Gastrointestinal System

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GIT4: Inflammatory BowelGIT4: Inflammatory Bowel
DiseasesDiseasesDR GAN SENG CHIEWDR GAN SENG CHIEW
Associate ProfessorAssociate Professor
Faculty of Medicine & Health Sciences
University Tunku Abdul Rahman

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Digestive Diseases
• Stomach Diseases include non-cancerous disorders and
gastric malignancies.
• Non-cancerous conditions we include peptic ulcers, acid
hypersecretory conditions such as Zollinger-Ellison
syndrome, and gastrointestinal bleeding. Stomach cancer,
also called gastric cancer or malignancies, may include
cancer of the upper part of the stomach where it meets
the esophagus, and is called gastric cardia cancer.
Stomach cancer that occurs in the lower stomach is called
non-cardia gastric cancer.
• Anorectal Diseases ; Celiac Disease ; Colorectal Cancer;
Esophageal Diseases ; Functional Dyspepsia;
Inflammatory Bowel Disease (IBD): Ulcerative Colitis,
Crohn's Disease &
Irritable Bowel Syndrome.

4. Watermelon stomach
• Characterized by the
presence of blood vessel
lesions in the lower part
of the stomach, called
the antrum. These
vessels are twisted and
dilated and radiate
outward from the
pylorus .
• The lesions resemble the
dark stripes on the
surface of a
watermelon .
Symptoms may include sudden (acute) hemorrhage,
chronic occult bleeding, and anemia.
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5. Abdominal Migraine
• Abdominal migraine is one of the variants of migraine
headache. It is also known by other terms including "periodic
syndrome." This variant most typically occurs in children. They
usually have a family history of migraine and go on to develop
typical migraine later in their life.
• The attacks are characterized by periodic bouts of moderate
to severe midline abdominal pain lasting for 1-72 hours. Along
with the abdominal pain they may have other symptoms such
as nausea and vomiting, flushing or pallor. Tests fail to reveal a
gastro-intestinal cause for the pain. Medications that are
useful for treating migraine work to control these attacks in
most children including daily preventive medications and anti-
nausea medications to take during the attack.
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6. Dumping syndrome
• Dumping syndrome is a group of symptoms developed after
surgery to remove all or part of your stomach, or the stomach
has been surgically bypassed to help lose weight. Also called
rapid gastric emptying, dumping syndrome occurs when the
undigested contents of the stomach are transported or
"dumped" into the small intestine too rapidly. Common
symptoms include abdominal cramps and nausea.
• In dumping syndrome, food and gastric juices from your
stomach move to your small intestine in an unregulated,
abnormally fast manner.
• Dumping syndrome often improves on its own without
medical treatment or after adjusting the diet. In more-serious
cases of dumping syndrome, medication or surgery may be
needed.
• Some experienced low blood sugar (hypoglycemia), related to
excessive levels of insulin delivered to the bloodstream as part
of the syndrome. Insulin influences your tissues to take up the
sugar present in your bloodstream. 6DR S C GAN FMHS/UTAR 09102012

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Gas in the Digestive
Tract
• Everyone has gas in the digestive tract.
• Gas comes from two main sources: swallowed air and
normal breakdown of certain foods by harmless bacteria
naturally present in the large intestine.
• Many foods with carbohydrates can cause gas. Fats and
proteins cause little gas.
• Foods that may cause gas include beans, vegetables,
such as broccoli, cabbage, brussels sprouts, onions,
artichokes, and asparagus; fruits, such as pears, apples,
and peaches; whole grains, such as whole wheat and
bran; soft drinks and fruit drinks; milk and milk products,
such as cheese and ice cream, and packaged foods
prepared with lactose, such as bread, cereal, and salad
dressing; foods containing sorbitol, such as dietetic foods
and sugar-free candies and gums

8. • The most common symptoms of gas are belching,
flatulence, bloating, and abdominal pain. However, some
of these symptoms may be caused by an intestinal
disorder, such as IBS, rather than too much gas.
• The most common ways to reduce the discomfort of gas
are changing one’s diet, taking digestive enzymes to help
digest carbohydrates, and reducing the amount of air
swallowed.
• Everyone has gas and eliminates it by burping or passing it
through the rectum. However, many people think they have
too much gas when they really have normal amounts. Most
people produce about 1 to 4 pints a day and pass gas
about 14 times a day.
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9. Gastroparesis
• Gastroparesis, also called delayed gastric emptying, is a disorder in
which the stomach takes too long to empty its contents.
Gastroparesis occurs when the vagus nerve is damaged and the
muscles of the stomach and intestines do not work normally. Food
then moves slowly or stops moving through the digestive tract.
• The most common cause of gastroparesis is diabetes; high blood
glucose can damage the vagus nerve.
• Many people have what is called idiopathic gastroparesis, meaning
the cause is unknown and cannot be found even after medical tests.
• Symptoms of gastroparesis include early fullness, abdominal pain,
stomach spasms, heartburn, nausea, vomiting, bloating,
gastroesophageal reflux, lack of appetite, and weight loss.
• Eating solid foods, high-fiber foods such as raw fruits and
vegetables, fatty foods, or drinks high in fat or carbonation may
contribute to these symptoms.
• Gastroparesis is diagnosed with tests such as x rays, manometry,
and gastric emptying scans.
• Treatment includes dietary changes, oral medications, adjustments
in insulin injections for people with diabetes, a jejunostomy tube,
parenteral nutrition, gastric neurostimulators, or botulinum toxin.
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10. Ménétrier Disease
• Ménétrier disease causes the ridges along the inside of the stomach
wall—called rugae—to enlarge, forming giant folds in the lining of the
stomach.
• Ménétrier disease is rare and more common in men, usually
appearing between the ages of 30 and 60.
• Recent studies suggest people with Ménétrier disease have stomachs
that make abnormally high amounts of transforming growth factor
alpha (TGF-α)—a protein that tells cells what to do.
• Ménétrier disease is diagnosed through x rays, endoscopy, and
biopsy of stomach tissue.
• Treatment for Ménétrier disease may include medications to relieve
nausea and pain and surgery to remove part or all of the stomach.
• Other conditions that can cause enlarged rugae but are not
Ménétrier disease include
Zollinger-Ellison syndrome—a condition in which tumors in the
pancreas cause the stomach to make too much acid
syphilis—a type of sexually transmitted bacterial infection
cytomegalovirus—a type of viral infection
histoplasmosis—a type of fungal infection
linitis plastica—a type of gastric cancer
gastric lymphoma—a type of cancer originating in the stomach
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11. Motility Disorders of the
Stomach
• Examples of stomach (gastric) motility disorders include
delayed gastric emptying (gastroparesis), rapid gastric
emptying (dumping syndrome), and functional dyspepsia.
• For each area of the GI tract, there are different GI motility
tests that assess different functions. Gastrointestinal motility
testing provides physicians with important information for
patient care including:
i. Correct diagnosis of GI motility disorders,
ii. A guide for treatment of patients, and
iii. Prognostic information of the patient.
• Sources :
Bruce A. Orkin, MD. Physiological Testing of the Colon, Rectum
and Anus. IFFGD Fact Sheet No. 111; 1993.
Henry Parkmann, MD. "On-Tract: Topics in Gut Motility,"
Digestive Health Matters. Vol 14 No 4; 2005.
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12. Stomach noise
• Stomach noise — such as rumbling, gurgling and growling — typically
is due to normal digestion. Stomach growling can occur when
hungry. But it can also occur after eating or between meals when
food is passing through the intestines.
• Hunger and appetite are controlled by a complex system of hormone-
like substances primarily made by the digestive system. When the
body has not eaten for a while, these substances are released and
cause the hypothalamus to "switch on" the desire to eat. A message
is then sent to the stomach and intestines. This triggers muscle
contractions and the release of acids and other digestive fluids —
which causes the rumbling, grumbling sounds you hear — as the
body prepares to eat. The thought, sight or smell of food also can
trigger this response.
• Sometimes excessive stomach noise can be a symptom of an
underlying gastrointestinal disorder, such as irritable bowel
syndrome. But in such cases, stomach noise usually is accompanied
by other signs and symptoms such as bloating, cramping, diarrhea or
excess gas.
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13. Stomach polyps
• Stomach polyps are masses of cells that form on the inside
lining of your stomach.
• Stomach polyps usually don't cause symptoms. However, as a
stomach polyp enlarges, ulcers may develop on its surface, or
rarely, the polyp may block the opening between your
stomach and your small intestine.
• Stomach polyps form in response to inflammation or other
damage to the lining of the stomach.
• The most common types of stomach polyps are:
i. Hyperplastic polyps form as a reaction to chronic
inflammation in the cells that line the inside of the stomach.
ii. Fundic gland polyps form from the glandular cells that are
found on the inside lining of the stomach.
iii. Adenomas form from the glandular cells found on the
inside lining of the stomach. But when adenomas form, their
cells develop errors in their DNA. These changes make the
cells vulnerable to becoming cancerous.
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14. • Factors that increase your chances of developing stomach
polyps are:
i. Increasing age.
ii. Bacterial stomach infection.
iii. An inherited colon cancer syndrome.
• Tests and procedures used to diagnose stomach polyps
include:
i. Using a scope to see inside your stomach.
ii. Removing a sample of tissue for testing (biopsy).
• Treatment may not be necessary
Small polyps that aren't adenomas may not require treatment.
These polyps typically don't cause signs and symptoms and
only rarely become cancerous.
i. Removing adenomas and large stomach polyps
ii. Stopping H. pylori infection to treat and prevent polyps
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15. The Dangers of Aspirin &
NSAIDS
• The second major cause for ulcers is irritation of the stomach
arising from regular use of non-steroidal anti-inflammatory
drugs, or NSAIDs.
• What are the Complications of Ulcers?
Bleeding: Internal bleeding in the stomach or the duodenum.
Perforation: When ulcers are left untreated, digestive juices
and stomach acid can literally eat a hole in the intestinal
lining, a serious medical problem that requires hospitalization,
and often surgery.
Obstruction: Swelling and scarring from an ulcer may close the
outlet of the stomach, preventing food to pass and causing
vomiting and weight loss.
• Conventional treatments for ulcers (classes of prescription
ulcer drugs called H2 blockers and proton pump inhibitors),
have been found to have a beneficial effect in treating NSAID-
induced ulcers and in preventing GI bleeding.
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16. Abdominal Pain Symptoms
Symptoms that occur with abdominal pain
include:
Back pain
Chest pain
Constipation
Coughing
Diarrhea
Difficulty breathing
Fever
Nausea
Pain during urination
Urinary frequency
Vaginal bleeding
Vaginal discharge
Vomiting
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17. Locations of the pain
• Pain may be generalized or occur all over the
abdomen
• Pain may be localized to one area of the
abdomen:
Left lower abdominal pain
Left upper abdominal pain
Right lower abdominal pain
Right upper abdominal pain
• Pain may be in the upper middle abdomen
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18. Some important
characteristics of abdominal
pain
Pain is continuous
Pain comes and goes
Pain is cramping
Pain is sharp or stabbing
Pain travels to your back, flank, or groin
Pain worsens with movement
Pain seems unrelated to movement
Pain is relieved by a bowel movement
Pain is relieved by antacids
Pain is relieved by urinating
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