The

Digestive
System
and its
DISEASES
• The digestive system is a tubular system.
It extends from the mouth to the anus, forms an
extensivesurface area in contact with the external environment, and
is closely associated with the cardiovascular system.
• The combination of extensive environmental exposure and close
association with blood vessels is essential for processing the food
that we eat.
• Gastroenterology
The medical specialty that deals with the structure, function, diagnosis, and
treatment of diseases of the stomach and intestines.
• Proctology
The medical specialty that deals with the diagnosis and treatment of disorders of
the rectum and anus.
 COMPOSITION OF THE DIGESTIVE SYSTEM
• GASTROINTESTINAL TRACT
-Organsof the gastrointestinal tract include the mouth, most of the
pharynx, esophagus, stomach, small intestine, and large intestine.
-In a living person when the muscles along the wall of the GI tract organs are in a state of
tonus (sustained contraction).
• ACCESSORY DIGESTIVE ORGANS
-Include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas.
-They produce or store secretions that flow into the GI tract through ducts; the secretions aid in
the chemical breakdown of food.
 FUNCTIONS OF THE DIGESTIVE SYSTEM
1. Ingestion: taking food into mouth.
2. Secretion: release of water, acid, buffers, and enzymes into lumen of GI tract.
3. Mixing and propulsion: churning and propulsion of food through GI tract.
4. Digestion: mechanical and chemical breakdown of food.
5. Absorption: passage of digested products from GI tract into blood and lymph.
6. Defecation: elimination of feces from GI tract.
 PHASES OF DIGESTION
• CEPHALIC PHASE
- During the cephalic phase of digestion, the smell, sight, thought, or initial taste of food activates neural centers
in the cerebral cortex, hypothalamus, and brain stem.
- The facial and glossopharyngeal nerves stimulate the salivary glands to secrete saliva, while the vagus nerves
stimulate the gastric glands to secrete gastric juice.
PURPOSE: to prepare the mouth and stomach for food that is about to be eaten.

• GASTRIC PHASE
-Once food reaches the stomach, the gastric phase of digestion begins. Neural and hormonal mechanisms
regulate the gastric phase of digestion to promote gastric secretion and gastric motility.
• INTESTINAL PHASE
-The intestinal phase of digestion begins once food enters the small intestine. In contrast to reflexes initiated
during the cephalic and gastric phases, which stimulate stomach secretory activity and motility, those
occurring during the intestinal phase have inhibitory effects that slow the exit of chyme from the stomach.

PLAY SONG
 DISORDERS
OF THE
DIGESTIVE SYSTEM
 COLORECTAL CANCER

• It is characterized by uncontrolled growth of cells within the

large intestine (colon) or rectum (terminal portion of the
large intestine).
• Colon cancer or Bowel cancer and rectal cancer are
sometimes referred to separately.
• Colorectal cancer develops slowly but can spread to
surrounding and distant tissues of the body.
 CAUSES AND SYMPTOMS
• Colorectal cancers have multiple causes, many of which remain
unknown.
• Some cases appear to be inherited, while others seem to occur
randomly or to have non-genetic causes.
• 95% of Colorectal cancers involve the glandular cells in the wall of
the colon called adenocarcinomas.
• Others may begin among hormone-producing cells, immune cells, or
underlying connective tissue.
 CAUSES AND SYMPTOMS (CONTINUED..)

• SYMPTOMS: Jaundice
episodes of diarrhea or abdominal pain
constipation that extend for
loss of appetite
days
fatigue.
blood in the stool
rectal bleeding
 DIAGNOSIS
• Diagnoses of colon and rectal cancers are made by means of several
techniques.
Digital Rectal Exam
Fecal Test
Sigmoidoscope
Colonoscopy
Biopsy
Double-contrast Barium Enema ( X-Ray Procedure)
 TREATMENT
• Colorectal cancer is treated by surgery, chemotherapy, or radiation.
 Colonoscope - or early-stage colon cancer to remove the cancerous tissue. Other
early cancers require a
 Surgical resection - the portion of the colon containing the cancerous tissue is
removed along with surrounding tissue and nearby lymph nodes and the
remainder of the colon is repaired.
 Removing only the cancerous polyp or polyps, the cancer plus surrounding
tissues, or larger sections of the rectum.
 Electrofulguration - removing cancer by burning.
 TREATMENT (CONTINUED..)
 Colostomy - the surgeon creates an artificial opening for the removal of waste in
cases where the lower portion of the rectum is involved.
 If colorectal cancer has spread to surrounding tissues such as those of the uterus,
prostate, liver, kidneys, or bladder, more extensive surgery may be required to
remove all or part of these organs.
• Radiation - using either external beams or surgically implanted radioactive
pellets. It is usually used in conjunction with surgery—either before the surgery
to shrink tumours or following surgery to destroy small amounts of remaining
cancerous tissue.
• Chemotherapy may also be indicated for treatment of colorectal cancers.
 GASTROESOPHAGEAL
REFLUX DISEASE (GERD)
• It is a relatively common digestive disorder characterized by frequent
passage of gastric contents from the stomach back into the esophagus.
 SYMPTOMS
 Heartburn
A Burning Sensation In The Chest And Upper Abdomen
Coughing
Frequent Clearing of The Throat
Difficulty in Swallowing (Dysphagia)
Hoarseness
Exacerbation of Asthma.
 
Endoscopic image of peptic
stricture showing narrowing of the
esophagus near the junction with
the stomach due to chronic
gastroesophageal reflux in the
setting of scleroderma.
 CAUSES
relaxation of the muscle that connects the esophagus and the
stomach (lower esophageal sphincter)
delayed emptying of the esophagus or stomach
hiatal hernia or obesity.
 Pregnancy – common cause for women
 TREATMENT
• GERD can be treated with antacids or with cessation of smoking
medications that inhibit acid production,
such as histamine receptor antagonists weight loss
(Zantac™, Pepcid™) or proton pump Surgery may be necessary in cases of
inhibitors (Prilosec™, Prevacid™). severe reflux.
• dietary and lifestyle changes such as:
not eating for three hours before
bedtime
avoiding acidic or fatty foods or
beverages
raising the head of the bed to
discourage nocturnal reflex
 JAUNDICE
• It is the excess accumulation of bile pigments in the bloodstream and
bodily tissues that causes a yellow to orange and sometimes even
greenish discoloration of the skin, the whites of the eyes, and the
mucous membranes.
• The degree of coloration depends on the concentration of bile
pigment (bilirubin) in the blood, its rate of tissue diffusion, and the
absorption and binding of bilirubin by the tissue.
 TYPES
• Jaundice is classified as hepatocellular, hemolytic or obstructive.
• Hepatocellular jaundice - a type of jaundice that occurs as a result of liver
disease or injury.
• Hemolytic jaundice - a type of jaundice that occurs as a result of hemolysis (an
accelerated breakdown of erythrocytes - red blood cells) leading to an increase
in production of bilirubin.
• Obstructive jaundice - a type of jaundice that occurs as a result of an
obstruction in the bile duct (a system of tubes that carries bile from the liver to
the gallbladder and small intestine), which prevents bilirubin from leaving the
liver.
 CAUSES
• Some underlying conditions that may cause jaundice are:
• Acute inflammation of the liver - may impair the ability of the liver
to conjugate and secrete bilirubin, resulting in a buildup of bilirubin.
• Inflammation of the bile duct - may prevent the secretion of bile
and removal of bilirubin, causing jaundice.
• Obstruction of the bile duct - prevents the liver from disposing of
bilirubin, which results in hyperbilirubinemia.
 CAUSES (CONTINUED..)

• Hemolytic anemia - Production of bilirubin increases when large

quantities of erythrocytes are broken down.
• Gilbert's syndrome - an inherited condition that impairs the ability
of enzymes (biomolecules that provoke chemical reactions between
substances) to process the excretion of bile.
• Cholestasis-a condition in which the flow of bile from the liver is
interrupted. The bile containing conjugated bilirubin remains in the
liver instead of being excreted.
 SYMPTOMS
Yellow tinge to the skin and the Vomiting
whites of the eyes Fever
Pruritis (itchiness) Paler than usual stools
Fatigue Dark urine.
Abdominal pain - typically
indicates a blockage of the bile
duct.
Weight loss
 LIVER CANCER

• Liver cancer is any of several forms of disease characterized by

tumours in the liver; benign liver tumours remain in the liver,
whereas malignant tumours are, by definition, cancerous.
• Most malignant liver tumours are hepatomas.
 SYMPTOMS
Losing weight without Abdominal swelling
trying Yellow discoloration of your
Loss of appetite skin and the whites of your
Upper abdominal pain eyes (jaundice)
Nausea and vomiting White, chalky stools
General weakness and
fatigue
 CAUSES
• The causes of liver cancer vary and in many cases remain unknown, but several
factors have been identified that increase the risk of developing the disease.
Previous infection with hepatitis B or hepatitis C viruses
Exposure to several chemicals (such as vinyl chloride, thorium dioxide,
aflatoxin and arsenic)
Use of anabolic steroids and oral contraceptives
Other illnesses such as gallstones, chronic inflammation of the colon or
gallbladder, and certain parasitic infections are also risk factors.
 DIAGNOSIS
• Blood tests - may reveal liver function abnormalities.
• Imaging tests - such as an ultrasound, computerized tomography
(CT) scan and magnetic resonance imaging (MRI).
• Removing a sample of liver tissue for testing - for laboratory testing
in order to make a definitive diagnosis of liver cancer.
 TREATMENT
• Surgery
1. Surgery to remove the tumor.
2. Liver transplant surgery.
• Localized treatments
1. Heating cancer cells
2. Freezing cancer cells.
3. Injecting alcohol into the tumor
4. Injecting chemotherapy drugs into the liver
5. Placing beads filled with radiation in the liver
 TREATMENT (CONT..)
• Radiation therapy
• Targeted drug therapy
• Supportive (palliative) care
• Alternative medicine
1. Acupressure
2. Acupuncture
3. Deep breathing
4. Listening to music (music therapy)
5. Massage
 DIARRHEA

• Diarrhea also spelled diarrhoea , abnormally swift passage of waste

material through the large intestine, with consequent discharge of
loose feces from the anus. Diarrhea may be accompanied by
cramping.
 SYMPTOMS

Frequent, loose, watery stools

Abdominal cramps
Abdominal pain
Fever
Blood in the stool
Bloating
 CAUSES
viral gastroenteritis (stomach lactose intolerance
flu) parasites (for example,
bacterial gastroenteritis (food giardiasis, hookworm, or
poisoning) amebiasis)
food allergies bacterial infection (for example,
PMS shigellosis or e. coli)
irritable bowel syndrome
 OTHER CAUSES
drug allergies colitis
appendicitis celiac disease
diverticulitis Crohn’s disease
fecal impaction West Nile virus
intestinal obstruction some forms of cancer
cystic fibrosis
 TREATMENT
replenish lost fluids, salts, and electrolytes to prevent dehydration
clear liquids as well as electrolyte-rich formulas like Pedialyte and
Gatorade can be helpful
Anti-diarrheal medications – such as loperamide (Imodium) and
bismuth subsalicylate (Pepto-Bismol) and kaolin pectin suspension
(Kaopectate) – can reduce the severity of symptoms but won’t speed
recovery
If a parasite or bacterial infection has caused diarrhea, a course of
antibiotics may be prescribed.
 CONSTIPATION

• Constipation is the delayed passage of waste through the

lower portion of the large intestine, with the possible
discharge of relatively dry, hardened feces from the anus.
 CAUSES
Antacid medicines containing Irritable bowel syndrome
calcium or aluminum Neurological conditions such as
Changes in your usual diet or Parkinson's disease or multiple
activities sclerosis
Colon cancer Not being active
Eating a lot of dairy products. Not enough water or fiber in your
Eating disorders diet
 CAUSES (CONT..)
Overuse of laxatives (Over time, Some medications (especially
this weakens the bowel muscles) strong pain drugs such as narcotics,
Pregnancy antidepressants, or iron pills)

Problems with the nerves and  Stress

muscles in the digestive system Under active thyroid
Resisting the urge to have a bowel (hypothyroidism)
movement, which some people do
because of hemorrhoids
 SYMPTOMS
Few bowel movements
Trouble having a bowel movement (straining)
Hard or small stools
A sense that everything didn’t come out
Swollen abdomen or abdominal pain
Vomiting
 DIAGNOSIS
Blood tests to check on hormone levels 
Barium studies to look for any blockages in your colon. For this test,
you'll down a special drink and then get an X-ray.
Colonoscopy or other tests to look for blockages in your colon
 TREATMENT
• Diet and Lifestyle changes 1. Osmotics
1. Increase your fiber intake 2. Lubricants
2. Exercise most days of the week 3. Stool softeners
3. Don't ignore the urge to have a • Other medications
bowel movement. 1. Medications that draw water into
• Laxatives your intestines.
1. Fiber supplements 2. Medications in clinical trials.
2. Stimulants
 GALLSTONE
• Also called cholelith, is a concretion composed of crystalline substances
(usually cholesterol, bile pigments, and calcium salts) embedded in a
small amount of protein material formed
• The most common type of gallstone consists principally of cholesterol; its
occurrence has been linked to secretion by the liver of bile that is
saturated with cholesterol and contains abnormally low levels of bile salts
and the phospholipid lecithin, which in normal bile are present in
sufficient quantities to keep cholesterol in solution.
A photomicrograph (100x magnification) of a
hematoxylin- and eosin-stained gallstone within
the gallbladder of a golden lion tamarin
(Leontopithecus rosalia).

Gallstones
 CAUSES
Your bile contains too much cholesterol

Your bile contains too much bilirubin.

Your gallbladder doesn't empty correctly.

 SYMPTOMS
Severe abdominal pain
Pain that may extend beneath the right shoulder blade or to the back
Pain that worsens after eating a meal, particularly fatty or greasy
foods
Pain that feels dull, sharp, or crampy
Pain that increases when you breathe in deeply
Chest pain (angina)
 SYMPTOMS (CONT…)
Heartburn, indigestion, and excessive gas
A feeling of fullness in the abdomen
Vomiting, nausea, fever
Shaking with chills
Tenderness in the abdomen, particularly the right upper quadrant
Jaundice (yellowing of the skin and eyes)
Stools of an unusual color (often lighter, like clay)
 DIAGNOSIS
Ultrasound.
Abdominal X-ray
Computed Tomography (CT) Scan. 
Magnetic Resonance Imaging (MRI) 
Endoscopic Retrograde Cholangiopancreatography (Ercp)
Cholescintigraphy (also called DISIDA, HIDA Scan, Or Gallbladder
Radionuclide Scan). 
 TREATMENT
• Keyhole surgery to remove the gallbladder
• Single-incision keyhole surgery
• Open surgery
• Endoscopic retrograde cholangio-pancreatography (ERCP)
• Medication to dissolve gallstones
 HEPATITIS
• Inflammation of the liver that results from a variety of causes, both
infectious and noninfectious.
• Infectious agents that cause hepatitis include viruses and parasites;
noninfectious substances include certain drugs and toxic agents.
• In some instances hepatitis results from an autoimmune reaction
directed against the liver cells of the body.
 HEPATITIS (CONT..)
• There are seven known hepatitis viruses, which are labeled A, B, C, D, E,
F, and G.
• Hepatitis A, E, and F viruses are transmitted through the ingestion of
contaminated food or water (called the fecal-oral route); the spread of
these agents is aggravated by crowded conditions and poor sanitation.
• The B, C, D, and G viruses are transmitted mainly by blood or bodily
fluids; sexual contact or exposure to contaminated blood are common
modes of transmission.
SIGNS AND SYMPTOMS
 HEPATITIS A

• Hepatitis A, caused by the hepatitis A virus (HAV), is the most

common worldwide.

• The onset of hepatitis A usually occurs 15 to 45 days after exposure

to the virus, and some infected individuals, especially children,
exhibit no clinical manifestations.
 HEPATITIS A (CONT..)
• In the majority of cases, no special treatment other than bed rest is
required; most recover fully from the disease.
• Hepatitis A does not give rise to chronic hepatitis. The severity of
the disease can be reduced if the affected individual is injected
within two weeks of exposure with immune serum globulin obtained
from persons exposed to HAV.
 HEPATITIS B

• Hepatitis B is a much more severe and longer-lasting disease than

hepatitis A.

• It may occur as an acute disease, or, in about 5 to 10 percent of

cases, the illness may become chronic and lead to permanent liver
damage.
 HEPATITIS B (CONT..)

• Symptoms usually appear from 40 days to 6 months after exposure

to the hepatitis B virus (HBV).
• Those persons at greatest risk for contracting hepatitis B include
intravenous drug users, sexual partners of individuals with the
disease, health care workers who are not adequately immunized, and
recipients of organ transplants or blood transfusions.
 HEPATITIS C
• Hepatitis C virus (HCV) was isolated in 1988.
• It typically is transmitted through contact with infected blood.
• Infection may cause mild or severe illness that lasts several
weeks or a lifetime; in the early 21st century, an estimated 130
to 170 million people worldwide had chronic HCV infection.
 HEPATITIS C (CONT..)

• About 80 percent of those who become infected are asymptomatic;

those who do show symptoms may experience a flu-like illness, with
fatigue, nausea, vomiting, and sometimes jaundice.
• Approximately 60 to 70 percent of chronic infections progress to
chronic liver disease, such as cirrhosis or liver cancer. Alcoholics
who are infected with hepatitis C are more prone to develop
cirrhosis.
 HEPATITIS D

• Infection with hepatitis D virus (HDV), also called the delta agent,
can occur only in association with HBV infection, because HDV
requires HBV to replicate.
• Infection with HDV may occur at the same time infection with HBV
occurs, or HDV may infect a person already infected with HBV.
• The HDV situation appears to give rise to a more serious condition,
leading to cirrhosis or chronic liver disease.
 HEPATITIS E

• Discovered in the 1980s, the hepatitis E virus (HEV) is similar to

HAV.
• HEV is transmitted in the same manner as HAV, and it, too, only
causes acute infection.
• The effects of infection with HEV are more severe than those caused
by HAV, and death is more common.
• The risk of acute liver failure from infection with HEV is especially
great for pregnant women.
 HEPATITIS F AND G
• Some cases of hepatitis transmitted through contaminated food or
water are attributed to the hepatitis F virus (HFV), which was first
reported in 1994.
• Another virus isolated in 1996, the hepatitis G virus (HGV), is
believed to be responsible for a large number of sexually transmitted
and bloodborne cases of hepatitis.
• HGV causes acute and chronic forms of the disease and often
infects persons already infected with HCV.
 OTHER CAUSES
• Most cases of chronic hepatitis are caused by the hepatitis viruses B, C, and D,
but other factors such as alcoholism, reaction to certain medications, and
autoimmune reactions lead to development of the disease.
• Chronic hepatitis may also be associated with some illnesses, such as Wilson
disease and alpha-1-antitrypsin deficiency.
• Chronic hepatitis B primarily affects males, whereas chronic hepatitis C arises
in equal numbers in both sexes.
• Autoimmune hepatitis, a disorder associated with a malfunction of the
immune system, generally occurs in young women.
 SYMPTOMS
The initial phase of hepatitis is called the acute phase. The symptoms are
like a mild flu, and may include:
 Diarrhea  Nausea
 Fatigue  Slight abdominal pain
 Loss of appetite  Vomiting
 Mild fever  Weight loss
 Muscle or joint aches
The acute phase is not usually dangerous, unless it develops into the fulminant or
rapidly progressing form, which can lead to death.
 SYMPTOMS (CONT…)
As the patient gets worse, these symptoms may follow:
Circulation problems (only toxic/drug- Hives
induced hepatitis) Itchy skin
Dark urine Light colored feces, the feces may
Dizziness (only toxic/drug-induced contain pus
hepatitis) Yellow skin, whites of eyes, tongue
Drowsiness (only toxic/drug-induced (jaundice).
hepatitis)
Enlarged spleen (only alcoholic hepatitis)
NOTE: Patient outcomes after the
Headache (only toxic/drug-induced acute phase depend on various factors,
especially the type of hepatitis.
hepatitis)
 DIAGNOSIS
Physical Exam
Liver Biopsy
Liver Function Tests
Ultrasound
Blood Tests
Viral Antibody Testing
 TREATMENT
• Bed rest, abstaining from alcohol, and taking medication to help
relieve symptoms. Most people who have hepatitis A and E get well
on their own after a few weeks.
• Hepatitis B is treated with drugs, such as lamivudine and adefovir
dipivoxil.
• Hepatitis C is treated with a combination of peginterferon and
ribovarin.
• Liver transplant of hepatitis B or C, or D-caused liver failure.
 INDIGESTION

• Indigestion can be pain or discomfort in your upper abdomen

(dyspepsia) or burning pain behind the breastbone (heartburn).

• Dyspepsia and heartburn may occur together or on their own. 

 CAUSES
Indigestion has many causes, including:
Diseases: • Thyroid disease • Thyroid medicines

• Ulcers • Pregnancy Lifestyle:

• GERD Medications: • Eating too much, eating too

• Aspirin and other painkillers, fast, eating high-fat foods, or
• Stomach cancer (rare)
such as  eating during stressful
• Gastro paresis  NSAIDs like ibuprofen (Motrin situations
• Irritable bowel syndrome , Advil), • Drinking too much alcohol
and naproxen (Naprosyn)
• Chronic pancreatitis • Cigarette smoking
• Estrogen and
oral contraceptives • Stress and fatigue
• Steroid medications
 SYMPTOMS
Bloating
Belching and gas
Nausea and vomiting
An acidic taste in your mouth
Fullness during or after a meal
Growling stomach
Burning in your stomach or upper belly
Belly pain
 TREATMENT
• Try not to chew with your mouth open, talk while you chew, or eat too fast.
This makes you swallow too much air, which can add to indigestion.
• Drink beverages after rather than during meals.
• Avoid late-night eating.
• Try to relax after meals.
• Avoid spicy foods.
• If you smoke, quit.
• Avoid alcohol.
 LARYNGITIS

• Inflammation of the larynx or voice box, caused by chemical or

mechanical irritation or bacterial infection.
• Laryngitis is classified as simple, diphtheritic, tuberculous, or
syphilitic laryngitis.
• Simple laryngitis is usually associated with the common cold or
similar infections.
 LARYNGITIS (CONT..)
• Diphtheritic laryngitis is caused by the spread of diphtheria from the
region of the upper throat down to the larynx.
• Tuberculous laryngitis is a secondary infection spread from the initial
site in the lungs. Tubercular nodule-like growths are formed in the
larynx tissue.
• Syphilitic laryngitis is one of the many complications of syphilis.
 CAUSES

•  Upper respiratory infection or the common cold

• Overuse of the vocal cords by talking, singing, or shouting
• Gastroesophageal reflux disease (GERD) causing reflux laryngitis
• Smoking
• Exposure to secondhand smoke
• Exposure to polluted air.
 SYMPTOMS

Hoarseness
Weak voice or voice loss
Tickling sensation and rawness of your throat
Sore throat
Dry throat
Dry cough
 TREATMENT
• Acute laryngitis often gets better on its own within a week or so. Self-care
measures also can help improve symptoms.
• Antibiotics- In almost all cases of laryngitis, an antibiotic won't do any good
because the cause is usually viral. But if you have a bacterial infection, your
doctor may recommend an antibiotic.
• Corticosteroids can help reduce vocal cord inflammation. However, this
treatment is used only when there's an urgent need to treat laryngitis — for
example, when you need to use your voice to sing or give a speech or oral
presentation, or in some cases when a toddler has laryngitis associated with
croup.
 PHARYNGITIS

• Inflammatory illness of the mucous membranes and underlying

structures of the throat (pharynx).
• Inflammation usually involves the nasopharynx, uvula, soft palate,
and tonsils.
• The illness can be caused by bacteria, viruses, mycoplasmas, fungi,
and parasites and by recognized diseases of uncertain causes.
Viral pharyngitis.
 CAUSES
• Measles
• Adenovirus, which is the cause of the common cold
• Chickenpox
• Croup, which is a childhood illness distinguished by a barking cough
• Whooping cough
• Viral infections
• Bacterial infection
 SYMPTOMS

Sneezing Body aches

Runny nose Chills
Headache Fever (a low-grade fever
Cough with a cold and higher-grade
fever with the flu)
Fatigue
 TREATMENT
• Getting plenty of rest (either in or out of bed)
• Taking ibuprofen (Advil, Motrin), acetaminophen (Tylenol) or aspirin (in
adults only) to relieve throat pain
• Drinking plenty of water to prevent dehydration
• Gargling with warm salty water to ease throat pain
• Drinking warm liquids (tea or broth) or cool liquids or eating gelatin desserts or
flavored ices to soothe the throat
• Using a cool mist vaporizer to relieve throat dryness
• Using nonprescription throat lozenges or anesthetic throat sprays
 STOMACH CANCER
• Also called gastric cancer, a disease characterized by abnormal growth of
cells in the stomach.
• The incidence of stomach cancer has decreased dramatically since the
early 20th century in countries where refrigeration has replaced other
methods of food preservation such as salting, smoking, and pickling.
• Stomach cancer rates remain high in countries where these processes are
still used extensively.
 RISK FACTORS
A diet high in salty and smoked Long-term stomach inflammation
foods Pernicious anemia
A diet low in fruits and vegetables Smoking
Eating foods contaminated with Stomach polyps
aflatoxin fungus
Family history of stomach cancer
Infection with Helicobacter pylori
 SIGNS AND SYMPTOMS
Fatigue Nausea that is persistent and
Feeling bloated after eating unexplained

Feeling full after eating small Stomach pain

amounts of food Vomiting that is persistent
Heartburn that is severe and Weight loss that is unintentional
persistent
Indigestion that is severe and
unrelenting
 DIAGNOSIS
• A tiny camera to see inside your stomach (upper endoscopy). A thin
tube containing a tiny camera is passed down your throat and into your
stomach. Your doctor can look for signs of cancer. If any suspicious areas
are found, a piece of tissue can be collected for analysis (biopsy).
• Imaging tests. Imaging tests used to look for stomach cancer include
computerized tomography (CT) scans and a special type of X-ray exam
sometimes called a barium swallow.
 DETERMINING THE STAGE OF
STOMACH CANCER
• Imaging tests. Tests may include a CT and positron emission tomography
(PET).
• Exploratory surgery. Your doctor may recommend surgery to look for
signs that your cancer has spread beyond your stomach within your
abdomen. Exploratory surgery is usually done laparoscopically. This
means the surgeon makes several small incisions in your abdomen and
inserts a special camera that transmits images to a monitor in the operating
room.
 STAGES OF STOMACH CANCER
• Stage I. At this stage, the tumor is limited to the layer of tissue that lines the inside of
the stomach. Cancer cells may also have spread to a limited number of nearby lymph
nodes.
• Stage II. The cancer at this stage has spread deeper, growing into the muscle layer of the
stomach wall. Cancer may also have spread to more of the lymph nodes.
• Stage III. At this stage, the cancer may have grown through all the layers of the stomach
and spread to nearby structures. Or it may be a smaller cancer that has spread more
extensively to the lymph nodes.
• Stage IV. This stage indicates that the cancer has spread to distant areas of the body.
 TREATMENT

• Surgery
The goal of surgery is to remove all of the stomach cancer and a margin of
healthy tissue, when possible. Options include:
1. Removing early-stage tumors from the stomach lining
2. Removing a portion of the stomach (subtotal gastrectomy).
3. Removing the entire stomach (total gastrectomy).
4. Removing lymph nodes to look for cancer.
5. Surgery to relieve signs and symptoms.
 TREATMENT (CONT..)
• Targeted drugs
1. Trastuzumab (Herceptin) for stomach cancer cells that produce too much
HER2.
2. Ramucirumab (Cyramza) for advanced stomach cancer that hasn't
responded to other treatments.
3. Imatinib (Gleevec) for a rare form of stomach cancer called gastrointestinal
stromal tumor.
4. Sunitinib (Sutent) for gastrointestinal stromal tumors.
5. Regorafenib (Stivarga) for gastrointestinal stromal tumors.
 TREATMENT (CONT..)

• Radiation therapy
• Chemotherapy
• Clinical trials
• Supportive (palliative) care
 VOLVULUS
• Volvulus is the twisting of a portion of the digestive tract on its
mesentery (the fold of membrane that attaches the intestine to the
posterior abdominal wall), resulting in intestinal obstruction, severe pain,
distension of the involved segment, and interference with circulation to
the affected area.
• Volvulus may be congenital or acquired; the areas most frequently
affected are the sigmoid colon, the ileocecal region, and the stomach.
Mesenteric volvulus
from a German
Shepherd Dog.
 
 CAUSES

• Volvulus is most commonly due to a birth defect called malrotation,

which is when the bowel becomes misaligned during fetal
development.
• Volvulus can also occur in the absence of underlying malrotation. If
the volvulus is associated with malrotation, it often occurs early in
life, frequently in the first year.
 SYMPTOMS
• Symptoms which may indicate bowel obstruction due to volvulus include:
• Abdominal tenderness
• Nausea or vomiting
• Vomiting green bile-looking material
• Bloody or dark red stool
• Constipation or difficulty expelling stools
• Distended abdomen
• Shock
 TESTING
• In testing for volvulus, the following tests may be performed:
1. A stool sample test finds blood in the stool.
2. An upper GI X-ray with small bowel follow-through shows a
malrotated bowel or midgut volvulus.
3. A CT scan may show evidence of intestinal obstruction.
4. A barium enema often shows an abnormal position of the bowel,
suggesting malrotation.
5. Blood tests to check the electrolytes may show abnormalities.
 TREATMENT
• Emergency surgery is necessary to repair a volvulus.
• An incision is made in the abdominal wall, and the bowels are untwisted and
the blood supply restored.
• If a small segment of bowel is necrotic (dead from lack of blood flow), it is
removed and the ends of the healthy bowel are sewn back together, or used to
form a colostomy or ileostomy (a tube to the outside through which bowel
contents can be removed -- the term depends on where the tube is placed).
• If the entire bowel is necrotic, the outlook is poor and life threatening.
 HEMATURIA
• also spelled Haematuria, presence of blood in the urine, an indication of
injury or disease of the kidney or some other structure of the urinary tract;
in males blood in the urine can also come from the reproductive tract.
• The blood may become apparent during urination or only upon
microscopic examination.
Hematuria in urine
sediment after
centrifugation.
 CAUSES
• In hematuria, your kidneys — or other parts of your urinary tract — allow blood
cells to leak into urine. A number of problems can cause this leakage, including:

Urinary tract infections. Cancer

Kidney infections. Inherited disorders.
A bladder or kidney stone Kidney injury.
Enlarged prostate. Medications.
Kidney disease Strenuous exercise 
 SYMPTOMS
• The visible sign of hematuria is pink, red or cola-colored urine — the
result of the presence of red blood cells. It takes very little blood to
produce red urine, and the bleeding usually isn't painful.
• If you're also passing blood clots in your urine, that can be painful.
Bloody urine often occurs without other signs or symptoms.
• It's possible to have blood in your urine that's visible only under a
microscope (microscopic hematuria).
 DIAGNOSIS
• To find a cause for urinary bleeding, the following tests and exams play a key role:
• Physical exam, which includes a discussion of your medical history.
• Urine tests. Even if your bleeding was first discovered through urine testing (urinalysis),
you're likely to have another test to see if your urine still contains red blood cells. Urinalysis
can also check for urinary tract infection or the presence of minerals that cause kidney
stones.
• Imaging tests
• Cystoscopy. In this procedure, your doctor threads a narrow tube fitted with a tiny camera
into your bladder to closely examine both the bladder and urethra for signs of disease.
 TREATMENT
• Hematuria has no specific treatment. Instead, your doctor will focus on
treating the underlying condition.
• This includes:

1. taking antibiotics to clear a urinary tract infection

2. trying a prescription medication to shrink an enlarged prostate
3. or shock wave therapy to break up bladder or kidney stones
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