MANAGEMENT OF PATIENTS WITH GASTRO-

INTESTINAL DISORDERS
INTRODUCTION
 TERMINOLOGIES
 DYSPHAGIA- Difficulty in swallowing
 ODYNOPHAGIA- Painful swallowing
 ACHALASIA- A motor disorder characterized by progressively incomplete relaxation of the lower esophageal
sphincter
 DYSPEPSIA- Heart burn, Indigestion, and Epigastric pain
 LAVAGE- Irrigation or washing out of an organ
 GAVAGE- Feeding/ Enteral Nutrition
 VAGOTOMY- Removal of vagus nerve
 HAEMATEMESIS- Blood vomitus
 HAEMATOCHEZIA- Blood in the stool
 MELENA- Tarry black stool
 OESOPHAGEAL DISORDERS
GERD
 Gastroesophageal reflux refers to regurgitation of gastric contents from the stomach into the oesophagus.

CAUSES : It occurs when the lower esophageal sphincter is weak or relaxes inappropriately, allowing the stomach's
contents to flow up into the esophagus. It’s mainly because of
 Overeating,
 Lying down after eating,
 Eating particular foods like spicy foods, gas containing foods etc…

GERD occurs more commonly in people who are

 overweight or obese because of increased pressure on the abdomen
 pregnant, due to the same increased pressure
 taking certain medications, including some asthma medications, calcium  channel blockers, antihistamines,
sedatives, and antidepressants.
 smoking, and being exposed to second-hand smoke
 Contd…

SIGNS AND SYMPTOMS

 A burning sensation in the chest (heartburn), usually after eating, which might be worse at night
 Chest pain
 Difficulty swallowing
 Regurgitation of food or sour liquid
 Sensation of a lump in the throat
Night time acid reflux
 Chronic cough
 Laryngitis
 New or worsening asthma
 Disrupted sleep
 DIAGNOSTIC EVALUATION

Bravo wireless esophageal pH

UPPER ENDOSCOPY Esophageal manometry monitoring
 NURSING MANAGEMENT
GERD
 Life style modifications such as avoiding intake of spicy foods, beverages like coffee, tea, alcohol and smoking.
 Take small frequent diets
 Provide OTC acid suppressions such as histamine2-receptor antagonists, PPIs, and antacids.
 Incase of chronic patients, Promotility agents, such as metoclopramide and baclofen, increase forward
movement of gastric contents and may reduce esophageal reflux symptoms.
SURGICAL TREATMENT
 Surgical fundoplication
INDICATIONS FOR LAPRASCOPIC ANTI-REFLUX SURGERY
 Repeated aspiration pneumonia or asthma related to reflux
 Barrett esophagus (controversial)
 Failed maximal medical therapy
 Unable to take medications due to compliance or side effects
 Younger patients who do not want to take chronic medications due to
adverse effects and high cost.
LINX Device

Linx (Torax Medical) is a small, surgically

implanted ring of interlinked titanium
beads with magnetic cores that prevent
reflux in patients with refractory GERD
by augmenting the barrier function of
the esophageal sphincter.
 COMPLICATIONS

Esophagitis: This is an inflammation of the esophagus.

Esophageal stricture: Narrowing of the esophagus, results in
dysphagia.
Barrett's esophagus: The cells lining the esophagus changed into
cells similar to the lining of the intestine. This can develop
into cancer.
Respiratory problems: It is possible to breathe stomach acid into
the lungs, which can cause a range of problems including chest
congestion, hoarseness, asthma, laryngitis, and pneumonia.
 PEPTIC ULCER

Peptic ulcer is the open sore in the stomach or abdomen

(i.e) breakdown of gastric or duodenal mucosal lining.
CAUSES
 Bacterial infections such as Helicobacter pylori
 NSAIDs
 Spicy foods
 Smoking, Alcohol and caffeinated beverages
 Stress
 Signs and symptoms
 Abdominal pain classically epigastric strongly correlated to mealtimes. In case of duodenal ulcers the pain appears
about three hours after taking a meal and awakes the patient from sleep;
 Bloating and abdominal fullness;
 Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus - although this is more
associated with gastroesophageal reflux disease)
 Nausea and copious vomiting;
 Loss of appetite and weight loss in gastric ulcer.
 Weight gain in duodenal ulcer as the pain is relieved by eating
 Hematemesis 
 Melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin)
 Rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis, extreme, stabbing pain,
and requires immediate surgery.
DIAGNOSTIC EVALUATION
 COMPLICATIONS

Complication Cause

ulcer wears away the stomach or small intestine and

Bleeding
breaks the blood vessels there

Perforation ulcer breaks through the lining and stomach wall, causing
bacteria, acid, and food to leak through

inflammation and infection of the abdominal cavity due to

Peritonitis
perforation

scar tissue can form as a result of the ulcers and keep food
Blockage
from leaving the stomach or duodenum
TO TREAT COMPLICATIONS

HAEMORRHAGE

Assess Bleeding

Prevent shock

Replace fluids

Administer vasopressin via an

infusion pump
Arterial embolization with
angiography
 PREVENTION
 Lower the intake of NSAIDs, or switch to another medication if taking NSAIDs regularly.
 Take NSAIDs, with meals or medications that protects stomach lining.
 Refrain from smoking, as it can slow healing and increases the risk of digestive tract cancers.
 If peptic ulcer diagnosed with H. pylori, take antibiotics regularly.
 Increase physical activity. Regular exercise can activate the immune system and helps to lower
inflammation throughout cells.
 GASTRIC DISORDERS

GASTRITIS

INFLAMMATION OF THE PROTECTIVE LINING

OF THE STOMACH.

 Weaknesses or injury to the mucus-lined

barrier that protects the stomach wall
allows digestive juices to damage and
inflames stomach lining.
 TYPES OF GASTRITIS

• Is a sudden inflammation or swelling in the

ACUTE GASTRITIS
lining of the stomach.

• Stomach lining becomes inflamed over a

CHRONIC GASTRITIS
long period of time
 RISK FACTORS

 Bacterial infection. 
 Regular use of pain relievers. 
 Older age. 
 Excessive alcohol use. 
 Stress. 
 Autoimmune gastritis
 Other diseases conditions includes HIV/AIDS, Crohn's disease and parasitic infections.
 SIGNS AND SYMPTOMS

Nausea or recurrent upset stomach

Abdominal bloating
Abdominal pain
Vomiting
Indigestion
Burning or gnawing feeling in the stomach between meals or at night
Hiccups
Loss of appetite
Vomiting blood or coffee ground-like material
Black, tarry stools
 MANAGEMENT

 Proton pump inhibitors

 Acid reducing medications
 Antacids
 Probiotics
 GI BLEEDING

Gastrointestinal (GI) bleeding is a serious symptom that occurs within the digestive tract. Digestive tract consists of
the following organs:
 Esophagus
 Stomach
 Small intestine, including the duodenum
 Large intestine or colon
 Rectum
 Anus

GI bleeding can occur in any of these organs. If bleeding occurs in your esophagus, stomach, or initial part of the
small intestine (duodenum), it’s considered upper GI bleeding. Bleeding in the lower small intestine, large intestine,
rectum, or anus is called lower GI bleeding.
Gastrointestinal bleeding can occur either in the upper or lower gastrointestinal tract. It can have a number of causes.
Upper GI bleeding
Causes can include:
 Peptic ulcer. This is the most common cause of upper GI bleeding. Peptic ulcers are sores that develop on the lining
of the stomach and upper portion of the small intestine. Stomach acid, either from bacteria or use of anti-
inflammatory drugs, damages the lining, leading to formation of sores.
 Tears in the lining of the tube (esophagus). Known as Mallory-Weiss tears, they can cause a lot of bleeding. These
are most common in people who drink alcohol to excess.
 Abnormal, enlarged veins in the esophagus (esophageal varices). This condition occurs most often in people with
serious liver disease.
 Esophagitis. This inflammation of the esophagus is most commonly caused by gastroesophageal reflux disease
(GERD).
Lower GI bleeding
Causes can include:
 Diverticular disease. This involves the development of small, bulging pouches in the digestive tract (diverticulosis). If one or more
of the pouches become inflamed or infected, it's called diverticulitis.
 Inflammatory bowel disease (IBD). This includes ulcerative colitis, which causes inflammation and sores in the colon and rectum,
and Crohn's disease, and inflammation of the lining of the digestive tract.
 Tumors. Non-cancerous (benign) or cancerous tumors of the esophagus, stomach, colon or rectum can weaken the lining of the
digestive tract and cause bleeding.
 Colon polyps. Small clumps of cells that form on the lining of your colon can cause bleeding. Most are harmless, but some might
be cancerous or can become cancerous if not removed.
 Hemorrhoids. These are swollen veins in your anus or lower rectum, similar to varicose veins.
 Anal fissures. These are small tears in the lining of the anus.
 Proctitis. Inflammation of the lining of the rectum can cause rectal bleeding.
 SIGNS AND SYMPTOMS

COMMON SYMPTOMS ACUTE BLEEDING

 black or tarry stool  A drop in blood pressure
 bright red blood in vomit  Little or no urination
 cramps in the abdomen  A rapid pulse
 Unconsciousness
 dark or bright red blood mixed with stool
CHRONIC BLEEDING
 dizziness or faintness  Abdominal pain
 feeling tired  Occult bleeding
 paleness  Anemia with tiredness and shortness of
 shortness of breath breath.
 vomit that looks like coffee grounds
 weakness
 DIAGNOSTIC EVALUATION

Blood tests
Stool tests 
Nasogastric lavage 
Upper endoscopy
Colonoscopy
Capsule endoscopy 
Flexible sigmoidoscopy 
Balloon-assisted enteroscopy 
Angiography
Imaging tests
MANAGEMENT
 MANAGEMENT

 Supplemental oxygen
 Crystalloid/colloid fluid resuscitation
 +/- blood transfusion
 Consider correcting coagulopathy (?benefit vs risk)
 Acid Suppression such as Proton pump inhibitor H2 R antagonists
 Somatostatin Analogue Octreotide
 Terlipressin
 Antibiotics
 Tranexamic acid
PYLORIC STENOSIS
In pyloric stenosis, the muscles in the part
of stomach enlarges, narrowing the
opening of the pylorus and eventually
preventing food from moving from the
stomach to the intestine.
 CAUSES
 GENDER
 RACE
 PREMATURE BIRTH
 HABIT OF SMOKING DURING ANTENATAL PERIOD
 BOTTLE FEED BABIES
 CERTAIN MEDICATIONS LIKE ANTIBIOTICS
 SIGNS AND SYMPTOMS

 Weight loss
 Projectile vomiting
 Ravenously hungry despite vomiting
 Lack of energy
 Fewer bowel movements
 Constipation
 Frequent, mucous stools
 DIAGNOSTIC EVALUATION

 HISTORY COLLECTION
 S. ELECTROLYTES
 ULTRASOUND
 BARIUM SWALLOW WITH UPPER GI SERIES
 MANAGEMENT

MEDICAL MANAGEMENT
 keep the infant in NPO.
 Correction of fluid loss, electrolytes, and acid-base imbalance.
 Obtain IV access- initial bolus (20 mL/kg) of isotonic crystalloid fluid.
 If serum electrolytes is normal then maintain intravenous fluid: 5% dextrose in 0.45% normal saline
with 20mEq/l of potassium chloride replacement.
 Infant's fluid status should be continuously reassessed with special attention to acid-base status and
urine output.
 Administered ATROPINE intravenously or orally for the cessation of projectile vomiting. 
SURGICAL MANAGEMENT
 Laparoscopic pyloromyotomy 
 HERNIAS

A hernia occurs when an organ or fatty tissue squeezes through a

weak spot in a surrounding muscle or connective tissue called fascia.
THE MOST COMMON TYPES OF HERNIA ARE
 Hiatal (upper stomach),
 Inguinal (inner groin),
 Incisional (resulting from an incision),
 Femoral (outer groin), and
 Umbilical (belly button)
REDUCIBLE VS. IRREDUCIBLE
 Hernias are often categorized as reducible or irreducible:
 Reducible hernias can be pushed back in. They may also shrink
when you lie down.
 Irreducible hernias happen when part of your intestine pushes
into the hernia, making it hard to push the hernia back in.
HIATAL HERNIA

A hiatal hernia occurs when the upper part of the

stomach pushes through an opening in the diaphragm
and into the chest cavity. 
TYPES OF HERNIA
 Sliding hiatal heria
 Paraesophageal hernia
 CAUSES
Increase pressure in the abdominal cavity
 Pressure can come from coughing , vomiting, straining during a bowel movement
 Heavy lifting or physical strain
 Pregnancy 
 Obesity or
 Extra fluid in the abdomen
 SIGNS AND SYMPTOMS
 Heartburn
 Bitter or sour taste in the back of the throat
 Bloating and belching
 Discomfort or pain in the stomach or esophagus
 Chest pain, resembles as heart attack.
 DIAGNOSTIC EVALUATION

 Barium swallow 
 Endoscopy 
 Esophageal manometry
 pH test
 Gastric emptying studies
 MANAGEMENT
 Lose weight, if overweight
 Take small frequent meals.
 Avoid certain acidic foods, such as tomato sauce and citrus fruits or juices, which irritates the esophageal lining.
 Limit the fried and fatty foods, foods containing caffeine (including chocolate), peppermint, carbonated
beverages, alcoholic beverages, ketchup and mustard, and vinegar.
 Eat meals at least three to four hours before lying down, and avoid bedtime snacks.
 Elevate the head 30 – 40 degrees higher than the rest of the body when lying on the back. Raising the level of
head helps gravity keep the stomach’s contents in the stomach.
 Quit smoking
 Do not wear a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top
hosiery and body shapers
 Take medications like over-the-counter medications includes antacids or H-blockers after eating to reduce acid
secretions in the stomach.
 SURGICAL MANAGEMENT

Surgery may be recommended if:

 symptoms are severe and interfere with quality of life
 symptoms do not respond to other treatments
 Hernia is at risk of becoming strangulated, which is where the blood supply to the herniated tissue is cut off, a situation
that can be fatal
 symptoms include bleeding, ulcers, or narrowing of the food pipe (esophagus), which is known as an esophageal stricture
TYPES OF SURGERIES
 Nissen fundoplication
 Endoluminal fundoplication
 Open surgery
 INGUINAL HERNIA
In  inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in
the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this
area.
CAUSES
 Increased pressure within the abdomen
 A pre-existing weak spot in the abdominal wall
 Straining during bowel movements or urination
 Strenuous activity
 Pregnancy
 Chronic coughing or sneezing
 SIGNS AND SYMPTOMS
 A bulge in the area on either side of the pubic bone, which becomes more obvious during upright position,
especially while coughing or straining.
 A burning or aching sensation at the bulge.
 Pain or discomfort in the groin, especially when bending over, coughing or lifting.
 A heavy or dragging sensation in the groin.
 Weakness or pressure in the groin.
 Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum
In Severe cases
Strangulated hernia includes:
 Nausea, vomiting or both.
 Fever.
 Sudden pain that quickly intensifies.
 A hernia bulge that turns red, purple or dark
 Inability to move your bowels or pass gas.
 INCISIONAL HERNIA
An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other
tissue protrudes. Incisional hernias results from a weakening of the abdominal muscle due to a surgical incision.
Incisional hernias are most likely to occur within three to six months post-surgery but can happen at any time.
CAUSES
 Individuals who participate in excessive or premature physical activity after surgery,
 gain considerable weight,
 become pregnant or increase abdominal pressure in any other way before the incision is fully healed are
especially at risk for an incisional hernia.
RISK FACTORS
 wound infection
 existing health conditions, such as renal failure, diabetes, or lung disease
 obesity
 smoking
 certain medications, including immunosuppressant drugs or steroids
 SIGNS AND SYMPTOMS
 visible bulge, while stand up, lift something, or cough.
 Nausea and vomiting
 Fever
 Burning or aching near the hernia
 Abdominal pain and discomfort, particularly around the hernia
 Faster heartbeat than usual
 Constipation
 Diarrhea
 Thin, narrow stool
 UMBILICAL HERNIA
 An umbilical hernia creates a soft swelling or bulge near the navel. It occurs when part of the intestine protrudes
through the umbilical opening in the abdominal muscles.
CAUSES
During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening
normally closes just after birth. If the muscles don't join together completely in the midline of the abdominal wall,
an umbilical hernia may appear at birth or later in life.
In adults,
 too much abdominal pressure contributes to umbilical hernias. Causes of increased pressure in the abdomen
include:
 Obesity
 Multiple pregnancies
 Fluid in the abdominal cavity (ascites)
 Previous abdominal surgery
 Long-term peritoneal dialysis to treat kidney failure
 SIGNS AND SYMPTOMS
INFANTS AND CHILDREN
 An umbilical hernia looks like a lump in the navel.
 More obvious when the infant is laughing, crying, going to the toilet, or coughing. and when the child is lying
down or relaxed, the lump may shrink.
ADULTS
 Pain or discomfort
 Vomiting
 The bulge swells up more or becomes discolored.
 OVERALL MANAGEMENT
 Hernia without symptoms, the usual course of action is to watch and wait, but this can be risky for certain
types of hernia, such as femoral hernias.
 Within 2 years of a femoral hernia being diagnosed, 40 percent result in bowel strangulation.
 Surgical repair to remove the risk of later strangulation of the gut, a complication where blood supply is cut off
to an area of tissue, which requires an emergency procedure.
SURGICAL MANAGEMENT
 open surgery - closes the hernia using sutures, mesh, or both, and the surgical wound in the skin is closed with
sutures, staples, or surgical glue.
 laparoscopic operation (keyhole surgery) - Surgical repair of a hernia guided by a laparoscope allows for the use
of smaller incisions, enabling a faster recovery from the operation.
 INTESTINAL DISORDERS

CELIAC DISEASE
 A serious autoimmune disease
 Occurs in genetically predisposed people Ingestion
of gluten leads to damage in the small intestine.
 Gluten is a protein found in wheat, rye and barley.
 Allergic reactions triggers immune response that
attacks the villi of the small intestine results in
Malabsorption.
 People with a first-degree relative with celiac
disease (parent, child, sibling) have a 1 in 10 risk of
developing celiac disease.
 RISK FACTORS

  Family member with celiac disease or dermatitis herpetiformis

 Type 1 diabetes
 Down syndrome or Turner syndrome
 Autoimmune thyroid disease
 Microscopic colitis (lymphocytic or collagenous colitis)
 Addison's disease
 SIGNS AND SYMPTOMS
For Adult
 Abdominal pain
 Nausea
 Anemia
 Itchy blistery rash (doctors call this dermatitis herpetiformis)
 Loss of bone density
 Headaches or general fatigue
 Bone or joint pain
 Mouth ulcers
 Weight loss
 Heartburn
For Children
 Nausea or vomiting
 Bloating or a swelling in the belly
 Diarrhea
 Constipation
 Pale, foul-smelling stool (steatorrhea)
 Weight loss
 Contd….

DIAGNOSTIC EVALUATION
 Serology tests to identify certain antibodies.
 Genetic testing to identify human leukocyte antigens to rule out celiac disease
 Biopsy of small intestine through endoscopy
MANAGEMENT
 Strict gluten-free diet.
 Avoid foods such as bread, cake, and other baked goods, beer, pasta, cereals, and even some toothpastes,
medications, and other products that contain gluten.
 gluten-free vitamins and mineral supplements.
 Cont…
INTESTINAL OBSTRUCTION

Intestinal obstruction refers to

the partial or complete
mechanical or non-mechanical
blockage of the small or large
intestine .
 CLASSIFICATION

 Cause of obstruction : Mechanical or Functional ( Ileus )

 Duration of obstruction: Acute or Chronic.

 Extent of obstruction : Partial or Complete.

 Type of obstruction : Simple or Complex (closed loop and strangulation)

 MECHANICAL OBSTRUCTION
(DYNAMIC ILEUS)

A mechanical bowel obstruction is a partial or complete blockage in the intestine where the

peristalsis movement is present which acts against the obstruction 
 NON-MECHANICAL OBSTRUCTION
(ADYNAMIC ILEUS)
 Non-mechanical obstruction can occur when the muscles or nerves within the small or large intestine no longer
function. This is called paralytic ileus. 
 Paralytic ileus refers to a non-mechanical obstruction where the rhythmic muscle contractions of the intestine,
known as peristalsis, stops.

CAUSES:
 Abdominal or Pelvic surgery
 Infections like gastroenteritis or appendicitis
 Opioid pain medications, Antidepressants, and Anti - muscarinic medications
 Electrolyte imbalances such as potassium depletion
 Parkinson’s disease and other nerve and muscle disorders
 Hirschsprung ‘s disease
 Intestinal ischaemia due to vascular occlusion or intestinal distention
 Contd…

In the small intestine,

 scar tissue is most often the cause.
 Hernias and Crohn's disease, which can twist or narrow the intestine, and
 Tumors which can block the intestine.
 Intussusception- one part of the intestine folds like a telescope into another part

In the large intestine, 

 cancer is most often the cause.
 Severe constipation from a hard mass of stool, and narrowing of the intestine caused by diverticulitis
or inflammatory bowel disease.
 DIAGNOSTIC EVALUATION
Phy Com
sica pute
Ult Air
X- rized ras or
l
tom bari
exa ray ogra ou um
min .  phy nd ene
atio (CT).
n.    .  ma.
 MANAGEMENT

MEDICAL MANAGEMENT
 Resuscitation
 Ryle tube free flow with 4 hourly aspiration- decompression of proximal to the obstruction, reduce
subsequent aspiration during induction of anesthesia and post extubation.
 3. IV drip normal saline / Hartmann (Sodium & water loss during IO)
 4. Broad spectrum antibiotic (not mandatory but need in all patient undergoing surgery.
SURGICAL MANAGEMENT
 Laparotomy.
 Resection and Anastomosis
 DISORDERS OF THE LARGE INTESTINE

APPENDICITIS
Appendicitis is an inflammation of the appendix, a
finger-shaped pouch that projects from the colon on
the lower right side of the abdomen. 
CAUSES
 Bacterial infection
 SIGNS AND SYMPTOMS

Classic symptoms of appendicitis include:

 Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen.
This is usually the first sign.
 Loss of appetite
 Nausea and/or vomiting  soon after abdominal pain begins
 Abdominal swelling
 Fever of 99-102 degrees Fahrenheit
 Inability to pass gas
 DIAGNOSTIC EVALUATION

 History collection
 Physical examination
 Urinalysis
 Ultrasound
 CT scan
 MANAGEMENT
 IV Antibiotics
Surgery includes
 open appendectomy
 Laprascopic appendectomy
COMPLICATIONS
 A ruptured appendix.
 A pocket of pus that forms in the abdomen. 
 HIRSCHSPRUNG’S DISEASE
Hirschsprung disease is a birth defect. This disorder is characterized by absence of ganglion nerve cells, causes the
bowel muscles to lose their ability to move stool through the intestine (peristalsis). Peristalsis creates wave-like
contractions from the muscles lining the intestines. These contractions propel stool and other waste material
through the digestive system. Ineffective peristalsis leads to stool backing up in the intestines.
SIGNS AND SYMPTOMS
The most obvious sign for newborn is
 failure to have a bowel movement within 48 hours after birth.
 Swollen belly
 Vomiting, including vomiting a green or brown substance
 Constipation or gas, which might make a newborn fussy
 Diarrhea
In older children, signs and symptoms can include:
 Swollen belly
 Chronic constipation
 Gas
 Failure to thrive
 Fatigue
 DIAGNOSTIC EVALUATION

 Abdominal X-ray using a contrast dye. 

 Measuring control of the muscles around the rectum (anal manometry). 
 Removing a sample of colon tissue for testing (biopsy). 
 Contd….

SURGICAL TREATMENT
 Pull-through surgery
 Ostomy surgery

LIFESTYLE AND HOME REMEDIES

 Serve high-fiber foods. 
 Increase fluids. 
 Encourage physical activity. 
 Laxatives
 Cont…
HAEMORRHOIDS

A dilated (enlarged) vein in the walls of the anus

and sometimes around the rectum, usually caused
HAEMORRHOIDS by untreated constipation. but occasionally
associated with chronic diarrhoea.
 CAUSES

 Increased pressure in the lower rectum

 Straining during bowel movements
 Sitting for long periods of time on the toilet
 Having chronic diarrhea or constipation
 Being obese
 Being pregnant
 Having anal intercourse
 Eating a low-fiber diet
 Regular heavy lifting
 SIGNS AND SYMPTOMS
External hemorrhoids
These are under the skin around your anus. Signs and symptoms might include:
Itching or irritation in your anal region
Pain or discomfort
Swelling around your anus
Bleeding
Internal hemorrhoids
Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining
or irritation, when passing stool it can cause painless bleeding during bowel movements.
You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.
Thrombosed hemorrhoids
If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:
Severe pain
Swelling
Inflammation
A hard lump near anus
DIAGNOSTIC EVALUATION

Digital
examin
ation. 

Visual
inspec
tion.
 TREATMENT
 Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so, softens the stool and increases its
bulk, which will help you avoid the straining that can worsen symptoms from existing hemorrhoids. Add fiber to
your diet slowly to avoid problems with gas.
 Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or
use pads containing witch hazel or a numbing agent.
 Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water for 10 to 15 minutes two to
three times a day. A sitz bath fits over the toilet.
 Take oral pain relievers. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB,
others) temporarily to help relieve your discomfort.

Medications
 Over-the-counter includes creams, ointments, suppositories or pads.
 These products contain ingredients such as witch hazel, or hydrocortisone and lidocaine, which can
temporarily relieve pain and itching.
Minimally invasive procedures
Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid
to cut off its circulation. The hemorrhoid withers and falls off within a week.
 Hemorrhoid banding can be uncomfortable and cause bleeding, which might begin two to four days after the
procedure but is rarely severe. Occasionally, more-serious complications can occur.
• Injection (sclerotherapy). Your doctor injects a chemical
solution into the hemorrhoid tissue to shrink it. While the
injection causes little or no pain, it might be less effective than
rubber band ligation.
• Coagulation (infrared, laser or bipolar). Coagulation techniques
use laser or infrared light or heat. They cause small, bleeding
internal hemorrhoids to harden and shrivel. Coagulation has
few side effects and usually causes little discomfort.
 COMPLICATIONS

Anemia. 

Strangulated
Blood clot. 
hemorrhoid. 
 PREVENTIVE MEASURES

Eat high-fiber
Avoid long foods. 
periods of sitting.

Drink plenty of
fluids.

Exercise

Consider fiber
supplements 

Go as soon as
you feel the urge
Don't strain. 
 DISORDERS OF ACCESSORY ORGANS

CIRRHOSIS OF LIVER

A type of liver disease that describes permanent

scarring of the liver.  Normal liver cells are
replaced with scar tissue that is incapable of
performing any liver function.
 Contd….

DISORDERS OF THE GALL BLADDER

 Contd…
DISORDERS OF THE PANCREAS

PANCREATITIS PANCREAS CARCINOMA

PHARMACOLOGICAL MANAGEMENT