Chapter 37

Disorders of
Gastrointestinal Function

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Signs and Symptoms Common

to Gastrointestinal Disorders
Anorexia
Nausea
Vomiting
Gastrointestinal bleeding

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Gastrointestinal Tract Bleeding

Hematemesis
Blood in the vomitus
May be bright red or have coffee-grounds appearance
Melena
Blood in the stool
Ranges in color from bright red to tarry black
May be occult (hidden)

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Swallowing
Mechanism
Depends on the coordinated action of the tongue and
pharynx
These structures are innervated by cranial nerves V, IX, X,
and XII.
Alterations
Dysphagia: difficulty in swallowing
Odynophagia: painful swallowing
Achalasia: failure of esophageal sphincter to relax

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Complaints Accompanying Esophageal

Diverticulum
Food stops before it reaches the stomach
Gurgling
Belching
Coughing
Foul-smelling breath

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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gastroesophageal Reflux
Avoid large meals

Heartburn
3060 minutes after
meal

Avoid alcohol use and

smoking

Evening onset

Eat meals sitting up

Pain in epigastric area

that radiates to throat,
shoulder, or back

Avoid recumbent position

several hours after a meal
Avoid bending for long
periods
Sleep with the head elevated
Lose weight if overweight

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Esophageal Cancer
Squamous cell carcinoma
Alcohol and tobacco use
Adenocarcinoma
Barrett esophagus

Dysphagia
Weight loss
Anorexia
Fatigue
Painful swallowing
Not easily diagnosed

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Major Causes of Gastric Irritation

and Ulcer Formation
Aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs)
Irritate the gastric mucosa and inhibit prostaglandin
synthesis
Infection with H. pylori
Thrives in acid environment of the stomach
Disrupts the mucosal barrier that protects the
stomach from harmful effects of its digestive
enzymes
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Gastritis
Acute gastritis
Transient inflammation of the gastric mucosa
Most commonly associated with local irritants such as
bacterial endotoxins, alcohol, and aspirin
Chronic gastritis
Characterized by the absence of grossly visible erosions
and the presence of chronic inflammatory changes
Leads eventually to atrophy of the glandular epithelium of
the stomach

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Major Types of Chronic Gastritis

Helicobacter pylori gastritis
Autoimmune gastritis
Chemical gastropathy

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Helicobacter pylori
Colonizes mucus-secreting epithelial cells of the stomach
Produces enzymes and toxins that have the capacity to
interfere with the local protection of the gastric mucosa
against acid
Produces intense inflammation
Elicits an immune response

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Methods for Establishing Presence of H.

pylori Infection
C urea breath test using a radioactive carbon isotope
Stool antigen test
Endoscopic biopsy for urease testing
Blood tests to obtain serologic titers of H. pylori
antibodies

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Peptic Ulcer
Ulcerative disorders that occur in areas of the upper
gastrointestinal tract that are exposed to acid-pepsin secretions
Spontaneous remissions and exacerbations are common
Causes
H. pylori
Aspirin
Age
Warfarin
Smoking

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Complications of Peptic Ulcer

Hemorrhage
Caused by bleeding from granulation tissue or from
erosion of an ulcer into an artery or vein
Obstruction
Caused by edema, spasm, or contraction of scar
tissue and interference with the free passage of
gastric contents through the pylorus or adjacent
areas

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Complications of Peptic Ulcer (cont.)

Perforation
Occurs when an ulcer erodes through all the layers of
the stomach or duodenum wall

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Treatment of Peptic Ulcer

Eradicate the cause and promote a permanent cure for the
disease
Eradicate H. pylori
Relieve ulcer symptoms
Heal the ulcer crater
Acid-neutralizing, acid-inhibiting, and mucosal-protective
drugs
Antacids
Proton pump inhibitors

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Risk Factors for Development

of Stress Ulcers
Large-surface-area burns
Trauma
Sepsis
Acute respiratory distress syndrome
Severe liver failure
Major surgical procedures
Zollinger-Ellison syndrome

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Risk Factors for Development of Gastric

Cancer
Genetic predisposition
Carcinogenic factors in the diet
Autoimmune gastritis
Gastric adenomas or polyps

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Layers of the Small and Large Intestines

Outer serosal layer
Muscularis layer
Divided into a layer of circular and a layer of
longitudinal muscle fibers
Submucosal layer
Inner mucosal layer
Lines the lumen of the intestine

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Conditions Causing Altered Intestinal

Function
Irritable bowel syndrome
Inflammatory bowel disease
Diverticulitis
Appendicitis
Alterations in bowel motility
Malabsorption syndrome
Cancer of the colon and rectum

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Characteristics of Irritable Bowel

Syndrome
Persistent or recurrent symptoms of abdominal pain
Altered bowel function
Varying complaints of flatulence, bloating
Nausea and anorexia
Constipation or diarrhea
Anxiety or depression

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Inflammatory Bowel Disease

Crohn disease
A recurrent, granulomatous type of inflammatory
response that can affect any area of the
gastrointestinal tract from the mouth to the anus
Ulcerative colitis
A nonspecific inflammatory condition of the colon

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Symptoms of Diverticulitis
Pain in the lower left quadrant
Nausea and vomiting
Tenderness in the lower left quadrant
Slight fever
Elevated white blood cell count

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Common Causes of Constipation

Failure to respond to the urge to defecate
Inadequate fiber in the diet
Inadequate fluid intake
Weakness of the abdominal muscles
Inactivity and bed rest
Pregnancy
Hemorrhoids

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Fecal Impaction
Painful anorectal disease
Tumors
Neurogenic disease
Use of constipating antacids or bulk laxatives
A low-residue diet
Drug-induced colonic stasis
Prolonged bed rest and debility

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Intestinal Obstruction
Mechanical

Abdominal distention

Paralytic

Loss of fluids and

electrolytes

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Peritoneal Cavity and Peritonitis

Perforated peptic ulcer
Ruptured appendix
Perforated diverticulum
Gangrenous bowel
Pelvic inflammatory disease
Gangrenous gallbladder
Abdominal trauma and wounds
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Intestinal Malabsorption
Failure to transport dietary
constituents from the lumen
of the intestine to the
extracellular fluid
Causes
Celiac disease
Inflammatory
reaction

Symptoms
Diarrhea
Steatorrhea
Flatulence
Bloating
Abdominal pain

Neoplasm

Cramps

Colorectal cancer

Weakness, muscle
wasting
Weight loss and
abdominal distention

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Manifestations of Classic Form

of Celiac Disease
Presents in infancy
Manifests as
Failure to thrive
Diarrhea
Abdominal distention
Occasionally, severe malnutrition

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Colorectal Cancers
Age

Stool occult blood tests

Family history

Digital rectal
examination

Crohn disease
Ulcerative colitis
Familial adenomatous
polyposis
Diet

x-ray studies using

barium (e.g., barium
enema)
Flexible sigmoidoscopy
and colonoscopy

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Ischemic bowel disease

Acute or chronic mesenteric ischemia
Cardiovascular disease
AMIEMERGENCYsevere pain out of proportion to
findings
Urgent CT..angiography
Intestinal infarction..sepsis..perforation..shock
CMI..abdominal angina

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Intestinal Infarction

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