Chronic intestinal disorders, accessory organ diseases, and GI cancers

Intestinal diseases and disorders

Inflammatory bowel disease

Inflammatory bowel disease (IBD), an autoimmune disorder, includes two chronic diseases that cause inflammation of the digestive tract:

• Ulcerative colitis: Usually starts in the rectum and spreads into the large intestine. Damaged areas are in patches along the intestine. The inflammation may affect many layers of the GI tract wall.
• Crohn disease: Can affect any part of the GI tract but most often affects the ileum. Damage appears in patches next to healthy tissue. The inflammation affects several layers of the GI tract walls.

The etiology of IBD is unknown, but it is the result of a defective immune system. IBD has a genetic component, and environmental triggers cause inflammation of the digestive tract. Common signs and symptoms of IBD include persistent diarrhea, abdominal pain, blood in the stool, weight loss, and fatigue.

After the medical history and physical exam, the provider will order imaging tests and endoscopy exams. Stool samples are tested to rule out other conditions. Treatment consists of corticosteroids, immunomodulators, and biologics. Severe IBD may require surgery to remove the damaged GI tract. Common surgical procedures include colectomy, proctocolectomy, proctocolectomy with ileal pouch-anal anastomosis (IPAA), and ileostomy.

Intestinal obstructions

Intestinal obstructions are also called bowel obstructions. The obstruction can be either partial or complete and prevents stool or food from moving through the intestine. A complete intestinal obstruction is a medical emergency.

The obstruction can be related to a mechanical cause, such as adhesions, hernias, volvulus, impacted feces, and cancers. A nonmechanical obstruction, also called ileus or paralytic ileus, occurs because peristalsis stops. A paralytic ileus can be caused by infections, certain medications (e.g., narcotics), an electrolyte imbalance, a decrease in intestinal blood flow, or abdominal surgery. Signs and symptoms include severe abdominal pain, cramping, bloating, nausea, vomiting, swelling of the abdomen, loud bowel sounds, inability to pass flatus (gas), and constipation.

Tests to diagnose an intestinal obstruction can include an abdominal CT scan, an abdominal x-ray, a lower gastrointestinal (LGI) series, and an upper gastrointestinal (UGI) series. Treatment includes hospitalization and a nasogastric tube (a tube passed from the nose to the stomach), which is used to relieve abdominal contents and swelling. A bowel resection surgery may be required if the obstruction continues. A temporary or permanent colostomy may be done.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a disorder of the large intestine, although it does not cause harm to the colon. IBS is a common disorder, affecting females twice as often as males. People younger than age 45 often have IBS.

There is no known cause of IBS. Factors that may lead to IBS include changes in peristalsis, severe infection, early life stress, and changes in the intestinal microbes. Stress can increase the symptoms of IBS. The signs and symptoms include abdominal cramping, bloating, constipation, and diarrhea. Sometimes people go back and forth between diarrhea and constipation.

There is no specific test for IBS. The provider may do a colonoscopy, an upper endoscopy, x-ray, or CT scan to rule out other diseases. Treatment for IBS includes dietary changes, stress management, medications, and probiotics.

Additional diseases and disorders of the accessory organs

The following diseases and disorders are related to the accessory organs:

• Acute cholecystitis: A sudden inflammation and swelling of the gallbladder, which causes severe abdominal pain; can be caused when a gallstone blocks the cystic duct, causing irritation and pressure in the gallbladder.
• Mumps: Caused by a viral infection, which leads to painful swelling of the salivary glands.
• Primary biliary cirrhosis: Chronic liver disease causing the bile ducts to be inflamed and damaged, leading to the buildup of bile in the liver.
• Hemochromatosis: Causes too much iron to build up in the body, especially in the liver, heart, and pancreas, which damages the organs and causes a bronze or gray skin color.
• Sialoliths: The buildup of crystallized saliva deposits blocks the flow of saliva, causing pain and swelling; also called salivary stones.
• Sialadenitis: A bacterial infection of a salivary gland, usually related to blockage of the duct; can cause a painful lump in the gland, severe pain, high fever, and foul-tasting pus in the mouth.

Gastrointestinal system cancers

Cancer can affect any part of the GI system. The cause of cancer is a mutation of the cells, which leads to a tumor. To diagnose cancer, the provider will do a physical exam, endoscopy procedures, imaging tests, blood work, and a biopsy. Treatment consists of surgery, radiation therapy, and chemotherapy. Targeted therapy, which uses medications that attack only the cancer cells, can be used for some types of GI system cancers.

The risk factors, signs, and symptoms can vary for the different types of cancer. These are discussed in the following sections.

Oral cavity, pharyngeal, and laryngeal cancers

Oral cavity, pharyngeal, and laryngeal cancers can form in any of the tissues in the mouth and throat. Males are more likely than females to have oral cavity or pharyngeal cancer.

Using alcohol and tobacco products (e.g., cigarettes, betel quid, and gutka) can increase the risk of these cancers. A personal history of oral or throat cancer, human papillomavirus (HPV) infection, or Epstein-Barr virus can also increase the risk. The signs and symptoms depend on the type of cancer:

• Oral cancer: White or red patches, bleeding, or a continuous sore in the mouth, loose teeth, pain with swallowing, earache, and a lump in the neck
• Throat cancer (pharyngeal and laryngeal cancers): Continuous sore throat, lump in the neck, ear pain, ringing in the ear, and problems swallowing

Besides a history and physical exam, the provider may order a biopsy of the mouth lesion. A UGI endoscopy and imaging tests, such as CT scans, are used for throat cancer. Treatment consists of the following:

• Surgical removal of the tumor, a laryngectomy, or a pharyngectomy
• Targeted therapy, which uses medications that attack only the cancer cells
• Radiation therapy and chemotherapy

Stomach cancer

About 65% of stomach cancer cases occur in adults over age 65. Diagnosing stomach cancer in its early stages can be difficult because the symptoms (e.g., indigestion and stomach discomfort) can be caused by many other conditions.

Males have a greater risk of stomach cancer. A personal history of H. pylori infection or stomach inflammation is also a risk factor, along with a family history of stomach cancer. The risk of stomach cancer increases with cigarette smoking and often consuming smoked, pickled, or salted foods. Besides indigestion and stomach discomfort, other signs and symptoms include bloody stools, vomiting, weight loss, jaundice, and difficulty swallowing.

Besides a history and physical exam, the provider will order UGI endoscopy and imaging tests (e.g., CT scan and UGI series). Treatment consists of the following:

• Surgical removal of the tumor, subtotal gastrectomy (with an anastomosis), or total gastrectomy
• Radiation therapy, chemotherapy, and targeted drug therapies

Pancreatic cancer

Pancreatic cancer is difficult to diagnose in its early stages because the symptoms are vague and may go unnoticed. This type of cancer spreads quickly, and because the condition usually is diagnosed in the later stages of the disease, it can be difficult to treat.

Risk factors for pancreatic cancer include smoking, long-term diabetes mellitus, chronic pancreatitis, and certain hereditary disorders. Signs and symptoms include jaundice, abdominal and back pain, weight loss, and fatigue.

Besides a history and physical exam, the provider will order an endoscopic ultrasound and imaging tests (e.g., CT scan, MRI, positron emission tomography [PET]). Blood tests and biopsies may also be done. Treatment consists of the surgical removal of the tumor, a partial or total pancreatectomy, radiation therapy, and chemotherapy.

Liver cancer

Liver cancer can either be primary (the initial site) or metastatic (spread to the liver from the initial site elsewhere in the body). Primary liver cancer may be difficult to treat if it is diagnosed in an advanced stage.

Risk factors for primary liver cancer include a personal history of hepatitis B or C, cirrhosis, obesity, diabetes, hemochromatosis, and heavy alcohol use. Signs and symptoms include jaundice, right abdominal pain, and a lump in the right abdomen. The symptoms may not appear until the cancer is in an advanced stage.

Besides a history and physical exam, the provider will order blood tests, imaging tests (e.g., CT scan, MRI, and US), and a biopsy. Treatment consists of the following:

• Surgical removal of the tumor or liver transplantation
• Localized treatments, including heating or freezing cancer cells, injecting alcohol or chemotherapy into the tumor or placing radiation beads into the liver
• Radiation therapy, chemotherapy, targeted drug therapies, and immunotherapy

Small intestinal cancer

Small intestinal or small bowel cancer can also be called duodenal, ileal, and jejunal cancer. Adenocarcinoma is the most common form of small intestine cancer.

Risk factors for small intestine cancer include eating a high-fat diet or having a personal history of Crohn disease, colonic polyps, or celiac disease. Signs and symptoms include abdominal pain, weight loss, bloody stools, and a lump in the abdomen.

Besides a history and physical exam, the provider will order blood tests, imaging tests (e.g., CT scan, MRI, PET, LGI series, and US), and endoscopic procedures (e.g., upper endoscopy and capsule endoscopy). Treatment consists of surgery, chemotherapy, targeted drug therapies, and immunotherapy.

Colorectal cancer

Colorectal cancer is also called colon cancer and rectal cancer. It affects both males and females. Screening is recommended to start at age 45 for those with an average risk.

Risk factors for colorectal cancer include being over 50 years of age, smoking tobacco, and eating a high-fat diet. A family history of colorectal cancer, ulcerative colitis, or Crohn disease also increases the risk. A person with colorectal cancer may experience diarrhea, constipation, bloody stools, cramps, bloating, flatus (gas), nausea, vomiting, fatigue, or weight loss.

Besides a history and physical exam, the provider will order a colonoscopy and biopsy. A carcinoembryonic antigen (CEA) blood test may also be done. CEA is sometimes produced by colon cancers. Treatment consists of the following:

• Surgical removal of the tumor or polyp (polypectomy) or colectomy
• Radiation therapy, chemotherapy, targeted drug therapies, and immunotherapy