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 The alimentary canal is a long, muscular tube
Digest This!
 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
 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
 Structure – it is 25 to 30 feet in length
 Includes the mouth, pharynx, esophagus,
stomach, small intestine, large intestine and
anus
 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
 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
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 This is where nutrients asborb into the blood  Rectum stores the indigestible food and
stream through the villi of the small intestine waste
 What remains goes into the large intestine –  Waste exits from the anus – also not sterile
also not sterile 
 This is where water and nutrients like B
complex and Vit K are asborbed

 GERD – Gastroesophageal reflux disease  Signs and symptoms of GERD

 It is the backwards flow of stomach contents  Dyspepsia (heartburn)
into the esophagus  Coughing
 Etiology – incompetent lower esophageal  AM hoarseness
sphincter makes the stomach contents dump  Belching
back into the esophagus  Chest pain
 Regurgitation
 Odynophagia – painful swallowing

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

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 Signs and symptoms of Acute gastritis:
◦ Rapid onset of epigastric pain
◦ Vomiting blood – can look like coffee grounds
◦ Stomach pain
◦ anorexia
 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.
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 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.
 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
 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
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 Diagnosis is same as the Acute – EGD and
antibiotics if needed
 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
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 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
 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
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 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
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 IBS – Irritable Bowel Syndrome
 Chronic recurrent diarrhea, constipation and
bloating, abdominal pain, flares up with
certain foods or stress
 Hemorrhoids – swollen engorged veins in the
anorectic area
 Caused by severe straining, childbirth,
cancer, liver disease due to portal
hypertension
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 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
 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
 Common signs and symptoms for Crohns:
◦ Diarrhea
◦ Cramping
◦ Bloody stools
◦ Ulcers – can be severe and perforate through the
bowel
◦ Weight loss
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 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.
 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.
 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
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 Diagnoses with a colonoscopy or barium
enema allows an x-ray of the entire colon
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 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