GIT DISORDERS

1. GIT DISORDERS

2. Upper GIT Disorders Disorders of the esophagus are caused by Obstruction, Inflammation or De-arrangement of the swallowing mechanism

3. Esophagitis Inflammation of the esophagus. The esophagus is that soft tube-like portion of the digestive tract connecting the pharynx with the stomach.

4. What Causes Esophagitis?1. Esophagitis is caused by an infection or irritation in the esophagus. 2. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include. 3. The esophagus becomes inflammed (swollen, irritated and red).

5. Infections that cause esophagitis include : • Candida. • This is a yeast infection of the esophagus caused by fungus . The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetesor HIV) • Herpes. • This viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.

6. Causes of Esophagitis • Irritation causing esophagitis may be caused by any of the following:---- • GERD, or gastro esophageal reflux disease • Vomiting • Surgery • Medications such as aspirin and other anti-inflammatory drugs • Taking a large pill with too little water or just before bedtime • Swallowing a toxic substance • Hernias • Radiation injury (after receiving radiation for cancer treatment)

7. Symptoms

8. Diagnosis for Esophagitis • Upper endoscopy. • A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus. Biopsy During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope

9. Upper GI series (or barium swallow). • During this procedure, x-rays are taken of the esophagus after drinking a barium solution. • Barium coats the lining of the esophagus and shows up white on an x-ray. • Helpful for doctors to view certain abnormalities of the esophagus.

10. Nutritional care & management Diet is often a key to limiting symptoms of esophagitis 1.Goal Decrease exposure to gastric contents Avoid: . Large meals . Dietary fat . Alcohol 2. Goal: Decrease acidity of gastric secretions Avoid: . Coffee . Fermented alcoholic beverages 3. Goal: • Prevent pain and irritation • Avoid: • . Acid pH foods • . Spices

11. Avoid tight clothing

12. How dysphasia occurs ? Dysphasia • The normal process of swallowing acts in 3 phases: • the oral, pharyngeal and esophageal • This phases acts together so that the food will be digested in the stomach from the mouth. • If there are medical conditions that hinder this process, dysphasia occurs. • Any difficulty, discomfort or pain when swallowing.

13. Types of dysphasia Or pharyngeal dysphasia — oral dysphasia related to nerve and muscle problems that can weaken your throat muscles and make it difficult to move food from your mouth into your throat. • Due to : • 1) Neuromuscular diseases:- • Parkinson’s disease • Motor neuron disease • Muscular dystrophy • 2) Stroke or head injury

14. 3) Physical obstruction:- • pharyngeal pouch • Goitre • Symptoms • Foods sticking in the throat • Choking when swallowing • Difficulty to initiate when swallowing • Recent pneumonia • Change in dietary habits (difficulty to swallow hard foods) • Weight loss • Hurt burn

15. 2. Esophageal dysphasia — Itreferring to the sensation of food sticking or getting hung up in the swallowing tube (esophagus). Causes -- • Usually due to stricture:- • Malignant- ( dysphasia for solid food) • Is intermittent at first, as difficulty experienced with both solid and liquids. • Esophagus may be cold sensitive than usual.

16. Diagnostic tests –An esophageal or barium swallow test-- is an imaging test used to visualize the structures of the esophagus. - swallows liquid barium - barium fills and then coats the lining of the esophagusX-ray images obtainedVideo fluoroscopy- alternative test to the barium swallow- video X-ray images of swallowing process. - better able to evaluate the muscular abnormalities that can affect swallowing

17. Esophageal Manometry – • Measure the pressure generated by the muscle contractions in the esophagus • Using a pressure-sensitive, thin tube that is passed into the esophagus through the nose. • Determines if the muscles of the esophagus are working properly

18. Diet Management- • Thin liquids are not recommended. Instead thickened fluids are easier to manage.( Fluids may be thickened with commercially purchased thickeners.) • Suitable soft foods that are recommended include cereals with hot milk, such as oatmeal or cream of wheat. • Sandwiches with moist fillings, such as egg with mayonnaise, are well tolerated. • Stewed fruits, such as apples, mashed bananas and custard, are part of a soft diet.

19. Hiatal hernia An outpouching of a portion of the stomach into the chest through the esophageal hiatus of the diaphragm.

20. Hiatal hernia Any time an internal body part pushes beyond a confining wall into an area where it doesn't belong, it is called a hernia. • The hiatus is an opening in the diaphragm • The muscular wall separating the chest cavity from the abdomen. • Normally, the esophagus (food pipe) goes through the hiatus to drain into the stomach. • In a hiatal hernia the stomach bulges up into the chest through that opening.

22. There are two main types of hiatal hernias: • A sliding hiatal hernia • the junction of the stomach and the esophagus herniate (slide) up into the chest through the hiatus. This is the most common type of hiatal hernia. • A Para esophageal hernia • The esophagus and stomach stay in their normal locations • part of the stomach squeezes through the hiatus • placing it next to the esophagus. • this type of hernia have no any symptoms, • stomach can become "strangled," (which means its blood supply is cut off.)

23. Types of hernia

24. Main causes - • A permanent shortening of the esophagus (perhaps caused by inflammation of stomach acid) which pulls the stomach up. 2. An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

25. Other Causes of hiatal hernia • Strain on the abdominal muscles,as when you lift a heavy object. • . Problem can be present from birth (a congenital hernia). • Hernias can also result from a marked weight gain. • When constipation leads to straining during bowel movements. • From repeated coughing attacks. • over the age of 50, in overweight people (especially women), and in smokers.

26. Symptoms of hiatal hernia • bitter or sour taste in the back of the throat. • bloating and belching, or discomfort or pain in the stomach or esophagus. Heartburn inflammation nausea

27. How is a hiatal hernia diagnosed? • A barium study, • Esophagoscopy a special X-ray that allows visualization of the esophagus. • ( in which the upper digestive system is examined with an endoscope (long-thin flexible instrument). On both the x-ray and endoscopy, the hiatal hernia appears as a separate "sac" lying between what is clearly the esophagus and what is clearly the stomach.

28. Treatment Main goal of treatment is to relieve symptoms. Suggestions include: • Eat smaller, more frequent meals. • Avoid foods and beverages that may cause acid reflux symptoms. • Don't eat within three hours before going to bed. • Elevate the head of your bed 4 to 8 inches. • Don't wear tight clothing around your waist. • Avoid bending or stooping after meals.

29. Avoid constipation. Talk to your doctor if you have a problem with this. • Don't do any heavy lifting. • Lose weight. • Stop smoking. • Take any medications the doctor prescribes. • Don't eat for at least two hours before bedtime.

30. Heart burns • Heart burn is a discomfort or pain caused by the stomach contents traveling up from the stomach into thelower part of your esophagus (gullet) • Also known as pyrosisor acid indigestion • Burning sensation in the chest, just behind the breastbone. • Heartburn has nothing to do with the heart. • Heart burn is a digestive problem. • Heart burn is usually related to meals and posture and can often be relieved by remedies for indigestion.

32. Factors that contribute to heart burn: • Pregnancy – It also causes abdominal pressure, affecting acid reflux. • smoking • wearing tight clothing around the waist. • Obesity – Excess weight and fat causes increased pressure in the abdomen. • Food and drink intake– Fatty and acidic food and drinks, and carbonated beverages stimulate the secretion of stomach acid.

33. Medications – Some prescription medications also increase stomach acid secretion. • Hiatal hernia – This happens when a part of the stomach that's suppose to be in the abdomen lies in the chest instead • gastritis - an inflammation of the stomach lining. • body's position • Eating too much • Eating too rapidly • Consuming too much caffeine • Consuming too much alcohol • Consuming too much chocolate

34. symptoms The main symptoms areburning sensation in the center of the chest and belching. • typically occurs 30-60 minutes after meals • Regurgitation (back flow) • Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). • passing blood in stools • Severe pain, dizziness, or lightheadedness • Difficulty swallowing • Dehydration • weight loss

35. Diagnosis tests- • small sample of tissue from the esophagus is removed. • studied to check for inflammation, cancer, or other problems. Endoscopy Thin lighted tube with a tiny camera attached through the mouth. Examine the esophagus and stomach esophageal inflammation can be detected . 2. Manometry Manometer is pass through the mouth into the esophagus. Measures the lower esophageal sphincter directly. 3. Biopsy

36. Nutritional management Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruit and juices, and tomato products. Quit smoking Take rest Avoid overeating. Watch consumption of alcohol. Do not lie down or go to bed right after a meal. Instead, wait a couple of hours. Lose weight Monitor the medications that are taking - some may irritate the lining of the stomach or esophagus.

37. Achalasia What is achalasia? • Achalasia is a rare disease of the muscle of the esophagus. • It means "failure to relax" • It refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. • patients with achalasia have difficulty in swallowing food.

38. How Achalasia occurs ? • A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) • normally relaxes during swallowing. • In people with achalasia, this muscle ring does not relax as well. • The reason for this problem is damage to the nerves of the esophagus.

40. Causes - Symptoms- • Backflow (regurgitation) of food • Chest pain, which may increase after eating or may be felt in the back, neck, and arms • Cough • Difficulty swallowing liquids and solids • Heartburn • Unintentional weight loss • Damage to the nerves of the esophagus • Cancer of the esophagus or upper stomach. • heredity or an abnormality of the immune system that causes the body itself to damage the esophagus.

41. Diagnosis • Manometry - Thin tube is inserted into the nose & patient swallow several times. • Measures the muscle contraction in different parts of the esophagus. • Endoscopy - Provide direct visualization of the inside of Esophagus.

42. Barium swallow test • Patient swallows a barium solution, with continuous X-ray recording. • Observe the flow of fluid through the Esophagus.

43. Treatment - If medication is ineffective, however, esophageal dilatation can correct the problem. To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. The balloon is inflated, thus stretching the sphincter.

44. Nutritional management: • eat slowly • chew very well • drink plenty of water with meals • avoid eating near bedtime • foods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided.

45. Dyspepsia • Also known as indigestion or upset stomach. • Describes discomfort or pain in the upper abdomen. • It is not a disease, a group of symptoms which often include bloating, nausea and burping.

46. How it occurs- • Stomach acid coming into contact with the mucosa of the digestive system • Stomach acids break down the mucosa, • causing irritation and inflammation, which trigger the symptoms of indigestion.

47. Causes of dispepsia • Eating too much • Eating too rapidly • Consuming fatty or greasy foods • Consuming spicy foods • Consuming too much caffeine • Consuming too much alcohol • Consuming too much chocolate • Consuming too many fizzy drinks • Gallstones • Gastritis (inflammation of the stomach) • Hiatus hernia • Infection, especially with bacteria known as Helicobacter pylori • Nervousness • Obesity - caused by more pressure inside the abdomen • Pancreatitis(inflammation of the pancreas) • Peptic ulcers • Smoking • Some medications, such as antibioticsand NSAIDs(non-steroidal anti-inflammatory drugs) • Stomach cancer

48. Medications that cause indigestion • Aspirin and many other painkillers • Estrogen and oral contraceptives • Steroid medications • Certain antibiotics • Thyroid medicines

49. Symptoms • Nausea • Belching • Feeling bloated (very full) See your doctor immediately if pain is severe, and the following also occur: -------- • Loss of appetite or weight loss • Vomiting • Black stools • Jaundice (yellow coloring of eyes and skin) • Chest pain when your exert yourself • Shortness of breath • Sweating

50. Diagnosis • Esophageal ph test • Endoscopy • Tests to diagnose Helicobacter pylori infection- this may include a urea breath test, a stool antigen test, and a blood test. • X-rays- usually an upper-gastrointestinal and small bowel series. X-rays are taken of the esophagus, stomach and small intestine. • Abdominal ultrasound- high-frequency sound waves make images that show movement, structure and blood flow. • Abdominal CT (computed tomography) scan– • this may involve injecting a dye into the patient's veins. The dye shows up on the monitor, by which produce a 3-dimensional image of the inside of the abdomen.