NTA Level 4 • Semester 1 • PST04103

Common Disorders of Gastrointestinal System

Human Anatomy and Physiology • Source Session/Topic 16

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Session 16: Common Disorders of Gastrointestinal System

Total Session Time: 60 minutes + 60 minutes assignment

Prerequisites

• None

Learning Tasks

By the end of this session, students are expected to be able to:

• List the Common Features of Gastrointestinal Pathologies

• Explain Common Features of Gastrointestinal Pathologies

• Explain Gastrointestinal Bleeding

• Describe Disorders of Gastrointestinal Motility

• Explain Functional Gastrointestinal Disorder

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Charts, OHP, Multimedia Projector, Computer, Pointer

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Features of Gastrointestinal Pathologies (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the features of gastrointestinal pathologies? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Regardless of the cause and type of a disease Gastrointestinal (GI

)pathologies have the following presenting features:

• Abdominal pain

• GI bleeding

• Diarrhoea

• Steatorrhea

• Constipation

• Nausea

• Vomiting

• Dysphagia

• Odynophagia

• Gastroesophageal reflux

• Anorexia

• Weight loss

Abdominal pain

• Pain originates from tissue injury, distention, contraction,

inflammation, and direct chemical injury.

• Visceral pain is often poorly localized and loosely corresponds to the

spinal segment that innervates the involved viscus.

• Examples include peptic ulcer disease in which pain is localized to the

epigastrium, and early appendicitis, in which pain is localized around

the periumbilical region.

o Somatoparietal pain arises from noxious stimulation of the parietal

peritoneum.

▪ This type of pain is more localized and intense and corresponds to

the dermatomal distribution that innervates the injured portion of the

peritoneum.

▪ Somatoparietal pain is aggravated by movement such as coughing or a

bumpy car ride.

▪ Examples of somatoparietal pain include appendicitis, with localized

right lower quadrant pain attributable to localized peritonitis, and

an abscess, with localized pain over the perforated viscus and

inflammatory collection.

• Referred pain is perceived by the patient in areas that are remote from

the diseased organ.

Diarrhoea

• An increased number or fluidity of stools is usually due to an excess

of water in stool.

• Most people have experienced loose stools for a day or two (e.g. viral

gastroenteritis), but other causes, such as inflammatory bowel disease,

can be chronic and cause intermittent symptoms for a patient's entire

lifetime.

• Diarrhoea results from

o An increase in secretion

o Decrease in absorption, or both

• It is classified as : secretory or osmotic diarrhoea

• Although there may be overlap, osmotic diarrhoea usually ceases when a

patient takes nothing by mouth, whereas secretory diarrhoea continues

• Large-volume diarrhoea generally originates from the small intestine

• Small-volume diarrhoea generally originates from the colon

• Blood in the stool always implies an underlying organic abnormality

• Bloody diarrhoea occurs with mucosal inflammation or erosions or

ulcerations secondary to infectious, inflammatory, or ischemic

enterocolitis.

Steatorrhea

• Steatorrhea, or fatty stools, arises from disruption of fat

solubilisation, digestion, or absorption in the small intestine.

• Mal digestion, or inadequate luminal breakdown of fats, occurs with

pancreatic exocrine deficiency or lack of bile.

• Malabsorption, or inadequate transport of the products of digestion,

occurs with mucosal diseases such as celiac sprue or during impaired

lymphatic transport.

Constipation

• Occurs most commonly in the elderly

• Often used to describe more than one symptom, including:

o Infrequent stools

o Difficult passage of stool

o A sense of incomplete evacuation

o Abdominal bloating or discomfort

• The causes of constipation are as varied as the complaints and include:

o Inadequate stool water or faecal material,

o Decreased colonic motility

o Reduced mobility

o Chronic illness

o Medication use

o Psychological factors

o Functional outlet obstruction

• Treatment plans vary, but the simplest and most common starting point

is to increase the patient's daily fibre and fluid intake.

Nausea and Vomiting

• Nausea and vomiting may be manifestations of GI diseases or primary non-

GI diseases and may lead to fluid and electrolyte imbalances,

nutritional deficiencies, aspiration pneumonia and oesophageal rupture

• Nausea is the unpleasant sensation of the desire to vomit

• Retching, or ‘dry heaves,’ is coordinated voluntary muscle activity of

the abdomen and chest without discharge of stomach contents into the

mouth

• Vomiting, or the act of emesis, occurs as gastric contents are

forcefully ejected out of the mouth

• Nausea and vomiting may be acute, such as with acute obstruction,

inflammation, or ischemia, other acute infections, medication,

pregnancy or head trauma.

• Nausea and vomiting that are chronic in nature are usually associated

with pregnancy, medications, and motility disorders such as diabetic,

gastroparesis, partial obstruction, intracranial disease, psychogenic

disorders, or an underlying metabolic or endocrine disturbance.

Dysphagia

• Dysphagia, or the sensation of solids or liquids not passing from the

mouth into the stomach,

• It is a common symptom and can be divided into: oropharyngeal dysphagia

and oesophageal dysphagia.

o The former may be caused by: neuromuscular disease, mechanical

obstruction, skeletal muscle disorders, depression, or dementia

o Patients are unable to propel their food from the hypopharynx into the

upper oesophagus specifically localize their symptoms to the upper

cervical region.

o Coughing or aspiration during meals indicates that food has passed into

the tracheobronchial tree

• Oesophageal dysphagia is caused by either :

o Motility disorder, such as achalasia, diffuse oesophageal spasm, or

scleroderma, or

o Mechanical obstruction, such as a benign stricture, ring, or neoplasm.

Gastroesophageal Reflux Disease (GERD)

• The terms heartburn, acid regurgitation, sour stomach, and bitter taste

are all used to describe GERD symptoms

• Reflux occurs when the oesophageal epithelium is exposed to gastric

secretions

• Some degree of gastric reflux is considered normal, but symptoms occur

when the mucosa's tolerance to acid is exceeded

• In addition to the typical symptoms of heartburn or chest pain, extra-

oesophageal manifestations of GERD include laryngitis, asthma, and

chronic cough

• GERD develops when acidic gastric contents reflux into the oesophagus

and remain there long enough to overcome the resistance of the

oesophageal epithelium.

Anorexia and Early Satiety

• Anorexia is loss of the desire to eat,

• Is a major symptom in many GI and non-GI diseases, including central

nervous system, systemic, and psychological disorders.

• Anorexia may be acute, such as that caused by inflammatory GI

processes, or chronic, such as that caused by depression.

• Chronic anorexia may lead to significant weight loss, especially in

patients with hypermetabolic states such as malignancy

• Early satiety may be acute or chronic, but it is usually insidious in

onset

• Patients report that they are simply not hungry at meal time, must

often ‘force’ themselves to eat, yet still eat far less than they had

in the past

• Common causes include

o Delayed gastric emptying such as occurs in long-term diabetes mellitus

o Decreased gastric distention secondary to gastric malignancy

o Gastric outlet obstruction caused by peptic ulcer disease

STEP3: Disorders of Gastrointestinal Motility (05 minutes)

• GI bleeding can be either acute or chronic, and it can be massive or

occult

• Acute upper GI bleeding, which may be manifested as

o Hematemesis

o Melena

o Haematochezia, is three times more common than acute lower GI bleeding

• The two most common causes of acute lower GI bleeding are

diverticulosis and arteriovenous malformations

• Occult bleeding is defined as the detection of asymptomatic blood loss

from the gastrointestinal tract, generally by routine faecal occult

blood testing or the presence of iron deficiency anaemia

STEP4: Disorders of Gastrointestinal Motility (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the disorders of gastrointestinal motility? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Motility disorders result from impaired control of the neuromuscular

apparatus of the gastrointestinal tract

• Associated symptoms include:

o Recurrent or chronic nausea and vomiting

o Bloating and abdominal discomfort

o Constipation or diarrhoea in the absence of intestinal obstruction

• Gastrointestinal motility disturbances result from disorders of the

extrinsic nervous system, enteric nervous system, intestinal

pacemakers, or smooth muscle

• Combined disorders occur in systemic sclerosis, amyloidosis and

mitochondrial cytopathy, which initially can manifest with neuropathic

patterns and later displaymyopathic characteristics with disease

progression.

• Genetic defects that result in congenital dysmotilities include

abnormalities of transcription factors which enhances maturation of

neural precursors, are associated with the phenotypic picture

recognized as Hirschsprung's disease, hypertrophic pyloric stenosis and

congenital megacolon

• Extrinsic neuropathic processes include vagotomy, trauma, Parkinson's

disease, diabetes amyloidosis and a para-neoplastic syndrome usually

associated with small cell carcinoma of the lung

STEP 5: Functional Gastrointestinal Disorders (10 minutes)

• The most widely recognized functional gastrointestinal disorders are

o Irritable bowel syndrome (IBS)

o Functional (or non-ulcer) dyspepsia

• Dyspepsia refers to persistent or recurrent epigastric pain or meal-

related upper abdominal discomfort that may be characterized by early

satiation or postprandial fullness

• Heartburn (typically a burning pain or discomfort that rises up the

retro sternum) is distinct from dyspepsia

• Helicobacter pylori infection is the most common cause of histologic

gastritis in humans and is causally linked to peptic ulcer disease and

gastric

o Reflux of bile into the stomach is not more frequent in patients with

functional dyspepsia than in healthy controls

• The role of major life stresses, such as bereavement or divorce, in the

pathogenesis of functional dyspepsia is controversial

• Coffee may induce symptoms in approximately 50% of patients with

functional dyspepsia versus one in five healthy controls, perhaps

because coffee acts as a direct irritant, stimulates acid secretion, or

precipitates gastroesophageal reflux.

• Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) cause

asymptomatic mucosal lesions in 30 to 60% of chronic users and can

cause dyspepsia, but symptoms do not correlate with mucosal damage

scores.

o Typical ulcer symptoms, such as epigastric pain related to meals or

waking the patient from sleep (ulcer-like dyspepsia).

STEP 6: Key Points (5 minutes)

• Common disorders of the gastrointestinal system and accessory organs

include ulcerations, hernia, pancreatitis, jaundice and haemorrhoids,

constipation

• Diarrhoea results from an increase in secretion, decrease in

absorption, or both

• Dysphagia, or the sensation of solids or liquids not passing from the

mouth into the stomach, is a common symptom and can be divided into

oropharyngeal dysphagia and oesophageal dysphagia.

• Anorexia must be distinguished from the fear of eating because of

associated discomfort, such as occurs in intestinal angina or

inflammatory bowel disease.

STEP 7: Evaluation (5 minutes)

• What are common features of gastrointestinal system?

• What are the common disorders of gastrointestinal system?

• What are the causes of constipation?

• What is steatorrhea?

• What are the causes of gastrointestinal bleeding?

Step 8: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE learners in groups or individual. |

| |

|ASK the learners to work on the following assignment |

| |

|Describe disorders of gastrointestinal motility |

| |

|ALLOCATE time for learners to do the assignment and submit |

| |

|REFER learners to recommended references |

References

Kumar, A. et al (2004). Robbins Basic Pathology. WB: Saunders.

Spector, T.D. & Axford, J. S. (1999). Introduction to General Pathology.

Edinburgh:

Seeley, R. R., Stephens, T. D. & Tate, P. (2003). Anatomy and Physiology.

New York:

McGraw-Hill

Shier, A., Butler, J., & Lewis, R. (2004). Hole’s Human Anatomy &

Physiology. New York:

McGraw-Hill

Standring, S. (2008). Grays’s Anatomy The anatomical basis of clinical

practice. United

Kingdom: Churchill Livingstone Elservier.

Thibodeau, G. A., & Patton, K. T. (1999). Anatomy & Physiology. Saint

Louis: Mosby,

Von Hoffman Press, Inc.

Tortora, G.J & Derrickson, B (2009). Principles of Anatomy and Physiology

12th Edition,

USA, John Wiley & Sons Inc, USA

Walter, J.B, & Talbot, I. C. (1996). General Pathology. New York: Churchill

Livingstone

Waugh, A. & Grant, A. (2006). Ross and Willson Anatomy and physiology in

Health and

illness. United Kingdom: Churchill Livingstone Elservier

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