approach to gi disorders

8/2/2019 Approach to GI Disorders

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Approach to GI disorders


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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


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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 pancreaticcancer


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Altered Secretion

Zollinger-Ellison syndrome, G cell hyperplasia, retainedantrum syndrome, and duodenal ulcer disease.

Atrophic gastritis or pernicious anemia

Diarrhea Acute bacterial or viral infection, chronic Giardia or

Cryptosporidia infections, small-intestinal bacterialovergrowth, bile salt diarrhea, microscopic colitis, diabeticdiarrhea, and abuse of certain laxatives

Large colonic villous adenomas and endocrineneoplasias

vasoactive intestinal polypeptide.


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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


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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


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Gastric outlet obstruction

The traditional sodium chlorideload test is performed byinfusing 750 cc of sodiumchloride solution into thestomach via a nasogastric tube

(NGT). A diagnosis of gastric outlet

obstruction (GOO) is made ifmore than 400 cc remain in thestomach after 30 minutes

Nuclear gastric emptyingstudies

Barium upper GI studies


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Immune Dysregulation

Celiac disease

Eosinophilic esophagitis and eosinophilicgastroenteritis

Ulcerative colitis and Crohn's disease Microscopic colitides, lymphocytic and

collagenous colitis

Colonic subepithelial infiltrates withoutvisible mucosal damage

Bacterial, viral, and protozoal organisms


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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


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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, weightloss, and jaundice

Hepatocellular carcinoma

Most GI cancers are carcinomas, but lymphomas canalso occur


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Disorders Without Obvious Organic

Abnormalities

No abnormalities on biochemical or structural

testing

Irritable bowel syndrome (IBS), functional

dyspepsia, non-cardiac chest pain, and functionalheartburn

Altered gut motor function


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Symptoms of Gastrointestinal Disease

Abdominal Pain

Heartburn

Altered Bowel Habits Nausea and Vomiting

Diarrhea

GI Bleeding Obstructive Jaundice


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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


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UGI endoscope


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Colonoscope


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Capsule endoscopy


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Gastrointestinal Disease: Treatment

Nutritional Manipulation

Pharmacotherapy

Over-the-Counter Agents

Prescription Drugs Alternative Therapies

Enteric Therapies/Interventional Endoscopy andRadiology

Surgery

Therapy Directed to External Influences

approach to gi disorders

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