1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1
Alterations of Digestive Function

2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2
Clinical Manifestations of
Gastrointestinal Dysfunction
 Anorexia
 A lack of a desire to eat despite physiologic
stimuli that would normally produce hunger
 Vomiting
 The forceful emptying of the stomach and
intestinal contents through the mouth
 Several types of stimuli initiate the vomiting
reflex

3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Nausea
 A subjective experience that is associated with
a number of conditions
 The common symptoms of vomiting are
hypersalivation and tachycardia
 Retching
 Nonproductive vomiting

4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Projectile vomiting
 Projectile vomiting is spontaneous vomiting
that does not follow nausea or retching

5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Constipation
 Constipation is defined as infrequent or difficult
defecation
 Pathophysiology
• Neurogenic disorders
• Functional or mechanical conditions
• Low-residue diet
• Sedentary lifestyle
• Excessive use of antacids
• Changes in bowel habits

6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Diarrhea
 Increased frequency of bowel movements
 Increased volume, fluidity, weight of the feces
 Major mechanisms of diarrhea:
• Osmotic diarrhea
• Secretory diarrhea
• Motility diarrhea
 Associated with malabsorption syndromes

7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Abdominal pain
 Abdominal pain is a symptom of a number of
gastrointestinal disorders
 Parietal pain
 Visceral pain
 Referred pain

8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)
 Gastrointestinal bleeding
 Upper gastrointestinal bleeding
• Esophagus, stomach, or duodenum
 Lower gastrointestinal bleeding
• Below the ligament of Treitz or bleeding from the
jejunum, ileum, colon, or rectum
 Hematemesis
 Hematochezia
 Melena
 Occult bleeding

9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9
Clinical Manifestations of
Gastrointestinal Dysfunction (cont’d)

10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10
Disorders of Motility
 Dysphagia
 Dysphagia is difficulty swallowing
 Types:
• Mechanical obstructions
• Functional obstructions
 Achalasia:
• Denervation of smooth muscle in the esophagus and
lower esophageal sphincter relaxation

11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11
Achalasia

12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12
Disorders of Motility
 Gastroesophageal reflux disease (GERD)
 GERD is the reflux of chyme from the stomach
to the esophagus
 If GERD causes inflammation of the
esophagus, it is called reflux esophagitis
 A normal functioning lower esophageal
sphincter maintains a zone of high pressure to
prevent chyme reflux

13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13
Disorders of Motility (cont’d)
 Gastroesophageal reflux disease (GERD)
(cont’d)
 Conditions that increase abdominal pressure
can contribute to GERD
 Manifestations:
• Heartburn
• Regurgitation of chyme
• Mid-epigastric pain within 1 hour of eating

14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14
Disorders of Motility (cont’d)
 Hiatal hernia
 Sliding hiatal hernia
 Paraesophageal hiatal hernia

15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15
Hiatal HerniaHiatal Hernia

16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16
Disorders of Motility
 Pyloric obstruction
 The blocking or narrowing of the opening
between the stomach and the duodenum
 Can be acquired or congenital
 Manifestations:
• Epigastric pain and fullness
• Nausea
• Succussion splash
• Vomiting
• With a prolonged obstruction, malnutrition,
dehydration, and extreme debilitation

17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17
Disorders of Motility (cont’d)
 Intestinal obstruction and paralytic ileus
 An intestinal obstruction is any condition that
prevents the flow of chyme through the
intestinal lumen or failure of normal intestinal
motility in the absence of an obstructing lesion
 An ileus is an obstruction of the intestines
 Simple obstruction
 Functional obstruction

18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18
Intestinal Obstruction

19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19
Gastritis
 Inflammatory disorder of the gastric
mucosa
 Acute gastritis
 Chronic gastritis
 Chronic fundal gastritis
 Chronic antral gastritis

20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20
Gastritis (cont’d)

21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21
Peptic Ulcer Disease
 A break or ulceration in the protective
mucosal lining of the lower esophagus,
stomach, or duodenum
 Acute and chronic ulcers
 Superficial
 Erosions
 Deep
 True ulcers
 Zollinger-Ellison syndrome

22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22
Peptic Ulcer Disease (cont’d)
 Duodenal ulcers
 Most common of the peptic ulcers
 Developmental factors:
• Helicobacter pylori infection
 Toxins and enzymes that promote inflammation and
ulceration
• Hypersecretion of stomach acid and pepsin
• Use of NSAIDs
• High gastrin levels
• Acid production by cigarette smoking

23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23
Duodenal Ulcer

24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24
Gastric Ulcer
 Gastric ulcers tend to develop in the antral
region of the stomach, adjacent to the
acid-secreting mucosa of the body
 Pathophysiology
 The primary defect is an increased mucosal
permeability to hydrogen ions
 Gastric secretion tends to be normal or less
than normal

25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25
Gastric Ulcer (cont’d)

26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26
Stress Ulcer
 A stress ulcer is a peptic ulcer that is
related to severe illness, neural injury, or
systemic trauma
 Ischemic ulcers
• Within hours of trauma, burns, hemorrhage, sepsis
 Cushing ulcers
• Ulcers that develop as a result of a head/brain injury

27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27
Postgastrectomy Syndromes
 Dumping syndrome
 Alkaline reflux gastritis
 Afferent loop obstruction
 Diarrhea
 Weight loss
 Anemia
 Bone and mineral disorders

28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28
Dumping Syndrome
 Dumping syndrome is the rapid emptying
of chyme from a surgically created residual
stomach into the small intestine
 Dumping syndrome is a clinical
complication of partial gastrectomy or
pyloroplasty surgery

29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29
Dumping Syndrome (cont’d)
 Developmental factors:
 Loss of gastric capacity
 Loss of emptying control
 Loss of feedback control by the duodenum
when it is removed
 Late dumping syndrome

30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30
Malabsorption Syndromes
 Maldigestion
 Failure of the chemical processes of digestion
 Malabsorption
 Failure of the intestinal mucosa to absorb
digested nutrients
 Maldigestion and malabsorption frequently
occur together

31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31
Malabsorption Syndromes (cont’d)
 Pancreatic insufficiency
 Insufficient pancreatic enzyme production
• Lipase, amylase, trypsin, or chymotrypsin
 Causes:
• Pancreatitis
• Pancreatic carcinoma
• Pancreatic resection
• Cystic fibrosis
 Fat maldigestion is the main problem, so the
patient will exhibit fatty stools and weight loss

32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32
Malabsorption Syndromes (cont’d)
 Lactase deficiency
 Inability to break down lactose into
monosaccharides and therefore prevent
lactose digestion and monosaccharide
absorption
 Fermentation of lactose by bacteria causes
gas (cramping pain, flatulence, etc.) and
osmotic diarrhea

33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33
Malabsorption Syndromes (cont’d)
 Bile salt deficiency
 Conjugated bile salts needed to emulsify and
absorb fats
 Conjugated bile salts are synthesized from
cholesterol in the liver
 Can result from liver disease and bile
obstructions
 Poor intestinal absorption of lipids causes fatty
stools, diarrhea, and loss of fat-soluble
vitamins (A, D, E, K)

34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34
Malabsorption Syndromes (cont’d)
 Fat-soluble vitamin deficiencies:
 Vitamin A
• Night blindness
 Vitamin D
• Decreased calcium absorption
• Bone pain
• Osteoporosis
• Fractures
 Vitamin K
• Prolonged prothrombin time
• Purpura
• Petechiae
 Vitamin E
• Uncertain

35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35
Inflammatory Bowel Diseases
 Chronic, relapsing inflammatory bowel
disorders of unknown origin
 Genetics
 Alterations of epithelial barrier functions
 Immune reactions to intestinal flora
 Abnormal T cell responses

36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36
Ulcerative Colitis
 Chronic inflammatory disease that causes
ulceration of the colonic mucosa
 Sigmoid colon and rectum
 Suggested causes:
 Infectious
 Immunologic (anticolon antibodies)
 Dietary
 Genetic (supported by family studies and
identical twin studies)

37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37
Ulcerative Colitis (cont’d)
 Symptoms:
 Diarrhea (10 to 20/day)
 Bloody stools
 Cramping
 Treatment:
 Broad-spectrum antibiotics and steroids
 Immunosuppressive agents
 Surgery
 An increased colon cancer risk
demonstrated

38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38
Crohn Disease
 Granulomatous colitis, ileocolitis, or
regional enteritis
 Idiopathic inflammatory disorder; affects
any part of the digestive tract, from mouth
to anus
 Difficult to differentiate from ulcerative
colitis
 Similar risk factors and theories of causation
as ulcerative colitis

39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39
Crohn Disease (cont’d)
 Causes “skip lesions”
 Ulcerations can produce longitudinal and
transverse inflammatory fissures that
extend into the lymphatics
 Anemia may result from malabsorption of
vitamin B12 and folic acid
 Treatment similar to ulcerative colitis

40. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40
Diverticular Disease of the Colon
 Diverticula
 Herniations of mucosa through the muscle
layers of the colon wall, especially the sigmoid
colon
 Diverticulosis
 Asymptomatic diverticular disease
 Diverticulitis
 The inflammatory stage of diverticulosis

41. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41
Appendicitis
 Inflammation of the vermiform appendix
 Possible causes:
 Obstruction, ischemia, increased intraluminal
pressure, infection, ulceration, etc.
 Epigastric and RLQ pain
 Rebound tenderness
 The most serious complication is
peritonitis

42. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42
Irritable Bowel Syndrome
 A functional gastrointestinal disorder with
no specific structural or biochemical
alterations as a cause of disease
 Characterized by recurrent abdominal pain
and discomfort associated with altered
bowel habits that present as diarrhea or
constipation or both
 Associated with anxiety, depression, and
chronic fatigue syndrome

43. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43
Irritable Bowel Syndrome (cont’d)
 Cause unknown but mechanisms
proposed:
 Visceral hypersensitivity
 Abnormal intestinal motility and secretion
 Intestinal infection
 Overgrowth of small intestinal flora
 Food allergy/intolerance
 Psychosocial factors

44. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44
Irritable Bowel Syndrome (cont’d)
 Manifestations:
 Can be diarrhea-predominant or constipation-
predominant
 Alternating diarrhea/constipation, gas, bloating,
and nausea
 Symptoms are usually relieved with
defecation and do not interfere with sleep

45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45
Vascular Insufficiency
 Blood supply to the stomach and intestine
 Celiac axis
 Superior and inferior mesenteric arteries
 Two of three must be compromised to cause
ischemia
 Mesenteric venous thrombosis
 Acute occlusion of mesenteric artery blood
flow
 Chronic mesenteric arterial insufficiency

46. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 46
Obesity
 An increase in body fat mass
 Body mass index greater than 30
 A major cause of morbidity, death, and
increased health care costs
 Risk factor for many diseases and
conditions

47. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 47
Obesity (cont’d)
 Hypothalamus
 Hormones that control appetite and
weight:
 Insulin
 Ghrelin
 Peptide YY
 Leptin
 Adiponectin
 Resistin
 Leptin resistance
 Hyperleptinemia

48. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 48
Obesity (cont’d)

49. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 49
Anorexia Nervosa and Bulimia
Nervosa
 Characteristics:
 Abnormal eating behavior
 Weight regulation
 Disturbed attitudes toward body weight, body
shape, and size

50. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 50
Anorexia Nervosa and Bulimia
Nervosa (cont’d)
 Anorexia nervosa
 A person has poor body image disorder and
refuses to eat
 Anorexic patients can lose 25% to 30% of their
ideal body weight as a result of fat and muscle
depletion
 Can lead to starvation-induced cardiac failure
 In women and girls, anorexia is characterized
by the absence of three consecutive menstrual
periods
 Binge eating/purging anorexia nervosa

51. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 51
Anorexia Nervosa and Bulimia
Nervosa (cont’d)
 Bulimia nervosa
 Body weight remains near normal but with
aspirations for weight loss
 Findings
• Recurrent episodes of binge eating
• Self-induced vomiting
• Two binge-eating episodes per week for at least 3
months
• Fasting to oppose the effect of binge eating, or
excessive exercise

52. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 52
Anorexia Nervosa and Bulimia
Nervosa (cont’d)
 Bulimia nervosa (cont’d)
 Continual vomiting of acidic chyme can cause:
• Pitted teeth
• Pharyngeal and esophageal inflammation
• Tracheoesophageal fistulas
 Overuse of laxative can cause rectal bleeding

53. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 53
Malnutrition and Starvation
 Starvation
 Decreased caloric intake leading to weight loss
 Cachexia
 Short-term starvation
• Glycogenolysis
• Gluconeogenesis
 Long-term starvation
• Marasmus
• Kwashiorkor

54. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 54
Liver Disorders
 Portal hypertension
 Abnormally high blood pressure in the portal
venous system caused by resistance to portal
blood flow
• Prehepatic
• Intrahepatic
• Posthepatic

55. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55
Liver Disorders (cont’d)
 Portal hypertension (cont’d)
 Consequences:
• Varices:
 Lower esophagus
 Stomach
 Rectum
• Splenomegaly
• Ascites
• Hepatic encephalopathy

56. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 56
Varices

57. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 57
Ascites

58. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 58
Ascites (cont’d)

59. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 59
Liver Disorders
 Hepatic encephalopathy
 A neurologic syndrome of impaired cognitive
function, flapping tremor, and EEG changes
 The condition develops rapidly during fulminant
hepatitis or slowly during chronic liver disease
 Cells in the nervous system are vulnerable to
neurotoxins absorbed from the GI tract that,
because of liver dysfunction circulate to the
brain

60. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 60
Liver Disorders (cont’d)
 Jaundice (icterus)
 Obstructive jaundice
• Extrahepatic obstruction
• Intrahepatic obstruction
 Hemolytic jaundice
• Prehepatic jaundice
• Excessive hemolysis of red blood cells or absorption
of a hematoma

61. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 61
Jaundice

62. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 62
Hepatorenal Syndrome
 Renal failure demonstrating oliguria,
sodium and water retention, hypotension,
and peripheral vasodilation as a result of
advanced liver disease

63. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 63
Viral Hepatitis
 Systemic viral disease that primarily
affects the liver
 Hepatitis A
• Formally known as infectious hepatitis
 Hepatitis B
• Formally known as serum hepatitis
 Hepatitis C, D, E, and G

64. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 64
Hepatitis A
 Hepatitis A can be found in the feces, bile,
and sera of infected individuals
 Usually transmitted by the fecal-oral route
 Risk factors:
 Crowded, unsanitary conditions
 Food and water contamination

65. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 65
Hepatitis B
 Transmitted through contact with infected
blood, body fluids, or contaminated
needles
 Maternal transmission can occur if the
mother is infected during the third trimester
 The hepatitis B vaccine prevents
transmission and development of hepatitis
B

66. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66
Hepatitis C
 Hepatitis C is responsible for most cases
of post-transfusion hepatitis
 Also implicated in infections related to IV
drug use
 50% to 80% of hepatitis C cases result in
chronic hepatitis

67. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 67
Hepatitis
 Hepatitis D
 Depends on hepatitis B for replication
 Hepatitis E
 Fecal-oral transmission
 Developing countries
 Hepatitis G
 Recently discovered
 Parentally and sexually transmitted

68. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 68
Hepatitis (cont’d)
 Sequence:
 Incubation phase
 Prodromal (preicteric) phase
 Icteric phase
 Recovery phase
 Chronic active hepatitis
 Fulminant hepatitis
 Results from impairment or necrosis of
hepatocytes

69. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 69
Cirrhosis
 Irreversible inflammatory disease that
disrupts liver function and even structure
 Decreased hepatic function caused by
nodular and fibrotic tissue synthesis
(fibrosis)

70. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 70
Cirrhosis (cont’d)
 Biliary channels become obstructed and
cause portal hypertension
 Because of the hypertension, blood can be
shunted away from the liver, and a hypoxic
necrosis develops

71. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 71
Cirrhosis (cont’d)
 Alcoholic
 The oxidation of alcohol damages hepatocytes
 Biliary (bile canaliculi)
 Cirrhosis begins in the bile canaliculi and ducts
 Primary biliary cirrhosis (autoimmune)
 Secondary biliary cirrhosis (obstruction)

72. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 72
Cirrhosis (cont’d)

73. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 73
Disorders of the Gallbladder
 Obstruction or inflammation (cholecystitis)
is the most common cause of gallbladder
problems
 Cholelithiasis—gallstone formation
 Types:
• Cholesterol (most common)
• Pigmented (cirrhosis)
 Risks:
• Obesity
• Middle age
• Female
• Native American ancestry
• Gallbladder, pancreas, or ileal disease

74. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 74
Disorders of the Gallbladder
(cont’d)
 Gallstones
 Obstruction or inflammation (cholecystitis) is
the most common cause of gallbladder
problems
 Cholesterol stones form in bile that is
supersaturated with cholesterol
 Theories:
• Enzyme defect increases cholesterol synthesis
• Decreased secretion of bile acids to emulsify fats
• Decreased resorption of bile acids from ileum
• Gallbladder smooth muscle hypomotility and stasis
• Genetic predisposition
• Combination of any or all of the above

75. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 75
Gallstones

76. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 76
Disorders of the Pancreas
 Pancreatitis
 Inflammation of the pancreas
 Associated with several other clinical disorders
• Caused by an injury or damage to pancreatic cells
and ducts, causing a leakage of pancreatic enzymes
into the pancreatic tissue
These enzymes cause autodigestion of
pancreatic tissue and leak into the
bloodstream to cause injury to blood
vessels and other organs

77. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 77
Disorders of the Pancreas (cont’d)
 Pancreatitis (cont’d)
 Manifestations and evaluation:
• Epigastric pain radiating to the back
• Fever and leukocytosis
• Hypotension and hypovolemia
 Enzymes increase vascular permeability
• Characterized by an increase in a patient’s serum
amylase level
 Chronic pancreatitis
• Related to chronic alcohol abuse

78. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 78
Cancer of the Gastrointestinal
Tract
 Esophagus
 Stomach
 Colon and rectum
 Liver
 Gallbladder
 Pancreas

79. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 79
Stomach Cancer

80. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 80
Colon Cancer