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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 |Pyrosis (heartburn), chest pain, nausea, and |Antacids (neutralize stomach acids, i.e., Mylanta, and Maalox) |

|(GERD) |mid-epigastric pain that improves with antacids. |H2 Blockers (decrease acid production, i.e., Tagamet, and Zantac) |

|(reflux of acid from the stomach |Complications of GERD may include: Esophageal ulcers or |Proton pump inhibitors or PPI (decrease acid release, i.e., Prilosic OTC, Nexium, and Prevacid) |

|into the esophagus) |strictures, Barrett’s esophagus (premalignant condition), | |

| |and cancer. | |

|Irritable Bowel Syndrome (IBS) |Abdominal pain |Dietary changes: Avoid foods that aggravate the condition such as, red meats, carbonated |

|IBS-A: Alternating constipation and|Constipation |beverages, caffeine, fatty foods, refined carbohydrates, MSG, and lactose |

|diarrhea |Diarrhea |High fiber diet: Fiber supplements, whole wheat products, vegetables, fruit |

|IBS-C: Constipation predominant |Bloating |Probiotic administration with acidophilus: provides supplementation of "good" bacteria to the |

|IBS-D: Diarrhea predominant |Abdominal distention |bowel which regulates bowel movements and decreases gas symptomology |

| | |Stress management |

| | |Complementary and Alternative medicines: Herbal therapy, Chinese herbal therapy, acupuncture |

|Diverticulosis |Usually no symptoms until the diverticuli become inflamed.|Increase fiber intake |

|(a balloon-like out pouching of the| | |

|colonic wall) | | |

|Diverticulitis |Pain |High fiber diet |

|(inflammation of the diverticula in|Anorexia |Fiber supplements |

|the intestines) |Fevers |Caution with peanuts, nuts, and popcorn intake |

| |Peritonitis | |

| |Mucus in stools | |

|Peptic Ulcer Disease: |Burning mid-epigastric pain relieved by food, milk, and |Removal of any offending medications |

|(acid related ulceration of the |antacids |Treatment of H. pylori infection |

|stomach or duodenal lining) |Nausea and vomiting |H2 blockers |

| |Bloating and bleeding |Proton pump inhibitors |

| |Halitosis (bad breath) | |

|Crohn's disease |Abdominal pain |Anti-inflammatory drugs |

|(an inflammatory bowel disease |Weight loss |Aminosalicylates: provide anti-inflammatory and immunosuppressive actions and are effective for |

|identified by full thickness |Diarrhea (may contain blood) |controlling Crohn’s disease |

|inflammation) |Stools positive for occult blood |Nutritional support |

| |Fever |Surgical removal of diseased segments of the bowel |

| |Inflammation in areas outside the intestine from the mouth| |

| |to the anus | |

| |Fistulas | |

|Ulcerative Colitis |Bloody diarrhea |Combinations of medications, such as: Mesalamine, Prednisone |

|(an inflammatory bowel disease |Pain with passage of stools |Entocort EC (synthetic steroid) |

|marked by continual inflammation of|More than six bloody bowel movements per day |Immunosuppressive drugs, and Remicade (anti-inflammatory drug) |

|the intestines) | |Surgery |

| | |Alternative medicine such as Chinese herbal therapy, acidophilus, and acupuncture |

|Cholelithiasis |Right upper quadrant pain following a meal |Surgical with laparoscopic cholecystectomy (removal of the gallbladder) |

|(disease that involves the |Fatty food intolerance | |

|formation of gallstones) |Nausea | |

| |Right shoulder pain | |

|Pancreatitis |Epigastric pain |Nothing by mouth until the pain, nausea, and vomiting have subsided, and the serum levels of the |

|(inflammation of the pancreas) |Nausea |pancreatic enzymes are returning to normal |

| |Vomiting |Administration of fluids and electrolytes |

| |Increased serum levels of pancreatic enzymes | |

|Hepatitis |Abdominal pain |Will vary according to the type of hepatitis. Refer to Chapter 10 for a comprehensive look at |

|(inflammation of the liver; several|Loss of appetite/weight loss |hepatitis. |

|different types) |Jaundice (yellow tinge to skin) | |

| |Fatigue | |

| |Dark colored urine | |

| |Nausea/vomiting | |

|Ascites |Swelling of the abdomen |Paracentesis (puncture of the abdominal cavity) to remove the fluid |

|(Serous fluid accumulation in the | | |

|peritoneal cavity) | | |

|Dyspepsia |Upper abdominal pain |Antacids |

|(indigestion) |Fullness |H2 Blockers (drugs that reduce the production of acid) |

| |Bloating |Proton pump inhibitors (PPI) like Prilosec and Prevacid |

| |Nausea | |

| |Loss of appetite | |

| |Belching | |

|Dysphagia |Inability to swallow |Dilatation of the esophagus to enlarge the opening |

|(difficulty swallowing) | |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 |Esophagogastro-duodenoscopy (EGD), barium swallow, chest CT |

| |of blood) | |

|Stomach |Midepigastric pain, nausea, vomiting, weight loss, |EGD, upper GI, abdominal CT |

| |hematemesis, occult GI bleeding | |

|Small Intestine |Vague abdominal pain, small bowel obstruction, nausea, |Small bowel series, abdominal CT, capsule endoscopy |

| |vomiting, weight loss, occult GI bleeding, iron deficiency | |

| |anemia | |

|Large intestine |Constipation or diarrhea, weight loss, vague abdominal |Colonoscopy, barium enema, CT colonoscopy |

| |pain, occult GI bleeding, hematochezia (passing stools that| |

| |contain bright red blood), iron deficiency anemia | |

|Pancreas |Vague abdominal pain, weight loss, jaundice (yellowish |Abdominal CT, abdominal ultrasound, MRI, ERCP (endoscopic retrograde cholangio-pancreatography) |

| |discoloration of body tissues and fluids), back pain | |

|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, |Abdominal CT, abdominal ultrasounds, cholecystectomy |

| |nausea | |

|Bile duct/ ampulla |Vague RUQ pain, weight loss, jaundice |Abdominal CT, abdominal ultrasound, ERCP, MRCP (magnetic resonance cholangio-pancreatography) |

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