Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Chapter 10 Diseases of the Digestive System Multimedia Asset Directory
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Organs of the Digestive System Mouth Salivary glands Pharynx Esophagus Stomach Liver Gallbladder (GB) Pancreas Small intestine Large intestine Rectum Anus
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Main Functions Digesting food – Physical and chemical breakdown of large food into molecules: glucose, triglycerides, amino acids Absorbing nutrients – From intestines – Circulated through the body by cardiovascular system Eliminating waste – Any food that cannot be digested or absorbed is expelled
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Pharynx After the food leaves the mouth it enters the oropharynx Laryngopharynx Epiglottis – Covers the larynx and trachea – Food is shunted away from the lungs into esophagus
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Sphincters Muscular valves Control flow of food in one direction only Cardiac sphincter located near the heart Lower esophageal sphincter keeps food from backing up into the esophagus Pyloric sphincter opens and closes – Allows small amount of highly acidic chyme to enter small intestines at a time – Pylor/o means gatekeeper
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Small Intestines or Small Bowel Duodenum (10–12 inches) Ileocecal valve (where ileum connects to colon) Ileum (about 12 feet in length) Jejunum (about 8 feet long) Averages 20 feet of intestines Longest portion of alimentary canal
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Rectum and Anus Rectum is area for storage of feces Leads to the anus, the external opening of the alimentary canal Feces are evacuated Defecation
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Accessory Organs of the Digestive System Gallbladder Liver Pancreas Salivary glands Generally function by producing enzymes necessary for chemical breakdown of food
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Salivary Glands Three pairs Produce saliva – Parotid glands Allow food to be – Sublingual glands swallowed without – Submandibular glands choking Saliva + food = bolus Contain amylase that begins digestion of carbohydrates
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Liver Large organ Located in right upper quadrant of abdomen Processes nutrients Detoxifies harmful substances Produces bile – Emulsification
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Pancreas Produces pancreatic enzymes Chemically digest: – Carbohydrates – Fats – Proteins
Also an endocrine gland
Produces insulin and glucagon – Regulate levels of glucose in blood
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Digestion – Small Intestine Food passes from the stomach into the small intestine through a sphincter muscle, the pyloric sphincter. – This sphincter is closed until it receives nerve and hormonal signals to relax and open. The moistened food, referred to as chyme at this stage, is propelled along its course by rhythmical smooth muscle contractions called peristalsis. The greatest amount of digestion occurs in the first part of the small intestine, the duodenum. – Intestinal juice contains mucus and is rich in enzymes. Here digestive substances from other organs enter by means of ducts. The pancreas secretes enzymes for the digestion of protein, lipid, and carbohydrate. It also secretes an alkaline solution for the neutralization of acid carried into the small intestine from the stomach. This pancreatic juice enters the duodenum through the pancreatic duct.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Digestion – Liver Bile, secreted by the liver and stored in the gallbladder, enters the duodenum through the common bile duct. Bile is not an enzyme but an emulsifier, a substance that reduces large fat droplets into much smaller fat droplets. The action of bile enables the lipid enzymes to digest fat into small, absorbable units. When digestion is complete, the nutrients are absorbed into blood capillaries and lymph vessels in the intestinal wall. The inner surface of the small intestine is arranged to provide the greatest amount of surface area possible for digestion and absorption. This mucosal surface contains numerous fingerlike projections called villi, each of which contains capillaries and lymph vessels for absorption.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diseases of the Mouth Oral inflammation caused by local infection of the mouth with bacteria, viruses, or fungi, or it may be a sign of a systemic infection Stomatitis refers to a widespread inflammation of oral tissue. Depending on the cause, inflammation may appear as patches, ulcers, redness, bleeding, or necrosis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diseases of the Mouth (continued) Streptococci, spread in salivary and respiratory droplets, are a common cause of oral bacterial infections, resulting in red, swollen mucosa. Bacteria also cause canker sores, small circular lesions with a red border. – These painful lesions heal without scars after a week. Neisseria gonorrhea, the cause of the sexually transmitted disease gonorrhea, causes painful ulcerations in the mouth and throat. Also sexually transmitted, Treponema pallidum causes syphilis, which causes oral chancres and ulcerations. These bacterial infections are treated with antibiotics.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Herpes Simplex – Mouth A common cause of oral virus infections; transmitted by oral-genital contact, herpes simplex type 2 causes vesicles that rupture to form ulcers These lesions can appear inside and outside the mouth. Herpes simplex type 1 can also be acquired from salivary droplets. Pain makes eating, drinking, and swallowing difficult. – The symptoms typically subside within two weeks when the viruses move from the area to nerve tissue known as ganglia. The infection can be reactivated following stressful events or suppression of immune function. Treatment is aimed at reducing inflammation and pain with systemic anti-inflammatory and analgesic medications or topical anesthetics.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cancer of the Esophagus Relatively uncommon, cancer of the esophagus narrows the lumen, causing the principal symptom, dysphagia. The obstruction causes vomiting, and the person may experience a bad taste in his or her mouth or bad breath. There is accompanying weight loss because of the inability to eat. The carcinoma spreads into adjacent organs and to remote sites through the lymph vessels. It frequently metastasizes before it is detected. Prognosis for cancer of the esophagus is poor. Like mouth cancer, tobacco and alcohol use are major risk factors.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Esophageal Varices Varicose veins that develop in the esophagus are called esophageal varices. They result from pressure within the veins, causing the veins to appear very dilated and knotty. Increased pressure develops when venous return to the liver is obstructed, as happens in cirrhosis. The most serious danger in esophageal varices is hemorrhage. Bleeding esophageal varices require emergency treatment. Infusion of vasopressin may reduce bleeding. Bleeding can be stopped with pressure on the varices by inserting a Minnesota or Sengstaken-Blakemore tube. Surgical bypass of the portal vein to systemic flow may reduce pressure in the veins and thus stop bleeding, but will not repair liver damage and ultimately may not improve the prognosis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Esophagitis Esophagitis, inflammation of the esophagus, causes burning chest pains, known as “heartburn,” which can resemble the pain of heart disease. The pain may follow eating or drinking, and some vomiting of blood may occur. The most common cause of esophagitis is a reflux, a backflow of the acid contents of the stomach. – This is caused by an incompetent cardiac sphincter, which normally prevents stomach contents from ascending the esophagus. The acid of the stomach irritates the lining of the esophagus and stimulates an inflammatory response. Treatment includes a nonirritating diet, antacids, and acid reducing medications. Frequent small meals are recommended. Alcohol is an irritant to the inflamed mucosal lining and should be avoided.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Hiatal Hernia A hernia is the protrusion of part of an organ through a muscular wall or body opening. A hiatal hernia is the protrusion of part of the stomach through the diaphragm at the point where the esophagus joins the stomach. Symptoms include – Indigestion and heartburn after eating and possibly shortness of breath – Avoidance of irritants such as spicy foods and caffeine and frequent small meals may be adequate treatment. If the person is obese, weight loss is recommended. Surgery is often required to correct the defect.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Gastritis Acute gastritis is an inflammation of the stomach caused by irritants such as aspirin, excessive coffee, tobacco, alcohol, or by an infection. Vomiting of blood frequently occurs as the principal symptom. Gastroscopy is extremely valuable in diagnosing this disease. Alcohol stimulates acid secretion, which irritates the mucosa.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Food Contaminants (continued) One of the common forms of food poisoning is caused by the bacterium Salmonella. – These bacteria invade the intestinal mucosa and cause sudden, colicky abdominal pain, nausea, vomiting, and sometimes bloody diarrhea and fever that begins approximately 6 to 48 hours after eating contaminated food and lasts up to 2 weeks. A stool culture can identify the bacteria. Salmonella food poisoning (salmonellosis) is associated with contaminated eggs and poultry, but most any food may harbor the bacteria.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Food Contaminants (continued) Treatment usually consists of replenishing water, electrolytes, and nutrients. Elderly individuals, young children, and immunocompromised people are at risk of developing serious infection, and they may require more intervention, including a short course of antibiotics and anti-diarrheal medications.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cancer of the Stomach Carcinoma of the stomach may be a large mass projecting into the lumen of the stomach or it may invade the stomach wall, causing it to thicken. As the tumor grows, the lumen is narrowed to the point of obstruction. The remainder of the stomach becomes extremely dilated due to the blockage, and pain is experienced from the pressure on nerve endings. Infection frequently accompanies cancer, which causes additional pain. Carcinoma of the stomach may be very advanced before it is detected. It may even have spread to the liver and surrounding organs through the lymph and blood vessels.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cancer of the Stomach (continued) Early symptoms are vague and include loss of appetite, heartburn, and general stomach distress. Blood may be vomited or appear in the feces. Pernicious anemia generally accompanies cancer of the stomach, because the gastric mucosa fails to secrete intrinsic factor. Gastric analysis by means of a stomach tube demonstrates the absence of hydrochloric acid, or achlorhydria. Biopsy of any lesions seen through the gastroscope is an essential diagnostic procedure for carcinoma of the stomach.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Etiology of Gastric Carcinoma The etiology of this malignancy is not known, but current research suggests an association with the consumption of preserved, salted, cured foods, and a diet low in fresh fruits and vegetables. It is more common in men than women. H. pylori infection appears to increase the risk for stomach cancer, probably through its damaging effects on the mucosal cells. Good prognosis for this disease depends on early detection and treatment.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diseases of the Intestines The small intestine is the site of most of the digestion and absorption that occurs in the digestive tract, while the large intestine absorbs remaining water and stores and concentrates the feces. Diseases in these areas may manifest themselves as diarrhea, constipation, changes in stool characteristics, or in secondary diseases that arise as a result of poor nutrition.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Appendicitis Appendicitis is an acute inflammation of the appendix. The pain of appendicitis often begins in the middle of the abdomen and shifts to the lower right quadrant. – Nausea, vomiting, and fever are often symptoms. The wormlike shape of the appendix and its location on the cecum make it a trap for fecal material, which contains bacteria, particularly Escherichia coli. – Obstruction with fecal material and infections cause the appendix to become swollen, red, and covered with an inflammatory exudate.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Appendicitis (continued) The pain of appendicitis often begins in the middle of the abdomen and shifts to the lower right quadrant. (continued) – Because the swelling interferes with circulation to the appendix, it is possible for gangrene to develop. The appendix then becomes green and black. – The wall of the appendix can become thin and rupture, spilling fecal material into the peritoneal cavity, causing peritonitis. Before antibiotic treatment, peritonitis was almost always fatal. Rupture of the appendix tends to give relief from the pain, which is very misleading. – Surgery should be performed before rupture occurs.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Malabsorption Syndrome Inability to absorb fat or some other substance from the small intestine is called malabsorption syndrome. Symptoms of malnutrition, including lack of energy and inability to maintain weight, result. Because fat cannot be absorbed from the intestine, it passes into the feces, and the result is unformed, fatty, pale stools that have a foul odor. The fat content causes the stools to float.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Complications Defective mucosal cells can account for the abnormal absorption. Many other diseases cause secondary malabsorption syndrome. – Diseased pancreas or blocked pancreatic duct deprives the small intestine of lipases. In the absence of the enzymes, fat is not digested and cannot be absorbed. Inadequate bile secretion, due to liver disease or a blocked bile duct, will also prevent lipid digestion and cause secondary malabsorption.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Complications (continued) One of the complications of the malabsorption syndrome is a bleeding tendency. Vitamin K, a fat-soluble vitamin that is essential to the blood- clotting mechanism, cannot be absorbed. Treatment for malabsorption syndrome depends on its cause, and diet is carefully controlled. Supplements are administered, such as the fat- soluble vitamins A, D, E, and K.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diverticulitis Diverticula are little pouches or sacs formed when the mucosal lining pushes through the underlying muscle layer. Diverticulitis is an inflammation of the diverticula. – This may occur in the colon or in the small intestines. The inflammation occurs when the sacs become impacted with fecal material and bacteria. Symptoms include low, cramp-like pain, usually on the left side of the abdomen. Obstruction of the intestine can develop and abscesses frequently form. Antibiotic therapy, together with a controlled diet, is usually effective.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Chronic Ulcerative Colitis (continued) The colon with chronic ulcerative colitis has a characteristic appearance on x-ray examination. The normal pouch-like markings of the colon, the haustra, are lacking. The colon appears straight and rigid, and it is referred to as a pipe- stem colon. There is a risk of a colon malignancy developing as a complication of long-standing ulcerative colitis. The cause is unclear.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Intestinal Obstruction (continued) Adhesions, the linking together of two surfaces normally separate, can distort the tract. Abdominal adhesions sometimes follow surgery, when fibrous connective tissue grows around the incision. Adhesions also develop as a result of inflammation. Another type of organic obstruction is intussusception, in which a segment of intestine telescopes into the part forward to it. This occurs more often in children than in adults.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Spastic Colon (continued) Laxatives should not be used. Adding fiber to the diet helps prevent constipation. Emotional stress has an adverse effect on the digestive system, because the nerves of the autonomic nervous system affect digestion. If stressful situations can be alleviated, the colon will function more normally.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Dysentery Dysentery is an acute inflammation of the colon, a colitis. The major symptom of dysentery is diarrhea in which the stools contain pus, blood, and mucus. Severe abdominal pain accompanies the diarrhea. Bacteria, parasitic worms, and other microorganisms can cause dysentery. The protozoan Entamoeba histolytica, which is transmitted in feces-contaminated food and water, causes amoebic dysentery.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Dysentery (continued) Organisms invade the wall of the colon and cause numerous ulcerations, which account for the pus and blood in the stools. Bacillary dysentery is caused by various species of gram negative bacteria in the genus Shigella. Antibiotics can be effective for bacillary dysentery, and amebicides that are poorly absorbed are used for amoebic dysentery.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Occult Bleeding Microscopic examination of stool may identify the cause of food poisoning, gastroenteritis, or dysentery. If the blood in the stools is bright red, the bleeding is from the distal end of the colon, the rectum. Streaks of red blood can indicate bleeding hemorrhoids. This symptom can also indicate cancer of the rectum.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Functions of the Liver (continued) The liver plays an important role in maintaining the proper level of glucose in the blood. It takes up excess glucose, storing it as glycogen. – When the level of circulating glucose falls below normal, the liver converts glycogen into glucose, which is then released into the blood. The liver also stores iron and vitamins.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Manifestations of Liver Disease Liver disease manifests itself when chronic damage to liver cells cannot be repaired. When fibrous tissue replaces liver cells, the normal functions of the liver become impaired. Jaundice, a yellow or orange discoloration of the skin, tissues, and the whites of the eyes, is caused by a build-up of bilirubin, a pigment that is normally secreted in the bile and removed from the body in the feces.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Hepatitis C Hepatitis C is the leading viral cause of chronic liver disease and cirrhosis, and is now the most common reason for liver transplants. The disease persists for months, even years. About 20% of infected persons develop cirrhosis, and a number of these can lead to end-stage liver disease. It is transmitted mostly through blood transfusions, although transmission has been traced to intravenous drug use and sexual contact with someone with hepatitis Treatment of hepatitis C includes interferon injections and oral ribavirin. Treatment for end-stage cirrhosis may include liver transplant.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Hepatitis A Known as Infectious hepatitis, it is the least serious form and can develop as an isolated case or in an epidemic The incubation period, the time from exposure to the development of symptoms, is from 2 to 6 weeks. The symptoms include anorexia, nausea, and mild fever. The urine becomes dark in color, and jaundice appears in some cases. On examination, the liver may be found to be enlarged and tender.
A cirrhotic liver loses this organization and, as a
result, the liver cannot function. Liver cells die and are replaced by fibrous connective tissue and scar tissue. This tissue has none of the liver cell functions. At first, the liver is generally enlarged due to regeneration but then becomes smaller as the fibrous connective tissue contracts. The surface acquires a nodular appearance. This is sometimes referred to as a “hobnailed” liver.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cirrhosis of Liver and Blockage (continued) When the liver fails to produce adequate amounts of albumin, an albumin deficiency (hypoalbuminemia) develops and fluid leaks out of the blood vessels, causing edema. Blockage of the bile ducts, like that of the blood vessels, follows the disorganization of the liver. Bile accumulates in the blood, leading to jaundice and, because bile is not secreted into the duodenum, stools are clay-colored. The excess of bile, carried by the blood to the kidneys, gives a dark color to urine.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Hepatocarcinoma Cancer of the liver, is sometimes a complication of cirrhosis The symptoms of hepatocarcinoma vary according to the site of the tumor. If the tumor is obstructing the portal vein, ascites develops in the abdominal cavity, as it does in cirrhosis. If the fluid is found to contain blood, a malignancy is indicated. A tumor blocking the bile duct will cause jaundice. General symptoms may include loss of weight, an abdominal mass, and pain in the upper right quadrant of the abdomen.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Hepatocarcinoma (continued) More often, cancer detected in the liver is a result of metastasis from other organs, such as the breast, colon, or pancreas. These tumors are secondary carcinomas. Because of the arrangement of blood and lymphatic vessels through the liver, it is a frequent site of metastases. A high percentage of people who die of cancer are found to have had liver metastases. A malignancy of the gallbladder or pancreas can grow into the liver. Prognosis for cancer of the liver is poor. Usually, the malignancy has developed elsewhere and has spread to the liver. Techniques such as the liver scan and needle biopsy are used in diagnosing the condition.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cholecystitis An inflammation of the gallbladder Symptoms include pain under the right rib cage that radiates to the right shoulder, chills and fever; nausea and vomiting, distress after eating fatty foods. Prolonged inflammation causes the gallbladder to lose its ability to concentrate bile. The walls of the gallbladder may thicken, making it impossible for the gallbladder to contract properly.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diagnosis and Treatment of Gallstones Gallstones can be located by sonography and x-ray. The usual treatment for cholecystitis and cholelithiasis is surgical removal of the gallbladder, a cholecystectomy. The cystic duct is then ligated, and the common bile duct examined for stones. Occasionally, undetected cholesterol stones are retained in the common bile duct after surgery. These stones have been successfully dissolved by administering a solubilizing agent through a catheter into the bile duct. This prevents the necessity of repeated surgery.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Acute Pancreatitis (continued) Secondary malabsorption syndrome develops, because fat that is not digested cannot be absorbed. In pancreatitis, the protein- and lipid-digesting enzymes become activated within the pancreas and begin to digest the organ itself. – Severe necrosis and edema of the pancreas result. The digestion can extend into blood vessels, which, of course, causes bleeding; if hemorrhaging occurs, the person may go into shock. When the condition becomes this severe, it is called acute hemorrhagic pancreatitis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Diagnosis of Pancreatitis Several factors can cause pancreatitis, but the most common one is excessive alcohol consumption. Inflammation of pancreatic ducts can also be caused by the presence of gallstones. Many cases of pancreatitis cannot be attributed to either of these causes. The etiology is said to be idiopathic—its cause is unknown. Pancreatitis is more common in women than in men and usually occurs after age 40. The most significant diagnostic procedures for pancreatitis are blood tests and urine tests. High levels of pancreatic enzymes, particularly amylase, confirm the diagnosis of pancreatitis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cancer of the Pancreas (Adenocarcinoma) Associated with high mortality rate If the malignancy is in the head of the pancreas, it can block the common bile duct. This will give earlier symptoms than cancer in the body or tail, which can be very advanced before it is discovered. Obstruction of the bile duct causes jaundice and impairs digestion because the pancreatic enzymes and bile cannot enter the duodenum. This causes malabsorption of fat, clay-colored stools, and weight loss.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond Upper Saddle River, New Jersey 07458 Human Diseases: A Systemic Approach, 6e All rights reserved. Cancer of the Pancreas (Adenocarcinoma) (continued) Severe pain is experienced as the tumor grows, and the cancer usually metastasizes to the surrounding organs: the duodenum, stomach, and liver. Prognosis for cancer of the pancreas is poor, and death usually occurs in a relatively short time. Pancreatic cancer is linked to cigarette smoking, high- protein and -fat diets, food additives, and exposure to industrial chemicals like beta-naphthalene, benzidine, and urea. Chronic alcohol abuse, chronic pancreatitis, and diabetes mellitus may increase the risk of developing pancreatic cancer. It occurs more frequently in males than in females.