Approach to GI disorders
Overview of Gastrointestinal Diseases
Classification of GI Diseases
Impaired Digestion and Absorption Altered Secretion Altered Gut Transit Immune Dysregulation Impaired Gut Blood Flow Neoplastic Degeneration Disorders Without Obvious Organic Abnormalities Genetic Influences
Impaired Digestion and Absorption
Zollinger-Ellison syndrome Lactase deficiency
gas and diarrhea
Celiac disease, bacterial overgrowth(>105 /ml), infectious enteritis, Crohn's ileitis, and radiation damage
Diffuse, Anemia, dehydration, electrolyte disorders, or malnutrition.
Biliary obstruction stricture or neoplasm
fat digestion.
Pancreatic enzymes in chronic pancreatitis or pancreatic cancer
Altered Secretion
Zollinger-Ellison syndrome, G cell hyperplasia, retained antrum syndrome, and duodenal ulcer disease. Atrophic gastritis or pernicious anemia Diarrhea
Acute bacterial or viral infection, chronic Giardia or Cryptosporidia infections, small-intestinal bacterial overgrowth, bile salt diarrhea, microscopic colitis, diabetic diarrhea, and abuse of certain laxatives
Large colonic villous adenomas and endocrine neoplasias
vasoactive intestinal polypeptide.
VIPoma
WDHA syndrome Verner morrison syndrome Pancreatic cholera Watery diarrhea, hypokalemia, achlorhydria Hypercalcemia, hyperglycemia, vasodilation A syndrome caused by non-beta pancreatic tumour Fasting VIP levels confirm diagnosis Surgery is the only treatment
Altered Gut Transit
Esophagus
Acid-induced stricture or neoplasm
Gastric outlet obstruction Small-intestinal obstruction
Adhesions, Crohn's disease, radiation- or drug-induced strictures, malignancy
colonic obstruction
Colon cancer, strictures (IBD), infections, or drugs.
Retardation of propulsion
Achalasia Gastroparesis Intestinal pseudoobstruction Slow-transit constipation Rectal prolapse, intussusception, or failure of anal relaxation
Gastric outlet obstruction
The traditional sodium chloride load test is performed by infusing 750 cc of sodium chloride solution into the stomach via a nasogastric tube (NGT). A diagnosis of gastric outlet obstruction (GOO) is made if more than 400 cc remain in the stomach after 30 minutes Nuclear gastric emptying studies Barium upper GI studies
Immune Dysregulation
Celiac disease Eosinophilic esophagitis and eosinophilic gastroenteritis Ulcerative colitis and Crohn's disease Microscopic colitides, lymphocytic and collagenous colitis
Colonic subepithelial infiltrates without visible mucosal damage
Bacterial, viral, and protozoal organisms
Impaired Gut Blood Flow
Ischemia
Arterial embolus, arterial thrombosis, venous thrombosis, or hypoperfusion from dehydration, sepsis, hemorrhage, or reduced cardiac output. Mucosal injury, hemorrhage, or even perforation
Neoplastic Degeneration
All GI regions are susceptible
Colorectal cancer in US Worldwide, gastric cancer
Esophageal cancer develops with chronic acid reflux, tobacco, alcohol Small-intestinal neoplasms are rare Pancreatic and biliary cancers elicit severe pain, weight loss, and jaundice Hepatocellular carcinoma Most GI cancers are carcinomas, but lymphomas can also occur
Disorders Without Obvious Organic Abnormalities
No abnormalities on biochemical or structural testing
Irritable bowel syndrome (IBS), functional dyspepsia, non-cardiac chest pain, and functional heartburn Altered gut motor function
Symptoms of Gastrointestinal Disease
Abdominal Pain Heartburn Altered Bowel Habits Nausea and Vomiting Diarrhea GI Bleeding Obstructive Jaundice
Evaluation of the Patient with Gastrointestinal Disease
History Physical Examination Tools for Patient Evaluation
Laboratory Luminal Contents Endoscopy
Upper Endoscopy Colonoscopy Endoscopic Retrograde Cholangiopancreatography Endoscopic Ultrasound
Radiography/Nuclear Medicine Histopathology Functional Testing
UGI endoscope
Colonoscope
Capsule endoscopy
Gastrointestinal Disease: Treatment
Nutritional Manipulation Pharmacotherapy
Over-the-Counter Agents Prescription Drugs Alternative Therapies
Enteric Therapies/Interventional Endoscopy and Radiology Surgery Therapy Directed to External Influences
