Digestive System Guide: What Is Digestion

PRESENTED BY : Dr. Pallavi Pathanaia

What Is Digestion?
Digestion is the complex process of turning the food you eat
into nutrients, which the body uses for energy, growth and cell
repair needed to survive. The digestion process also involves
creating waste to be eliminated.
The digestive tract (or gastrointestinal tract) is a long twisting
tube that starts at the mouth and ends at the anus.
It is made up of a series of muscles that coordinate the
movement of food and other cells that produce enzymes and
hormones to aid in the breakdown of food. Along the way are
three other organs that are needed for digestion: the liver,
gallbladder, and the pancreas.

DESCRIPTION OF THE DIGESTIVE
SYSTEM
Also known as the gastrointestinal (GI) tract, the digestive system
begins at the mouth, includes the esophagus, stomach, small
intestine, large intestine (also known as the colon) and rectum, and
ends at the anus. The entire system — from mouth to anus — is about
30 feet (9 meters) long.
The small intestine, a 20-feet (6-meter) tube-shaped organ. The function of
the large intestine, which is about 5 feet long (1.5 meters), is primarily for
storage and fermentation of indigestible matter. Also called the colon, it has
four parts: the ascending colon, the transverse colon, the descending colon
and the sigmoid colon.

INTRODUCTION
The digestive system is
used for breaking down
food into nutrients
which then pass into the
circulatory system and
are taken to where they
are needed in the body.

There are four stages to
food processing:
1. Ingestion: taking in food
2.Digestion: breaking down
food into nutrients
3. Absorption: taking in
nutrients by cells
4.Egestion: removing any
leftover wastes

MOUTH & TEETH
Begins when food enters
the mouth.
It is physically broken
down by the teeth.
It is begun to be
chemically broken down
by amylase, an enzyme in
saliva that breaks down
carbohydrates.

TONGUE
The average length of the human tongue
from the oropharynx to the tip
is 10cms in length.
The tongue moves the food around until it
forms a ball called a bolus.
The bolus is passed to the pharynx (throat)
and the epiglottis makes sure the bolus
passes into the esophagus and not down the
windpipe!

The esophagus is a 25-cm
long muscular tube that
connects the pharynx to
the stomach.
The bolus passes down the
esophagus by peristalsis.
Peristalsis is a wave of
muscular contractions that
push the bolus down
towards the stomach.
ESOPHAGUS

STOMACH
To enter the stomach, the
bolus must pass through
the lower esophageal
sphincter, a tight muscle
that keeps stomach acid
out of the esophagus.

The stomach has folds
called rugae and is a big
muscular pouch which
churns the bolus
(Physical Digestion) and
mixes it with gastric
juice, a mixture of
stomach acid, mucus
and enzymes.

The acid kills off any
invading bacteria or
viruses.
The enzymes help break
down proteins and lipids.
The mucus protects the
lining of the stomach from
being eaten away by the
acid.

The stomach does do
some absorption too.
Some medicines (i.e.
aspirin), water and
alcohol are all absorbed
through the stomach.
The digested bolus is
now called chyme and it
leaves the stomach by
passing through the
pyloric sphincter.

Pancreas :
The pancreas is about 6 inches long and sits across the back of the abdomen,
behind the stomach.
 The pancreas secretes digestive enzymes into the duodenum, the first
segment of the small intestine. These enzymes break down protein, fats, and
carbohydrates. The pancreas also makes insulin, secreting it directly into the
bloodstream. Insulin is the chief hormone for metabolizing sugar.
Liver
 The liver has multiple functions, but its main function within the digestive
system is to process the nutrients absorbed from the small intestine. Bile from
the liver secreted into the small intestine also plays an important role in
digesting fat. The liver also detoxifies potentially harmful chemicals. It breaks
down many drugs.
Gallbladder
 The gallbladder stores and concentrates bile, and then releases it into the
duodenum to help absorb and digest fats.

SMALL INTESTINE
About 6 meters or 20 feet
long .
Chyme is now in the small
intestine.
The majority of absorption
occurs here.
The liver and pancreas help
the small intestine to
maximize absorption.
The small intestine is broken
down into three parts:

1. Duodenum
 Bile, produced in the
liver but stored in the
gall bladder, enters
through the bile duct.
It breaks down fats.
 The pancreas secretes
pancreatic juice to
reduce the acidity of
the chyme.

2. Jejunum
 The jejunum is where
the majority of
absorption takes place.
 It has tiny fingerlike
projections called villi
lining it, which increase
the surface area for
absorbing nutrients.

 Each villi itself has tiny fingerlike projections called
microvilli, which further increase the surface area
for absorption.

3. Ileum
 The last portion of the
small intestine is the
ileum, which has fewer
villi and basically
compacts the leftovers
to pass through the
caecum into the large
intestine.

LARGE INTESTINE
The large intestine
is about 1.5 meters or 5
feet long
The large intestine (or
colon) is used to absorb
water from the waste
material leftover and to
produce vitamin K and
some B vitamins using the
helpful bacteria that live
here.

All leftover waste is
compacted and stored at
the end of the large
intestine called the
rectum.
When full, the anal
sphincter loosens and
the waste, called feces,
passes out of the body
through the anus.

RECTUM : The average length of the human rectum may range between 10 and 15 cm
 The rectum is an 8-inch chamber that connects the colon to the anus. It is the
rectum's job to receive stool from the colon. When anything (gas or stool) comes
into the rectum, sensors send a message to the brain. The brain then decides if the
rectal contents can be released or not.
Anus
 The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of
the pelvic floor muscles and the two anal sphincters (internal and external). The
lining of the upper anus is specialized to detect rectal contents. It lets you know
whether the contents are liquid, gas, or solid. The anus is surrounded by sphincter
muscles that are important in allowing control of stool.

DIGESTIVE SYSTEM FUNCTION
Secretion enzymes
Absorption of nutrients
Excretion of waste products
Ingestion of food
Secretion of fluids
Breakdown food into small particles
Ingestion of the food

ESOPHAGITIS
Esophagitis (or oesophagitis) is inflammation of the
esophagus. It may be acute or chronic.
Esophagitis is irritation or inflammation of the esophagus
. Theesophagus is the tube that carries food from throat
to stomach. Esophagitis can be painful and can make it
hard to swallow.

CAUSES
Gastroesophageal reflux disease, hiatal hernia,
Medicines that irritate the esophagus,
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin,
ibuprofen, or naproxen.
Antibiotics, such as clindamycin or tetracycline.
Vitamin and mineral supplements, such as vitamin C, iron
, Infection.
A weak immune system
Radiation therapy.
Allergies

Common symptoms of esophagitis include:
Heartburn.
Pain when you swallow.
Trouble swallowing food or liquids.
Chest pain
 cough.
Sometimes it also causes:
Nausea or vomiting.
Fever.
Belly pain.

DIAGNOSIS
An endoscopy. During this test, the doctor puts a
thin, flexible tube down your throat to look at your
esophagus. This test also lets the doctor get a sample
of the cells to test for infection. Sometimes a small
piece of tissue is removed for a biopsy. A biopsy is a
test that checks for inflammation or cancer cells.
A barium swallow. This is an X-ray of the throat and
esophagus. Before the X-ray, you will drink a chalky
liquid called barium. Barium coats the inside of your
esophagus so that it shows up better on an X-ray.

TREATMENT
Do not smoke or use smokeless tobacco.
Antacids, such as omeprazole or ranitidine
If esophagitis is caused by an infection, you may need
to take antibiotics or other medicines to treat the
infection.
If has esophagitis caused by a food allergy, provide
corticosteroids.

Achalasia is a disorder of the esophagus, the
tube that carries food from the mouth to the
stomach. This condition affects the ability of
the esophagus to move food into the stomach.
A condition in which the muscles of the lower part of the oesophagus
fail to relax, preventing food from passing into the stomach.
Causes
Normal muscle activity of the esophagus (peristalsis) is
reduced.
Damage to the nerves of the esophagus.

Symptoms
Backflow (regurgitation) of food
Chest pain, which may increase after eating or may be
felt in the back, neck, and arms
Cough
Difficulty swallowing liquids and solids
Heartburn
Unintentional weight loss
Exams and Tests
 Physical exam may show signs of anaemia or malnutrition.
 Tests include:
 Esophagogastroduodenoscopy
 Upper GI x-ray

Treatment
The goal of treatment is to reduce the pressure at the lower
esophageal sphincter.
Injection with (Botox). This may help relax the sphincter
muscles.
Medications, such as long-acting nitrates or calcium channel
blockers. These drugs can be used to relax the lower
esophagus sphincter.
Surgery (called an esophagomyotomy). This procedure may
be needed to decrease the pressure in the lower sphincter.
Widening (dilation) of the esophagus at the location of the
narrowing. This is done during esophagogastroduodenoscopy.

Esophagus is the tube that carries food from your
mouth to stomach. Gastroesophageal reflux disease
(GERD) happens when a muscle at the end of
esophagus does not close properly. This allows
stomach contents to leak back, or reflux, into the
esophagus and irritate it.
Gastroesophageal reflux disease (GERD), gastro-
oesophageal reflux disease (GORD), gastric reflux
disease, acid reflux disease, or reflux is a chronic
condition of mucosal damage caused by stomach acid
coming up from the stomach into the esophagus.

CAUSES
GERD is usually caused by changes in the abnormal
relaxation of the lower esophageal sphincter, which
normally holds the top of the stomach closed,
impaired expulsion of gastric reflux from the
esophagus, or a hiatal hernia, esophagitis, by motility
disorders, Achalasia, esophageal spasm.

SYMPTOMS OF GERD ARE
Heartburn and regurgitation, pain with swallowing/sore throat,
increased salivation (also known as water brash), nausea chest pain,
and coughing.
Sometimes causes injury of the esophagus. These injuries may
include one or more of the following:
Reflux esophagitis – necrosis of esophageal epithelium causing ulcers
near the junction of the stomach and esophagus
Esophageal strictures – the persistent narrowing of the esophagus
caused by reflux-induced inflammation
Barrett's esophagus – intestinal metaplasia (changes of the epithelial
cells from squamous to intestinal columnar epithelium) of the distal
esophagus
Esophageal adenocarcinoma – a form of cancer
Some peoplehave proposed that symptoms such as sinusitis, recurrent
ear infections, and idiopathic pulmonary fibrosis are due to GERD.

DIAGNOSTIC EVALUATION
Endoscopy can visualize inflammation, lesions, or
erosions. Biopsy can confirm diagnosis.
Esophageal manometry measures LES pressure and
determines if esophageal peristalsis is adequate. This
study should be used before patients undergo surgical
treatment for reflux. This test is also done before a pH
probe for determination of correct catheter placement.
Barium esophagography use of barium with radiographic
studies to diagnose mechanical and motility disorders.
This test is rarely useful in diagnosing GERD.

TREATMENT
 Initial treatment is frequently with a proton-pump inhibitor such
as omeprazole.
Lifestyle Modifications
 Head of bed raised 6 to 8 inches (15 to 20 cm).
 Do not lie down for 3 to 4 hours after eating time frame for greatest reflux.
 Bland diet avoid garlic, onion, peppermint, fatty foods, chocolate, coffee
,citrus juices, colas, and tomato products.
 Avoid overeating causes LES relaxation.
 No tight-fitting clothes.
 Weight control.
 Smoking cessation.
 Reduce alcohol.

PHARMACOLOGIC TREATMENT
Antacids reduce gastric acidity.
Histamine-2 (H2) receptor antagonists, such as ranitidine
(Zantac), cimetidine (Tagamet), famotidine (Pepcid),
decrease gastric acid secretions.
If symptoms do not respond to H2-receptor antagonist,
change to a once-per-day proton pump inhibitor (PPI),
such as omeprazole (Prilosec), esomeprazole (Nexium),
pantoprazole (Protonix), rabeprazole (Aciphex), to block
gastric acid secretion.

ANTIREFLUX SURGERY
 May be indicated for patients who do not respond to medical management.
Common procedure is Nissen fundoplication.
 Upper portion of the stomach is wrapped around the distal esophagus and sutured,
creating a tight LES.
 This procedure can be performed laparoscopic ally.
 Combined with vagotomy-pyloroplasty if associated with gastro duodenal ulcer.
 Antireflux surgery may not eliminate the need for future pharmacologic treatment.
ENDOSCOPIC TREATMENTS FOR GERD
 The Stretta procedure is a radiofrequency energy delivery system used
to provide a thermal burn to the Gastroesophageal junction.
 Enteryx, an endoscopically implanted device, prevents reflux of gastric acid
into the throat. The device is permanently placed and may eliminate the need
for pharmacologic treatment of GERD symptoms.

The Stretta procedure is a radiofrequency
energy delivery system used to provide a
thermal burn to the Gastroesophageal junction

Enteryx, an endoscopically implanted device, prevents reflux of
gastric acid into the throat

INTRODUCTION
The protrusion of an organ, typically the stomach,
through the oesophageal opening in the diaphragm.
 A hiatal hernia is a protrusion of a portion of the
stomach through the hiatus of the diaphragm and
into the thoracic cavity.

DEFINITION
A hiatus hernia or hiatal hernia is the protrusion
(or herniation) of the upper part of the stomach into
the thorax through the esophageal hiatus because of a
tear or weakness in the diaphragm. Hiatus hernias
often result in heartburn but may also cause chest
pain or pain with eating

CAUSES
The most common cause is obesity , straining
during bowel movements
by muscle weakening due to aging & other
conditions, such as esophageal carcinoma or trauma,
or following certain surgical procedures

Risk factors
Hiatal hernias occur more often in women, people
who are overweight, and people older than 50.
The following are risk factors that can result in a
hiatus hernia.
Increased pressure within the abdomen caused by:
Heavy lifting or bending over
Frequent or hard coughing
Hard sneezing
Violent vomiting
straining
Stress

CLASSIFICATION
There are two types of hiatal hernias.
Sliding hernia: Stomach and gastroesophageal junction
slip up into the chest (most common)
Paraesophageal hernia (rolling hernia): Part of the
greater curvature of the stomach rolls through the
diaphragmatic defect

Clinical Manifestations
May be asymptomatic
Heartburn (with or without regurgitation of gastric
contents into the mouth)
Dysphasia, chest pain

Diagnostic Evaluation
X-RAY
Barium study of the esophagus outlines hernia.
Endoscopic examination visualizes defect

Management
Elevation of head of bed (6 to 8 inches [15 to 20 cm])
to reduce night time reflux.
Antacid therapy to neutralize gastric acid.
H2-receptor antagonist (cimetidine, ranitidine) if
patient has esophagitis.
LAPROSCOPIC Surgical repair of hernia if symptoms
are severe.

An esophageal diverticulum is an out
pouching of the esophageal wall, usually
in the posterior side, secondary to an
obstructive or inflammatory process.
CAUSES
Zenker's diverticulum protrusion of
pharyngeal mucosa at the
pharyngoesophageal junction between the
interior pharyngeal constrictor and crico
pharyngeal muscle.
Mid or distal esophageal diverticula may
develop above strictures or may be
secondary to motility disorders.

Zenker's Diverticulum: Difficulty in swallowing,
fullness in neck, throat discomfort, a feeling that food
stops before it reaches the stomach, and regurgitation
of undigested food
Belching, gurgling, or nocturnal coughing brought
about by diverticulum becoming filled with food or
liquid, which is regurgitated and may irritate the
trachea
Halitosis and foul taste in mouth caused by food
decomposing in a pouch
Weight loss due to nutritional depletion

Barium esophagogram outlines diverticulum.
Endoscopy is not indicated and may be dangerous
due to the possibility of rupture

Management
Small diverticula may not be treated,
but the underlying cause is treated with
dilatation or myotomy.
A transverse cervical diverticulectomy
or diverticuloplexy with suspension
and cricopharyngeal myotomy may be
done.
Sac is dissected free and then excised flush
with esophageal wall.

Esophageal cancer (or oesophageal cancer)
is cancer arising from the esophagus—the food pipe
that runs between the throat and the stomach.
Malignant lesions of the esophagus occur in four
types worldwide: squamous cell, adenocarcinoma,
carcinosarcoma, and sarcoma.

CAUSES
The two main types (i.e. squamous-cell
carcinoma and adenocarcinoma) have distinct sets
of risk factors
Squamous-cell carcinoma is linked to lifestyle factors
such as smoking and alcohol.
 Adenocarcinoma has been linked to effects of long-
term acid reflux.
Tobacco is a risk factor for both types. Both types are
more common in men and in the over-60s.

Cause is unknown but has been associated with:
Barrett's esophagus.
Achalasia.
Chronic use of alcohol and tobacco (squamous cell
carcinoma).
Genetic predisposition nonwhite male population.
Ingestion of caustic substances which cause
esophageal strictures.
Other head and neck cancers

Dysphagia is the usual presenting symptom, although it is a late sign,
by which time there often is regional or systemic involvement.
Mild, atypical chest pain associated with eating precedes dysphagia
but is rarely significant enough for the patient to seek health care.
Pain on swallowing (odynophagia).
Progressive weight loss, Hoarseness ,Later symptoms hiccups,
respiratory difficulty, foul breath, regurgitation of food and saliva.

Chest X-ray may show adenopathy; mediastinal, widening,
metastasis; or a tracheoesophageal fistula.
Endoscopy with cytology and biopsy.
Surveillance endoscopy of Barrett's esophagus is beneficial
for early detection of malignant changes.
Barium esophagram may show polypoid, infiltrative, or
ulcerative lesion requiring biopsy.
CT scanning may be helpful in delineating the extent of
the tumour as well as in identifying presence of adjacent
tissue invasion and metastases

Management
Surgery.
 Lesions of the middle and lower esophagus are excised with use of the
thoracotomy approach with esophagogastrectomy or colon interposition
(section of colon is used to replace the excised portion of the esophagus).
 Lesions of the cervical esophagus are excised with a bilateral neck
dissection and esophagogastrectomy; laryngectomy and thyroidectomy
may be necessary.
 A two-step approach may be selected when resection with a cervical
esophagostomy and feeding gastrostomy are performed initially;
subsequent reconstructive surgery is performed.
Radiation, chemotherapy, or their combination; combination therapy
appears to have better results.
By endoscopy or laser therapy.

Gastritis is an inflammation, irritation, or
erosion of the lining of the stomach. It can
occur suddenly (acute) or gradually (chronic)

CAUSES OF GASTRITIS
Medications such as Nonsteroidal anti-
inflammatory drugs (NSAIDs) and corticosteroids,
Bacterial infections such as H. Pylori,
Excessive alcohol consumption

PATHOPHYSIOLOGY
Due to etiological factor
Destruction of protective
mucosal layer
Inflammatory reactions
Superficial gastritis
Atrophic gastritis
Hypertrophic gastritis

ACUTE GASTRITIS
The acute form of gastritis may be seen with nausea & vomiting,
epigastric discomfort, bleeding , malaise & anorexia.
Acute gastritis is a sudden inflammation or swelling in the lining of
the stomach. It causes severe and nagging pain
It occurs when the lining of your stomach is damaged or weak. This
allows digestive acids to irritate the stomach. There are many things
that can damage your stomach lining.
The causes of acute gastritis include: medications such as
Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids,
bacterial infections such as H. Pylori, excessive alcohol consumption

Who Is at Risk for Acute Gastritis?
Factors that increase your risk of acute gastritis include:
taking NSAIDs
taking corticosteroids
drinking a lot of alcohol
having a major surgery
kidney failure
liver failure
respiratory failure

What Are the Symptoms of Acute Gastritis?
 Some people with acute gastritis do not have any symptoms. Other people
may have symptoms that range from mild to severe. Common symptoms
include:
 appetite loss
 indigestion
 black stools
 nausea
 vomiting
 bloody vomit that looks like used coffee grounds
 pain in the upper part of the abdomen
 a full feeling in the upper abdomen after eating

Chronic Gastritis is inflammation of the stomach lining
and is usually termed acute or chronic gastritis.
This condition appears with 3 stages:
Superficial gastritis
Atrophic gastritis
Hypertrophic gastritis

What Causes Chronic Gastritis?
The following can irritate the lining of your stomach and lead to
chronic gastritis:
The long-term use of certain medications, such as aspirin and
ibuprofen
Excessive alcohol consumption
The presence of helicobacter pylori bacteria, which causes stomach
ulcers
Certain illnesses, such as kidney failure
A viral infection in a weakened immune system
Persistent, intense stress
Bile flowing into the stomach, or bile reflux

What Are the Symptoms of Chronic
Gastritis?
Upper abdominal pain
Indigestion
Bloating
Nausea
Vomiting
Belching
Loss of appetite
Weight loss
Chest pain

GASTRITIS DIAGNOSED
 Personal and family medical history, perform a thorough physical evaluation, and may
recommend any of the following tests:
 Upper endoscopy. An endoscope, a thin tube containing a tiny camera, is inserted
through your mouth and down into your stomach to look at the stomach lining. The
doctor will check for inflammation and may perform a biopsy, a procedure in which a
tiny sample of tissue is removed and then sent to a laboratory for analysis.
 Blood tests. The doctor may perform various blood tests, such as checking your red
blood cell count to determine whether you have anaemia, which means that you do not
have enough red blood cells. He or she can also screen for H. pylori infection
and pernicious anaemia with blood tests.
 stool test): This test checks for the presence of blood in your stool, a possible sign of
gastritis.

TREATMENT FOR GASTRITIS
 Taking antacids and other drugs (such
as proton pump inhibitors or H-2
blockers) to reduce stomach acid
 Avoiding hot and spicy foods
 For gastritis caused by H. pylori
infection, antibiotics plus an acid
blocking drug (used for heartburn)
 If the gastritis is caused by pernicious
anaemia, B12 vitamin shots will be given.
 Avoid spicy food, caffeine & large heavy
meals.

Foods include:
All vegetables and fruits,
except citrus fruits
Low-fat dairy products
Pasta and rice prepared
with little or no fat

PEPTIC ULCER DISEASE
Peptic ulcer disease (PUD), also known as a peptic
ulcer or stomach ulcer, is a break in the lining of the stomach, first
part of the small intestine, or occasionally the lower esophagus.
An ulcer in the stomach is known as a gastric ulcer while that in the
first part of the intestines is known as a duodenal ulcer.
 Peptic ulcer disease refers to ulcerations in the mucosa of the lower
esophagus, stomach, or duodenum

A peptic ulcer is an open sore or raw area in the lining of
the stomach or intestine.
A gastric ulcer occurs in the stomach.
A duodenal ulcer occurs in the first part of the small intestine.

Common causes include
The bacteria, helicobacter pylori
Non-steroidal anti-inflammatory drugs (nsaids).
Other less common causes include
Tobacco , smoking,
Stress due to serious illness
 Drinking too much alcohol
 Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-
inflammatory drugs (nsaids). Taking aspirin or nsaids once in a while is
safe for most people.
 Being very ill, such as being on a breathing machine
 Having radiation treatments

PATHOPHYSIOLOGY
Due to etiology
Increased vagal activity
Break down of gastric mucosal
layer
Acid back
Destruction of mucoid cells
Increased acid & pepsin production
Destruction of blood cells
Further mucosal erosion
Bleeding
Ulceration

A duodenal ulcer is a type of peptic ulcer that occurs
in the duodenum, the beginning of the small
intestine. Peptic ulcers are eroded areas in the lining
of stomach and duodenum, which result in abdominal
pain, possible bleeding, and other gastrointestinal
symptoms.
The most common cause of duodenal ulcer is a
stomach infection associated with the Helicobacter
pylori (H pylori) bacteria.

SURGICAL MANAGEMENT
Antrectomy
Gastric resection includes a small cuff of duodenum,
the pylorus, and the antrum (lower half of stomach).
The duodenal stump is closed, and the jejunum is
anastomosed to the stomach.

Gastroduodenostomy (Billroth I).
Partial gastrectomy with removal of antrum and pylorus of
stomach.
The gastric stump is anastomosed with the duodenum.
Gastrojejunostomy (Billroth II)
Partial gastrectomy with removal of antrum and pylorus of
stomach.
The gastric stump is anastomosed with the jejunum

Vagotomy
The surgical division of the vagus nerve to eliminate the impulses
that stimulate HCL secretion.
Traditionally performed by laparotomy, the vagotomy procedure
can also be done using a laparoscope.

Pyloroplasty
A longitudinal incision is made in the pylorus, and it is closed transversely to
permit the muscle to relax and to establish an enlarged outlet.

Nursing Diagnoses
Deficient Fluid Volume related to haemorrhage
Acute Pain related to epigastric distress secondary to
hypersecretion of acid, mucosal erosion, or
perforation
Diarrhea related to GI bleeding
Imbalanced Nutrition: Less Than Body Requirements
related to the disease process
Deficient Knowledge related to physical, dietary, and
pharmacologic treatment of disease

INFLAMMATORY DISORDERS
GASTROENTRITIES

ULCERATIVE COLITIS
Ulcerative colitis (UC) is a chronic form
of inflammatory bowel disease (IBD) that causes
inflammation and ulcers in the colon. The disease is a
type of colitis, which is a group of diseases that cause
inflammation of the colon, the largest section of the
large intestine, either in segments or completely.
Ulcerative colitis is a chronic idiopathic
inflammatory disease of the mucosa and, less
frequently, the submucosa of the colon and rectum. If
only the rectum is involved, it may be called
ulcerative proctitis.

CAUSES
Genetic predisposition.
Environmental factors may trigger disease (viral or
bacterial pathogens, dietary).
Immunologic imbalance or disturbances.
Defect in intestinal barrier causing hypersensitive
mucosa and increased permeability.
Defect in repair of mucosal injury, which may develop
into a chronic condition.

Diffuse ulceration of superficial mucosa
Shedding of the colonic epithelium
Bleeding occurs due to ulceration
Inflammation of mucosal layer
Abscess formation
Bowel narrowing and shortening
Muscular hypertrophy

SURGICAL MANAGEMENT
It is the surgical removal of the rectum and all or part of the
colon. It is a most widely accepted surgical method for
ulcerative colitis and Familial adenomatous polyposis (FAP).

The Kock Pouch is an example of a continent
ileostomy, so called because the contents of
the small intestine stay within the body
until the patient decides to empty it.

Crohn's disease, also known as Crohn
syndrome and regional enteritis, is a type
of inflammatory bowel disease (IBD) that may affect
any part of the gastrointestinal
tract from mouth to anus.

PATHOPHYSIOLOGY
Due to etiologic factor
Inflammatory reaction
Thickness of bowel wall
Fibrosis and narrowing of lumen
Interstitial obstruction

 Appendix sits in the lower right abdomen.
 The function of appendix is unknown but it act as a storehouse of good bacteria
rebooting the digestive system after diarrheal illness.

USG
Abdominal X-ray may visualize shadow consistent with
fecalith in appendix; perforation will reveal free air.
Abdominal ultrasound or CT scan can visualize appendix
and rule out other conditions, such as diverticulitis and
Crohn's disease. Focused appendiceal CT can quickly
evaluate for appendicitis.

Management
Surgery (appendectomy) is indicated.
Simple appendectomy or laparoscopic appendectomy
in absence of rupture or peritonitis.
An incisional drain may be placed if an abscess or
rupture occurs.
Preoperatively maintain bed rest, NPO status, I.V.
hydration, possible antibiotic prophylaxis, and
analgesia.

ABDOMINAL HERNIAS
A hernia is a protrusion of an organ, tissue, or
structure through the wall of the cavity in which it is
normally contained. It is often called a rupture.

Bulging over herniated area appears when patient
stands or strains, and disappears when supine.
Hernia tends to increase in size and recurs with intra-
abdominal pressure.
Strangulated hernia presents with pain, vomiting,
swelling of hernial sac, lower abdominal signs of
peritoneal irritation, fever.

surgical repair of HERNIA, with suture of the abdominal wall.
When the weakened area is very large, some type of strong
synthetic material is sewn over the defect to reinforce the area
; this type of repair is sometimes specifically called
HERNIOPLASTY,

Anal fissures are cracks or tears in the anus and anal
canal. They may be acute or chronic.
Anal fissures are caused primarily by trauma, but
several non-traumatic diseases are associated with
anal fissures and should be suspected if fissures occur
in unusual locations.

The primary symptom of anal fissures is pain during
and following bowel movements. Other symptoms
that may occur are:
bleeding,
itching, and a
malodorous discharge.
Anal fissures are diagnosed and evaluated by visual
inspection of the anus and anal canal.

Anal fissures are initially
treated conservatively with
home remedies and OTC
products by: adding bulk to
the stool,
softening the stool,
consuming a
high fiber diet,
utilizing sitz baths.

Prescription drugs used to treat anal fissures that fail
to heal with less conservative treatment include:
ointments containing anesthetics,
steroids,
nitroglycerin, and
calcium channel blocking drugs (CCBs).
Surgery by lateral sphincterotomy is the gold
standard for curing anal fissures. Because of
complications, however, it is reserved for patients
who are intolerant of non-surgical treatments or in
whom non-surgical treatments have proven to be
ineffective.

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