Duodenal Ulcer

Gastric Ulcer

　

Acute Gastritis

Chronic Gastritis

Crohn's Disease

Diverticulosis

　

Ulcerative Colitis

Toxic Megacolon

　

Acid

Pepsin

Bile

　

Bowel Sounds (Hyperactive, Hypoactive)

Ileus

　

Herniation

Necrosis

　

　

Campylobacter jejuni

Esceria coli

Salmonella, Shigella

Tuberculosis

Yersinia enterocolitica

　

Dysentery

Amebiasis

　

We are all familiar with the common symptoms of heartburn, diarrhea, or stomachaches. However, there are a host of disorders of the digestive tract that are far more serious and troubling.

　

First of all, peptic ulcers are a most common disorder of the digestive system. They may occur in the stomach or alternatively in the duodenum. Duodenal ulcers are genetically influenced, occurring in Blood Group O and Monozygotic twins, and is common in the US. Gastric Ulcers on the other hand are more common in Japan.

　

Gastric Peptic Ulcers are caused by a breakdown in gastric mucosal defense to acid/pepsin are accompanied by normal or low levels of acidity. 80% have chronic antral gastritis - it is hypothesized that pyloric sphincter incompetence allows bile reflux causing the chronic antral gastritis.

　

Duodenal Peptic Ulcers are caused by rapid gastric emptying, before the meal can buffer the gastric acid.

　

Acute Gastritis is a transient but serious condition characterized by multiple, small circular erosions or superficial ulcers. It is caused by damage to the surface mucosal barrier, which prevents the back-diffusion of h ions. This may be a result of the use of aspirin, alcohol and tobacco. Also stresses and shock may be considered as causes of this condition.

　

Chronic Gastritis is unrelated to Acute gastritis and is a common disorder, especially among the elderly. It is usually due to antral gastritis.

　

Crohn's Disease is a recurrent inflammatory bowel disease predominantly of the small intestine. It is characterized by intermittent attacks of mild diarrhea, abdominal pain, and fever. There are long asymptomatic periods that may vary from weeks to months.

　

The etiology is unknown. It is much more common in US, Britain, Scandinavia than in Japan. Among possible causes are infectious agents, like viruses or immunological mechanisms (immune complexes and t-lymphocytes).

　

Crohn's disease shows patches of unaffected regions of small intestine that are large and continuous. These "skip regions" alternate with regions that are thickened with inflammation and fibrosis. The inflammation may cause adhesions both among the intestines and between the intestines and other regions.

　

Diverticulosis is very common, especially among the elderly. This disease may result from low bulk diets, which produce low stool volume. This low, compact volume stool requires increased effort for expulsion. The mechanical forces change the muscle bundle configuration and allow the mucosa to be herniated out through the muscularis. The muscle often becomes hypertrophic as the result of the increased intraluminal pressure cause by straining.

　

Primarily a mucosal disease, CUC increases the risk for carcinoma and may result in toxic megacolon, an acute dilatation of the colon due to loss of muscle tone, with an associated systemic toxicity and shock. It does not exhibit "skip areas" which are seen in Crohn's disease. It is more common in women than in men, and among whites.

　

Ulcerative Colitis is limited to the rectum and rectosigmoid in 40-50% of the cases, and only 20% involve the entire colon. Most cases are readily treated with medication, but 20% of cases have associated symptoms of electrolyte/fluid imbalance, systemic toxicity and shock. During periods of remission, the colon may appear relatively normal.

　

Bowel Sounds are evaluated by listening to the abdomen with a stethoscope. Absent bowel sounds, called ileus, is a condition in which the examiner is unable to find any sounds after listening to each area of the abdomen for five minutes. This signifies that the intestines are not active. The inactivity of the intestines can be a life and death emergency because gas, secretions, and intestinal contents can accumulate to the point where the bowel wall ruptures. An absence of bowel sounds may also indicate the strangulation of a bowel with necrosis of bowel tissue.