Antacids, PPI, H2 blockers, eradication of H. pylori , ulcer coating agents such as sucralfate, surgical resection for perforation, obstruction or peritonitis. Risk of duodenal ulcers may be reduced with diet high in vit A and fiber. Disorders of the Intestines 3. Differentiate between the etiology, clinical manifestations, and pathophysiology of disorders of the small and large intestines. a. Analyze the etiology, clinical manifestations, and pathophysiology of ulcerative colitis and crohn’s disease and describe the implications on nutritional status. Disease Etiology Clinical Manifestations Pathophysiology Nutrition Implications
Ulcerative Colitis Unknown origin, associated with genetic factors, alterations in epithelial cell barrier functions, immunopathology related to abnormal T cell reactions to commensal microflora and other luminal antigens Chronic, recurrent, bloody diarrhea. Febrile, polyarthritis, uveitis, sclerosing cholangitis, erythema nodosum, and pyoderma gangrenosum. Inflammatory disease of large intestine. Like Crohn’s it has periods of remission and exacerbations. Severe inflammation and ulcerations of large intestine which begins in rectum and involves entire large intestine. It only affects colon (not small intestine) and does not have skipped lesions no transmural inflammations and ulcerations = it remains superficial. Complications include toxic megacolon, colon perforation, and colorectal adenocarcinoma. Increase risk for colon cancer. Nicotine has a protective effect. In extreme cases IV fluids and IV nutrition Crohn’s Disease Affects persons in their 20s-30s and of Jewish descent. Causes include infectious agents (viruses or bacteria), autoimmune, psychosomatic, and impaired T-cell immunity. Abdominal pain, diarrhea, dehydration, bloody stools, malabsorption, malnutrition, weight loss (most nutrients absorbed in small intestine), intestinal obstruction from chronic inflammation, fistulas (abnormal tracts/channels that develop in the presence of inflammation), and perforation of the intestine. They can develop strictures which cause obstruction or fistulas between intestines, bladder, and Inflammatory disorder of GI tract with exacerbations and remissions. May affect any portion of the GI tract (mouth to anus) but most often in the ileum or proximal colon. Pathophys includes transmural involvement of the affected area (entire wall of the intestine is affected) and presence of skip lesions. This means that there are healthy, unaffected tissue surrounded by diseased tissue which are randomly present in the GI tract. Increased risk of colon cancer. If ileum is involved, one can have vit B12 deficiency anemia, folic acid and vit d and calcium. Loss of protein leading to hypoalbuminemia
vagina. b. Compare the etiology, clinical manifestations, and pathophysiology of diverticulitis, diverticulosis, appendicitis, and bowel obstruction and describe the implications for clinical practice.
- Fall '15
- clinical manifestations