Digestive Disorders

Digestive Disorders

Introduction

·       The digestive system is responsible for breaking down food into nutrients, absorbing them, and eliminating waste products.

·       When its normal structure or function is disrupted, digestive disorders arise.

·       These conditions may be acute or chronic and can involve any organ from the mouth to the anus, as well as accessory organs (liver, pancreas, gallbladder).

·       Digestive disorders are caused by multiple factors including infections, inflammation, autoimmune reactions, mechanical obstruction, metabolic dysfunction, tumors, and lifestyle factors such as diet, alcohol, and smoking.

Ulcers

• Definition: Open sores that develop on the lining of the stomach (gastric ulcer), duodenum (duodenal ulcer), or esophagus.
• Causes:
• Helicobacter pylori infection
• Prolonged NSAID use (aspirin, ibuprofen)
• Excessive alcohol, smoking, stress
• Hyperacidity, Zollinger-Ellison syndrome
• Symptoms:
• Burning epigastric pain (worse when stomach empty in duodenal ulcer, after meals in gastric ulcer)
• Nausea, bloating, loss of appetite
• Bleeding → hematemesis, melena
• Complications: Perforation, hemorrhage, gastric outlet obstruction.
• Management:
• Eradication of H. pylori (antibiotics + proton pump inhibitors)
• Antacids, H2 blockers, PPIs
• Avoid NSAIDs, alcohol, smoking
• Surgery (rare, for complications).

Crohn’s Disease

• Definition: A chronic inflammatory bowel disease (IBD) affecting any part of the GI tract, most commonly ileum and colon.
• Etiology: Autoimmune reaction, genetic predisposition, environmental triggers.
• Pathology: Transmural inflammation, skip lesions, cobblestone mucosa, strictures, fistulas.
• Symptoms:
• Chronic diarrhea (may be bloody)
• Abdominal pain, weight loss, fever
• Malabsorption → anemia, vitamin deficiencies
• Complications: Fistulas, strictures, intestinal obstruction, colon cancer risk.
• Treatment:
• Anti-inflammatory drugs (5-ASA, corticosteroids)
• Immunosuppressants, biologics (anti-TNF)
• Nutritional support
• Surgery (for complications).

Hernia

• Definition: Protrusion of an organ (commonly intestine) through a weak spot in the abdominal wall.
• Types:
• Inguinal (most common), femoral, umbilical, incisional, hiatal.
• Causes: Congenital weakness, chronic cough, heavy lifting, obesity, constipation.
• Symptoms:
• Visible bulge, worsens with straining
• Pain or discomfort in affected area
• Incarcerated or strangulated hernia → obstruction, ischemia.
• Management:
• Surgical repair (herniorrhaphy/mesh repair)
• Lifestyle modification (avoid heavy lifting, weight reduction).

Intestinal Obstruction

• Definition: Partial or complete blockage of intestinal contents.
• Types: Mechanical (tumor, adhesions, hernia, volvulus, intussusception) or paralytic ileus.
• Symptoms:
• Colicky abdominal pain
• Vomiting (bilious or feculent)
• Abdominal distension, constipation, absent flatus
• Complications: Perforation, peritonitis, sepsis.
• Management:
• Nil per oral, IV fluids, nasogastric tube decompression
• Surgery for mechanical obstruction.

Jaundice

• Definition: Yellow discoloration of skin, sclera, and mucous membranes due to elevated bilirubin levels.
• Types:
• Pre-hepatic (hemolysis)
• Hepatic (liver disease – hepatitis, cirrhosis)
• Post-hepatic (obstructive – gallstones, tumors).
• Symptoms:
• Yellow skin/eyes, dark urine, pale stools, pruritus
• Fatigue, nausea, hepatomegaly (depends on cause).
• Management: Treat underlying cause (antivirals for hepatitis, surgery for obstruction).

Hepatitis

• Definition: Inflammation of the liver.
• Types: Viral (A, B, C, D, E), alcoholic, autoimmune, drug-induced.
• Symptoms:
• Malaise, anorexia, nausea
• Jaundice, dark urine, hepatomegaly
• Chronic cases → cirrhosis, hepatocellular carcinoma.
• Management:
• Rest, hydration, avoid hepatotoxic drugs
• Antivirals (for Hep B, C)
• Vaccination (Hep A, B prevention).

Gastritis

• Definition: Inflammation of stomach lining.
• Causes: H. pylori, NSAIDs, alcohol, stress, autoimmune.
• Symptoms:
• Epigastric pain, nausea, vomiting
• Bloating, loss of appetite
• Hematemesis in severe cases.
• Management:
• Eliminate cause (stop NSAIDs, treat H. pylori)
• Antacids, PPIs, H2 blockers.

Appendicitis

• Definition: Acute inflammation of appendix, usually due to obstruction by fecolith.
• Symptoms:
• Periumbilical pain shifting to right lower quadrant (McBurney’s point)
• Fever, nausea, vomiting, rebound tenderness
• Complications: Perforation, peritonitis, abscess.
• Management: Appendectomy + antibiotics.

Cirrhosis

• Definition: Chronic progressive liver disease characterized by fibrosis, nodular regeneration, and loss of liver function.
• Causes: Chronic alcohol use, chronic hepatitis (B/C), fatty liver, autoimmune disease.
• Symptoms:
• Fatigue, jaundice, hepatosplenomegaly
• Ascites, variceal bleeding, encephalopathy
• Complications: Portal hypertension, hepatocellular carcinoma.
• Management:
• Stop alcohol, treat underlying cause
• Diuretics for ascites, beta-blockers for varices
• Liver transplantation (end-stage).

Gallstones (Cholelithiasis)

• Definition: Solid deposits in gallbladder (cholesterol, pigment, mixed).
• Risk Factors: Female, forty, fertile, fat.
• Symptoms:
• Biliary colic (RUQ pain after fatty meals)
• Nausea, vomiting, jaundice (if obstructive).
• Complications: Cholecystitis, pancreatitis, gallbladder carcinoma.
• Management:
• Symptomatic → cholecystectomy
• Asymptomatic → observation.

Hemorrhoids (Piles)

• Definition: Swollen and inflamed veins in rectum/anus.
• Causes: Chronic constipation, pregnancy, prolonged sitting, portal hypertension.
• Symptoms:
• Rectal bleeding (bright red), pain, itching, prolapse.
• Management:
• High-fiber diet, stool softeners
• Sitz baths, topical ointments
• Surgical removal/ligation if severe.

Pancreatitis

• Definition: Inflammation of pancreas (acute or chronic).
• Causes: Gallstones, alcohol, drugs, trauma, hypertriglyceridemia.
• Symptoms:
• Severe epigastric pain radiating to back
• Nausea, vomiting, fever
• Jaundice (if biliary obstruction).
• Complications: Shock, pseudocyst, diabetes, necrosis.
• Management:
• NPO, IV fluids, analgesics
• Treat underlying cause (gallstones removal, alcohol abstinence).

Ascites

• Definition: Accumulation of fluid in peritoneal cavity.
• Causes: Portal hypertension (cirrhosis), malignancy, TB, heart failure.
• Symptoms:
• Abdominal distension, shifting dullness, difficulty breathing
• Management:
• Salt restriction, diuretics, paracentesis
• Treat underlying cause.

Dysentery

• Definition: Infectious diarrhea with blood and mucus in stools.
• Causes: Shigella, Entamoeba histolytica.
• Symptoms:
• Frequent painful stools with blood/mucus
• Abdominal cramps, fever, dehydration.
• Management:
• Oral rehydration, antibiotics/antiparasitics as indicated.

Cholera

• Definition: Acute diarrheal disease caused by Vibrio cholerae.
• Transmission: Contaminated water/food.
• Symptoms:
• Profuse watery stools ("rice-water stools")
• Severe dehydration, hypotension, shock.
• Management:
• Immediate rehydration (ORS, IV fluids)
• Antibiotics (doxycycline, azithromycin).
• Prevention: Safe water, sanitation, vaccination.

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