PATHOPHYSIOLOGY

DISEASES OF THE DIGESTIVE SYSTEM

BN3-S12012

Manukau Institute of
Technology

Common Manifestations of GIT

Diseases

Pain/heartburn/discomfort
Difficulty in swallowing
Loss of appetite
Nausea
Vomiting
Gaseous distension
Diarrhoea
Constipation
Bleeding

Simple Classification

I
T
I
T

Simple Classification

Infection

Viral
Bacterial
fungal

Traumatic
Inflammatory
Tumour

Benign
Malignant

Diseases of the Mouth

Infection: herpes simplex, thrush

Trauma: injuries, accidental biting, burns

(hot drinks)

Inflammation: aphthus ulcer

Tumour: lip cancer, tongue cancer

Dysphagia
Difficulty in swallowing

Dys: Bad

Phagia: eating/swallowing

Anorexia

Loss of appetite

Causes

a: without
orexe: appetite
ia: state or act
Psychosocial
Side effects of drugs
Diseases

Treatment

Treat the underlying cause

Nausea

Unpleasant sensation
Preceded by loss of appetite
Usually followed by vomiting
Usually associated with:

Sweating
Pallor
Tachycardia (increased heart rate)
Salivation
Vasoconstriction

Vomiting (emesis)
Forceful oral expulsion (throwing out)
of stomach and portions of small
intestine contents

Protective mechanism

Usually preceded by nausea

Can lead to complications (alkalosis,

dehydration, etc.)

Vomiting

The vomiting centre receives impulses from:

GIT

Cerebral cortex

Vestibular apparatus : motion sickness

Other factors:

Drugs and toxins

Hypoxia

Vomiting

Treatment of Nausea and

Vomiting

Supportive measures

reassurance

avoidance of triggering factors

bed rest if necessary

rehydration, IV fluids

Treat the underlying cause

Gastroesophageal Reflux

The return movement of stomach

contents
Can cause heartburn
Usually mild
If persists, can cause

GastroEsophageal Reflux Disease

(GERD) which can lead to severe
heartburns and may interfere with some
activities

Diarrhoea
The (frequent) passage of loose stool
Types:
Acute or chronic
Watery or bloody
Osmotic diarrhoea

Non-absorbable substances (fibre) draw excess

water into the intestinal lumen from the vascular
component (lactase deficiency)

Secretory diarrhoea

Mucosa of the gut secretes excessive amounts of

water and electrolytes into interstitial lumen in
response to irritation (bacteria, inflammation)

GIT Bleeding
Manifests as blood in vomit or blood in stool

Haematemesis:
Blood in the stomach is an irritant and causes vomiting.
May be bright red or ground coffee coloured
Haematochezia:
Red blood (fresh looking) in stool usually indicates
bleeding in lower bowel, below the cecum. May often be
the result of bleeding hemorrhoids.
Melaena:
Dark blood usually indicates bleeding above the cecum.
Occult:
Hidden blood can only be detected in a lab (stool
sample)

Diseases of the Stomach

Gastritis
Inflammation of the gastric mucosa
Types:
Acute

Extreme stress
Drugs:
Aspirin
NSAI
Corticosteroid
Alcohol

Infection: H. Pylori

Chronic

Peptic Ulcer
A group of ulcerative disorders of the upper
GIT that are exposed to acid-pepsin
secretions.

Most common peptic ulcers:

Gastric

Duodenal

Peptic Ulcer
Lesions that do not extend through the mucosal lining are
called erosions.
Causes:

Helicobacter pylori

Aspirin and other NSAIDs

Exposure to irritants (cigarette smoke, alcohol, caffeine)

Physiological stress: major operations, extensive burns,

severe diseases.

Peptic Ulcer

Diseases of the Small and Large Intestine

Infection
Trauma
Inflammatory Bowel Disease (IBD)

Crohn Disease
Ulcerative Colitis

Tumour
Others:

Irritable Bowel Syndrome (IBS)

Diverticular Disease
Intestinal Obstruction
Malabsorption

Irritable Bowel Syndrome

Click on the black area to watch the video
http://www.youtube.com/watch?v=eInvmxGhsko

Inflammatory Bowel Disease

http://www.youtube.com/watch?v=TSLKKzZ04Dk

Diseases of the Liver and

Hepatobiliry System

Common Manifestations

Pain/heaviness/discomfort
Nausea
Vomiting
Diarrhoea
Jaundice
Oedema and ascites
Bleeding tendency
Hepatomegaly (liver enlargement)

Other Manifestations

Telangiectasia

Spider nevi

Palmar erythema

Caput medusae

Fetor hepaticus

Muscle wasting

Gynaecomastia

Telangiectasia

Spider nevi

Caput Medusae

Palmar Erythema

Jaundice

Yellowish discolouration of sclera and mucous

membrane due to increased serum bilirubin.
Causes:

Pre-hepatic:
haemolytic

anaemia

Hepatic:
Infection
Cirrhosis
Cancer

Post-hepatic
Gall

bladder stones

Diseases of the Liver

Viral Hepatitis

A
B
C
D
E

Liver cirrhosis
Portal hypertension
Hepatic cancer

Liver Damage

Alcoholic Liver Disease

Chronic Excess Alcohol Consumption

Alcoholic Steatosis
-Liver decreases the formation and
release of lipoproteins
-Lipid accumulates in liver
-Over time fat cells become surrounded by fibrous tissue

Alcoholic Hepatitis
-Liver necrosis begins
-Mallory's Bodies lead to fibrosis around cells and veins
-Hepatocytes become infiltrated with WBCs
-Liver enlarges
-Scar tissue develops

Alcoholic Cirrhosis
-Liver becomes firm and nodules form
-The liver eventually shrinks and nodules become
surrounded by connective tissue

DEATH due to....

Hepatocellular
Carcinoma

Infection

Hepatic
Encephalopathy

Liver Failure

G.I. Bleeds

Liver Failure

Portal Hypertension

High pressure in the portal vein and its

branches

Causes

Prehepatic: Blockage occurs in bloodflow to

the liver

Intrahepatic: Blockage occurs in bloodflow

within liver

Portal vein thrombosis

Cirrhosis

Post hepatic: Increased pressure in inferior

vena cava

Right heart failure

Portal Hypertension

The vessels most susceptible to high portal

pressures are:

Esophageal
Veins

bulge and protrude into the lumen of the esophagus.

Vessels may haemorrhage causing exsanguination and death

Haemorrhoidal
Causes

haemorrhoids which may also rupture into the rectum

Cholelithiasis

Gall Stones

(chole) = bile

(lithia) = stone

(sis) = process

Caused by the precipitation of substances

contained in bile particularly
cholesterol and bilirubin

Cholelithiasis
Factors that contribute to the
formation of gallstones include:

Excessive excretion of cholesterol from the

liver into bile
obesity,

pregnancy, oral contraceptive use,

drugs that lower serum cholesterol

The presence of gallbladder sludge

pregnancy,

Malabsorption of bile salts

intestinal

starvation and rapid weight loss

bypass surgery, ileal disease

Inflammation of the gall bladder

Cholelithiasis

Most people experience no symptoms

except when the stones obstruct the bile
flow
Small stones can pass into the common
bile duct causing symptoms of
indigestion and bilary colic (a severe
pain in the upper right section of the
abdomen)
Large stones are more likely to obstruct
flow and cause jaundice

References

Brown, D. & Edwards, H. (Eds). (2008). Lewiss medical-surgical

nursing: Assessment & management of clinical problems (2nd ed).
Sydney, Australia: Elsevier-Mosby.

Craft, J., Gordon, L., & Tiziani, A. (2011). Understanding

pathophysiology. Sydney, Australia: Elsevier-Mosby

Johnstone, C., Farley, A., & Hendry, C. (2006). Nurses role in

nutritional assessment and screening Part one of a two-part
series. Nursing Times 102 (49), 28-29

Johnstone, C., Farley, A., & Hendry, C. (2006). Nurses role in

nutritional assessment and screening Second of a two-part series.
Nursing Times 102 (50), 28-29

Mark A. Marinella. (2008) Umbilical Complications of Malignancy.

Journal of Gastrointestinal Cancer 39:1-4, 37-41