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SC2110 Chp 5
Pathology of the Digestive System
| Term | Definition |
|---|---|
| SIGNS AND SYMPTOMS | |
| anorexia | Lack of appetite. Anorexia (-orexia = appetite) often is a sign of malignancy or liver disease. Anorexia nervosa is loss of appetite associated with emotional problems such as anger, anxiety, and irrational fear of weight gain. |
| ascites | Abnormal accumulation of fluid in the abdomen. This condition occurs when fluid passes from the bloodstream and collects in the peritoneal cavity. |
| borborygmi ( singular: borborygmus) | Rumbling or gurgling noises produced by the movement of gas, fl uid, or both in the gastrointestinal tract. Signs of hyperactive intestinal peristalsis, borborygmi (bowel sounds) often are present in cases of gastroenteritis and diarrhea. |
| constipation | Difficulty in passing stools (feces). When peristalsis is slow, stools are dry and hard. A diet with plentiful fruits, vegetables, and water is helpful. Laxatives and cathartics are medications to promote movement of stools. |
| diarrhea | Frequent passage of loose, watery stools. Abrupt onset of diarrhea immediately after eating suggests acute infection or toxin in the gastrointestinal tract. Untreated, severe diarrhea may lead to dehydration. Antidiarrheal drugs are helpful. |
| dysphagia | Difficulty in swallowing.This sensation feels like a “lump in the throat” when a swallowed bolus fails to progress, either because of a physical obstruction or because of a motor disorder in which esophageal peristalsis is not coordinated. |
| eructation | Gas expelled from the stomach through the mouth. Eructation produces a characteristic sound and also is called belching. |
| flatus | Gas expelled through the anus. Flatulence is the presence of excessive gas in the stomach and the intestines. One sign of a bowel obstruction is the inability to pass flatus. |
| hematochezia | Passage of fresh, bright red blood from the rectum. The cause of hematochezia is usually hemorrhoids, but can also be colitis, ulcers,polyps, or cancer. |
| jaundice (icterus) | Yellow-orange coloration of the skin and whites of the eyes caused by high levels of bilirubin in the blood (hyperbilirubinemia) Jaundice can occur when (1) excessive destruction of erythrocytes, as in hemolysis, causes excess bilirubin in the blood; |
| jaundice continued..... | (2) malfunction of liver cells (hepatocytes) due to liver disease prevents the liver from excreting bilirubin with bile; or |
| jaundice continued .... | (3) obstruction of bile fl ow, such as from choledocholithiasis or tumor, prevents bilirubin in bile from being excreted into the duodenum. |
| melena | Black, tarry stools; feces containing digested blood. This clinical sign usually reflects a condition in which blood has had time to be digested (acted on by intestinal juices) and results from bleeding in the upper gastrointestinal tract (duodenal ulcer) |
| nausea | Unpleasant sensation in the stomach with a tendency to vomit. Common causes are motion sickness, early pregnancy, and viral gastroenteritis. |
| nausea continued ...... | Nausea and vomiting may be symptomatic of a perforation of an abdominal organ; obstruction of a bile duct, stomach, or intestine; or exposure to poisons. |
| steatorrhea | Fat in the feces. Steatorrhea is production of frothy, foul-smelling fecal matter that often floats in the toilet. Improper digestion or absorption of fat causes fat to remain in the intestine. |
| steatorrhea continued.... | This may occur with disease of the pancreas (pancreatitis) when pancreatic enzymes are not excreted. It also is a sign of intestinal disease that involves malabsorption of fat. |
| ORAL CAVITY AND TEETH | |
| aphthous stomatitis | Inflammation of the mouth with small, painful ulcers. The ulcers associated with this condition are commonly called canker (K Ă NK- ĕ r) sores ; the cause is unknown |
| dental caries | Tooth decay. Dental plaque results from the accumulation of foods, proteins from saliva, and necrotic debris on the tooth enamel. |
| dental caries continued..... | Bacteria grow in the plaque and cause production of acid that dissolves the tooth enamel, resulting in a cavity (area of decay). If the bacterial infection reaches the pulp of the tooth, root canal therapy may be necessary. |
| herpetic stomatitis | Infl ammation of the mouth caused by infection with the herpesvirus. Painful fl uid-fi lled blisters on the lips, palate, gums, and tongue, commonly called fever blisters or cold sores ( Figure 5-20D ). |
| herpetic stomatitis continued... | It is caused by herpes simplex virus type 1 (HSV1). Herpes genitalis (due to HSV2) involves the reproductive organs. Both conditions are highly contagious. |
| oral leukoplakia | White plaques or patches on the mucosa of the mouth. This precancerous lesion can result from chronic tobacco use (pipe smoking or chewing tobacco). Malignant potential is assessed by microscopic study of biopsied tissue. |
| periodontal disease | Infl ammation and degeneration of gums, teeth, and surrounding bone. Gingivitis occurs as a result of accumulation of dental plaque and dental calculus or tartar (a yellow-brown calcified deposit on teeth). |
| periodontal disease continued... | In gingivectomy , the periodontist uses a metal instrument to scrape away plaque and tartar from teeth; any pockets of pus (pyorrhea) are then drained and removed to allow new tissue to form. Localized infections are treated with systemic antibiotics. |
| UPPER GASTROINTESTINAL TRACT | |
| achalasia | Failure of the lower esophagus sphincter (LES) muscle to relax. Achalasia (-chalasia = relaxation) results from the loss of peristalsis so that food cannot pass easily through the esophagus. |
| achalasia continued... | Both failure of the LES to relax and the loss of peristalsis cause dilatation (widening) of the esophagus above the constriction. Physicians recommend a bland diet low in bulk and mechanical stretching of the LES to relieve symptoms. |
| esophageal cancer | Malignant tumor of the esophagus. The most common symptom of esophageal cancer is difficulty swallowing (dysphagia). Smoking and chronic alcohol use are major risk factors. |
| esophageal cancer continued... | Long-term irritation of the esophagus caused by gastric reflux is a premalignant condition called Barrett esophagus. Surgery, radiation therapy, and chemotherapy are treatment options |
| esophageal varices | Swollen, varicose veins at the lower end of the esophagus Liver disease (such as cirrhosis and chronic hepatitis) causes increased pressure in veins near and around the liver ( portal hypertension ). |
| esophageal varices continued... | This leads to enlarged, tortuous esophageal veins with danger of hemorrhage (bleeding).Treatment may include banding (tying off the swollen esophageal veins) or sclerotherapy (injecting veins with a solution that closes them). |
| gastric cancer | Malignant tumor of the stomach.Smoking, alcohol use, and chronic gastritis associated with bacterial infection are major risk factors for gastric carcinoma. |
| gastric cancer continued... | Gastric endoscopy and biopsy diagnose the condition. Cure depends on early detection and surgical removal. |
| gastroesophageal reflux disease (GERD) | Solids and fluids return to the mouth from the stomach. Heartburn is a burning sensation caused by regurgitation of hydrochloric acid from the stomach to the esophagus. |
| gastroesophageal refl ux disease (GERD) continued... | Chronic exposure of esophageal mucosa to gastric acid and pepsin (an enzyme that digests protein) leads to reflux esophagitis. Drug treatment for GERD includes antacid (acid-suppressive) agents and medication to increase the tone of the LES. |
| hernia | Protrusion of an organ or part through the tissues and muscles normally containing it. A hiatal hernia occurs when the upper part of the stomach protrudes upward through the diaphragm. This condition can lead to GERD. |
| hernia continued... | An inguinal hernia occurs when a small loop of bowel protrudes through a weak lower abdominal wall tissue (fascia) surrounding muscles. Surgical repair of inguinal hernias is known as herniorrhaphy (-rrhaphy means suture). |
| peptic ulcer | Open sore in the lining of the stomach or duodenum. A bacterium, Helicobacter pylori ( H. pylori ), is responsible for many cases ofpeptic ulcer disease. The combination of bacteria, hyperacidity, and gastric juice damages epithelial linings. |
| LOWER GASTROINTESTINAL TRACT (Small and Large intestines) | |
| anal fistula | Abnormal tube-like passageway near the anus. The fistula often results from a break or fissure in the wall of the anus or rectum, or from an abscess (infected area) there. |
| colonic polyps | Polyps (benign growths) protrude from the mucous membrane of the colon. There are two types of polyps: pedunculated (attached to themembrane by a stalk) and sessile (sitting directly on the mucous membrane). |
| colonic polyps continued... | Many polyps are premalignant (adenomatous polyps); these growths often are removed (polypectomy) as a preventative measure and for further examination (biopsy). |
| colorectal cancer | Adenocarcinoma of the colon or rectum, or both. Colorectal cancer can arise from polyps in the colon or rectal region. Diagnosis is determined by detecting blood in stool and by colonoscopy. |
| colorectal cancer continued... | Surgical treatment may require excision of a major section of colon with rejoining of the cut ends (anastomosis). Chemotherapy and radiotherapy are administered as needed. |
| Crohn disease (“Crohn ’ s”) | Chronic infl ammation of the intestinal tract. Crohn ’ s can occur anywhere from mouth to anus but most commonly in the ileum (ileitis) and colon. Signs and symptoms include diarrhea, severe abdominal pain, fever, anorexia, weakness, and weight loss. |
| Crohn disease (“Crohn ’ s”) continued... | Both Crohn disease and ulcerative colitis are forms of inflammatory bowel disease (IBD). Treatment is with drugs that control infl ammation&other symptoms or by surgical removal of diseased portions of the intestine, with anastomosis of remaining parts. |
| diverticulosis | Abnormal outpouchings (diverticula) in the intestinal wall of the colon. Diverticulitis is a complication of diverticulosis. When fecal matter becomes trapped in diverticula, diverticulitis can occur. Pain and rectal bleeding are symptoms. |
| diverticulosis continued... | Initial treatment for an attack of diverticulitis includes a liquid diet and oral antibiotics. Sometimes, the patient may need hospitalization, intravenous antibiotics, and surgery to remove the affected area of the colon with anastomosis of the cut ends. |
| dysentery | Painful inflammation of the intestines commonly caused by bacterial infection. |
| dysentery continued... | Often occurring in the colon, dysentery results from ingestion of food or water containing bacteria (salmonellae or shigellae), amebae (one-celled organisms), or viruses. Symptoms are bloody stools, abdominal pain, and sometimes fever. |
| hemorrhoids | Swollen, twisted, varicose veins in the rectal region. Varicose veins can be internal (within the rectum) or external (outside the anal sphincter). Pregnancy and chronic constipation, which put pressure on anal veins, often cause hemorrhoids. |
| ileus | Loss of peristalsis with resulting obstruction of the intestines. Surgery, trauma, or bacterial injury to the peritoneum can lead to a paralytic ileus (acute, transient loss of peristalsis). |
| inflammatory bowel disease (IBD) | Infl ammation of the colon and small intestine. See Crohn disease and ulcerative colitis. |
| intussusception | Telescoping of the intestines. |
| irritable bowel syndrome (IBS) | Group ofGI symptoms (abdominal pain, bloating, diarrhea, constipation), but w/o defined abnormalities in the intestines.IBS may be associated with stress or occur after infection. |
| irritable bowel syndrome (IBS) continued | Treatment includes a diet high in bran&fiber and laxatives plus antidiarrheals to establish reg bowel movements. Other names for IBS are irritable colon and spastic colon. IBS is a type of functional gastrointestinal disorder (FGID). |
| ulcerative colitis | Chronic inflammation of the colon with presence of ulcers. This idiopathic, chronic, recurrent diarrheal disease manifests with rectal bleeding and pain. Often beginning in the colon, the inflammation spreads proximally, involving entire colon. |
| ulcerative colitis continued,,, | Drug treatment and careful attention to diet are recommended. Resection of diseased bowel with ileostomy may be necessary. In some cases it is cured by total colectomy. Patients with ulcerative colitis are at a higher risk for developing colon cancer. |
| volvulus | Twisting of the intestine on itself. Volvulus causes intestinal obstruction. Severe pain, nausea and vomiting, and absence of bowel sounds are clinical features. Surgical correction is necessary to prevent necrosis of the affected segment of the bowel. |
| LIVER, GALLBLADDER, AND PANCREAS | |
| cholelithiasis | Gallstones in the gallbladder. Calculi prevent bile from leaving the gallbladder and bile ducts Patients remain asymptomatic & dont require treatment; symptoms related to gallbladder stones are either biliary colic or cholecystitis |
| cholelithiasis continued... | Currently, laparoscopic or minimally invasive surgery (laparoscopic cholecystectomy) can be performed to remove the gallbladder and stones |
| cirrhosis | Chronic degenerative disease of the liver. Cirrhosis is commonly the result of chronic alcoholism, viral hepatitis, iron overload, or other causes. |
| cirrhosis continued... | Lobes of the liver become scarred with fibrous tissue, hepatic cells degenerate, and the liver is infiltrated with fat. Cirrh/o means yelloworange, which describes the liver ’ s color caused by fat accumulation. |
| hepatocellular carcinoma (HCC) | Liver cancer. Cancer that starts in the liver is primary liver cancer (as opposed to secondary liver cancer, which starts in another organ and metastasizes to the liver). |
| hepatocellular carcinoma (HCC) continued | HCC is commonly associated with hepatitis B and C virus infections and cirrhosis due to chronic alcohol use. Nonalcoholic steatohepatitis (NASH) is fatty infiltration of the liver, which may progress to cirrhosis and HCC. |
| hepatocellular carcinoma (HCC) continued | Surgery and chemotherapy are therapeutic options. Hepatocellular carcinomas produce alpha-fetoprotein (AFP) , a tumor marker that is elevated in the blood in patients with this cancer. AFP is used as a screen for HCC in patients with cirrhosis. |
| hepatocellular carcinoma (HCC) continued | Liver cancers that begin in the bile ducts are called cholangiocarcinomas . Bile duct cancers also can arise from the gallbladder. |
| pancreatic cancer | Infl ammation of the pancreas. Digestive enzymes attack pancreatic tissue and damage the gland. Other etiologic factors include chronic alcoholism, drug toxicity, gallstone obstruction of the common bile duct, and viral infections. |
| pancreatic cancer continued... | Treatment includes medications to relieve epigastric pain, intravenous fl uids, bowel rest, and subtotal pancreatectomy if necessary. |
| viral hepatitis | Inflammation of the liver caused by a virus. Hepatitis A is viral hepatitis caused by the hepatitis A virus ( HAV ). It is a disorder spread by contaminated food or water and characterized by slow onset of symptoms. |
| viral hepatitis continued... | Hepatitis B is caused by the hepatitis B virus ( HBV ) and is transmitted by sexual contact, blood transfusions,the use of contaminated needles or may be acquired by maternal to fetal transmission. |
| viral hepatitis continued... | Severe infection can cause destruction of liver cells, cirrhosis, or death. A vaccine that provides immunity is available and recommended for persons at risk for exposure. |
| viral hepatitis continued... | Hepatitis C is caused by the hepatitis C virus ( HCV ) and is transmitted by blood transfusions or needle inoculation (such as among intravenous drug users sharing needles). |
| viral hepatitis continued... | The acute illness may progress to chronic hepatitis and hepatocellular carcinoma. Two new drugs, simeprevir (Olysio) and sofosbuvir (Sovaldi), are effective for treating HCV infection. |
| viral hepatitis continued... | In all types, liver enzyme levels may be elevated, indicating damage to liver cells. Signs and symptoms include malaise, anorexia, hepatomegaly, jaundice, and abdominal pain. |
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