Common disorders

Symptoms relating to the stomach are extremely common, but are frequently not caused by discernable organic disease (see Chapter 29). Typical symptoms include nausea, epigastric pain and bloating. Collectively these symptoms are termed dyspepsia and patients may refer to them as indigestion. With serious conditions of the stomach, there may also be vomiting, haematemesis, melaena and loss of weight. The main serious gastric conditions are peptic ulcer and gastritis, which are most frequently...

Endoscopic retrograde cholangiopancreatography and biliary endoscopy

A duodenoscope with a sideways-facing tip allows visualization and cannulation of the ampulla of Vater. Contrast material can then be injected into the pancreatic and biliary ducts and X-ray images taken. Close-up ultrasound images can be obtained by inserting compact ultrasound probes into the duct. Cannulae and instruments can be introduced to obtain brushings or biopsies, remove gallstones, and dilate strictures. The sphincter of Oddi may be cut (sphincterotomy), allowing gallstones to pass...

Caecum and appendix

Rotates and twists on normal mesentery position Rotates and twists on normal mesentery position Faecalith blocks appendiceal orifice The caecum is the most proximal part of the large intestine, into which the ileum opens. The appendix is a blind-ended tube protruding from the caecum.

Haemorrhoids and anorectal disease

Acute thrombosis in superficial vein External pile Acute thrombosis in superficial vein External pile Occasional bright red bleeding, leakage, pruritis 2 Spontaneous reduction Non-reducible, ulcerated, The peri-anal region is a frequent source of pain, discomfort and distress. Fortunately, many conditions affecting this region are benign and treatable.

Structure and function

The gastrointestinal system comprises the hollow organs from mouth to anus that form the gastrointestinal tract, the pancreas, which mainly secretes digestive juices into the small intestine, and the liver and biliary system, which perform vital metabolic functions in addition to their contribution to digestion and absorption of nutrients. A hollow tubular structure into which nutrient-rich food is coerced, and from which wastes are expelled, is found in the most primitive multicellular...

Gastrooesophageal reflux and hiatus hernia

Acid in contact with squamous epithelium causes pain and heartburn and possibly damage (oesophagitis) Diaphragm contributes to sphincter function Axis of gastro-oesophegeal junction Lower oesophageal sphincter Axis of gastro-oesophegeal junction Lower oesophageal sphincter Reduced efficacy of sphincter (loss of angle, no diaphragmatic contraction) Reduced efficacy of sphincter (loss of angle, no diaphragmatic contraction) Columnar epithelium (gastric or intestinal type) Columnar epithelium...

Anal fissure

A split in the skin of the anal canal causes acute tearing pain, particularly on defecation. There may also be some bleeding. The cause is constipation and hard stool. On examination, there is a linear tear in the skin. Ninety percent of tears are posterior and 10 anterior. There may be a skin tag, called a sentinel pile, at the edge of a chronic tear. Stool softeners and alleviating constipation are the main treatments and, in the acute state, local application of glyceryl trinitrate ointment,...

Starvation malnutrition and anorexia

Malnutrition has many causes, of which economic deprivation is the commonest. However, even in wealthy societies, ill health, gastrointestinal diseases, such as oesophageal cancer, and anorexia nervosa, as well as voluntary fasting, can all cause malnutrition and starvation. The BMI is abnormally low and other measures, such as skin-fold thickness and muscle strength and mass, are low. Listlessness and lethargy occur and with severe starvation, multiple organ failure may occur. In women,...

Carbohydrates

Blood glucose levels are maintained within tight limits. Glucose is 58 Integrated function essential for neuronal function and, if levels fall too low, hypogly-caemia causes neuroglycopenia, which can cause coma and death. On the other hand, sustained high blood glucose levels cause widespread damage to the body, particularly to blood vessels, as in diabetes mellitus. The liver plays a critical role in maintaining normal blood glucose levels. It is a major store of glucose, in the form of...

Peptic ulcer and Helicobacter pylori

' Up to 80 of population infected 1 15 get peptic ulcer 1 Others may develop - gastric lymphoma Most remain well Gastrectomy 1 Vagotomy J Antacids - ineffective H2 receptor antagonists n Proton pump inhibitors J Proton pump inhibitors + 2 antibiotics ' Up to 80 of population infected 1 15 get peptic ulcer 1 Others may develop - gastric lymphoma Most remain well Gastrectomy 1 Vagotomy J Antacids - ineffective H2 receptor antagonists n Proton pump inhibitors J Proton pump inhibitors + 2...