Approach to GI disorders

Overview of Gastrointestinal Diseases

Classification of GI Diseases
Impaired Digestion and Absorption Altered Secretion Altered Gut Transit Immune Dysregulation Impaired Gut Blood Flow Neoplastic Degeneration Disorders Without Obvious Organic Abnormalities Genetic Influences

Impaired Digestion and Absorption

Zollinger-Ellison syndrome Lactase deficiency
gas and diarrhea

Celiac disease, bacterial overgrowth(>105 /ml), infectious enteritis, Crohn's ileitis, and radiation damage
Diffuse, Anemia, dehydration, electrolyte disorders, or malnutrition.

Biliary obstruction stricture or neoplasm

fat digestion.

Pancreatic enzymes in chronic pancreatitis or pancreatic cancer

Altered Secretion
Zollinger-Ellison syndrome, G cell hyperplasia, retained antrum syndrome, and duodenal ulcer disease. Atrophic gastritis or pernicious anemia Diarrhea
Acute bacterial or viral infection, chronic Giardia or Cryptosporidia infections, small-intestinal bacterial overgrowth, bile salt diarrhea, microscopic colitis, diabetic diarrhea, and abuse of certain laxatives

Large colonic villous adenomas and endocrine neoplasias

vasoactive intestinal polypeptide.

VIPoma
WDHA syndrome Verner morrison syndrome Pancreatic cholera Watery diarrhea, hypokalemia, achlorhydria Hypercalcemia, hyperglycemia, vasodilation A syndrome caused by non-beta pancreatic tumour Fasting VIP levels confirm diagnosis Surgery is the only treatment

Altered Gut Transit

Esophagus
Acid-induced stricture or neoplasm

Gastric outlet obstruction Small-intestinal obstruction

Adhesions, Crohn's disease, radiation- or drug-induced strictures, malignancy

colonic obstruction
Colon cancer, strictures (IBD), infections, or drugs.

Retardation of propulsion
Achalasia Gastroparesis Intestinal pseudoobstruction Slow-transit constipation Rectal prolapse, intussusception, or failure of anal relaxation

Gastric outlet obstruction

The traditional sodium chloride load test is performed by infusing 750 cc of sodium chloride solution into the stomach via a nasogastric tube (NGT). A diagnosis of gastric outlet obstruction (GOO) is made if more than 400 cc remain in the stomach after 30 minutes Nuclear gastric emptying studies Barium upper GI studies

Immune Dysregulation
Celiac disease Eosinophilic esophagitis and eosinophilic gastroenteritis Ulcerative colitis and Crohn's disease Microscopic colitides, lymphocytic and collagenous colitis
Colonic subepithelial infiltrates without visible mucosal damage

Bacterial, viral, and protozoal organisms

Impaired Gut Blood Flow

Ischemia
Arterial embolus, arterial thrombosis, venous thrombosis, or hypoperfusion from dehydration, sepsis, hemorrhage, or reduced cardiac output. Mucosal injury, hemorrhage, or even perforation

Neoplastic Degeneration
All GI regions are susceptible
Colorectal cancer in US Worldwide, gastric cancer

Esophageal cancer develops with chronic acid reflux, tobacco, alcohol Small-intestinal neoplasms are rare Pancreatic and biliary cancers elicit severe pain, weight loss, and jaundice Hepatocellular carcinoma Most GI cancers are carcinomas, but lymphomas can also occur

Disorders Without Obvious Organic Abnormalities

No abnormalities on biochemical or structural testing
Irritable bowel syndrome (IBS), functional dyspepsia, non-cardiac chest pain, and functional heartburn Altered gut motor function

Symptoms of Gastrointestinal Disease

Abdominal Pain Heartburn Altered Bowel Habits Nausea and Vomiting Diarrhea GI Bleeding Obstructive Jaundice

Evaluation of the Patient with Gastrointestinal Disease

History Physical Examination Tools for Patient Evaluation
Laboratory Luminal Contents Endoscopy
Upper Endoscopy Colonoscopy Endoscopic Retrograde Cholangiopancreatography Endoscopic Ultrasound

Radiography/Nuclear Medicine Histopathology Functional Testing

UGI endoscope

Colonoscope

Capsule endoscopy

Gastrointestinal Disease: Treatment

Nutritional Manipulation Pharmacotherapy
Over-the-Counter Agents Prescription Drugs Alternative Therapies

Enteric Therapies/Interventional Endoscopy and Radiology Surgery Therapy Directed to External Influences