Etiology:

Upper GI bleeding (more common):

– Peptic ulcer disease (associated with H. pylori infection)

– Esophagitis and esophageal varices due to liver cirrhosis

– Medications (eg. NSAIDs)

– Others: cancer, angiodysplasia

Lower GI Bleeding:

– Hemorrhoids

o Ulcerative colitis and Crohn’s disease

– Others: cancer, angiodysplasia

Appendicitis

Inflammation of the vermiform appendix

Etiology:

Lymphoid hyperplasia

Obstruction of lumen: Fecaliths, FB

Infection

Pathophysiology:

Mechanical blockage of the appendix leads to increased intraluminal pressure, decreased blood flow, inflammation

Bacterial growth increases inflammation (swelling, tissue injury)

Clinical manifestations

Epigastric and RLQ pain

Rebound tenderness

Peritonitis (most serious complication)

Inflammatory Bowel Diseases (IBD) -KNOW

A group of disorders characterized by chronic and relapsing inflammation of the bowel

1 /150 Canadians is living with Crohn’s or Colitis (the highest rate worldwide)

A leading cause for colorectal cancer

– Colorectal cancer is 3rd most common cancer in Canada

– Anyone > 50 y should be screened for colon cancer

Irritable Bowel Syndrome (IBS)

A functional gastrointestinal disorder with no specific structural or biochemical alterations

Clinical manifestations:

Recurrent abdominal pain and discomfort associated with altered bowel habits

o Can be diarrhea or constipation-predominant or alternating

– Gas, bloating, and nausea

– Symptoms are usually relieved with defecation

– Associated with anxiety, depression, chronic fatigue syndrome

Pancreatitis

Inflammation of the pancreas

Etiology & Pathophysiology:

Acute or chronic

Injury/ inflammation leads to leakage of pancreatic enzymes

Autodigestion of pancreatic tissue and other organs

Can be associated with several other clinical disorders

Clinical manifestations and evaluation:

Mid epigastric pain radiating to the back

Fever and leukocytosis

Hypotension and hypovolemia

– Enzymes increase vascular permeability

Elevated serum lipase & amylase

Malabsorption Syndromes

Pathological interference with normal physiological sequence of digestion, absorption and transport of nutrients

– Maldigestion: failure of chemical processes of digestion

– Malabsorption: failure of intestinal mucosa to absorb digested nutrients

– Combined

Etiology (selected):

Infections: traveler diarrhea, intestinal parasites, intestinal TB, HIV

Surgical: post gastrectomy, vagotomy, bariatric surgery

Celiac disease

Enzyme deficiencies:

– Intestinal disaccharidase deficiency

– Eg. lactase intolerance

Pancreatic disease

– Eg. cystic fibrosis

Terminal ileal disease such as Crohn’s disease, surgical resection

Obstructive jaundice

Endocrine diseases: thyroid, adrenal

Diet: fiber deficiency

Malnutrition

Malabsorption Syndromes- Selected

Pancreatic insufficiency

Insufficient pancreatic enzyme production (lipase, amylase, trypsin, chymotrypsin)

Causes:

– Pancreatitis

– Pancreatic carcinoma

– Pancreatic resection

– Cystic fibrosis

Fat maldigestion → steatorrhea and weight loss

Lactase deficiency

No breakdown of lactose into monosaccharides → reduced absorption of monosaccharides

Fermentation of lactose by bacteria → gas, cramping pain, flatulence, and osmotic diarrhea

Bile salt deficiency

Cause: liver disease and bile obstruction

Pathophysiology:

– Bile salts are synthesized from cholesterol/ bile acids inside liver

– Conjugated bile salts are needed to emulsify/absorb fat

– Poor intestinal absorption of lipids causes steatorrhea, diarrhea, and poor absorption of fat-soluble vitamins (A, D, E, K)

Fat-soluble vitamin deficiencies and their effects:

Vitamin A

– Night blindness

Vitamin D

– Decreased calcium absorption

– Bone pain

– Osteoporosis

– Fractures

Vitamin K

– Prolonged prothrombin time (PT)

– Bleeding tendencies

Diverticulitis & Diverticulosis

Pathophysiology:

Acute inflammation of a diverticulum (mucosal outpouching of colon wall), especially the sigmoid colon

– Results from increased pressure within the lumen as diameter shrinks in response to consumption of low residue, refined diets

Obstruction by fecal matter and undigested food particles

Increased colonic intraluminal pressure

Hypertrophy, thickened mucosal folds

Clinical manifestations:

Asymptomatic (Diverticulosis, absence of inflammation)

Left lower quadrant abdominal pain

Fever, leukocytosis, melena

Complications:

Abscess, perforation, fistula

Jaundice (icterus)

Occurs in unconjugated and conjugated hyperbilirubinemia

Viral Hepatitis

Systemic viral disease that primarily affects the liver

Acute or chronic or fulminant hepatitis

Causes:

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