Gastrointestinal disease
| Digestive disease | |
|---|---|
 | |
| Organsof thegastrointestinal tract | |
| Specialty | Gastroenterology |
Gastrointestinal diseases(abbrev.GI diseasesorGI illnesses) refer to diseases involving thegastrointestinal tract,namely theesophagus,stomach,small intestine,large intestineandrectum;and theaccessory organs of digestion,theliver,gallbladder,andpancreas.
Oral disease
[edit]The oral cavity is part of the gastrointestinal system and as such the presence of alterations in this district can be the first sign of both systemic and gastrointestinal diseases.[1]By far the most common oral conditions areplaque-induced diseases (e.g.,gingivitis,periodontitis,dental caries). Oral symptoms can be similar to lesions occurring elsewhere in the digestive tract, with a pattern of swelling, inflammation, ulcers, and fissures. If these signs are present, then patients are more likely to also have anal and esophageal lesions and experience other extra-intestinal disease manifestations.[2]Some diseases which involve other parts of the GI tract can manifest in the mouth, alone or in combination, including:
- Gastroesophageal reflux disease can causeacid erosionof the teeth andhalitosis.
- Gardner's syndromecan be associated with failure oftooth eruption,supernumerary teeth,anddentigerous cysts.
- Peutz–Jeghers syndromecan cause dark spots on theoral mucosaor on the lips or the skin around the mouth.
- Several GI diseases, especially those associated withmalabsorption,can cause recurrentmouth ulcers,atrophic glossitis,andangular cheilitis(e.g.,Crohn's diseaseis sometimes termedorofacial granulomatosiswhen it involves the mouth alone).
- Sideropenic dysphagiacan cause glossitis, angular cheilitis.[3]
Oesophageal disease
[edit]Oesophageal diseases include a spectrum of disorders affecting theoesophagus.The most common condition of the oesophagus in Western countries isgastroesophageal reflux disease,[4]which in chronic forms is thought to result in changes to theepitheliumof the oesophagus, known asBarrett's oesophagus.[5]: 863–865
Acutedisease might includeinfectionssuch asoesophagitis,trauma caused by the ingestion of corrosive substances, or rupture ofveinssuch asoesophageal varices,Boerhaave syndromeorMallory-Weiss tears.Chronic diseases might includecongenitaldiseases such asZenker's diverticulumandesophageal webbing,andoesophageal motility disordersincluding thenutcracker oesophagus,achalasia,diffuse oesophageal spasm,andoesophageal stricture.[5]: 853, 863–868
Oesophageal disease may result in asore throat,throwing up blood,difficultyswallowingorvomiting.Chronic or congenital diseases might be investigated usingbarium swallows,endoscopyandbiopsy,whereas acute diseases such as reflux may be investigated and diagnosed based onsymptomsand amedical historyalone.[5]: 863–867
Gastric disease
[edit]Gastric diseases refer to diseases affecting thestomach.Inflammation of the stomach by infection from any cause is calledgastritis,and when including other parts of the gastrointestinal tract calledgastroenteritis.When gastritis persists in a chronic state, it is associated with several diseases, includingatrophic gastritis,pyloric stenosis,andgastric cancer.Another common condition isgastric ulceration,peptic ulcers.Ulceration erodes thegastric mucosa,which protects the tissue of the stomach from the stomach acids. Peptic ulcers are most commonly caused by a bacterialHelicobacter pyloriinfection.[5]Epstein–Barr virusinfection is another factor to induce gastric cancer.[6][7]
As well as peptic ulcers,vomiting bloodmay result from abnormal arteries or veins that have ruptured, includingDieulafoy's lesionandGastric antral vascular ectasia.Congenital disorders of the stomach includepernicious anaemia,in which a targetedimmuneresponse againstparietal cellsresults in an inability to absorbvitamin B12.Other common symptoms that stomach disease might cause includeindigestionordyspepsia,vomiting,and in chronic disease, digestive problems leading to forms ofmalnutrition.[5]: 850–853 In addition to routine tests, anendoscopymight be used to examine or take abiopsyfrom the stomach.[5]: 848
Intestinal disease
[edit]Thesmallandlarge intestinesmay be affected byinfectious,autoimmune, and physiological states. Inflammation of the intestines is calledenterocolitis,which may lead todiarrhea.
Acute conditions affecting the bowels includeinfectious diarrheaandmesenteric ischaemia.Causes ofconstipationmay includefaecal impactionandbowel obstruction,which may in turn be caused byileus,intussusception,volvulus.Inflammatory bowel diseaseis a condition of unknown aetiology, classified as eitherCrohn's diseaseorulcerative colitis,that can affect the intestines and other parts of the gastrointestinal tract. Other causes of illness includeintestinal pseudoobstruction,andnecrotizing enterocolitis.[5]: 850–862, 895–903
Diseases of the intestine may causevomiting,diarrhoeaorconstipation,and alteredstool,such as withblood in stool.Colonoscopymay be used to examine the large intestine, and a person's stool may be sent forcultureandmicroscopy.Infectious disease may be treated with targetedantibiotics,and inflammatory bowel disease withimmunosuppression.Surgery may also be used to treat some causes of bowel obstruction.[5]: 850–862
The normal thickness of the smallintestinal wallis 3–5 mm,[8]and 1–5 mm in the large intestine.[9]Focal, irregular and asymmetrical gastrointestinal wall thickening onCT scansuggests a malignancy.[9]Segmental or diffuse gastrointestinal wall thickening is most often due to ischemic, inflammatory or infectious disease.[9]Though less common, medications such asACE inhibitorscan causeangioedemaand small bowel thickening.[10]
Small intestine
[edit]The small intestine consists of theduodenum,jejunumandileum.Inflammation of the small intestine is calledenteritis,which if localised to just part is calledduodenitis,jejunitisandileitis,respectively.Peptic ulcersare also common in the duodenum.[5]: 879–884
Chronic diseases ofmalabsorptionmay affect the small intestine, including the autoimmunecoeliac disease,infectivetropical sprue,and congenital or surgicalshort bowel syndrome.Other rarer diseases affecting the small intestine includeCurling's ulcer,blind loop syndrome,Milroy diseaseandWhipple's disease.Tumours of the small intestine includegastrointestinal stromal tumours,lipomas,hamartomasandcarcinoid syndromes.[5]: 879–887
Diseases of the small intestine may present with symptoms such asdiarrhoea,malnutrition,fatigueandweight loss.Investigations pursued may includeblood teststo monitor nutrition, such asiron levels,folateandcalcium,endoscopyandbiopsyof the duodenum, andbarium swallow.Treatments may include renutrition, andantibioticsfor infections.[5]: 879–887
Large intestine
[edit]
Diseases that affect thelarge intestinemay affect it in whole or in part.Appendicitisis one such disease, caused by inflammation of theappendix.Generalised inflammation of the large intestine is referred to ascolitis,which when caused by the bacteriaClostridium difficileis referred to aspseudomembranous colitis.Diverticulitisis a common cause of abdominal pain resulting from outpouchings that particularly affects the colon.Functional colonic diseasesrefer to disorders without a known cause, includingirritable bowel syndromeandintestinal pseudoobstruction.Constipationmay result from lifestyle factors,impaction of a rigid stoolin the rectum, or inneonates,Hirschprung's disease.[5]: 913–915
Diseases affecting the large intestine may cause blood to be passed with stool, may causeconstipation,or may result inabdominal painor a fever. Tests that specifically examine the function of the large intestine include barium swallows,abdominal x-rays,andcolonoscopy.[5]: 913–915
Rectum and anus
[edit]Diseases affecting therectumandanusare extremely common, especially in older adults.Hemorrhoids,vascular outpouchings of skin, are very common, as ispruritus ani,referring to anal itchiness. Other conditions, such asanal cancermay be associated withulcerative colitisor withsexually transmitted infectionssuch asHIV.Inflammation of the rectum is known asproctitis,one cause of which is radiation damage associated withradiotherapyto other sites such as theprostate.Faecal incontinencecan result from mechanical and neurological problems, and when associated with a lack of voluntary voiding ability is described asencopresis.Pain on passing stool may result fromanal abscesses,small inflamed nodules,anal fissures,andanal fistulas.[5]: 915–916
Rectal and anal disease may be asymptomatic, or may present with pain when passing stools,fresh blood in stool,a feeling of incomplete emptying,or pencil-thin stools. In addition to regular tests, medical tests used to investigate the anus and rectum include thedigital rectal examandproctoscopy.[citation needed]
Accessory digestive gland disease
[edit]Hepatic
[edit]Hepatic diseases refers to those affecting theliver.Hepatitisrefers to inflammation of liver tissue, and may beacuteorchronic.Infectiousviral hepatitis,such ashepatitis A,BandC,affect in excess of (X) million people worldwide. Liver disease may also be a result of lifestyle factors, such asfatty liverandNASH.Alcoholic liver diseasemay also develop as a result of chronic alcohol use, which may also causealcoholic hepatitis.Cirrhosismay develop as a result of chronichepatic fibrosisin a chronically inflamed liver, such as one affected byalcoholor viral hepatitis.[5]: 947–958
Liver abscessesare often acute conditions, with common causes beingpyogenicandamoebic.Chronic liver disease, such as cirrhosis, may be a cause ofliver failure,a state where the liver is unable to compensate for chronic damage, and unable to meet the metabolic demands of the body.In the acute setting,this may be a cause ofhepatic encephalopathyandhepatorenal syndrome.Other causes of chronic liver disease are genetic or autoimmune disease, such ashemochromatosis,Wilson's disease,autoimmune hepatitis,andprimary biliary cirrhosis.[5]: 959–963, 971
Acute liver disease rarely results in pain, but may result injaundice.Infectious liver disease may cause a fever. Chronic liver disease may result ina buildup of fluid in the abdomen,yellowing of the skinoreyes,easy bruising,immunosuppression,and feminization.[11]Portal hypertensionis often present, and this may lead to the development of prominent veins in many parts of the body, such asoesophageal varices,andhaemorrhoids.[5]: 959–963, 971–973
In order to investigate liver disease, a medical history, including regarding a person'sfamily history,travel to risk-prone areas, alcohol use and food consumption, may be taken. Amedical examinationmay be conducted to investigate for symptoms of liver disease. Blood tests may be used, particularlyliver function tests,and other blood tests may be used to investigate the presence of the Hepatitis viruses in the blood, and ultrasound used. If ascites is present, abdominal fluid may be tested for protein levels.[5]: 921, 926–927
Pancreatic
[edit]Pancreatic diseases that affect digestion refers to disorders affecting theexocrine pancreas,which is a part of the pancreas involved in digestion.[citation needed]
One of the most common conditions of the exocrine pancreas isacute pancreatitis,which in the majority of cases relates togallstonesthat have impacted in the pancreatic part of thebiliary tree,or due to acute or chronichazardous alcohol useor as a side-effect ofERCP.Other forms of pancreatitis includechronicandhereditaryforms. Chronic pancreatitis may predispose topancreatic cancerand is strongly linked to alcohol use. Other rarer diseases affecting the pancreas may includepancreatic pseudocysts,exocrine pancreatic insufficiency,andpancreatic fistulas.[5]: 888–891
Pancreatic disease may present with or without symptoms. When symptoms occur, such as inacute pancreatitis,a person may experience acute-onset, severe mid-abdominal pain, nausea and vomiting. In severe cases, pancreatitis may lead to rapid blood loss andsystemic inflammatory response syndrome.When the pancreas is unable to secrete digestiveenzymes,such as with a pancreatic cancer occluding thepancreatic duct,result in jaundice. Pancreatic disease might be investigated usingabdominal x-rays,MRCPorERCP,CT scans,and through blood tests such as measurement of theamylaseandlipaseenzymes.[5]: 888–894
Gallbladder and biliary tract
[edit]Diseases of thehepatobiliary systemaffect thebiliary tract(also known as thebiliary tree), which secretesbilein order to aid digestion of fats. Diseases of thegallbladderand bile ducts are commonly diet-related, and may include theformation ofgallstonesthat impact in the gallbladder (cholecystolithiasis) or in thecommon bile duct(choledocholithiasis).[5]: 977–978
Gallstones are a common cause of inflammation of the gallbladder, calledcholecystitis.Inflammation of thebiliary ductis calledcholangitis,which may be associated withautoimmunedisease, such asprimary sclerosing cholangitis,or a result of bacterial infection, such asascending cholangitis.[5]: 977–978, 963–968
Disease of the biliary tree may cause pain in the upper right abdomen,particularly when pressed.Disease might be investigated usingultrasoundorERCP,and might be treated with drugs such asantibioticsorUDCA,or by the surgicalremoval of the gallbladder.[5]: 977–979
Cancer
[edit]The Wikipedia article "Gastrointestinal cancer"describes the specific malignant conditions of the gastrointestinal tract. In general, a significant factor in the etiology of gastrointestinal cancers appears to be excessive exposure of the digestive organs tobile acids.[12][13]
See also
[edit]References
[edit]- ^"An overview on oral manifestations of gastrointestinal diseases".Italian Journal of Dental Medicine.2018-12-31. Archived fromthe originalon 2022-09-24.Retrieved2021-11-23.
- ^GIS."Oral Manifestations of GI Diseases".Gastrointestinal Society.Retrieved2021-11-23.
- ^Yamada T;Alpers DH;et al. (2009).Textbook of gastroenterology(5th ed.). Chichester, West Sussex: Blackwell Pub. pp. 2774–2784.ISBN978-1-4051-6911-0.
- ^"Esophagus Disorders".Medline Plus.U.S. National Library of Medicine.Retrieved23 December2013.
- ^abcdefghijklmnopqrstuvwNicki R. Colledge; Brian R. Walker; Stuart H. Ralston, eds. (2010).Davidson's principles and practice of medicine.Illustrated by Robert Britton. (21st ed.). Edinburgh: Churchill Livingstone/Elsevier.ISBN978-0-7020-3085-7.
- ^Yau, Tung On; Tang, Ceen-Ming; Yu, Jun (2014-06-07)."Epigenetic dysregulation in Epstein-Barr virus-associated gastric carcinoma: disease and treatments".World Journal of Gastroenterology.20(21): 6448–6456.doi:10.3748/wjg.v20.i21.6448.ISSN2219-2840.PMC4047330.PMID24914366.
- ^Liang, Qiaoyi; Yao, Xiaotian; Tang, Senwei; Zhang, Jingwan; Yau, Tung On; Li, Xiaoxing; Tang, Ceen-Ming; Kang, Wei; Lung, Raymond W.M.; Li, Jing Woei; Chan, Ting Fung (December 2014)."Integrative Identification of Epstein–Barr Virus–Associated Mutations and Epigenetic Alterations in Gastric Cancer".Gastroenterology.147(6): 1350–1362.e4.doi:10.1053/j.gastro.2014.08.036.PMID25173755.
- ^Ali Nawaz Khan."Small-Bowel Obstruction Imaging".Medscape.Retrieved2017-03-07.Updated: Sep 22, 2016
- ^abcFernandes, Teresa; Oliveira, Maria I.; Castro, Ricardo; Araújo, Bruno; Viamonte, Bárbara; Cunha, Rui (2014)."Bowel wall thickening at CT: simplifying the diagnosis".Insights into Imaging.5(2): 195–208.doi:10.1007/s13244-013-0308-y.ISSN1869-4101.PMC3999365.PMID24407923.
- ^Sing, Ronald F.; Heniford, B. Todd; Augenstein, Vedra A. (1 March 2013)."Intestinal Angioedema Induced by Angiotensin-Converting Enzyme Inhibitors: An Underrecognized Cause of Abdominal Pain?".The Journal of the American Osteopathic Association.113(3): 221–223.ISSN0098-6151.PMID23485983.S2CID245177279.
- ^Sharma B, Savio J (2018).Hepatic Cirrhosis.StatPearls.PMID29494026.Retrieved22 Sep2020.
- ^Bernstein, Harris; Bernstein, Carol; Payne, Claire M.; Dvorak, Katerina (2009)."Bile acids as endogenous etiologic agents in gastrointestinal cancer".World Journal of Gastroenterology.15(27): 3329–3340.doi:10.3748/wjg.15.3329.PMC2712893.PMID19610133.
- ^Bernstein H, Bernstein C (January 2023)."Bile acids as carcinogens in the colon and at other sites in the gastrointestinal system".Exp Biol Med (Maywood).248(1): 79–89.doi:10.1177/15353702221131858.PMC9989147.PMID36408538.