Chapter 14 Gastrointestinal Evaluations and Procedures
Diseases and Disorders of the Gastrointestinal System
Digestive diseases are diverse and can encompass any organ located in the abdominal cavity. The esophagus is also included in the digestive disease spectrum. The following table lists common diseases of the digestive tract.
Disease / Symptoms / Treatment /Gastroesophageal reflux disease (GERD)
(reflux of acid from the stomach into the esophagus) / Pyrosis (heartburn), chest pain, nausea, and mid-epigastric pain that improves with antacids.
Complications of GERD may include: Esophageal ulcers or strictures, Barrett’s esophagus (premalignant condition), and cancer. / Antacids (neutralize stomach acids, i.e., Mylanta, and Maalox)
H2 Blockers (decrease acid production, i.e., Tagamet, and Zantac)
Proton pump inhibitors or PPI (decrease acid release, i.e., Prilosic OTC, Nexium, and Prevacid)
Irritable Bowel Syndrome (IBS)
§ IBS-A: Alternating constipation and diarrhea
§ IBS-C: Constipation predominant
§ IBS-D: Diarrhea predominant / Abdominal pain
Constipation
Diarrhea
Bloating
Abdominal distention / Dietary changes: Avoid foods that aggravate the condition such as, red meats, carbonated beverages, caffeine, fatty foods, refined carbohydrates, MSG, and lactose
High fiber diet: Fiber supplements, whole wheat products, vegetables, fruit
Probiotic administration with acidophilus: provides supplementation of "good" bacteria to the bowel which regulates bowel movements and decreases gas symptomology
Stress management
Complementary and Alternative medicines: Herbal therapy, Chinese herbal therapy, acupuncture
Diverticulosis
(a balloon-like out pouching of the colonic wall) / Usually no symptoms until the diverticuli become inflamed. / Increase fiber intake
Diverticulitis
(inflammation of the diverticula in the intestines) / Pain
Anorexia
Fevers
Peritonitis
Mucus in stools / High fiber diet
Fiber supplements
Caution with peanuts, nuts, and popcorn intake
Peptic Ulcer Disease:
(acid related ulceration of the stomach or duodenal lining) / Burning mid-epigastric pain relieved by food, milk, and antacids
Nausea and vomiting
Bloating and bleeding
Halitosis (bad breath) / Removal of any offending medications
Treatment of H. pylori infection
H2 blockers
Proton pump inhibitors
Crohn's disease
(an inflammatory bowel disease identified by full thickness inflammation) / Abdominal pain
Weight loss
Diarrhea (may contain blood)
Stools positive for occult blood
Fever
Inflammation in areas outside the intestine from the mouth to the anus
Fistulas / Anti-inflammatory drugs
Aminosalicylates: provide anti-inflammatory and immunosuppressive actions and are effective for controlling Crohn’s disease
Nutritional support
Surgical removal of diseased segments of the bowel
Ulcerative Colitis
(an inflammatory bowel disease marked by continual inflammation of the intestines) / Bloody diarrhea
Pain with passage of stools
More than six bloody bowel movements per day / Combinations of medications, such as: Mesalamine, Prednisone
Entocort EC (synthetic steroid)
Immunosuppressive drugs, and Remicade (anti-inflammatory drug)
Surgery
Alternative medicine such as Chinese herbal therapy, acidophilus, and acupuncture
Cholelithiasis
(disease that involves the formation of gallstones) / Right upper quadrant pain following a meal
Fatty food intolerance
Nausea
Right shoulder pain / Surgical with laparoscopic cholecystectomy (removal of the gallbladder)
Pancreatitis
(inflammation of the pancreas) / Epigastric pain
Nausea
Vomiting
Increased serum levels of pancreatic enzymes / Nothing by mouth until the pain, nausea, and vomiting have subsided, and the serum levels of the pancreatic enzymes are returning to normal
Administration of fluids and electrolytes
Hepatitis
(inflammation of the liver; several different types) / Abdominal pain
Loss of appetite/weight loss
Jaundice (yellow tinge to skin)
Fatigue
Dark colored urine
Nausea/vomiting / Will vary according to the type of hepatitis. Refer to Chapter 10 for a comprehensive look at hepatitis.
Ascites
(Serous fluid accumulation in the peritoneal cavity) / Swelling of the abdomen / Paracentesis (puncture of the abdominal cavity) to remove the fluid
Dyspepsia
(indigestion) / Upper abdominal pain
Fullness
Bloating
Nausea
Loss of appetite
Belching / Antacids
H2 Blockers (drugs that reduce the production of acid)
Proton pump inhibitors (PPI) like Prilosec and Prevacid
Dysphagia
(difficulty swallowing) / Inability to swallow / Dilatation of the esophagus to enlarge the opening
Surgery
Medications
Dietary changes
GI Cancers
Digestive disease cancers are varied and may be directly related to the organ or may involve metastatic disease from another primary cancer. The following table provides of description of the various GI cancers that are commonly diagnosed and the type of diagnostic modality that may be used to assist with diagnosis. The medical assistant may be responsible for scheduling the diagnostic modalities listed below.
Location / Symptoms / Diagnostic Modality /Esophagus / Dysphagia, weight loss, chest pain, hematemesis (vomiting of blood) / Esophagogastro-duodenoscopy (EGD), barium swallow, chest CT
Stomach / Midepigastric pain, nausea, vomiting, weight loss, hematemesis, occult GI bleeding / EGD, upper GI, abdominal CT
Small Intestine / Vague abdominal pain, small bowel obstruction, nausea, vomiting, weight loss, occult GI bleeding, iron deficiency anemia / Small bowel series, abdominal CT, capsule endoscopy
Large intestine / Constipation or diarrhea, weight loss, vague abdominal pain, occult GI bleeding, hematochezia (passing stools that contain bright red blood), iron deficiency anemia / Colonoscopy, barium enema, CT colonoscopy
Pancreas / Vague abdominal pain, weight loss, jaundice (yellowish discoloration of body tissues and fluids), back pain / Abdominal CT, abdominal ultrasound, MRI, ERCP (endoscopic retrograde cholangio-pancreatography)
Liver / Vague RUQ pain, weight loss, jaundice / Abdominal CT, abdominal ultrasound, MRI, laparoscopy, liver biopsy
Gallbladder / Vague RUQ pain, post-prandial pain, weight loss, jaundice, nausea / Abdominal CT, abdominal ultrasounds, cholecystectomy
Bile duct/ ampulla / Vague RUQ pain, weight loss, jaundice / Abdominal CT, abdominal ultrasound, ERCP, MRCP (magnetic resonance cholangio-pancreatography)