GI diseases

• Satiety and Hunger


  • Grehlin secreted by stomach when empty indicating hunger.
  • Leptin is secreted by adipose tissue to control your intake and body weight.
• Grehlin


  Secreted by stomach when empty indicating hunger
• Leptin


  Secreted by adipose tissue to control your intake and body weight
• The digestive systems is 9 meters long, from the esophagus to the end of the colon
• The small intestine is 5.5 meters long with the deudenum at approixmatly 25 cm, 2.5 meters jejenum, 3 meters ileum meter long
• The large intestine is 1.5 meters long
• Each part of the digestive system is specialized in absorbing specific nutrients
• A gastrectomy where parts of the GI removed posses a certain risk of nutrient defecies for the individual
• The upper and lower GI are responsible for physically altering food, chewing, and chemichally breaking down food, enymatic breakdown, and absorption of nutreints in the circulation
• Accessory organs have other functions that aid in digestion and absoprtion of food
• There is a wide range of diseases and conditions that affect the GI including accessory organs
• The process of chewing

  1. Food entering the oral cavity (Oral phase)

  2. Food mixed with saliva, mechanichally broken, and formed into a bolus

  3. Food enters the pharynx (Pharyngeal phase)

  4. Upper egiglottis sphincter opens and food then eneter the esophagus

  5. Upper esopahgael sphincter closes and the esopahgeal phase begins

  6. Food entering the stomach from the lower esophageal sphincter
• Dysphagia


  • Oropharyngeal: Loss of ability to transfer food from the mouth and pharynx to the esophagus; caused by neurological or muscular disorder
  • Esophageal: Loss of ability to move food through the esophagus; caused by an obstruction or a motility disorder
• Dysphagia

  • Stricture: Narrowing of esophagus due to inflammation or congenital disorder
  • Achalasia: A neurodegenerative condition where peristalsis movement in esophagus is impaired and Lower Esophageal sphincter does not relax completely
• Dysphagia diet levels


  • Level 1-dysphagia pureed: Mashed, cohesive, homogenous
  • Level 2-dyshagia mechanically altered: Moist, cohesive, soft texture
  • Level 3-dysphagia advanced: Moist and bite sized pieces
• Liquid consistencies for dysphagia

  • Thin
  • Nectar
  • Honey
  • Spoon-thick
• Gastroesophageal Reflux Disease (GERD)


  Gastroesophageal reflux is charachtarized by the return of acid from the stomach to esopghagus. It can be due to relaxed Lower esophageal sphinckter or high pressure on the stomach causing.
• Causes of GERD


  • Hiatal hernia
  • Obesity
  • Pregnancy
  • Lying flat after eating
  • Sedentary lifestyle
  • Diet
• Consequences of Gastroesophageal Reflux


  • Barret's esophagus
  • Reflux esophagitis
• Treatments for GERD


  • Anti-acids
  • Proton pump inhibitor
  • Histamine-2 receptor blocker
• Dyspepsia


  Indigestion resulting in different symptoms ranging from nausea, vomting, acid reflux, and pain after eating, during eating, and feeling of fullness
• Causes of Dyspepsia


  • Peptic ulcer
  • H.pylori
  • GER
  • Unknown causes
• Nausea & Vomiting


  When happening within one hour of eating the cause can be peptic ulcer or psychological. If after one hour it can be related to stomach emptying (obstruction or motility) or food poisoning.
• Gastritis


  Inflammation of stomach lining, can be caused by bouts of inflammation due to helicobacter pylori or certain foods that can become chronic resulting in destroying the lining of the stomach
• Peptic Ulcer


  May be caused by NSAIDs, smoking, alcohol, stress and many more causes. A peptic ulcer can result in severe pain or further infection with H.Pylori increasing the risk of stomach cancer.
• H.Pylori


  This gram negative bacteria infect most the world population, few strains are virulent. Most people are infected with it but don't have symptoms. However, damaging of the stomach lining through chronic gastritis may weaking stomach lining and cause ulcer formation.
• Constipation


  Less than 3 stools per week
• Types of Constipation


  • Atonic Constipation (lazy Bowel)
  • Spastic Constipation (overstimulation)
• Causes of Constipation


  • Supplements: Ca2+ and Fe2+
  • Medications: Anti acids containing Al3+, Anti depressant and Anti Convulsions
• Alleviating Constipation


  • Hydration
  • Increase fiber intake 20-25 g/day
  • Physical activity
  • Doctor adjusting medication
  • Supplement modification or termination
• Diarrhea


  Frequent passing of stool. Dia (flow) rrhea (throw)
• Causes of Diarrhea


  • Infection: inflammatory
  • Food: overconsumption of sugar (osmotic diarrhea)
  • Medication
  • Disease
• Types of Diarrhea


  • Osmotic Diarrhea: Overconsumption of sugar, Malabsorption, CHO most common
  • Secretory: Active Chloride secretion (Cholera)
  • Exudative: Damage of mucosal lining, E.Coli or food poisoning, Can lead to ulcerative colitis
  • Inflammatory: Virus, autoimmune, parasite
  • Hypermotility: Hyperthyrodism
• Classes of Diarrhea


  • Acute: 14 (two weeks) days of frequent passing of stool, Persistent: >14 days
  • Dysentery: Blood is visible, Shigella, Entamoeba histolyca, Salmonella
  • Chronic: Long and lasting
• immediate treatment and recovery of diarrhea


  • Treat the root cause
  • Fluid and Electrolyte replacement: Broth (Magi) and electrolyte high in potassium and sodium
  • Pectin in apples and Bananas: Binds residues solidifying the stool
  • Avoid stimulants
  • If chronic and patient cant eat enteral and parenteral maybe recommended
  • Recovery: Starchy food followed by protein foods, Modest residue foods (low in fiber), Minimum fat, Avoid sweeteners and lactose, Provide probiotics and prebiotics, MCT and/or SCFA if chronic diarrhea persists
• Important to Remember for Diarrhea

  • Reduce stool output - Add food that decrease motility, Hold residue
  • Replace fluids and electrolytes
  • Do not rest the gut - The gut can absorb at least 50% during Diarrhea
  • Follow hyenic procedure in weaning infants
• Causes of Fat Malabsorption

  • Enzyme deficiency
  • Intestinal disorder related to certain diseases: AIDs, Celiac, etc.
  • Infections
  • Bile insufficiency
  • Surgery: Gastric bypass surgery
• Recommended and Avoid Foods for Fat Malabsorption

  • Recommended: Limit to 50g fat (8tbsp vegetable oil, olive oil, butter, margarine mayonnaise, 2 tbsp low fat salad dressing)

  Avoid: Exceeding the recommended amount of fat
• Recommended and Avoid Foods for Carbohydrates in Fat Malabsorption

  • Recommended: Whole grains, bakeries that are plain with no added sugar or fat, salted cracker, plain rice, noodles and pasta

  Avoid: Noodles, rice, and pasta cooked with oils, biscuits, muffins, waffles, cakes, fried potatoes and rice
• Recommended and Avoid Foods for Meats and Alternatives in Fat Malabsorption

  • Recommended: Lean with no fat, 2 eggs/week, chicken breast, skinless chicken, turkey (low fat)

  Avoid: Processed meats, meats with fat, sausages, salame, etc...