ANATOMY OF THE HUMAN DIGESTIVE SYSTEM

DIGESTIVE SYSTEM DIAGRAM

DIGESTIVE SYSTEM GLOSSARY

1.anus - the opening at the end of the digestive system from which feces (waste) exits the body. 2.appendix - a small sac located on the cecum. 3.ascending colon - the part of the large intestine that run upwards; it is located after the cecum. 4.bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine. 5.cecum - the first part of the large intestine; the appendix is connected to the cecum. 6.chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion. 7.descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon. 8.duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.

DIGESTIVE SYSTEM GLOSSARY

9.epiglottis - the flap at the back of the tongue that keeps chewed food from Going down the windpipe to the lungs. When you swallow, the epiglottis Automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe. 10.esophagus - the long tube between the mouth and the stomach. It uses Rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach. 11.gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine. 12.ileum - the last part of the small intestine before the large intestine begins. 13.jejunum - the long, coiled mid-section of the small intestine; it is between the Duodenum and the ileum.

DIGESTIVE SYSTEM GLOSSARY

14.liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and some blood proteins. 15.mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food). 16.pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small intestine. 17.peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat and drink while upside-down. 18.rectum - the lower part of the large intestine, where feces are stored before they are excreted.

DIGESTIVE SYSTEM GLOSSARY

19.salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules. 20.sigmoid colon - the part of the large intestine betweenthe descending colon and the rectum 21.stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in a bath of acids and enzymes. 22.transverse colon - the part of the large intestine that runs horizontally across the abdomen.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM

1.Appendicitis - Appendicitis is an inflammation of the appendix, a 3 1/2-inchlong tube of tissue that extends from the large intestine. No one is absolutely certain what the function of the appendix is. One thing we do know: We can live without it, without apparent consequences. - Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity's lining (the peritoneum) that can be fatal unless it is treated quickly with strong antibiotics.

What is appendicitis and what causes appendicitis? Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in the appendix may swell and block the appendix. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside the appendix.. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue, for example, inflammation, that line the wall of the appendix.)

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a peri-appendiceal abscess). Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. The patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.

*What Causes Appendicitis? Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer. Blockage may also occur from infection, since the appendix swells in response to any infection in the body.

*What Are the Symptoms of Appendicitis? The classic symptoms of appendicitis include: Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign. Loss of appetite Nausea and/or vomiting soon after abdominal pain begins Abdominal swelling Fever of 99 F to 102 F Inability to pass gas Almost half the time, other symptoms of appendicitis appear, including: Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum Painful urination Vomiting that precedes the abdominal pain Severe cramps Constipation or diarrhea with gas

*Complications of appendicitis
The most frequent complication of appendicitis is perforation. Perforation of the appendix can lead to a periappendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis). The major reason for appendiceal perforation is delay in diagnosis and treatment. In general, the longer the delay between diagnosis and surgery, the more likely is perforation. The risk of perforation 36 hours after the onset of symptoms is at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay. A less common complication of appendicitis is blockage of the intestine. Blockage occurs when the inflammation surrounding the appendix causes the intestinal muscle to stop working, and this prevents the intestinal contents from passing. If the intestine above the blockage begins to fill with liquid and gas, the abdomen distends and nausea and vomiting may occur. It then may be necessary to drain the contents of the intestine through a tube passed through the nose and esophagus and into the stomach and intestine. A feared complication of appendicitis is sepsis, a condition in which infecting bacteria enter the blood and travel to other parts of the body. This is a very serious, even life-threatening complication. Fortunately, it occurs infrequently.

*Call your doctor if: You have pain that matches these symptoms. Do not eat, drink, or use any pain remedies, antacids, laxatives, or heating pads, which can cause an inflamed appendix to rupture. If you have any of the mentioned symptoms seek medical attention immediately since timely diagnosis and treatment is very important. If you have any of the mentioned symptoms, seek medical attention immediately since timely diagnosis and treatment is very important.

*The following tests are usually used to make the diagnosis. Abdominal exam to detect inflammation Urine test to rule out a urinary tract infection Rectal exam Blood test to see if your body is fighting infection CT scans and/or ultrasound

How is appendicitis diagnosed? The diagnosis of appendicitis begins with a thorough history and physical examination. Patients often have an elevated temperature, and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there. If inflammation has spread to the peritoneum, there is frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his hand after gently pressing on the abdomen over the area of tenderness. White Blood Cell Count The white blood cell count in the blood usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts. Almost any infection or inflammation can cause this count to be abnormally high. Therefore, an elevated white blood cell count alone cannot be used as a sign of appendicitis.

Urinalysis Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine. Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder. The urinalysis also may be abnormal with appendicitis because the appendix lies near the ureter and bladder. If the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis. Most patients with appendicitis, however, have a normal urinalysis. Therefore, a normal urinalysis suggests appendicitis more than a urinary tract problem. Abdominal X-Ray An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. This is especially true in children. Ultrasound

An ultrasound is a painless procedure that uses sound waves to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, the appendix can be seen in only 50% of patients. Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis. Ultrasound also is helpful in women because it can exclude the presence of conditions involving the ovaries, fallopian tubes and uterus that can mimic appendicitis.

Barium Enema

A barium enema is an x-ray test where liquid barium is inserted into the colon from the anus to fill the colon. This test can, at times, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon. Barium enema also can exclude other intestinal problems that mimic appendicitis, for example Crohn's disease.

Computerized tomography (CT) Scan

In patients who are not pregnant, a CT Scan of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis.

 Laparoscopy Laparoscopy is a surgical procedure in which a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. Laparoscopy allows a direct view of the appendix as well as other abdominal and pelvic organs. If appendicitis is found, the inflamed appendix can be removed with the laparascope. The disadvantage of laparoscopy compared to ultrasound and CT is that it requires a general anesthetic. There is no one test that will diagnose appendicitis with certainty. Therefore, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

2.Bowel Obstruction *What is a bowel obstruction? A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes. This topic covers a blockage caused by tumors, scar tissue, or twisting or narrowing of the intestines. It does not cover ileus , which most commonly happens after surgery on the belly (abdominal surgery).

*What causes a bowel obstruction? Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstruction. In the small intestine, scar tissue is most often the cause. Other causes include hernias and Crohn's disease, which can twist or narrow the intestine, and cancer, which can cause tumors. A blockage also can happen if one part of the intestine folds like a telescope into another part, which is called intussusception. In the large intestine, cancer is most often the cause. Other causes are severe constipation from a hard mass of stool and twisting or narrowing of the intestine caused by diverticulitis or inflammatory bowel disease.

*What are the symptoms? Symptoms include: Cramping and belly pain that comes and goes. The pain can occur around or below the belly button. Vomiting. Bloating. Constipation and a lack of gas, if the intestine is completely blocked. Diarrhea, if the intestine is partly blocked. Call your doctor right away if your belly pain is severe and constant. This may mean that your intestine's blood supply has been cut off or that you have a hole in your intestine. This is an emergency.

*How is a bowel obstruction diagnosed? Your doctor will ask you questions about your symptoms and other digestive problems you've had. He or she will check your belly for tenderness and bloating. Your doctor may do: An abdominal X-ray ,which can find blockages in the small and large intestines. A CT scan of the belly, which helps your doctor see whether the blockage is partial or complete.

*How is it treated? - Most bowel obstructions are treated in the hospital. A partial blockage may go away on its own, or you may need treatments that don't require surgery (nonsurgical treatments). These treatments include using liquids or air (enemas), small mesh tubes (stents), or medicine to open up the blockage. You will stay in the hospital while waiting to see if the blockage goes away. If these treatments don't work, you'll need surgery to remove the blockage. Surgery is almost always needed when the intestine is completely blocked Or when the blood supply is cut off. Surgery is often done laparoscopically. This means that the surgeon uses a lighted scope and tools inserted through a few small cuts rather than making a large cut. If your blockage was caused by another health problem, such as diverticulitis, the blockage may come back if you don't treat that health problem.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

3.Celiac Disease What is celiac disease? Celiac disease is a problem some people have with foods that contain gluten. Gluten is a kind of protein found in foods like bread, crackers, and pasta. With celiac disease, your immune system attacks the gluten and harms your small intestine when you eat these kinds of foods. This makes it hard for your body to absorb nutrients that keep you healthy. Gluten comes from grains like wheat, barley, and rye. It s important to get treatment, because celiac disease can lead to iron deficiency anemia and osteoporosis. It can also raise your risk of lymphoma. Celiac disease can slow growth and weaken bones in children. If it is not treated, your child can get very sick. Call a doctor if your child is losing a lot of weight, has diarrhea, or feels weak and tired for many days for no reason.

What causes celiac disease? Doctors don't really know what causes the disease. Having certain genes can increase your chance of getting it. You are more likely to have these genes and get celiac disease if a close family member has it. In some people, viruses or infections can also trigger changes in your immune system that can lead to celiac disease. What are the symptoms? Symptoms of celiac disease include: Gas and bloating. Changes in bowel movements. Weight loss. Feeling very tired. Weakness. These symptoms can be very mild. Some people vomit after they eat gluten. This is more likely to happen in children than in adults.

How is celiac disease diagnosed? Your doctor will ask questions about your symptoms and do a physical exam. You may have blood tests to see if you have certain antibodies that could mean you have the disease. To make sure you have celiac disease, you will probably have an endoscopy. In this test, a doctor uses an endoscope-a thin, lighted tube that bends-to look at the inside of your small intestine. During the endoscopy, the doctor may take a small sample of tissue to be tested in a lab. This is called a biopsy. Often celiac disease is mistaken for another problem such as food Intolerance or irritable bowel syndrome. You may be treated for one of these problems first. After your celiac disease diagnosis, your doctor may do more tests, such as an X ray, a stool test, or a bone density exam. These will help your doctor find out if you have other problems, such as osteoporosis, that can arise when you have celiac disease. How is it treated? To get and stay well, you need to avoid all foods that have gluten. Do not eat any foods made with wheat, rye, or barley. Don't drink any beer or ale.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

4.The Basics of Constipation *What Is Constipation? Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements ranges widely from person to person. Some people have bowel movements three times a day; others, only one or two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass.

You are considered constipated if you have two or more of the following for at least 3 months: Straining during a bowel movement more than 25% of the time. Hard stools more than 25% of the time. Incomplete evacuation more than 25% of the time. Two or fewer bowel movements in a week. *What Causes Constipation? Constipation is usually caused by a disorder of bowel function rather than a structural problem. Common causes of constipation include: Inadequate water intake. Inadequate fiber in the diet. A disruption of regular diet or routine; traveling. Inadequate activity or exercise or immobility. Eating large amounts of dairy products.

 Stress. Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids. Overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles. Hypothyroidism Neurological conditions such as Parkinson's disease or multiple sclerosis. Antacid medicines containing calcium or aluminum. Medicines (especially strong pain medicines, such as narcotics, antidepressants ,or iron pills). Depression. Eating disorders. Irritable bowel syndrome. Pregnancy. Colon cancer. In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

What Are the Symptoms of Constipation? Symptoms of constipation can include: Infrequent bowel movements and/or difficulty having bowel movements. Swollen abdomen or abdominal pain. Pain. Vomiting. How Is Constipation Diagnosed? Most people do not need extensive testing to diagnose constipation. Only a small number of patients with constipation have a more serious medical problem. If you have constipation for more than two weeks, you should see a doctor so he or she can determine the source of your problem and treat it. If constipation is caused by colon cancer, early detection and treatment is very important.

Tests your doctor may perform to diagnose the cause of your constipation include: Blood tests if a hormonal imbalance is suspected. Barium studies to look for obstruction of the colon. Colonoscopy to look for obstruction of the colon. The vast majority of patients with constipation do not have any obvious illness to explain their symptoms and suffer from one of two problems: Colonic inertia - A condition in which the colon contracts poorly and retains stool. Obstructed defecation - A condition in which the person excessively strains to expel stool from the rectum.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

5.What is Crohn's Disease? Crohn's disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932. It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis. Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn's disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's disease have no medical cure. Once the diseases begin, they tend to fluctuate between periods of inactivity (remission) and activity (relapse). They affect approximately 500,000 to two million people in the United States. Men and women are equally affected. IBD most commonly begins during adolescence and early adulthood, but it also can begin during childhood and later in life.

What Causes Crohn s Disease? Although there are many theories about what causes Crohn's disease, none of them have been proven. So exactly what causes it is unknown. There is a benefit, though, in understanding the possible causes of Crohn's disease and how they interact with one another. Doing so can help you better understand the symptoms, diagnosis, and treatment of Crohn's disease. Scientists believe that Crohn's disease is caused by these factors: Immune system problems Genetics Environmental factors Is genetics connected to Crohn's disease? Brothers, sisters, children, and parents of persons with IBD, including Crohn's disease, are more likely to develop the disease themselves. About 10% to 20% of people with Crohn's disease have at least one other family member who also has the disease.And the disease is more common in certain ethnic groups, such as people of Jewish descent and whites.

What can I do to control Crohn's disease? The factors involved in causing Crohn's disease are complex. Scientists continue to seek more information about the causes -- in hopes of finding better ways to diagnose, treat, and perhaps even cure this frustrating and painful disease. In the meantime, understanding current theories about the causes of Crohn's disease can help you work with your doctor to explore how various treatments might work to control this condition. Crohn's Disease - Symptoms The main symptoms of Crohn's disease include: Abdominal pain. The pain often is described as cramping and intermittent, and the abdomen may be sore when touched. Abdominal pain may turn to a dull, constant ache as the condition progresses. Diarrhea. Some people may have diarrhea 10 to 20 times a day. They may wake up at night and need to go to the bathroom. Crohn's disease may cause blood in stools, but not always.

 Loss of appetite. Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that you have a complication involving infection, such as an abscess. Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss. Too few red blood cells (anemia). Some people with Crohn's disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself. People with Crohn's disease also may have: Sores in the mouth. Nutritional deficiencies, such as lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food. Bowel obstruction.

Signs of disease in or around the anus. These may include: Abnormal tunnels or openings called fistulas that sometimes form between organs. These develop because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall. Fistulas may form between parts of the intestine or between the intestine and another organ such as the bladder, vagina, or skin. A fistula may be the first sign of Crohn's disease . Pockets of infection (abscesses). Small tears in the anus (anal fissures). Skin tags that may resemble hemorrhoids. These are caused by inflamed skin. *Because there is some immune system involvement, you also may have symptoms and complications outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease. *Other conditions with symptoms similar to Crohn's disease include diverticulitis and ulcerative colitis.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

6.Diverticulosis What is diverticulosis? Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the colon (large intestine). These pouches may be up to 0.25in. or larger in diameter. In diverticulosis, the pouches in the colon wall do not cause symptoms. Diverticulosis may not be discovered unless symptoms develop, such as in painful diverticular disease or in diverticulitis. As many as 80% of the people who have diverticulosis never get diverticulitis.1 In many cases, diverticulosis is discovered only when tests are done to find the cause of a different medical problem or during a screening exam.

What causes diverticulosis? The reason pouches (diverticula) form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall. Normally, a diet with adequate fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure. Pouches may form when the high pressure pushes against weak spots in the colon where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall.

What are the symptoms? Most people don't have symptoms.1 You may have had diverticulosis for years by the time symptoms develop (if they do). Over time, some people develop an infection in the pouches (diverticulitis). For more information, see the topic Diverticulitis. The symptoms of painful diverticular disease are the same as those of irritable bowel syndrome (IBS), including diarrhea and cramping abdominal pain, with no fever or other sign of an infection. For information on the symptoms of IBS, see the topic Irritable Bowel Syndrome (IBS). How is diverticulosis diagnosed? In many cases, diverticulosis is discovered only when tests, such as a barium enema X-ray or a colonoscopy, are done to find the cause of a different medical problem or during a screening exam.

How is it treated? If you have diverticulosis, you will be encouraged to eat a high-fiber diet and drink plenty of water to prevent constipation. Try eating more whole grains, leafy green vegetables, and fruits. You also may add fiber supplements such as Citrucel, Fibercon, and Metamucil. This treatment may help reduce the formation of new pouches (diverticula) and lower the risk of developing diverticulitis. Treatment for painful diverticular disease involves adding fiber to the diet and eliminating any foods that cause gas, pain, or other symptoms. Treatment is the same as that for irritable bowel syndrome (IBS), because many people who have this condition also have IBS. For information on the treatment of IBS, see the topic Irritable Bowel Syndrome (IBS). Can diverticulosis be prevented? Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent diverticulosis.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

7.Gallstones

What are the gallbladder and gallstones? The gallbladder is a small sac found just under the liver. It stores bile made by the liver. Bile helps you digest fats. Bile moves from the gallbladder to the small intestine through tubes called the cystic duct and common bile duct.

The most common symptom of gallstones is pain in the stomach area or in the upper right part of the belly, under the ribs. The pain may: Develop suddenly in the center of the upper belly and spread to the right upper back or shoulder blade area. It is usually hard to get comfortable; moving around does not make the pain go away. Prevent you from taking normal or deep breaths. Last 15 minutes to 24 hours; 1 to 5 hours of continuous pain is common. Begin at night and be severe enough to wake you. Occur after meals

*There are many other conditions that cause similar symptoms, including heartburn, pain caused by a heart attack, and liver problems. Stomach flu (gastroenteritis) and food poisoning also can cause symptoms similar to gallstones.

What causes gallstones? Gallstones form when cholesterol and other things found in bile make stones. They can also form if the gallbladder does not empty as it should. People who are overweight or who are trying to lose weight quickly are more likely to get gallstones. What are the symptoms? Most people who have gallstones do not have symptoms. If you have symptoms, you most likely will have mild pain in the pit of your stomach or in the upper right part of your belly. Pain may spread to your right upper back or shoulder blade area. Sometimes the pain is more severe. It may be steady, or it may come and go. Or it may get worse when you eat.

How are they treated? If you do not have symptoms, you probably do not need treatment. If your first gallstone attack causes mild pain, your doctor may tell you to take pain medicine and wait to see if the pain goes away. You may never have another attack. Waiting to see what happens usually will not cause problems. If you have a bad attack, or if you have a second attack, you may want to have your gallbladder removed. A second attack means you are more likely to have future attacks. Many people have their gallbladders removed, and the surgery usually goes well. Doctors most often use laparoscopic surgery. For this, your surgeon will make small cuts in your belly and remove your gallbladder. You will probably be able to go back to work or your normal routine in a week or two, but it may take longer for some people. Sometimes the surgeon will have to make a larger cut to remove the gallbladder. It will take longer for you to recover from this type of surgery.

Do I need my gallbladder? Your body will work fine without a gallbladder. Bile will flow straight from the liver to the intestine. There may be small changes in how you digest food, but you probably will not notice them.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

8.Understanding Hemorrhoids - the Basics What Are Hemorrhoids? Hemorrhoids are swollen blood vessels of the rectum. The hemorrhoidal veins are located in the lowest area of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements. Hemorrhoids are classified into two general categories: internal and external.

What Causes Hemorrhoids? About half of the people in the U.S. will suffer from hemorrhoids at some point in life; for most, this will happen between ages 20 and 50. Researchers are not certain what causes hemorrhoids. "Weak" veins -leading to hemorrhoids and other varicose veins -- may be inherited. It's likely that extreme abdominal pressure causes the veins to swell and become susceptible to irritation. The pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do physical labor. *Diet has a pivotal role in causing -- and preventing -- hemorrhoids. People who consistently eat a high-fiber diet are less likely to get hemorrhoids, but those who prefer a diet high in processed foods can expect them. A low fiber diet or inadequate fluid intake can cause constipation, which can contribute to hemorrhoids in two ways: It promotes straining on the toilet and it also aggravates the hemorrhoids by producing hard stools that further irritate the swollen veins.

Hemorrhoids and other Anorectal Conditions

 Hemorrhoids are vascular masses that protrude into the lumen of the lower rectum or perianal area. They result when increased intra-abdominal pressure causes engorgement in the vascular tissue lining the anal canal. Loosening of vessels from surrounding connective tissue occurs with protrusion or prolapse into the anal canal. There are two main types of hemorrhoids: external hemorrhoids appear outside the external sphincter, and internal hemorrhoids appear above the internal sphincter. When blood within the hemorrhoids becomes clotted because of obstruction, the hemorrhoids are referred to as being thrombosed.

Surgical Interventions:

1. Injection of sclerosing solutions to produce scar tissue and decrease prolapse is an office procedure. 2. Cryodestruction (freezing) of hemorrhoids is an office procedure. 3. Surgery may be indicated in presence of prolonged bleeding, disabling pain, intolerable itching, and general unrelieved discomfort.

Nursing Interventions: 1. After thrombosis or surgery, assist with frequent repositioning using pillow support for comfort. 2. Provide analgesics, warm sitz baths, or warm compresses to reduce pain and inflammation. 3. Apply witch-hazel dressing to perianal area or anal creams or suppositories, if ordered, to relieve discomfort. 4. Observe anal area postoperatively for drainage and bleeding. 5. Administer stool softener or laxative to assist with bowel movements soon after surgery, to reduce risk of stricture. 6. Teach anal hygiene and measures to control moisture to prevent itching. 7. Encourage the patient to exercise regularly, follow a high fiber diet, and have an adequate fluid intake (8 to 10 glasses per day) to avoid straining and constipation, which predisposes to hemorrhoid formation. 8. Discourage regular use of laxatives; firm, soft stools dilate the anal canal and decrease stricture formation after surgery. 9. Tell patient to expect a foul-smelling discharge for 7 to 10 days after cryodestruction. 10. Determine the patient s normal bowel habits and identify predisposing factors to educate patient about preventing recurrence of symptoms.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

9.Understanding Hernia - the Basics What Is a Hernia? A hernia occurs when an organ or fatty tissue squeezes through a hole or a weak spot in a surrounding muscle or connective tissue called fascia. The most common types are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 80% of all hernias are inguinal, and most occur in men because of a natural weakness in this area. In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery. A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese. In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.

 A hiatal hernia happens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.

What Causes Hernias? Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia: The pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life. Poor nutrition, smoking, and overexertion all can weaken muscles and make hernias more likely. Anything that causes an increase in pressure in the abdomen can then cause a hernia, including obesity, lifting heavy objects, diarrhea or constipation, or persistent coughing or sneezing.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

10.What Is Pancreatitis? The pancreas is a large gland located behind the stomach and next to the duodenum (the first section of the small intestine). The pancreas has two primary functions: To secrete powerful digestive enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat. To release the hormones insulin and glucagon into the bloodstream. These hormones are involved in blood glucose metabolism regulating how the body stores and uses food for energy. Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas.

There are two forms of pancreatitis: acute and chronic. Acute pancreatitis Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute pancreatitis, the cause is unknown. The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of people with acute pancreatitis (more than 80%) recover completely after receiving the appropriate treatment. Chronic pancreatitis Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas. In more than 70% of the cases, chronic pancreatitis is caused by prolonged alcohol use. Other, less common causes include metabolic disorders. Very rarely, patients have chronic pancreatitis that tends to run in families (hereditary pancreatitis). Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.

What Are the Symptoms of Pancreatitis? ymptoms of acute pancreatitis Upper abdominal pain that radiates (travels) to their back. Patients may describe this as a "boring sensation" that may be aggravated by eating, especially foods high in fat. Swollen and tender abdomen Nausea and vomiting Fever Increased heart rate. Symptoms of chronic pancreatitis The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. Patients frequently experience constant pain in the upper abdomen that radiates to the back. In some patients, the pain may be disabling. Other symptoms may include weight loss caused by poor absorption (malabsorption) of food. This malabsorption occurs because the gland is not secreting enough enzymes to break down the food normally. Also, diabetes may develop if the insulin-producing cells of the pancreas become damaged.

What Causes Pancreatitis? In the majority of cases, acute pancreatitis is caused by gallstones and alcohol use. Other causes include medications, lipid (triglyceride) disorders, infections, surgery, or trauma to the abdomen. In about 10% to 15% of people with pancreatitis, the cause is unknown. In many people with chronic pancreatitis, the condition is caused by prolonged alcohol use, resulting in pancreatic damage and scarring. In other cases of chronic pancreatitis, the cause may be metabolic, hereditary, or simply unknown. What Are the Risk Factors for Pancreatitis? Pancreatitis can happen to anyone; however, it is more common in people with certain risk factors. *Risk factors of acute pancreatitis include: Gallstone disease Heavy alcohol consumption

Can Pancreatitis Be Prevented? Since most cases of pancreatitis are caused by alcohol abuse, prevention is directed at responsible drinking, or no drinking at all. If heavy drinking is a concern, talk to your doctor or health care provider about a referral to an alcohol treatment center. In addition, you may benefit from a support group such as Alcoholics Anonymous.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

11.Peptic Ulcer Disease
What is a peptic ulcer? A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine (duodenum). Ulcers develop when the intestine or stomach's protective layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. These strong juices, which contain hydrochloric acid and an enzyme called pepsin, also can injure the esophagus. The esophagus is the tube that leads from your throat to your stomach. Peptic ulcers are no longer a condition that most people have to live with their entire lives. Treatment cures most ulcers, and symptoms go away quickly. Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say "doo-uh-DEE-nul" or "doo-AW-duh-nul") ulcers.

What causes peptic ulcers? The two most common causes of peptic ulcers are: Infection with Helicobacter pylori (H. pylori) bacteria. Use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori and NSAIDs break down the stomach or intestine s protective mucus layer. The mucus layer prevents digestive juices from damaging the stomach and intestine. What are the symptoms? Symptoms include: A burning, aching, gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks. Pain that usually goes away for a while after you take an antacid or acid reducer. Loss of appetite and weight loss. Bloating or nausea after eating. Vomiting. Vomiting blood or material that looks like coffee grounds. Passing black stools that look like tar or stools that have streaks of dark red blood. *Different people have different symptoms, and some people have no symptoms at all.

How are they treated? To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics. If your doctor prescribes antibiotics to treat your infection, you need to take all the pills. It is much more likely that the infection will be cured if you take all the antibiotics. You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back. Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment. The symptoms of a peptic ulcer vary and, by themselves, are not a reliable way to tell whether you have an ulcer. Also, some people may not have symptoms. The symptoms of an ulcer often can be confused with other abdominal conditions such as dyspepsia or gastro esophageal reflux disease (GERD).

*Common ulcer symptoms include: A burning, aching pain-or a pain that feels like hunger-between the navel and the breastbone. The pain sometimes extends to the back. Belly pain that can last from a few minutes to a few hours and usually goes away for a while after taking an antacid or acid reducer. Weeks of pain that comes and goes and may alternate with pain-free periods. Loss of appetite and weight loss. Bloating or nausea after eating. *Less common but more serious symptoms of ulcers include:

Vomiting after meals. Vomiting blood and/or material that looks like coffee grounds. Black stools that look like tar, or stools that contain dark red blood.

*Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the stomach (gastric ulcers) are similar, except for when pain occurs. Pain from a duodenal ulcer may occur several hours after eating (when the stomach is empty) and may improve after eating. Pain also may wake you frequently in the middle of the night. Pain from a gastric ulcer may occur shortly after eating (when food is still in the stomach). Some ulcers do not cause symptoms. These are known as silent ulcers. Silent ulcers are more common in older adults, people who have diabetes, or people who use nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), or naproxen (Aleve). Complications of an ulcer include bleeding, perforation, penetration, or obstruction of the digestive tract. Complications can happen in both silent ulcers and ulcers that cause symptoms. In children, symptoms vary with age: Toddlers and young children may complain of general stomach pain. Teenagers may have symptoms more like those experienced by adults

Nursing Interventions
Monitor the patient for signs of bleeding through fecal occult blood, vomiting, persistent diarrhea, and change in vital signs. Monitor intake and output. Monitor the patient s hemoglobin, hematocrit, and electrolyte levels. Administered prescribed I.V. fluids and blood replacements if acute bleeding is present. Maintain nasogastric tube for acute bleeding, perforation, and postoperatively, monitor tube drainage for amount and color. Perform saline lavage if ordered for acute bleeding. Encourage bed rest to reduce stimulation that may enhance gastric secretion. Provide small, frequent meals to prevent gastric distention if not actively bleeding. Watch for diarrhea caused by antacids and other medications. Restrict foods and fluids that promote diarrhea and encourage good perineal care. Advise patient to avoid extremely hot or cold food and fluids, to chew thoroughly, and to eat in a leisurely fashion to reduce pain. Administer medications properly and teach patient dose and duration of each medication. Advise patient to modify lifestyle to include health practices that will prevent recurrences of ulcer pain and bleeding.

*MOST COMMON DISORDERS OF THE DIGESTIVE SYSTEM*

12.What is diarrhea? Diarrhea is an increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool). Although changes in frequency of bowel movements and looseness of stools can vary independently of each other, changes often occur in both. Diarrhea needs to be distinguished from four other conditions. Although these conditions may accompany diarrhea, they often have different causes and different treatments than diarrhea.

These other conditions are: incontinence of stool, which is the inability to control (delay) bowel movements until an appropriate time, for example, until one can get to the toilet rectal urgency, which is a sudden urge to have a bowel movement that is so strong that if a toilet is not immediately available there will be incontinence incomplete evacuation, which is a sensation that another bowel movement is necessary soon after a bowel movement, yet there is difficulty passing further stool the second time bowel movements immediately after eating a meal

What are common causes of chronic diarrhea? Irritable bowel syndrome. The irritable bowel syndrome (IBS) is a functional cause of diarrhea or constipation. Inflammation does not typically exist in the affected bowel. (Nevertheless, recent information suggests that there MAY be a component of inflammation in IBS.) It may be caused by several different underlying problems, but it is believed that the most common cause is rapid passage of the intestinal contents through the colon. Infectious diseases. There are a few infectious diseases that can cause chronic diarrhea, for example, Giardia lamblia . Patients with AIDS often have chronic infections of their intestines that cause diarrhea. Bacterial overgrowth of the small intestine. Because of small intestinal problems, normal colonic bacteria may spread from the colon and into the small intestine. When they do, they are in a position to digest food that the small intestine has not had time to digest and absorb. The mechanism that leads to the development of diarrhea in bacterial overgrowth is not known.

 Post-infectious. Following acute viral, bacterial or parasitic infections, some individuals develop chronic diarrhea. The cause of this type of diarrhea is not clear, but some of the individuals have bacterial overgrowth of the small intestine. This condition also is referred to as post-infectious IBS. Inflammatory bowel disease (IBD). Crohn's disease and ulcerative colitis, diseases causing inflammation of the small intestine and/or colon, commonly cause chronic diarrhea. Colon cancer. Colon cancer can cause either diarrhea or constipation. If the cancer blocks the passage of stool, it usually causes constipation. Sometimes, however, there is secretion of water behind the blockage, and liquid stool from behind the blockage leaks around the cancer and results in diarrhea. Cancer, particularly in the distal part of the colon, can lead to thin stools. Cancer in the rectum can lead to a sense of incomplete evacuation. Severe constipation. By blocking the colon, hardened stool can lead to the same problems as colon cancer, as discussed previously.

Carbohydrate (sugar) malabsorption. Carbohydrate or sugar malabsorption is an inability to digest and absorb sugars. The most well-recognized malabsorption of sugar occurs with lactase deficiency (also known as lactose or milk intolerance) in which milk products containing the milk sugar, lactose, lead to diarrhea. The lactose is not broken up in the intestine because of the absence of an intestinal enzyme, lactase, that normally breaks up lactose. Without being broken up, lactose cannot be absorbed into the body. The undigested lactose reaches the colon and pulls water (by osmosis) into the colon. This leads to diarrhea. Although lactose is the most common form of sugar malabsorption, other sugars in the diet also may cause diarrhea, including fructose and sorbitol. Fat malabsorption. Malabsorption of fat is the inability to digest or absorb fat. Fat malabsorption may occur because of reduced pancreatic secretions that are necessary for normal digestion of fat (for example, due to pancreatitis or pancreatic cancer) or by diseases of the lining of the small intestine that prevent the absorption of digested fat (for example, celiac disease). Undigested fat enters the last part of the small intestine and colon where bacteria turn it into substances (chemicals) that cause water to be secreted by the small intestine and colon. Passage through the small intestine and colon also may be more rapid when there is malabsorption of fat.

 Endocrine diseases. Several endocrine diseases (imbalances of hormones) may cause diarrhea, for example, an over-active thyroid gland (hyperthyroidism) and an under-active pituitary or adrenal gland (Addison's disease). Laxative abuse. The abuse of laxatives by individuals who want attention or to lose weight is an occasional cause of chronic diarrhea.

What are common causes of acute diarrhea? The most common cause of acute diarrhea is infection--viral, bacterial, and parasitic. Bacteria also can cause acute food poisoning. A third important cause of acute diarrhea is starting a new medication. 1.Viral gastroenteritis Viral gastroenteritis (viral infection of the stomach and the small intestine) is the most common cause of acute diarrhea worldwide. Symptoms of viral gastroenteritis (nausea, vomiting, abdominal cramps, and diarrhea) typically last only 48-72 hrs. Unlike bacterial enterocolitis (bacterial infection of the small intestine and colon), patients with viral gastroenteritis usually do not have blood or pus in their stools and have little if any fever. Viral gastroenteritis can occur in a sporadic form (in a single individual) or in an epidemic form (among groups of individuals). Sporadic diarrhea probably is caused by several different viruses and is believed to be spread by person-toperson contact. The most common cause of epidemic diarrhea (for example, on cruise ships) is infection with a family of viruses known as caliciviruses of which the genus norovirus is the most common (for example, "Norwalk agent"). The caliciviruses are transmitted by food that is contaminated by sick food-handlers or by person-to-person contact.

2.Food poisoning Food poisoning is a brief illness that is caused by toxins produced by bacteria. The toxins cause abdominal pain (cramps) and vomiting and also cause the small intestine to secrete large amounts of water that leads to diarrhea. The symptoms of food poisoning usually last less than 24 hours. With some bacteria, the toxins are produced in the food before it is eaten, while with other bacteria, the toxins are produced in the intestine after the food is eaten. Symptoms usually appear within several hours when food poisoning is caused by toxins that are formed in the food before it is eaten. It takes longer for symptoms to develop when the toxins are formed in the intestine (because it takes time for the bacteria to produce the toxins). Therefore, in the latter case, symptoms usually appear after 7-15 hours. Staphylococcus aureus is an example of a bacterium that produces toxins in food before it is eaten. Typically, food contaminated with Staphylococcus (such as salad, meat or sandwiches with mayonnaise) is left un-refrigerated at room temperature overnight. The Staphylococcal bacteria multiply in the food and produce toxins. Clostridium perfringens is an example of a bacterium that multiplies in food (usually canned food), and produces toxins in the small intestine after the contaminated food is eaten.

3.Traveler's diarrhea There are many strains of E. coli bacteria. Most of the E. coli bacteria are normal inhabitants of the small intestine and colon and are non-pathogenic, meaning they do not cause disease in the intestines. Nevertheless, these non pathogenic E. coli can cause diseases if they spread outside of the intestines, for example, into the urinary tract (where they cause bladder or kidney infections) or into the blood stream (sepsis). Certain strains of E. coli, however, are pathogenic (meaning they can cause disease in the small intestine and colon). These pathogenic strains of E. coli cause diarrhea either by producing toxins (called enterotoxigenic E. coli or ETEC) or by invading and inflaming the lining of the small intestine and the colon and causing enterocolitis (called enteropathogenic E. coli or EPEC). Traveler's diarrhea usually is caused by an ETEC strain of E. coli that produces a diarrhea-inducing toxin. Tourists visiting foreign countries with warm climates and poor sanitation (Mexico, parts of Africa, etc.) can acquire ETEC by eating contaminated foods such as fruits, vegetables, seafood, raw meat, water, and ice cubes. Toxins produced by ETEC cause the sudden onset of diarrhea, abdominal cramps, nausea, and sometimes vomiting. These symptoms usually occur 3-7 days after arrival in the foreign country and generally subside within 3 days. Occasionally, other Giardia, Campylobacter bacteria or parasites can cause diarrhea in travelers (for example, Shigella,). Diarrhea caused by these other organisms usually lasts longer than 3 days.