Digestive System Diseases: Symptoms, Causes, and Diagnosis
Digestive System Diseases
Esophagus
Achalasia
Achalasia is characterized by the inability of the lower esophageal sphincter to relax during swallowing. This leads to disorganized esophageal peristalsis and prevents food from reaching the stomach, potentially causing megaesophagus.
Clinical Presentation: Dysphagia (difficulty swallowing), retrosternal pain, regurgitation.
Stomach
Gastritis
Gastritis is an inflammation of the gastric mucosa that can be acute or chronic.
Acute Gastritis
Acute gastritis develops rapidly and can be caused by alcohol, drugs (aspirin, NSAIDs), large meals, or caustic ingestion.
Clinical Presentation: Anorexia, nausea, vomiting, and potentially gastrointestinal bleeding with hematemesis (vomiting blood) and melena (dark, tarry stools).
Chronic Gastritis
Chronic gastritis involves prolonged inflammation of the gastric mucosa. Chronic atrophic gastritis is the most common type and is often found in patients with pernicious anemia (related to vitamin B12 deficiency) and the elderly.
Clinical Presentation: Similar to acute gastritis.
Gastric Ulcer
Gastric ulcers are lesions that penetrate the muscularis mucosae. They are often associated with Helicobacter pylori infection, as well as factors like NSAID use, stress, spicy foods, and blood type O.
Clinical Presentation: Chronic, recurring epigastric pain often described as hunger-like. Symptoms may last for days or weeks and then disappear, often with seasonal patterns (spring and autumn). Complications include gastrointestinal bleeding, perforation, and malignant degeneration.
Gastric Cancer
Gastric cancer can occur at any age but is rare before age 30, with increasing frequency with age. Risk factors include hereditary and environmental factors, high-salt diets, achlorhydria (lack of stomach acid), chronic atrophic gastritis, and hypochlorhydria (low stomach acid).
Clinical Presentation: Early stages are often asymptomatic. Later symptoms include anorexia, epigastric pain, nausea, vomiting, gastrointestinal bleeding, and weight loss.
Bowel Diseases
Crohn’s Disease
Crohn’s disease is a chronic inflammatory condition primarily affecting the terminal ileum. It affects both sexes and typically first appears between ages 20 and 30. The cause is unknown.
Clinical Presentation: Symptoms occur in flares and vary, sometimes mimicking appendicitis.
Ulcerative Colitis
Ulcerative colitis is an inflammatory bowel disease of unknown cause, more common in women aged 18 to 40. It is characterized by the formation of small ulcers that can enlarge.
Clinical Presentation: Symptoms occur in flares and include bloody diarrhea with mucus and pus, abdominal pain, rectal tenesmus (feeling of incomplete evacuation), fatigue, anorexia, and weight loss.
Celiac Disease
Celiac disease is an immune reaction to gliadin, a component of gluten.
Clinical Presentation: Steatorrhea (fatty stools), weight loss, fatigue, abdominal distension due to bloating, and bleeding due to vitamin K deficiency.
Diverticulosis
Diverticulosis involves the formation of small pouches (diverticula) in the large intestine, typically the size of a pea. These can become inflamed, leading to diverticulitis. Chronic constipation is a risk factor.
Colon Carcinoma
Colon cancer is a leading cause of death in Spain, particularly after age 50. 50% of cases occur in the rectum and sigmoid colon, 20% in other parts of the colon.
Clinical Presentation: Often asymptomatic initially. Symptoms include changes in bowel habits, rectal bleeding, abdominal pain, asthenia (weakness), anorexia, and weight loss.
Hemorrhoids
Hemorrhoids are dilated veins in the internal or external hemorrhoidal plexus. External hemorrhoids are due to dilation of the inferior hemorrhoidal plexus, while internal hemorrhoids involve the superior hemorrhoidal plexus. Causes include chronic constipation, portal hypertension, and pregnancy.
Clinical Presentation: Burning, itching, anal pain, rectal tenesmus, rectal bleeding, and prolapsed hemorrhoids. External hemorrhoids are often painful, while internal hemorrhoids are usually not.
Liver
Cirrhosis
Cirrhosis is a chronic, diffuse liver disease characterized by cell necrosis, fibrosis, and nodule formation. Common causes include alcoholism, chronic viral hepatitis (B, C, D), drugs, and autoimmune disorders.
Clinical Presentation: Portal hypertension (increased pressure in the portal vein), ascites (fluid accumulation in the abdomen), splenomegaly (enlarged spleen), esophageal varices (enlarged veins in the esophagus) that can cause hematemesis or melena, caput medusae (visible abdominal veins), endocrine disorders (testicular atrophy, gynecomastia, amenorrhea, infertility), and in advanced stages, hepatic encephalopathy (asterixis/flapping tremor, lethargy, coma).
Liver Cancer
Liver cancer can be primary or secondary (metastatic). Primary liver cancer is often associated with chronic viral hepatitis, cirrhosis, and exposure to carcinogens in food.
Clinical Presentation: Asthenia, anorexia, fever, weight loss, right upper quadrant pain, hepatomegaly (enlarged liver), ascites, and jaundice.
Cholelithiasis (Gallstones)
Gallstones are common, especially in individuals with the “4 Fs”: female, forty, fat, and fertile. Gallstones can be cholesterol stones (most common) or pigment stones (calcium bilirubinate).
Clinical Presentation: Many people are asymptomatic. Symptoms include dyspepsia (indigestion), belching, fullness, bloating, epigastric pain, and pain in the right upper quadrant approximately 2 hours after eating, often accompanied by nausea, vomiting, and fever.
Pancreas
Acute Pancreatitis
Acute pancreatitis is inflammation of the pancreas with varying degrees of destruction due to the activation of digestive enzymes within the pancreas, leading to autodigestion (by trypsin, chymotrypsin, and lipase). Common causes include alcoholism and gallstones.
Chronic Pancreatitis
Chronic pancreatitis is a chronic inflammatory disease characterized by a decrease in pancreas size, fibrosis (hardening), and calcification. Common causes include alcoholism, hyperlipidemia (high blood fats), and biliary tract diseases.
Clinical Presentation: Epigastric pain radiating to the back, lasting for hours or days, nausea, vomiting, steatorrhea, weight loss, and sometimes insulin-dependent diabetes mellitus (IDDM).
Pancreatic Carcinoma
Pancreatic cancer arises from the exocrine portion of the pancreas and is more common in men aged 50 to 60.
Clinical Presentation: Intense epigastric pain, weight loss, jaundice, and often metastasis to neighboring structures.