Additional digestive system diseases and disorders

The following are additional diseases and disorders of the esophagus: * Achalasia: The lower esophageal sphincter does not relax. Also, the esophageal peristalsis is reduced. Both factors delay the emptying of the food from the esophagus.

• Barrett esophagus: Caused by GERD; the lining of the esophagus changes to resemble the lining of the intestines; this can lead to a potentially fatal condition called esophageal adenocarcinoma.
• Esophageal atresia: The esophagus ends in a blind pouch and does not connect to the stomach.
• Esophageal varices: Enlarged veins in the esophagus, usually associated with severe liver disease; the veins can leak or rupture, causing life-threatening bleeding. * Additional diseases and disorders of the stomach include the following:
• Cyclic vomiting syndrome (CVS): Causes sudden, repeated episodes of severe nausea and vomiting; vomiting episodes usually occur at the same time each day and last for about the same amount of time.
• Dumping syndrome: Rapid gastric emptying; occurs when foods (most commonly carbohydrates) empty too quickly into the duodenum; can occur after bypass surgery or other types of bariatric surgeries for weight loss.
• Gastritis: Inflammation of the stomach lining; caused by bacteria, pain relievers, and alcohol.
• Gastroparesis: Stomach motility is slowed, causing delayed gastric emptying; can be caused by certain medications (e.g., opioids, antidepressants, and antihypertensives).
• Hypochlorhydria: Deficiency in the hydrochloric acid in the stomach, which can lead to improper digestion, lack of nutrient absorption, infections, and other health issues.

Intestinal diseases and disorders

Many intestinal diseases and disorders occur in adults, but some conditions affect children. The following sections describe common diseases and disorders of the intestine.

Acute appendicitis

Appendicitis is an inflammation of the appendix. Commonly, it occurs between the ages of 10 and 30, though it can occur at any age. The etiology is a blockage in the appendix that can increase pressure, affect blood flow, and cause inflammation. If the blockage is not treated, the appendix can burst and cause peritonitis (inflammation of the peritoneum), a life-threatening condition. The pain usually begins near the umbilicus and then moves to the lower right side of the abdomen. Rebound pain can occur with peritonitis. Additional signs and symptoms include low fever, abdominal bloating, anorexia, nausea, vomiting, constipation, diarrhea, and an inability to pass gas. After the physical exam, blood and urine laboratory tests will be performed to rule out other conditions. A complete blood count (CBC) will show an elevated white blood cell count. Imaging tests (e.g., x-ray, computed tomography [CT] scan, and abdominal ultrasound [US]) will be done to confirm appendicitis or rule out other conditions. Treatments consist of antibiotics and an appendectomy. Laparoscopic surgery will result in a few small incisions. If a laparotomy is done, the incision may be 2 to 4 inches long. If the appendix bursts and an abscess forms, surgery may be delayed while the abscess is drained.

Celiac disease

Celiac disease, also called gluten-sensitive enteropathy or celiac sprue, is a digestive and autoimmune disorder. When people with this disease eat foods with gluten, their immune system damages their small intestine. Gluten, a protein, is found in barley, rye, wheat, spelt, and triticale. It can also be found in other products, including vitamins and supplements, toothpaste, lip balm, and hair and skin products. Celiac disease is a genetic autoimmune disorder. The signs and symptoms of celiac disease can vary depending on the age of the person:

• Young children: Abdominal pain, vomiting, diarrhea, bloating, and constipation; irritability, emotional withdrawal, or very dependent behavior; failure to gain weight and grow; and obesity
• Teenagers: Diarrhea, constipation, delayed puberty, hair loss, slowed growth, and short height.
• Adults: Diarrhea, constipation, fatigue, bone or joint pain, depression, anxiety, irritability, missed menstrual periods, anemia, and osteoporosis. * Celiac disease can also cause lactose intolerance, anemia, dermatitis herpetiformis (an itchy, blistering skin condition), and canker sores in the mouth. The provider will perform a history and physical exam. Blood tests and an intestinal biopsy may be ordered. Treatment consists of a gluten-free diet. Foods that are safe to eat include rice, oats, corn, quinoa, millet, and buckwheat.

Diverticulitis

Diverticula are small marble-sized pouches that form in the large intestine. The pouches protrude through the weakened walls of the large intestine. These pouches are common after age 40 and usually do not cause symptoms unless they become inflamed or infected. When the diverticula become inflamed or infected, the condition is called diverticulitis. When a diverticulum tears, inflammation and infection can occur. Risk factors include aging, obesity, smoking cigarettes, lack of exercise, a low-fiber diet, and a high saturated fat diet. Medications such as steroids, opioids, and NSAIDs can also increase the risk. Signs and symptoms of diverticulitis include constant lower left abdomen pain and tenderness, nausea, vomiting, diarrhea, constipation, and fever. After a physical exam, the provider will order imaging and medical laboratory tests. Blood and urine tests are used to rule out infection, pregnancy, and liver disease. A CT scan can identify the inflamed pouches, thus confirming the diagnosis. Treatment depends on the symptoms. Antibiotics, over-the-counter (OTC) analgesics, and a liquid diet may be recommended. With severe attacks, intravenous (IV) antibiotics are given, and abscesses, if present, are drained. A primary bowel resection or a bowel resection with a colostomy may be done.

Foodborne illnesses

Eating or drinking contaminated food can result in a food-borne illness. Typically, food-borne diseases and disorders are acute illnesses, which occur suddenly and last for a short time. Most people recover without treatments, though sometimes more serious complications can occur. Many different types of bacteria, viruses, parasites, and chemicals can contaminate food:

• Salmonella: Found in raw or undercooked meat, poultry, and seafood. It can also be found in dairy products, eggshells, and inside eggs. * Shigella: Bacterium that spreads to others from one infected person’s unwashed hands after using the bathroom.
• Escherichia coli (E. coli): Found in raw or undercooked hamburger, unpasteurized milk and fruit juices, and fresh produce.
• Listeria monocytogenes: Found in raw and undercooked meats, unpasteurized milk, deli meats, soft cheeses, and hot dogs.
• Clostridium botulinum: Found in improperly canned foods and smoked and salted fish.
• Norovirus: Found in foods prepared by infectious food handlers; can cause inflammation of the intestines and stomach.
• Hepatitis A: A virus spread through food or drinks contaminated with a small amount of stool from an infected person.
• Trichinella spiralis: A roundworm parasite found in raw or undercooked pork or wild game. Common signs and symptoms include vomiting, diarrhea, abdominal pain, chills, and fever. Symptoms may last for a few hours to a few days. Complications can lead to dehydration, hemolytic uremic syndrome, and other disorders, such as reactive arthritis and irritable bowel syndrome. After a physical exam, the provider may order a stool culture and blood work. Treatment consists of replacing lost fluids and electrolytes. Over-the-counter antidiarrheal medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate) can help decrease diarrhea in adults. These medications should not be used if the person has bloody diarrhea, which could be a sign of a parasitic or bacterial infection.

Hemorrhoids

Hemorrhoids are swollen and inflamed veins. External hemorrhoids are located around the anus, and internal hemorrhoids affect the lining of the anus and the lower rectum. About 50% of those over 50 years of age have hemorrhoids. Hemorrhoids can be caused by straining during a bowel movement, pregnancy, aging, chronic constipation, and diarrhea. The most common symptom of internal hemorrhoids is bright red bleeding, which usually goes away within a few days. Anal itching can occur with external hemorrhoids. During the physical exam, the provider will check the anal area and perform a digital rectal exam. An anoscope, a proctoscope, or a sigmoidoscope may be used to examine the lower part of the large intestine and rectum. Home treatment includes a high-fiber diet, topical treatments (e.g., hydrocortisone, analgesic), sitz baths (soaking in a warm bath), cold packs, oral analgesics, and keeping the area clean.

Hernia

A hernia is a common disorder that occurs when part of an internal organ (e.g., intestine) bulges through a weak area in the muscles. The hiatal hernia was already discussed in a prior section. Other types include the following:

• Femoral hernia: A bulge below the groin, in the upper thigh. More common in women.
• Inguinal hernia: Most common type of hernia. A bulge forms in the groin and may extend into the scrotum.
• Umbilical hernia: The muscle around the umbilicus does not close at birth, and a bulge forms.

Inguinal hernia

An inguinal hernia occurs when tissue (e.g., part of the intestine) protrudes through a weak spot in the abdominal muscles (Figure 34.9). Sometimes people can gently push the hernia back into the abdomen, but other times the hernia may become trapped (incarcerated), and blood flow may be cut off to the tissue (strangulation), causing tissue death. This can be a life-threatening complication if it is not treated. For some inguinal hernias, the etiology is unknown. Other times, straining, strenuous activities, pregnancy, or chronic coughing may cause it. Signs and symptoms include bulging on the side of the pubic bone, burning or aching at the bulge, and groin heaviness, pain, or pressure. The provider will do a physical examination. The patient may be asked to stand and cough, which makes the inguinal hernia more prominent. A CT or magnetic resonance imaging (MRI) scan may be ordered if the hernia is not felt. For a small hernia that is asymptomatic, the provider may just wait and monitor it. Painful or enlarged hernias are treated with surgery (either an open hernia repair or a laparoscopic repair).