: Endoscopic examination, stool cultures
Treatment: Anti-inflammatory medications, surgery

Diverticular Disease

Definition: Formation of pouches (diverticula) in the colon wall
Causes: Increased intraluminal pressure, low-fiber diet
Types and Signs/Symptoms:
1. Diverticulosis: Asymptomatic
2. Diverticulitis: Inflamed pouches leading to fever, pain, nausea
3. Diverticular Bleeding: Bright blood in stool (hematochezia)
Treatment: Increased fiber intake, antibiotics, surgery

Appendicitis

Definition: Inflammation of the appendix, a medical emergency
Causes: Obstruction with stool (fecalith), infection
Signs and Symptoms: Initial pain near the umbilicus shifting to the right lower quadrant (RLQ), rebound tenderness, nausea
Treatment: Appendectomy

Peritonitis

Definition: Inflammation of the peritoneum
Causes: Bacterial infection, chemical irritants, surgery
Signs and Symptoms: Fever, nausea, abdominal pain
Diagnosis: Peritoneal fluid analysis
Treatment: Antibiotics or surgery

Malabsorption Syndrome

Definition: Decreased nutrient absorption from the intestinal lumen
Causes: Damage to the intestinal lining, liver/pancreatic disorders, chemotherapy
Signs and Symptoms: Diarrhea, bloating, flatulence, muscle wasting, weight loss, fatigue, fat-containing stools (steatorrhea)
Diagnosis: Stool test for parasites/fat content, blood tests for nutrient levels
Treatment: Addressing the underlying cause

Celiac Disease (Gluten-Sensitive Enteropathy)

Definition: Autoimmune disorder where gluten triggers an immune response, damaging the small intestine
Causes: Gluten leads to inflammation, loss of absorptive villi, and nutritional deficiency
Signs and Symptoms: Abdominal pain, diarrhea/constipation, bloating, flatulence, nausea
Treatment: Complete gluten exclusion from the diet

Hemorrhoids (Piles)

Definition: Swollen veins in the lower rectum/anus
Causes: Increased pressure in the rectum
Types: Internal (inside the rectum), external (around the anus)
Signs and Symptoms: Discomfort, itching, bleeding (external)
Treatment: Increased dietary fiber, over-the-counter creams, surgery

Colorectal Cancer

Definition: Malignant growths in the colon or rectum
Causes: Family history, diet high in fat/refined sugar, IBD
Signs and Symptoms: Hematochezia, diarrhea/constipation, weight loss, appetite loss
Diagnosis: Endoscopic examination (biopsy)
Treatment: Surgery; chemotherapy/radiation as palliative care

Jaundice (Icterus)

Definition: Yellow discoloration of the skin and sclerae from elevated bilirubin levels (greater than 2.5)
Types:
1. Pre-hepatic: Prior to the liver, in the blood
2. Intra-hepatic: Within the liver
3. Post-hepatic: Beyond the liver

Pre-hepatic Jaundice

Cause: Increased red blood cell (RBC) destruction
Pathologic Conditions: Sickle cell disease, hemolytic blood transfusion reaction
Laboratory Findings: Increased unconjugated bilirubin

Intra-hepatic Jaundice

Cause: Hepatocyte injury leading to decreased uptake/secretion of bilirubin
Pathologic Conditions: Viral hepatitis, alcohol or drug-induced liver damage, liver cancers
Laboratory Findings: Increased unconjugated and conjugated bilirubin

Post-hepatic Jaundice

Cause: Bile flow obstruction
Pathologic Conditions: Gallstones, bile duct strictures
Laboratory Findings: Increased conjugated bilirubin

Neonatal Jaundice (Neonatal Hyperbilirubinemia)

Definition: Yellowing in newborns due to immature liver processing of bilirubin
Cause: Hepatic mechanisms for conjugating/excreting bilirubin are immature around birth
Severe Cases: May lead to brain damage (kernicterus)
Treatment: Phototherapy (blue-green light to convert bilirubin into an excretable form)

Cholestasis

Definition: Impaired bile flow from the liver to the duodenum, causing bile buildup
Excess bile in the liver results in a greenish discoloration
Signs and Symptoms: Itching (pruritus), jaundice, fat deposits (joints = xanthomas, eyelids = xanthelasmas)
Treatment: Medications to decrease itching and lipid levels; surgery

Types of Cholestasis

Intra-hepatic: Bile canaliculi
- Cause: Bile canaliculi or terminal bile duct damage
- Pathologic Conditions: Viral hepatitis, alcohol or drug-induced liver damage, liver cancers
Extra-hepatic: Hepatobiliary tree
- Cause: Hepatobiliary tree obstruction
- Pathologic Conditions: Gallstones, bile duct strictures

Viral Hepatitis

Definition: Inflammation of the liver
Causes: Viruses (HAV, HBV, HCV, HDV, HEV), high alcohol intake, medications
Acute (less than 6 months): HAV/HEV
1. Pre-icterus: Myalgia, nausea, fatigue, elevated ALT/AST
2. Icterus: Jaundice, abdominal pain, increased bilirubin
3. Convalescent: Recovery
Chronic (6 months or longer): HBV, HCV, HDV
Cirrhosis followed by portal hypertension, liver failure, or hepatocellular carcinoma
Vaccines: HAV, HBV (also prevents HDV)
No vaccines for HCV or HEV
Treatment: Supportive care for HAV/HEV; antivirals for HBV, HCV

Alcohol-Induced Liver Damage

Definition: Liver damage from excessive alcohol intake (the final product of alcohol metabolism is toxic acetaldehyde)
Stages: Steatosis, steatohepatitis, cirrhosis
Leads to complications like portal hypertension and liver failure

Steatosis (Alcoholic Fatty Liver)

Fatty liver from alcohol or high-calorie intake
Cause: Triglycerides accumulate in hepatocytes
Signs and Symptoms: Asymptomatic, increased ALT and AST levels
Signet ring appearance

Steatohepatitis (Alcoholic Hepatitis)

Hepatocyte necrosis and inflammation with neutrophils
Signs and Symptoms: Jaundice, loss of appetite, nausea, liver pain
Severe cases may progress to cirrhosis

Cirrhosis and its Complications

Irreversible liver scarring, nodule formation
Complications: Portal hypertension, liver failure, increased risk of liver cancer

Types of Cirrhosis

Micronodular Cirrhosis: Less than 3mm, uniform – associated with alcohol
Macronodular Cirrhosis: Greater than 3mm, irregular – associated with HBV, HCV
Mixed Cirrhosis: Features of both micronodular and macronodular cirrhosis

Drug-Induced Liver Damage

Cause: Most commonly acetaminophen overdose
Phase I (Oxidation, Reduction, Hydrolysis): Breaks down drugs to generate impaired metabolites
Phase II (Conjugation, Methylation, Sulfation): Binds hydrophilic molecules to drugs and converts them into secretable substances
Risk Factors: Females over 55, genetics, high alcohol intake, interacting drug use
Prevention: Patient education
Treatment: Discontinuation of the implicated drug

Fulminant Hepatitis

Definition: Rapid liver failure due to massive hepatocyte necrosis
The liver cannot combine ammonia with CO2 to form urea
Causes: Acetaminophen overdose, mushroom poisoning
Treatment: Counteractive medications, antivirals, liver transplant

Portal Hypertension

Definition: Hypertension in the hepatic portal system, comprised of the hepatic portal vein and its tributaries
Types: Pre-hepatic (portal vein blockage), intra-hepatic (liver fibrosis), post-hepatic (venous blockage)
Signs and Symptoms: Ascites (fluid in the abdomen), caput medusae (engorged abdominal veins), hemorrhoids, esophageal varices (engorged esophageal veins), hepatic encephalopathy (asterixis), hypersplenism

Liver Failure

Definition: Consequence of liver disease where more than 80% of function is lost
Types:
1. Acute: Sudden impairment (e.g., fulminant hepatitis)
2. Chronic: Gradual loss (e.g., cirrhosis)
Signs and Symptoms: Fatigue, jaundice, confusion, ascites, musty odor (fetor hepaticus)
Treatment: Addressing the underlying cause, nutritional support, liver transplant

Hepatocellular Carcinoma

Origin: Hepatocytes (common)
Risk Factors: Chronic hepatitis, alcohol, aflatoxins (mold from crops)
Signs and Symptoms: Weight loss, pain, weakness, fatigue
Treatment: Surgery, liver transplant

Cholangiocarcinoma

Origin: Cells lining bile ducts (rare)
Risk Factors: Chronic bile duct inflammation, liver fluke infection
Signs and Symptoms: Weight loss, dull abdominal pain, fatigue
Treatment: Surgery, liver transplant

Cholelithiasis

Definition: Gallstones
Causes: Bile stasis or abnormalities in bile composition
Asymptomatic in 80% of cases; if stones block ducts, it leads to right upper quadrant (RUQ) pain (biliary colic), nausea, vomiting
Treatment: Medications for gallstones, cholecystectomy

Types of Gallstones

Gallstones are hardened deposits of bile containing varying amounts of:

Cholesterol – yellow
Bilirubin and calcium salts – brown/black
Cholesterol, bilirubin, and calcium salts – mixed

Cholecystitis

Definition: Inflammation of the gallbladder
Types:
1. Acute: Often from cystic duct obstruction by gallstones
2. Chronic: Recurrent inflammation from repeated episodes
Signs and Symptoms: Right upper quadrant (RUQ) pain, fever, nausea, vomiting
Treatment: Antibiotics, cholecystectomy

Choledocholithiasis

Definition: Gallstones in the common bile duct
Signs and Symptoms: Biliary colic, nausea, vomiting
Treatment: Surgery to remove gallstones

Cholangitis

Definition: Inflammation of the common bile ducts
Types:
1. Acute: Bacterial infection from bile duct blockage
2. Chronic: Autoimmune or progressive destruction of the bile duct
Signs and Symptoms: Right upper quadrant (RUQ) pain, fever, loss of appetite, nausea
Treatment: Antibiotics, analgesics

Gallbladder Cancer

Rare cancer found most often in females aged 70 and older
Risk Factors: Gallstones, chronic inflammation, obesity, cholecystitis
Signs and Symptoms: Right upper quadrant (RUQ) pain, appetite loss, weight loss, fatigue
Treatment: Surgery, chemotherapy, radiation (limited success)

Acute Pancreatitis

Reversible due to autodigestion
Causes: Alcohol, gallstones
Signs and Symptoms: Left upper quadrant (LUQ) pain, fever, vomiting
Complications: Fluid-filled sacs (pseudocysts), necrosis
Treatment: Analgesics, intravenous (IV) fluids for nutrition, and antibiotics

Chronic Pancreatitis

Irreversible damage
Causes: Alcohol abuse, gallstones, smoking
Signs and Symptoms: Persistent left upper quadrant (LUQ) pain, flatulence, steatorrhea
Complications: Reduced enzyme production (malabsorption), β cell loss (hyperglycemia), α cell loss (hypoglycemia)
Treatment: Analgesics, enzyme supplements, blood glucose management

Pancreatic Cancer

Malignant tumor, men over 55
Risk Factors: Chronic pancreatitis, obesity, family history of cancer
Signs and Symptoms: Later symptoms include left upper quadrant (LUQ) pain, weight loss, fatigue
Treatment: Chemotherapy, radiation, surgery