Digest This!

The alimentary canal is a long, muscular tube

Structure – it is 25 to 30 feet in length Includes the mouth, pharynx, esophagus,

stomach, small intestine, large intestine and anus

The mouth or buccal cavity chews food called mastication

Saliva is produced by the parotid, sublingual, and submadibular glands

Food is broken down by an enzyme called salivary amylase

The mouth is not a sterile area

Food is swallowed in a bolus – and enters the pharynx

This triggers the epiglottis to close The bolus continues down the esophagus to

the stomach Esophagus and stomach are not sterile

Once food bolus is in the stomach, the cardiac sphincter closes to prevent food from flowing back into the esophagus

Peristalsis begins to mechanically digest the food, and HCL, pepsin, lipase are chemically breaking down food

HCL – kills bacteria Pepsin – breaks down protein Lipase breaks down fat

Food dumps from the stomach to the small intestine into the duodenum

This section is where bile from the gallbladder and liver and pancreatic juice enter through the ducts

After this point the small intestine produces enzymes; maltase, sucrase, and lactase – these break down sugars into simple forms

Peptidase – for protein Steapsin – digestion of fat

This is where nutrients asborb into the blood stream through the villi of the small intestine

What remains goes into the large intestine – also not sterile

This is where water and nutrients like B complex and Vit K are asborbed

Rectum stores the indigestible food and waste

Waste exits from the anus – also not sterile

GERD – Gastroesophageal reflux disease It is the backwards flow of stomach

contents into the esophagus Etiology – incompetent lower esophageal

sphincter makes the stomach contents dump back into the esophagus

Signs and symptoms of GERD Dyspepsia (heartburn) Coughing AM hoarseness Belching Chest pain Regurgitation Odynophagia – painful swallowing

Teach patient◦Small meals◦Avoid spicy foods◦Elevate HOB 8-12”◦Sleep in left lateral position◦Stop smoking!!!!

Gastritis – inflammation of the gastric mucosa

Two kings◦No. 1 Acute gastritis (erosive) – can be caused by

infection of the helicobacter pylori bacteria. This is normal to have in your stomach, but if you become stressed it can have an overgrowth, and cause an ulcer. It could also be caused by e.coli, or salmonella.

◦ Inflammation can also be “set off” by irritating foods, chronic aspirin use and alcohol.

Signs and symptoms of Acute gastritis:◦Rapid onset of epigastric pain◦Vomiting blood – can look like coffee grounds◦Stomach pain◦anorexia

Treatment:◦EGD (esophagogastroduodenoscopy) is an

examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat.

◦Antibiotics to help with h.pylori infection

No. 2 Chronic gastritis (non erosive) – constant irritation without ulcers, develops gradually and is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no signs or symptoms at all.

Chronic gastritis signs and symptoms – causes few symptoms:◦Vague epigastria pain – usually relieved with food◦ Intolerance of spicy foods◦Anemia – can’t absorb your B12 from food – you

need this for red blood cells to function

Diagnosis is same as the Acute – EGD and antibiotics if needed

Treatment for chronic gastritis:◦Remove the cause – don’t take too much aspirin,

eat too much acidic/fatty/spicy foods, stop smoking

◦Medications – antacids, H2 receptor antagonist, antibiotics, Pepto

PUD – Peptic ulcerative Disease – lesions in the stomach – stress ulcers, h.pylori causes acid increase

Usually located in the lower stomach, upper duodenum

Complications of PUD:◦Bleeding◦Melena – blood in the stool is black and tarry, very

smelly◦ Perforation – ulcer wears through the bowel or

stomach, and leaks into the peritoneal cavity – 2-3% of people perforate, and of this 67% die

◦4% have pyloric obstruction – valve is obstructed and patient has vomiting

Test for PUD:◦EGD◦Blood chemistry (CBC) – checks for anemia◦Check of occult blood◦Urea breath test – check after midnight if h.pylori

is present patient will have an increase in CO2◦Surgery – goes in an stems bleeding

IBS – Irritable Bowel Syndrome – 10-20% of U.S. citizens have this

Chronic recurrent diarrhea, constipation and bloating, abdominal pain, flares up with certain foods or stress

IBS can flare up with stress or anxiety, food allergies like lactose intolerance

Can have exacerbation – flare up Can be in remission – no problems

Teach:◦Avoid precipitating factors◦ Patient may need fiber supplements for

constipation or Lomotil for diarrhea◦Stress management◦May need antidepressants

Hemorrhoids – swollen engorged veins in the anorectic area

Caused by severe straining, childbirth, cancer, liver disease due to portal hypertension

Two types of hemorrhoids◦External – swelling of the anus◦ Internal – inflammation near the anus, and can

swell to the outside – it is possible to have both at the same time

Both cause pain an ditching, sometimes bleeding can occur – will be bright red, unlike melena, which is black

Thrombosed hemorrhoid – Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.

Treatment of hemorrhoids:◦Topical creams – decreases inflammation, eases

pain◦Diet high in fiber◦Avoid – nuts, spices, coffee, alcohol◦Avoid sitting for prolonged periods◦Avoid valsalva maneuver – no straining, lifting◦ In case of thrombosed hemorrhoid – surgery is

required to release the blood for the swollen vein – follow with cold pack

Crohn’s disease – is a form of IBS because it causes inflammation of the lining of the digestive tract. Crohn’s can extend deep into the layers of the affected bowel tissue.

Common signs and symptoms for Crohns:◦Diarrhea◦Cramping◦Bloody stools◦Ulcers – can be severe and perforate through the

bowel◦Weight loss

Other signs and symptoms People with severe Crohn’s disease may also

experience:◦ Fever◦ Fatigue◦Arthritis◦Eye inflammation◦Skin disorders◦ Inflammation of the liver or bile ducts◦Delayed growth or sexual development, in children◦See handout

Diagnoses with a colonoscopy or barium enema allows an x-ray of the entire colon

Also a form of IBS – Inflammation of the colon

Can be severe and life threatening Difference in the Chrohn’s and ulcerative is

right side Crohn’s left side colitis Signs and symptoms can range from rectal

bleeding, bloody diarrhea, cramps, pain, malnutrition, dehydration, shock and even death

Treatment for both: Crohns and Ulcerative Colitis◦Steroids – reduce inflammation◦Diet◦Stop smoking◦No alcohol◦ For people who do not respond to all of the above,

they might try to suppress the immune system to stop the body’s allergic response