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Esophageal
Achalasia
Motility
disorder of the
lower
esophagus and LES (do not relax properly)
Esophageal
Achalasia
Makes it
difficult
for
food
and liquid to pass from the esophagus into the stomach
normal: LES (smooth muscle) contracts under stimulation by vagal cholinergic inputs
normal: When swallow is initiated, vagal inhibitory fibers allow sphincter to relax
Cause of Esophageal Achalasia
Degeneration
of the myenteric plexus
Loss of the
inhibitory
neurons that allow for
relaxation
of the LES
LES remains
closed
Effective esophageal
peristalsis
is also often lost
Hiatal hernia
Protrusion of the
stomach
above the
diaphragmatic esophageal
opening
Reflux esophagitis
Caused by conditions that result in persistent or repetitive acid exposure to the
esophageal mucosa
Recurrent reflux
Results in a change in the esophageal epithelium from
squamous
to columnar histology → Barrett
esophagus
2-5% of cases with Barrett esophagus lead to the development of esophageal adenocarcinoma (cancer)
Peptic ulcer disease
Characterized by discrete ulcerative lesions which may spontaneously
heal
or enlarge/rupture (with increased
motility
)
Approximately
95
% of duodenal ulcers and 85% of gastric ulcers occurred in the presence of
H. pylori
infection
Not all individuals infected with
H. pylori
or taking NSAIDs develop
PUD
H. pylori Infection
Bacteria
protects itself by producing large amounts of
urease
Hydrolyzes
the urea (from protein metabolism) to
ammonia
Ammonia
neutralizes
acid – good for bacteria but
toxic
to mammalian cells
Ammonia damages
mucous
layer and
epithelial
cells
HCL
and
enzymes
leak in and cause further damage
SRMD (Stress-Related Mucosal Damage)
Cause: systemic response to
stress
– commonly seen in the
ICU
setting
May resolve upon treatment of primary disease, but requires aggressive treatment to prevent
blood
loss, mucosal
damage
, and reduce mortality
Gastritis
Inflammation of the
gastric
mucosa
NSAID-induced gastric damage
NSAIDs cause breaks in
gastric mucosal
barrier
H+
ion leaks into mucosa →
epithelial
cell injury and death
Overwhelms mucosa ability to
protect
itself
Local capillaries
are also damaged →
bleeding
Inhibit activity of
cyclo-oxygenase-enzyme
important in synthesis of
gastroprotective prostaglandins
Neoplasms of the Stomach
Gastric
ulcer predisposition
Genetic
factors - family predisposition
Dietary
factors - dietary carcinogens
Infectious
disease factors - bacterial and viral
Motility Disorder and the Small Intestine
Transit
time – normally
40-180
min
Uncoordinated contractions, obstruction, or herniation have serious
consequences
: N/V, Cramping or sharp pain, Peritonitis,
Fever
and sepsis
Lactose intolerance
Lactose is not broken down and stays in the lumen
Diagnosis
: lactose challenge - stop consuming lactose then reintroduce to see if symptoms occur
Most common cause:
lactase deficiency
Irritable Bowel Syndrome
IBS-C –
Decreased
GI motility and spasm (Constipation)
IBS-D –
Increased
GI motility and spasm (Diarrhea)
Associated with changes in
dietary
,
emotional
, or environmental status
Bowel Infarction – Intestinal Ischemia
Irreversible
injury to the intestine resulting from
insufficient
blood flow
May result from
atherosclerosis
or embolism
Gray
appearance upon visual exam
Mesenteric
artery occlusion
Bowel Infarction
– Intestinal Ischemia is
rare
: 1:200,000
Diverticulosis
Caused by
low
fiber diet
Small
outpouchings
of the colon
Common in
sigmoid
Fecal
impaction, seeds, and nuts may lodge into these spaces resulting in an acute inflammatory condition
diverticulitis
Diverticulitis
Cause:
inflammation
or infection of one or more
diverticula
Left
sided pain (
sigmoid
)
Fever
Constipation
Feeling of
fullness
Lack of
appetite
Appendicitis
Acute
– inflammation, ulceration, and perforation of medical emergency
Repeated episodes of diverticulitis may lead to
abscess
, ulceration,
scarring transmural adhesion
and fistulas
Diverticulosis is caused by a
low fiber
diet
Diverticulosis
Small
outpouchings
of the colon
Common in
sigmoid
Fecal
impaction, seeds, and nuts may lodge into
diverticula
spaces resulting in an acute inflammatory condition diverticulitis
Diverticulitis
is caused by inflammation or
infection
of one or more diverticula
Bowel incontinence
is the inability to control
bowel
movements
Causes of bowel incontinence
Surgery
Hemorrhoids
Aging
Crohn's disease
Trauma
Diabetic neuropathy
AIDS
Hemorrhoids
Masses of swollen veins that may become inflamed, bleed, and can be
extremely painful
Internal
and
external
hemorrhoids
Hemorrhoids
are associated with
pregnancy
, aging, heavy lifting, and changes in bowel habits
Adenomatous
polyps
Painless
, pre-malignant growths into the
lumen
of the colon
Most common in men/
women
>
40y
/o
Screening by
endoscopy
for adenomatous polyps is important, especially for those over
50
years old
Adenomatous
polyps are always removed, since they are premalignant lesions and
ulceration
may indicate malignant transformation
Screening tests for colorectal cancer
Fecal
occult
blood
test
Sigmoidoscopy
Air contrast barium
enema
Colonoscopy
Fecal occult blood test
Exam for
stool
blood
Sigmoidoscopy
View
lining
of rectum and lower
third
of the colon
Air contrast barium
enema
X-ray the
entire
colon and
rectum
Colonoscopy
Rectum and inside of the entire colon is examined
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