Problem 5 GIT

Josephine Angelia S. 405140233

Defecation
• Distention of the rectum with feces initiates reflex contractions of its musculature
& the desire to defecate
• Sympathetic nerve supply  internal (involuntary) anal sphincter  excitatory
• Parasympathetic supply  inhibitory
• The sphincter is maintained in a state of tonic contraction, & moderate distention
of the rectum ↑ the force of its contraction
• The urge to defecate 1st occurs when rectal pressure ↑ to about 18 mm Hg
• When this pressure reaches 55 mm Hg  external & internal sphincter relaxes &
there is reflex expulsion of the contents of the rectum
• This is why reflex evacuation of the rectum can occur even in the setting of spinal
injury
Defecation
• Before the pressure that relaxes the external anal sphincter is reached, voluntary
defecation can be initiated by straining
• The angle between the anus & the rectum is approximately 90° degrees & this plus
contraction of the puborectalis muscle inhibit defecation
• With straining, the abdominal muscles contract, the pelvic floor is lowered 1 to 3
cm, & the puborectalis muscle relaxes
• The anorectal angle is reduced to 15° or less
• This is combined with relaxation of the external anal sphincter & defecation occurs
• Defecation is therefore a spinal reflex that can be voluntarily inhibited by keeping
the external sphincter contracted or facilitated by relaxing the sphincter &
contracting the abdominal muscles
Ulcerative Colitis
• The most common symptoms are pain in the abdomen and blood or pus in diarrhea
• Other symptoms may include:
• Anemia
• Severe tiredness
• Weight loss
• Loss of appetite
• Bleeding from the rectum
• Sores on the skin
• Joint pain
• Growth failure in children
• About half of people with UC have mild symptoms
• Diagnose : blood tests, stool tests, colonoscopy/sigmoidoscopy, & imaging tests
• Several types of drugs can help control it. Some people have long periods of remission, when they
are free of symptoms. In severe cases, doctors must remove the colon
Ulcerative Colitis
• Diagnosis/Symptoms
• Bleeding in the Digestive Tract
• C-Reactive Protein (CRP) Test
• Diagnosing and Managing IBD
• Lower GI Series (Barium Enema)
• Colonoscopy
• Stool Culture
Ulcerative Colitis
• Treatment
• Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and
Continent Ileostomy
• Large bowel resection
• Sulfasalazine and the 5-Aminosalicylates
• Surgery for Crohn's Disease and Ulcerative Colitis
Diverticulosis
• Diverticulosis : the presence of small out-pouchings (called
diverticula) or sacs that can develop in the lining of the GIT
• While diverticula can be present anywhere in the entire digestive
tract, they are most common on the left side of the large intestine,
the area known as the descending & sigmoid colon
Diverticulosis
• Abnormal contraction & spasm (resulting in intermittent high
pressure in the colon) may cause diverticula to form in a weak spot of
the intestinal wall
• Low fiber diets may play a role in the development of diverticulosis
• There also appears to be a genetic predisposition to diverticulosis,
that is, if your parent or grandparent had diverticulosis you may
develop it as well
Diverticulosis
• Most patients with diverticulosis have no symptoms
• Many will never know they have the condition until it is discovered
during an endoscopic or radiographic (Xray) examination
• While most people have no symptoms, some individuals may
experience pain or discomfort in the left lower abdomen, bloating,
and/or a change in bowel habits
Diverticulosis
• Diverticulosis is generally discovered through one of the following
examinations:
• Barium enema: This x-ray test involves injection of liquid material into the
colon through a tube inserted in the rectum. The x-ray image shows the
anatomy of the colon, and can identify if diverticula, large polyps or growths
are present
• Colonoscopy: This test uses a thin, flexible tube with a light and camera to
view the inside of the colon. Diverticula as well as polyps and other growths
can be seen with this instrument
• CT scan: This x-ray test takes multiple cross section pictures of the body. It is
not generally performed to make a diagnosis of diverticulosis, but this type of
exam may identify diverticula
Diverticulosis
• Constipation, a major cause of excess intra-colonic pressure and thought to be
responsible for some cases of diverticulosis, should be avoided
• A diet rich in fiber (bran cereals, whole wheat breads, fresh fruits, and leafy
vegetables) may ↓ the development of diverticulosis, improve symptoms of
constipation and ↓ the likelihood of complications
• Benefits of a high fiber diet may be seen in those who eat between 15 & 30gr
of fiber a day
• Diverticulosis does not appear to be associated with alcohol, smoking or
caffeine consumption
• ↑ fiber in the diet to soften & bulk the stool may ↓ the development of more
diverticula, or prevent complications
Diverticulosis
• Persons with diverticulosis are sometimes instructed to avoid foods
that contain undigestible particles such as popcorn, nuts and fruits
with small seeds
• The theory of such a diet is that these particles might get "caught" in
a diverticulum and precipitate diverticulitis
Hirschsprung's disease
• Hirschsprung's disease is a blockage of the large intestine
• It occurs due to poor muscle movement in the bowel
• It is a congenital condition, which means it is present from birth
Hirschsprung's disease (causes)
• Muscle contractions (peristalsis) in the gut help digested foods and liquids
move through the intestine, nerves between the muscle layers trigger the
contractions
• In Hirschsprung's disease, the nerves are missing from a part of the bowel
 areas without these nerves cannot push material through  causes a
blockage  Intestinal contents build up behind the blockage  The
bowel & abdomen swell
• Hirschsprung's disease causes about 25% of all newborn intestinal
blockages. It occurs five times more often in males than in females.
Hirschsprung's disease is sometimes linked to other inherited or
congenital conditions, such as Down syndrome.
Hirschsprung's disease (Symptoms)
• Symptoms that may be present in newborns and infants include:
• Difficulty with bowel movements
• Failure to pass meconium shortly after birth
• Failure to pass a first stool within 24 - 48 hours after birth
• Infrequent but explosive stools
• Jaundice
• Poor feeding
• Poor weight gain
• Vomiting
• Watery diarrhea (in the newborn)
• Symptoms in older children:
• Constipation that gradually gets worse
• Fecal impaction
• Malnutrition
• Slow growth
• Swollen belly
Hirschsprung's disease (Exams & Tests)
• Milder cases may not be diagnosed until the baby is older
• During a physical exam, the doctor may be able to feel loops of bowel
in the swollen belly. A rectal exam may reveal tight muscle tone in the
rectal muscles.
• Tests used to help diagnose Hirschsprung's disease may include:
• Abdominal x-ray
• Anal manometry (a balloon is inflated in the rectum to measure pressure in
the area)
• Barium enema
• Rectal biopsy
Hirschsprung's disease (Treatment)
• Serial rectal irrigation helps relieve pressure in (decompress) the
bowel
• The abnormal section of colon must be taken out with surgery. Most
commonly, the rectum and abnormal part of the colon are removed.
The healthy part of the colon is then pulled down and attached to the
anus.
• Sometimes this can be done in one operation. However, it is often
done in two parts. A colostomy is performed first. The other part of
the procedure is done later in the child's first year of life.
Hirschsprung's disease (Prognosis)
• Symptoms improve or go away in most children after surgery
• A small number of children may have constipation or problems controlling stools
(fecal incontinence)
• Children who get treated early or who have a shorter segment of bowel involved
have a better outcome
• Possible Complications
• Inflammation & infection of the intestines (enterocolitis) may occur before surgery, &
sometimes during the first 1 - 2 years afterwards
• Symptoms are severe, including swelling of the abdomen, foul-smelling watery diarrhea,
lethargy, and poor feeding
• Perforation or rupture of the intestine
• Short bowel syndrome, a condition that can lead to malnourishment and dehydration
Irritable Bowel Syndrome
• A functional bowel disorder characterized by abdominal pain or
discomfort & altered bowel habits in the absence of detectable
structural abnormalities
Irritable bowel syndrome (Causes)
• The reasons why IBS develop are not clear. It can occur after an infection of the
intestines. This is called postinfectious IBS. There may also be other triggers.
• The intestine is connected to the brain. Signals go back and forth between the
bowel and brain. These signals affect bowel function and symptoms. The
nerves can become more active during stress. This can cause the intestines to
be more sensitive and contract more.
• IBS can occur at any age. Often, it begins in the teen years or early adulthood.
It is twice as common in women as in men.
• About 1 in 6 people in the U.S. have symptoms of IBS. It is the most common
intestinal problem that causes patients to be referred to a bowel specialist
(gastroenterologist).
Irritable bowel syndrome (Symptoms)
• IBS symptoms vary from person to person and range from mild to
severe. Most people have mild symptoms. You are said to have IBS
when symptoms are present for at least 3 days a month for a period
of 3 months or more.
• The main symptoms include:
• Abdominal pain
• Gas
• Fullness
• Bloating
Irritable bowel syndrome (Treatment)
• The goal of treatment is to relieve symptoms
• Lifestyle changes  regular exercise and improved sleep habits
• Avoiding foods and drinks that stimulate the intestines (such as caffeine, tea, or colas)
• Eating smaller meals
• ↑ fiber in the diet (this may improve constipation, but make bloating worse)
• Anticholinergic medications (dicyclomine, propantheline, belladonna, and hyoscyamine) taken about a
half-hour before eating to control intestinal muscle spasms
• Bisacodyl to treat constipation
• Loperamide to treat diarrhea
• Low doses of tricyclic antidepressants to help relieve intestinal pain
• Lubiprostone for constipation symptoms
• Rifaximin, an antibiotic
• Psychological therapy or medicines for anxiety or depression may help with the problem
Irritable bowel syndrome (Prognosis)
• Irritable bowel syndrome may be a lifelong condition. For some
people, symptoms are disabling and interfere with reduce work,
travel, and social activities.
• Symptoms often get better with treatment.
• IBS does not cause permanent harm to the intestines. Also, it does
not lead to a serious disease, such as cancer.
Colon cancer
• Colon or colorectal cancer : cancer that starts in the large intestine
(colon) or the rectum (end of the colon)
• Other types of cancer can affect the colon. These include lymphoma,
carcinoid tumors, melanoma, and sarcomas. These are rare. Colon
cancer refers to colon carcinoma only.
Colon cancer (Causes)
• Almost all colon cancers start in the lining of the colon and rectum
• There is no single cause of colon cancer
• Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer
• High risk of colon cancer:
• older than 60
• African American or of eastern European descent
• Eat a a lot of red or processed meats
• Have colorectal polyps
• Have IBS (Crohn disease or ulcerative colitis)
• Have a family history of colon cancer
• Have a personal history of breast cancer
• Colon cancer may be linked to a high-fat, low-fiber diet and to a high intake of red meat
• Smoking cigarettes and drinking alcohol are other risk factors for colorectal cancer
Colon cancer (Symptoms)
• Many cases of colon cancer have no symptoms
• If there are symptoms, the following may indicate colon cancer:
• Abdominal pain & tenderness in the lower abdomen
• Blood in the stool
• Diarrhea, constipation, or other change in bowel habits
• Narrow stools
• Weight loss with no known reason
Colon cancer (Exams & Tests)
• The physical exam rarely shows any problems, although may feel a lump (mass) in the abdomen
• A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer
• A fecal occult blood test (FOBT) may detect small amounts of blood in the stool  may suggest colon
cancer
• A sigmoidoscopy, or colonoscopy, will be done to evaluate the cause of blood in your stool
• Only colonoscopy can see the entire colon  the best screening test for colon cancer
• Blood tests may be done for those diagnosed with colorectal cancer, including:
• Complete blood count (CBC) to check for anemia
• CT or MRI scans of the abdomen  stage the cancer. Sometimes, PET scans are also used
• Stages of colon cancer are:
• Stage 0: Very early cancer on the innermost layer of the intestine
• Stage I: Cancer is in the inner layers of the colon
• Stage II: Cancer has spread through the muscle wall of the colon
• Stage III: Cancer has spread to the lymph nodes
• Stage IV: Cancer has spread to other organs outside the colon
Colon cancer (Treatment)
• Surgery (most often a colectomy)  remove cancer cells
• Surgery
• Stage 0 colon cancer may be treated by removing the cancer cells. This is done using colonoscopy. For
stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is
cancerous. This surgery is called colon resection.
• Chemotherapy  kill cancer cells
• Almost all patients with stage III colon cancer should receive chemotherapy after surgery for 6 to 8
months. This is called adjuvant chemotherapy
• Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon
cancer
• You may receive just one type of medicine or a combination of medicines
• Radiation
• Radiation therapy is sometimes used for colon cancer. It is usually used in combination with
chemotherapy for patients with stage III rectal cancer
Colon cancer (Prognosis)
• Colon cancer is treatable when caught early
• When treated at an early stage, many patients survive at least 5 years after
diagnosis (the 5-year survival rate)
• If the colon cancer does not come back (recur) within 5 years, it is considered
cured. Stages I, II, and III cancers are considered possibly curable. In most
cases, stage IV cancer is not considered curable, although there are exceptions.
• Possible Complications
• Blockage of the colon, causing bowel obstruction
• Cancer returning in the colon
• Cancer spreading to other organs or tissues (metastasis)
• Development of a second primary colorectal cancer
Colon cancer (Prevention)
• Colon cancer can almost always be caught by colonoscopy in its earliest and most
curable stages. Almost all men and women age 50 and older should have a colon
cancer screening. Patients at higher risk may need earlier screening.
• Colon cancer screening can often find polyps before they become cancerous.
Removing these polyps may prevent colon cancer.
• Changing your diet and lifestyle is important. Medical research suggests that low-
fat and high-fiber diets may reduce your risk of colon cancer.
• Some studies have reported that NSAIDs (aspirin, ibuprofen, naproxen, celecoxib)
may help reduce the risk of colorectal cancer. But these medicines can increase
your risk of bleeding and heart problems. Your health care provider can tell you
more about the risks and benefits of the medicines and other ways that help
prevent colorectal cancer.
Functional constipation
• Functional constipation often occurs in children during one of three
periods:
• when infants are transitioned from breast milk to formula or when solid foods
are introduced
• when toddlers are being toilet trained & attempt to control bowel
movements
• when children start school & avoid using the bathroom at school for bowel
movements
Functional constipation
• Functional constipation is diagnosed in children up to 4 years of age
who have had at least two of the following symptoms for 1 month:
• two or fewer bowel movements per week
• at least one episode of fecal incontinence—accidental leakage of solid or
liquid stool—per week in toilet-trained children
• history of excessive stool retention
• history of painful or hard bowel movements
• presence of a large fecal mass in the rectum
• history of large-diameter stools that may block the toilet
Functional constipation
• Functional constipation is diagnosed in children 4 to 18 years of age
who have had at least two of the following symptoms for 2 months
and do not have irritable bowel syndrome (IBS):
• two or fewer bowel movements per week
• at least one episode of fecal incontinence per week
• history of excessive stool retention
• history of painful or hard bowel movements
• presence of a large fecal mass in the rectum
• history of large-diameter stools that may block the toilet