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Alterations of Digestive FunctionAlterations of Digestive Function
Chapter 39Chapter 39
Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
22Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
AnorexiaAnorexia A lack of desire to eat despite physiologic stimuli A lack of desire to eat despite physiologic stimuli
that would normally produce hungerthat would normally produce hunger VomitingVomiting
The forceful emptying of the stomach and The forceful emptying of the stomach and intestinal contents through the mouthintestinal contents through the mouth
Several types of stimuli initiate the vomiting reflexSeveral types of stimuli initiate the vomiting reflex
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
NauseaNausea A subjective experience associated with a number of A subjective experience associated with a number of
conditionsconditions Common symptoms: hypersalivation and tachycardiaCommon symptoms: hypersalivation and tachycardia
RetchingRetching Nonproductive vomitingNonproductive vomiting
Projectile vomitingProjectile vomiting Spontaneous vomiting that does not follow nausea or Spontaneous vomiting that does not follow nausea or
retching retching
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
ConstipationConstipation Infrequent or difficult defecationInfrequent or difficult defecation PathophysiologyPathophysiology
• Neurogenic disorders, functional or mechanical Neurogenic disorders, functional or mechanical conditions, low-residue diet, sedentary lifestyle, conditions, low-residue diet, sedentary lifestyle, excessive use of antacids, changes in bowel habitsexcessive use of antacids, changes in bowel habits
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
DiarrheaDiarrhea Increased frequency of bowel movementsIncreased frequency of bowel movements Increased volume, fluidity, weight of the fecesIncreased volume, fluidity, weight of the feces
• May be protectiveMay be protective
Major mechanisms of diarrheaMajor mechanisms of diarrhea• Osmotic diarrheaOsmotic diarrhea
• Secretory diarrheaSecretory diarrhea
• Motility diarrheaMotility diarrhea
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
Systemic effects of GI dysfunctionSystemic effects of GI dysfunction Manifestations of diarrheaManifestations of diarrhea
• Dehydration, electrolyte imbalance, metabolic acidosis, and Dehydration, electrolyte imbalance, metabolic acidosis, and weight lossweight loss
Manifestations of acute bacterial or viral infectionManifestations of acute bacterial or viral infection• Fever, with or without cramping pain Fever, with or without cramping pain
Manifestations of inflammatory bowel diseaseManifestations of inflammatory bowel disease• Fever, cramping pain, bloody stools Fever, cramping pain, bloody stools
Manifestations of malabsorption syndromesManifestations of malabsorption syndromes• Steatorrhea (fat in the stools) and diarrheaSteatorrhea (fat in the stools) and diarrhea
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
Abdominal painAbdominal pain A symptom of a number of GI disordersA symptom of a number of GI disorders Parietal painParietal pain Visceral painVisceral pain Referred painReferred pain
Biochemical mediators of the inflammatory Biochemical mediators of the inflammatory response (histamine, bradykinin, and response (histamine, bradykinin, and serotonin) stimulate organic nerve endings serotonin) stimulate organic nerve endings producing abdominal pain producing abdominal pain
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Clinical Manifestations of Clinical Manifestations of Gastrointestinal DysfunctionGastrointestinal Dysfunction
GI bleedingGI bleeding Upper GI bleedingUpper GI bleeding
• Esophagus, stomach, or duodenumEsophagus, stomach, or duodenum
Lower GI bleedingLower GI bleeding• Below the ligament of Treitz, or bleeding from the Below the ligament of Treitz, or bleeding from the
jejunum, ileum, colon, or rectumjejunum, ileum, colon, or rectum
HematemesisHematemesis HematocheziaHematochezia MelenaMelena Occult bleedingOccult bleeding
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Disorders of MotilityDisorders of Motility DysphagiaDysphagia
Difficulty swallowingDifficulty swallowing TypesTypes
• Mechanical obstructionsMechanical obstructions
• Functional obstructionsFunctional obstructions
AchalasiaAchalasia• Denervation of smooth muscle in the esophagus and Denervation of smooth muscle in the esophagus and
lower esophageal sphincter relaxationlower esophageal sphincter relaxation
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Disorders of MotilityDisorders of Motility Gastroesophageal reflux disease (GERD)Gastroesophageal reflux disease (GERD)
The reflux of chyme from the stomach to the The reflux of chyme from the stomach to the esophagusesophagus
If GERD causes inflammation of the esophagus, it If GERD causes inflammation of the esophagus, it is called reflux esophagitisis called reflux esophagitis
A normal functioning lower esophageal sphincter A normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent maintains a zone of high pressure to prevent chyme refluxchyme reflux
1111Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of MotilityDisorders of Motility Gastroesophageal reflux disease (GERD)Gastroesophageal reflux disease (GERD)
Conditions that increase abdominal pressure can Conditions that increase abdominal pressure can contribute to GERD contribute to GERD
ManifestationsManifestations• Heartburn, regurgitation of chyme, and upper abdominal Heartburn, regurgitation of chyme, and upper abdominal
pain within 1 hour of eatingpain within 1 hour of eating
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Gastroesophageal Reflux DiseaseGastroesophageal Reflux Disease
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Disorders of MotilityDisorders of Motility Hiatal herniaHiatal hernia
Sliding hiatal herniaSliding hiatal hernia Paraesophageal hiatal herniaParaesophageal hiatal hernia
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Hiatal HerniaHiatal Hernia
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Disorders of MotilityDisorders of Motility Pyloric obstructionPyloric obstruction
The blocking or narrowing of the opening between The blocking or narrowing of the opening between the stomach and the duodenumthe stomach and the duodenum
Can be acquired or congenitalCan be acquired or congenital ManifestationsManifestations
• Epigastric pain and fullness, nausea, succussion splash, Epigastric pain and fullness, nausea, succussion splash, vomiting, and with a prolonged obstruction, malnutrition, vomiting, and with a prolonged obstruction, malnutrition, dehydration, and extreme debilitationdehydration, and extreme debilitation
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Disorders of MotilityDisorders of Motility Intestinal obstruction and ileusIntestinal obstruction and ileus
An intestinal obstruction is any condition that An intestinal obstruction is any condition that prevents the flow of chyme through the intestinal prevents the flow of chyme through the intestinal lumen or failure of normal intestinal motility in the lumen or failure of normal intestinal motility in the absence of an obstructing lesionabsence of an obstructing lesion
An ileus is an obstruction of the intestinesAn ileus is an obstruction of the intestines ManifestastionsManifestastions
• Colicky pain, vomiting, distention, hypovolemia, Colicky pain, vomiting, distention, hypovolemia, metabolic acidosismetabolic acidosis
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Disorders of MotilityDisorders of Motility Intestinal obstruction and ileusIntestinal obstruction and ileus
Simple obstructionSimple obstruction Functional obstructionFunctional obstruction Small intestinal obstructionSmall intestinal obstruction Large bowel obstructionLarge bowel obstruction
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Intestinal ObstructionIntestinal Obstruction
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GastritisGastritis Inflammatory disorder of the gastric mucosaInflammatory disorder of the gastric mucosa Acute gastritisAcute gastritis
H. pylori,H. pylori, NSAIDs NSAIDs Chronic gastritisChronic gastritis
Chronic fundal gastritisChronic fundal gastritis Chronic antral gastritisChronic antral gastritis
• Signs and symptoms of chronic gastritis often do not Signs and symptoms of chronic gastritis often do not correlate with the severity of the disease correlate with the severity of the disease
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Peptic Ulcer DiseasePeptic Ulcer Disease A break or ulceration in the protective A break or ulceration in the protective
mucosal lining of the lower esophagus, mucosal lining of the lower esophagus, stomach, or duodenumstomach, or duodenum
Acute and chronic ulcersAcute and chronic ulcers SuperficialSuperficial
Erosions Erosions DeepDeep
True ulcersTrue ulcers
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Chronic Peptic UlcerChronic Peptic Ulcer
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Peptic Ulcer DiseasePeptic Ulcer Disease Duodenal ulcersDuodenal ulcers
Most common of the peptic ulcersMost common of the peptic ulcers Developmental factorsDevelopmental factors
• H. pyloriH. pylori infection infection Toxins and enzymes that promote inflammation and Toxins and enzymes that promote inflammation and
ulcerationulceration
• Hypersecretion of stomach acid and pepsinHypersecretion of stomach acid and pepsin• Use of NSAIDsUse of NSAIDs• High gastrin levelsHigh gastrin levels• Acid production by cigarette smokingAcid production by cigarette smoking
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Duodenal UlcerDuodenal Ulcer
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Gastric UlcerGastric Ulcer Tends to develop in the antral region of the Tends to develop in the antral region of the
stomach, adjacent to the acid-secreting stomach, adjacent to the acid-secreting mucosa of the bodymucosa of the body
PathophysiologyPathophysiology The primary defect is an increased mucosal The primary defect is an increased mucosal
permeability to hydrogen ionspermeability to hydrogen ions Gastric secretion is normal or less than normalGastric secretion is normal or less than normal
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Gastric UlcerGastric Ulcer
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Gastric UlcerGastric Ulcer
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Stress UlcerStress Ulcer Stress ulcer is a peptic ulcer that is related to Stress ulcer is a peptic ulcer that is related to
severe illness, neural injury, or systemic severe illness, neural injury, or systemic traumatrauma Ischemic ulcersIschemic ulcers Cushing ulcersCushing ulcers
• Ulcers that develop as a result of a burn injuryUlcers that develop as a result of a burn injury
ManifestastionsManifestastions• Bleeding most commonBleeding most common
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Dumping SyndromeDumping Syndrome Rapid emptying of chyme from surgically Rapid emptying of chyme from surgically
created residual stomach into small intestine created residual stomach into small intestine A clinical complication of partial gastrectomy A clinical complication of partial gastrectomy
or pyloroplasty surgeryor pyloroplasty surgery Developmental factorsDevelopmental factors
Loss of gastric capacity, loss of emptying control, Loss of gastric capacity, loss of emptying control, and loss of feedback control by the duodenum and loss of feedback control by the duodenum when it is removed when it is removed
Late dumping syndromeLate dumping syndrome
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Postgastrectomy SyndromesPostgastrectomy Syndromes Alkaline reflux gastritisAlkaline reflux gastritis Afferent loop obstructionAfferent loop obstruction DiarrheaDiarrhea Weight lossWeight loss AnemiaAnemia
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MalabsorptionMalabsorption Syndromes Syndromes Inadequate digestionInadequate digestion Pancreatic insufficiencyPancreatic insufficiency Lactase deficiencyLactase deficiency Bile salt deficiencyBile salt deficiency Gluten-sensitive enteropathyGluten-sensitive enteropathy
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Malabsorption SyndromesMalabsorption Syndromes Pancreatic insufficiencyPancreatic insufficiency
Insufficient pancreatic enzyme productionInsufficient pancreatic enzyme production• Lipase, amylase, trypsin, or chymotrypsinLipase, amylase, trypsin, or chymotrypsin
Causes: pancreatitis, pancreatic carcinoma, Causes: pancreatitis, pancreatic carcinoma, pancreatic resection, and cystic fibrosispancreatic resection, and cystic fibrosis
Fat maldigestion is the main problem, so the Fat maldigestion is the main problem, so the person will exhibit fatty stools and weight lossperson will exhibit fatty stools and weight loss
3232Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Malabsorption SyndromesMalabsorption Syndromes Lactase deficiencyLactase deficiency
Inability to break down lactose into Inability to break down lactose into monosaccharides and thus prevent lactose monosaccharides and thus prevent lactose digestion and monosaccharide absorptiondigestion and monosaccharide absorption
Fermentation of lactose by bacteria causes gas Fermentation of lactose by bacteria causes gas (cramping pain, flatulence, etc.) and osmotic (cramping pain, flatulence, etc.) and osmotic diarrheadiarrhea
3333Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Malabsorption SyndromesMalabsorption Syndromes
Bile salt deficiencyBile salt deficiency Conjugated bile salts needed to emulsify and absorb Conjugated bile salts needed to emulsify and absorb
fatsfats Conjugated bile salts are synthesized from cholesterol Conjugated bile salts are synthesized from cholesterol
in the liverin the liver Result from liver disease and bile obstructionsResult from liver disease and bile obstructions Poor intestinal absorption of lipids causes fatty stools, Poor intestinal absorption of lipids causes fatty stools,
diarrhea, and loss of fat-soluble vitamins (A, D, E, K)diarrhea, and loss of fat-soluble vitamins (A, D, E, K)
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Malabsorption SyndromesMalabsorption Syndromes Fat-soluble vitamin deficienciesFat-soluble vitamin deficiencies
Vitamin AVitamin A• Night blindnessNight blindness
Vitamin DVitamin D• Decreased calcium absorption, bone pain, osteoporosis, Decreased calcium absorption, bone pain, osteoporosis,
fracturesfractures Vitamin KVitamin K
• Prolonged prothrombin time, purpura, and petechiaeProlonged prothrombin time, purpura, and petechiae Vitamin EVitamin E
• Uncertain Uncertain
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Inflammatory Bowel DiseasesInflammatory Bowel Diseases Chronic, relapsing inflammatory bowel Chronic, relapsing inflammatory bowel
disorders of unknown origindisorders of unknown origin GeneticsGenetics Alterations of epithelial barrier functionsAlterations of epithelial barrier functions Immune reactions to intestinal floraImmune reactions to intestinal flora Abnormal T-cell responsesAbnormal T-cell responses
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Ulcerative ColitisUlcerative Colitis Chronic inflammatory disease that causes Chronic inflammatory disease that causes
ulceration of the colonic mucosa ulceration of the colonic mucosa Sigmoid colon and rectumSigmoid colon and rectum
Suggested causesSuggested causes Infectious, immunologic (anticolon antibodies), Infectious, immunologic (anticolon antibodies),
dietary, genetic (supported by family studies and dietary, genetic (supported by family studies and identical twin studies)identical twin studies)
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Ulcerative ColitisUlcerative Colitis SymptomsSymptoms
Diarrhea (10-20/day), bloody stools, crampsDiarrhea (10-20/day), bloody stools, cramps TreatmentTreatment
Broad-spectrum antibiotics and steroidsBroad-spectrum antibiotics and steroids Immunosuppressive agentsImmunosuppressive agents SurgerySurgery
Increased colon cancer risk demonstratedIncreased colon cancer risk demonstrated
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Crohn DiseaseCrohn Disease Granulomatous colitis, ileocolitis, or regional Granulomatous colitis, ileocolitis, or regional
enteritisenteritis Idiopathic inflammatory disorder; affects any Idiopathic inflammatory disorder; affects any
part of the digestive tract, from mouth to anuspart of the digestive tract, from mouth to anus Difficult to differentiate from ulcerative colitisDifficult to differentiate from ulcerative colitis
Similar risk factors and theories of causationSimilar risk factors and theories of causation
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Crohn DiseaseCrohn Disease Causes “skip lesions”Causes “skip lesions” Ulcerations can produce longitudinal and Ulcerations can produce longitudinal and
transverse inflammatory fissures that extend transverse inflammatory fissures that extend into the lymphaticsinto the lymphatics
Anemia may result due to malabsorption of Anemia may result due to malabsorption of vitamin Bvitamin B1212 and folic acid and folic acid
Treatment is similar to ulcerative colitisTreatment is similar to ulcerative colitis
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Ulcerative Colitis and Ulcerative Colitis and Crohn DiseaseCrohn Disease
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Crohn DiseaseCrohn Disease
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Diverticular Disease of the ColonDiverticular Disease of the Colon DiverticulaDiverticula
Herniations of mucosa through the muscle layers Herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colonof the colon wall, especially the sigmoid colon
DiverticulosisDiverticulosis Asymptomatic diverticular diseaseAsymptomatic diverticular disease
DiverticulitisDiverticulitis The inflammatory stage of diverticulosisThe inflammatory stage of diverticulosis
ManifestationsManifestations Low abdominal pain, diarrhea, constipation, fever, Low abdominal pain, diarrhea, constipation, fever,
leukocytosisleukocytosis
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AppendicitisAppendicitis
Inflammation of the vermiform appendix Inflammation of the vermiform appendix Possible causesPossible causes
Obstruction, ischemia, increased intraluminal Obstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc.pressure, infection, ulceration, etc.
ManifestationsManifestations Epigastric and right lower quadrant pain, rebound Epigastric and right lower quadrant pain, rebound
tendernesstenderness Nausea, vomiting, fever, leukocytosisNausea, vomiting, fever, leukocytosis
Most serious complication is peritonitisMost serious complication is peritonitis
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Vascular InsufficiencyVascular Insufficiency Blood supply to the stomach and intestineBlood supply to the stomach and intestine
Celiac axisCeliac axis Superior and inferior mesenteric arteriesSuperior and inferior mesenteric arteries Two of three must be compromised to cause Two of three must be compromised to cause
ischemiaischemia Mesenteric venous thrombosisMesenteric venous thrombosis Acute occlusion of mesenteric artery blood Acute occlusion of mesenteric artery blood
flowflow Chronic mesenteric insufficiencyChronic mesenteric insufficiency
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ObesityObesity Obesity is an increase in body fat massObesity is an increase in body fat mass
Body fat index >30Body fat index >30 A major cause of morbidity, death, and A major cause of morbidity, death, and
increased health care costsincreased health care costs Risk factor for many diseases and conditionsRisk factor for many diseases and conditions
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ObesityObesity HypothalamusHypothalamus Hormones that control appetite and weightHormones that control appetite and weight
Insulin, ghrelin, peptide YY, leptin, adiponectin, Insulin, ghrelin, peptide YY, leptin, adiponectin, and resistinand resistin
Leptin resistanceLeptin resistance HyperleptinemiaHyperleptinemia
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Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa
Characterized by abnormal eating behavior, Characterized by abnormal eating behavior, weight regulation, and disturbed attitudes weight regulation, and disturbed attitudes toward body weight, body shape, and sizetoward body weight, body shape, and size
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Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa
Anorexia nervosaAnorexia nervosa Person has poor body image disorder and refuses Person has poor body image disorder and refuses
to eatto eat Person can lose 25% to 30% of ideal body weight Person can lose 25% to 30% of ideal body weight
due to fat and muscle depletiondue to fat and muscle depletion Can lead to starvation-induced cardiac failureCan lead to starvation-induced cardiac failure In females, characterized by absence of three In females, characterized by absence of three
consecutive menstrual periodsconsecutive menstrual periods Binge eating/purgingBinge eating/purging
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Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa
Bulimia nervosaBulimia nervosa Body weight remains near normal but with Body weight remains near normal but with
aspirations for weight lossaspirations for weight loss FindingsFindings
• Recurrent episodes of binge eatingRecurrent episodes of binge eating• Self-induced vomitingSelf-induced vomiting• Two binge-eating episodes per week for at least 3 Two binge-eating episodes per week for at least 3
monthsmonths• Fasting to oppose the effect of binge eating, or excessive Fasting to oppose the effect of binge eating, or excessive
exerciseexercise
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Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa
Bulimia nervosaBulimia nervosa Continual vomiting of acidic chyme can cause Continual vomiting of acidic chyme can cause
pitted teeth, pharyngeal and esophageal pitted teeth, pharyngeal and esophageal inflammation, and tracheoesophageal fistulaeinflammation, and tracheoesophageal fistulae
Overuse of laxative can cause rectal bleedingOveruse of laxative can cause rectal bleeding
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Anorexia Nervosa and Anorexia Nervosa and Bulimia NervosaBulimia Nervosa
StarvationStarvation Decreased caloric intake leading to weight lossDecreased caloric intake leading to weight loss Short-term starvationShort-term starvation
• Glycogenolysis Glycogenolysis
• GluconeogenesisGluconeogenesis
Long-term starvationLong-term starvation• MarasmusMarasmus
• KwashiorkorKwashiorkor
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Manifestations of Liver DiseaseManifestations of Liver Disease
Portal hypertensionPortal hypertension AscitesAscites Hepatic-encephalopathyHepatic-encephalopathy JaundiceJaundice Hepatorenal syndromeHepatorenal syndrome
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Liver DisordersLiver Disorders Portal hypertensionPortal hypertension
Abnormally high blood pressure in the portal Abnormally high blood pressure in the portal venous system due to resistance to portal blood venous system due to resistance to portal blood flow flow • PrehepaticPrehepatic
• IntrahepaticIntrahepatic
• Posthepatic Posthepatic
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Liver DisordersLiver Disorders Portal hypertensionPortal hypertension
ConsequencesConsequences• VaricesVarices
Lower esophagus, stomach, rectumLower esophagus, stomach, rectum
• SplenomegalySplenomegaly
• AscitesAscites
• Hepatic encephalopathyHepatic encephalopathy
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VaricesVarices
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Hepatic EncephalopathyHepatic Encephalopathy
Accumulation of toxins related to liver failure Accumulation of toxins related to liver failure cause disruption of neurotransmissioncause disruption of neurotransmission Ammonia-bacterial urease acting on gut proteinsAmmonia-bacterial urease acting on gut proteins Neurotoxins: result from hepatic failureNeurotoxins: result from hepatic failure
SymptomsSymptoms Personality changesPersonality changes ConfusionConfusion Memory lossMemory loss Stupor, coma, deathStupor, coma, death
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Liver DisordersLiver Disorders Jaundice (icterus)Jaundice (icterus)
Obstructive jaundiceObstructive jaundice• Extrahepatic obstructionExtrahepatic obstruction
• Intrahepatic obstructionIntrahepatic obstruction
Hemolytic jaundice Hemolytic jaundice • Prehepatic jaundicePrehepatic jaundice
• Excessive hemolysis of red blood cells or absorption of a Excessive hemolysis of red blood cells or absorption of a hematomahematoma
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JaundiceJaundice
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Hepatorenal Syndrome (HRS)Hepatorenal Syndrome (HRS) Renal failure demonstrating oliguria, sodium Renal failure demonstrating oliguria, sodium
and water retention, hypotension, and and water retention, hypotension, and peripheral vasodilation due to advanced liver peripheral vasodilation due to advanced liver diseasedisease
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Hepatorenal SyndromeHepatorenal Syndrome
Renal failure associated with liver failureRenal failure associated with liver failure HypovolemiaHypovolemia HypotensionHypotension Decreased renal blood flowDecreased renal blood flow Intrarenal vasoconstrictionIntrarenal vasoconstriction Decreased GFR and urine outputDecreased GFR and urine output
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Viral HepatitisViral Hepatitis Systemic viral disease that primarily affects Systemic viral disease that primarily affects
the liverthe liver Hepatitis AHepatitis A
• Formally known as infectious hepatitisFormally known as infectious hepatitis
Hepatitis BHepatitis B• Formally known as serum hepatitisFormally known as serum hepatitis
Hepatitis C, D, E, GHepatitis C, D, E, G
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Hepatitis AHepatitis A Can be found in the feces, bile, and sera of Can be found in the feces, bile, and sera of
infected individualsinfected individuals Usually transmitted by the fecal-oral routeUsually transmitted by the fecal-oral route Risk factorsRisk factors
Crowded, unsanitary conditionsCrowded, unsanitary conditions Food and water contaminationFood and water contamination
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Hepatitis AHepatitis A
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Hepatitis BHepatitis B Transmitted through contact with infected Transmitted through contact with infected
blood, body fluids, contaminated needlesblood, body fluids, contaminated needles Maternal transmission if the mother is Maternal transmission if the mother is
infected during the third trimesterinfected during the third trimester Hepatitis B vaccine prevents transmission Hepatitis B vaccine prevents transmission
and development of hepatitis Band development of hepatitis B
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Hepatitis BHepatitis B
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Hepatitis CHepatitis C Responsible for most cases of post-Responsible for most cases of post-
transfusion hepatitistransfusion hepatitis Also implicated in infections related to IV drug Also implicated in infections related to IV drug
useuse 50% to 80% of hepatitis C cases result in 50% to 80% of hepatitis C cases result in
chronic hepatitischronic hepatitis
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HepatitisHepatitis Hepatitis DHepatitis D
Depends on hepatitis B for replication Depends on hepatitis B for replication Hepatitis EHepatitis E
Fecal-oral transmissionFecal-oral transmission Developing countriesDeveloping countries
Hepatitis GHepatitis G Recently discoveredRecently discovered Parenterally and sexually transmittedParenterally and sexually transmitted
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HepatitisHepatitis
SequenceSequence Incubation phaseIncubation phase Prodromal (preicteric) phaseProdromal (preicteric) phase Icteric phaseIcteric phase Recovery phaseRecovery phase
Chronic active hepatitisChronic active hepatitis Fulminant hepatitisFulminant hepatitis
From impairment or necrosis of hepatocytesFrom impairment or necrosis of hepatocytes Acute hepatic failureAcute hepatic failure
Acetaminophen overdoseAcetaminophen overdose
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CirrhosisCirrhosis Irreversible inflammatory disease that Irreversible inflammatory disease that
disrupts liver function and even structuredisrupts liver function and even structure Decreased hepatic function from nodular and Decreased hepatic function from nodular and
fibrotic tissue synthesis (fibrosis)fibrotic tissue synthesis (fibrosis) Biliary channels become obstructed and Biliary channels become obstructed and
cause portal hypertension; due to the cause portal hypertension; due to the hypertension, blood shunted away from the hypertension, blood shunted away from the liver, and a hypoxic necrosis developsliver, and a hypoxic necrosis develops
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CirrhosisCirrhosis
AlcoholicAlcoholic Oxidation of alcohol damages hepatocytesOxidation of alcohol damages hepatocytes
Biliary (bile canaliculi)Biliary (bile canaliculi) Cirrhosis begins in bile canaliculi and ductsCirrhosis begins in bile canaliculi and ducts Primary biliary cirrhosis (autoimmune)Primary biliary cirrhosis (autoimmune) Secondary biliary cirrhosis (obstruction)Secondary biliary cirrhosis (obstruction)
PostnecroticPostnecrotic Consequence of chronic diseaseConsequence of chronic disease
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CirrhosisCirrhosis
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CirrhosisCirrhosis
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Disorders of the GallbladderDisorders of the Gallbladder CholecystitisCholecystitis GallstonesGallstones
Cholesterol stones form in bile that is Cholesterol stones form in bile that is supersaturated with cholesterol. Theories:supersaturated with cholesterol. Theories:• Enzyme defect; increases cholesterol synthesisEnzyme defect; increases cholesterol synthesis
• Decreased secretion of bile acids to emulsify fatsDecreased secretion of bile acids to emulsify fats
• Decreased resorption of bile acids from the ileumDecreased resorption of bile acids from the ileum
• Gallbladder smooth muscle hypomotility, stasisGallbladder smooth muscle hypomotility, stasis
• Genetic predispositionGenetic predisposition
• Combination of any or all of the aboveCombination of any or all of the above
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Disorders of the PancreasDisorders of the Pancreas PancreatitisPancreatitis
Inflammation of the pancreasInflammation of the pancreas Associated with several clinical disorders (alcohol Associated with several clinical disorders (alcohol
intake and cholelithiasis)intake and cholelithiasis)• Caused by injury or damage to pancreatic cells and ducts, Caused by injury or damage to pancreatic cells and ducts,
causing a leakage of pancreatic enzymes into the pancreatic causing a leakage of pancreatic enzymes into the pancreatic tissuetissue
These enzymes cause autodigestion of pancreatic These enzymes cause autodigestion of pancreatic tissue and leak into the bloodstream to cause injury to tissue and leak into the bloodstream to cause injury to blood vessels and other organsblood vessels and other organs
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Disorders of the PancreasDisorders of the Pancreas PancreatitisPancreatitis
Manifestations and evaluationManifestations and evaluation• Epigastric pain radiating to the backEpigastric pain radiating to the back• Fever and leukocytosisFever and leukocytosis• Hypotension and hypovolemiaHypotension and hypovolemia
Enzymes increase vascular permeabilityEnzymes increase vascular permeability
• Characterized by an increase in a patient’s serum Characterized by an increase in a patient’s serum amylase levelamylase level
Chronic pancreatitisChronic pancreatitis• Related to chronic alcohol abuseRelated to chronic alcohol abuse
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Cancer of the Gastrointestinal Cancer of the Gastrointestinal TractTract
EsophagusEsophagus StomachStomach Colon and rectumColon and rectum LiverLiver GallbladderGallbladder PancreasPancreas
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Stomach CancerStomach Cancer
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Colon CancerColon Cancer
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Colon CancerColon Cancer
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Colon CancerColon Cancer