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Digestive System Diseases and Disorders 227
180-degree twisting of bowel
Volvulus
Figure 11-20 Volvulus and intussusception.
mild to severe abdominal pain and distention, nausea,
and vomiting.
■ Diagnosis. Barium enema, abdominal CT scan, upper
GI, and abdominal films all aid in the diagnosis.
■ Treatment. Intestinal obstruction can be relieved by
nasogastric suctioning, but more commonly, surgery is
required.
■ Prevention. Prevention depends on the cause. If the
condition is related to adhesions, intussusception, or
volvulus, intestinal obstruction might not be prevent
able. Treatment of other causes, such as tumors and her
nias, is helpful in prevention of intestinal obstruction.
Ulcerative Colitis
■ Description. Ulcerative colitis is a chronic inflam
mation of the colon (Figure 11-21) that causes
inflammation and ulcers in the lining of the rectum
and colon. Like regional enteritis, it is commonly
called inflammatory bowel disease until diagnosis is
confirmed.
■ Etiology. The cause of ulcerative colitis is unknown.
Exacerbations of the disease often occur during
stressful times, leading to the belief that a psychogenic
factor is involved. Other causative theories include
hereditary, autoimmune, and dietary factors. Patients
with ulcerative colitis are at high risk for developing
colon cancer.
■ Symptoms. The colon and rectum have multiple
ulcerations that lead to lower abdominal pain, blood in
the stools, anemia, and diarrhea.
■ Diagnosis. Diagnostic tests include blood tests to check
for anemia, stool sample, CT scan, and colonoscopy. A
colonoscopy is the best test to confirm the diagnosis.
■ Treatment. Treatment can include dietary limitations,
stress reduction, mild sedatives, and anti-inflammatory
medications. Surgery is usually considered only if con
servative treatment fails. Surgical intervention often
results in a colostomy (opening in the colon), either
temporary or permanent (Figure 11-17). If the colos
tomy is permanent, a portion of the colon might be
removed.
■ Prevention. Since the cause is unknown, prevention
is not possible. Taking steps to reduce stress is helpful
in reducing the severity of the symptoms.
Figure 11-21 Ulcerative colitis. (A) Location. (B) Internal view.
228 Chapter 11
Complementary and Alternative Therapy
Curcumin
C
urcumin comes from the Indian herb turmeric. It has long been used for treatment
in inflammatory conditions. There are some studies that demonstrate its benefits in
individuals with ulcerative colitis. There are no guidelines at present time for its use in
treating ulcerative colitis, but one study looked at research using curcumin conjunction
with mesalamine therapy. The researchers concluded that further studies are needed
before recommendations for curcumin use as an adjunct to mesalamine therapy are made.
Source: Chandan et al. (2020)
Healthy Highlight
Food Poisoning
M
icroorganisms that we ingest (eat) can cause GI upset in a variety of ways. Most
microorganisms that we ingest are easily incapacitated and destroyed by the
acid in the stomach. Some microorganisms will cause illness only if we ingest great
numbers of them at a time. Ingestion of these great numbers allows a large number of
microorganisms to escape the acid environment, invade the small intestine, and cause
illness. An example of this type of microorganism is Salmonella (SAL-moh-NEL-ah).
For Salmonella to make us ill, we must eat food that has been tainted with it. The bac
teria reproduce in the food product before we eat it, thus providing the circumstances
for ingestion of a large number of bacteria at one time. Salmonella bacteria invade the
lining of the small intestine and bring about symptoms, usually 24 to 48 hours after
ingestion of the food. Salmonella food poisoning can be prevented by refrigerating
foods and by cooking foods thoroughly. Salmonella food poisoning is determined by a
stool culture.
Other types of microorganisms also are very virulent and are thus able to withstand
the stomach’s acid environment. Ingestion of even small numbers of these will allow pas
sage into the small intestine and cause illness. These organisms include viruses, amoebae,
and Shigella, which are frequently spread by a fecal-oral route.
Another way that microorganisms make us ill is by producing a toxin (poisoning).
The bacteria themselves do not cause the harm, but the enterotoxin (intestine poison)
they produce does the damage. Staphylococcal food poisoning is of this type. Staphy
lococcal organisms contaminate nonrefrigerated food and release enterotoxins. When
these enterotoxins are ingested, they quickly invade the lining of the stomach and small
intestine, leading to symptoms within one to four hours. Staphylococcal food poisoning
can be prevented by proper refrigeration of food products. This type of food poisoning
is determined by a food culture. Prognosis is good, and symptoms usually resolve within
24 hours.
Observing the following measures can prevent most GI upset caused by contami
nated food:
■
■
■
■
■
Always wash your hands before and after preparing food.
Wash your hands before and after a meal.
Keep eating utensils and plates clean and stored until ready for use.
Cover and refrigerate food properly.
Cook foods thoroughly, especially meats and seafood.
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Digestive System Diseases and Disorders 229
Inflammatory Bowel Disease (IBD)
IBD refers to both regional enteritis (Crohn’s disease)
and ulcerative colitis. Both diseases (as previously dis
cussed) are chronic in nature with undetermined etiol
ogy. However, a general diagnosis of IBD can be used
until a definite diagnosis of another bowel disorder is
made.
Irritable Bowel Syndrome (Spastic Colon)
■ Description. Irritable bowel syndrome (IBS) is the
most common intestinal disorder and often can be con
fused with IBD, but they are not the same. IBD is an
inflammation of the bowel with chronic lesions. Inflam
mation and lesions do not occur in IBS.
■ Etiology. The cause of IBS is unknown, but a strong
psychogenic factor has been considered. IBS is chronic,
and onset usually occurs in the young adult. Frequent
recurrence over the years is very frustrating to the
affected individual and the physician.
■ Symptoms. IBS is a functional disorder of motility
and can cause a group of symptoms, including abdom
inal pain and altered motility. Typically, an individual
suffering from IBS has bouts of diarrhea, constipation,
or both.
Spicy foods, caffeine, alcohol, and seasonings can
irritate the colon and bring about symptoms of IBS.
Stress also has an adverse effect and often causes alter
ations in intestinal motility.
■ Diagnosis. Tests to assist in diagnosis include stool
sampling, blood test, X-rays, and endoscopy. Colonos
copy is the most helpful in confirming the diagnosis.
■ Treatment. Avoidance of causative factors and stress
reduction techniques often allow the colon to return to
its normal functional state.
■ Prevention. IBS cannot be prevented, but symptoms
can be reduced. Avoiding causative agents along with
stress reduction techniques will help prevent symp
toms. Stress reduction techniques include counseling,
biofeedback, regular exercise, yoga, meditation, deep
breathing, and hypnosis.
Dysentery
■ Description. Dysentery is a general term for a group
of GI disorders characterized by acute inflammation.
Dysentery commonly affects those in underdeveloped
countries and those who travel to these countries.
According to the Centers for Disease Control and Pre
vention (CDC), most cases in the United States occur in
immigrants, in those who live in inner-city housing, in
frequent travelers, in children in day care, and in people
in nursing homes.
■ Etiology. Invasion of microorganisms into the lin
ing of the colon causes dysentery, usually as a result of
ingestion of contaminated food, water, or both due to
poor sanitary conditions.
Natural Therapies
for IBS
Complementary and Alternative Therapy
I
rritable bowel syndrome (IBS) can cause mild or very severe symptoms including
pain, diarrhea, constipation, and decreased motility. There are some natural alterna
tive therapies that may relieve some of the symptoms of the disorder with or without the
use of prescription medications. Some of the alternative therapies that have shown posi
tive results in relieving symptoms include the following:
■ a plant-based diet including whole grains but limiting milk products if necessary
■ probiotic supplements
■ fiber supplements like psyllium
■ amino acid supplements like L-glutamine
■ stress relief strategies such as deep breathing, yoga, or music
■ acupuncture to reduce pain
■ essential oils such as peppermint and lemon
Some of these strategies have relieved the symptoms of IBS in individuals in various
research studies and may have even put them into remission.
Source: Gordon (2020)
230 Chapter 11
(A)
Colon
Diverticulosis
Diverticulitis
Perforation 18%
Hemorrhage 25%
Figure 11-22 (A) Diverticulosis. (B) Colon d
iverticulosis: internal view of pockets. (C) Colon diverticulosis: external view.
■ Symptoms. The main symptom is massive bloody or
watery diarrhea along with severe abdominal pain and
cramping. Dysentery is the disease and should not be
confused with diarrhea, the symptom.
■ Diagnosis. Diagnosis is based on stool samples show
ing the presence of causative microorganisms.
■ Treatment. Treatment depends on the cause of the
disease. Antibiotics are usually effective for dysentery
caused by a bacterial infection.
■ Prevention. Dysentery is spread by poor hygiene.
Preventive steps include handwashing and not sharing
eating utensils and straws. If traveling to an underdevel
oped country, do not drink the water, use ice cubes, or
eat salad or any fresh fruit or vegetables.
Diverticulosis/Diverticulitis
■ Description. Diverticulosis is a condition of having
diverticula, or little pouches, in the colon (Figure 11-22),
especially in the sigmoid colon. It can be asymptomatic
(without symptoms) until the pouches become packed
with fecal material and become irritated and inflamed.
Once inflamed, the condition is called diverticulitis.
■ Etiology. Diverticulitis increases in incidence with
age and has been associated with poor dietary habits,
lack of physical activity, and poor bowel habits.
■ Symptoms. Low abdominal pain and cramping are
indicative of diverticulitis. Because this inflammatory
disease progresses, it can lead to hemorrhage, perfora
tion, or narrowing of the lumen of the colon and, thus,
obstruction.
■ Diagnosis. Diagnosis is easily made by performing a
colonoscopy and visualizing the pouches.
■ Treatment. Increasing the amount of fiber in the diet
is usually effective in relieving symptoms and prevent
ing complications. Foods high in fiber include fruits,
vegetables, beans, potatoes, rice, and cereals. Fiber
keeps the stool soft, allowing it to move more easily
Healthy Highlight
Bean Poisoning
P
hytohaemagglutinin is a naturally occurring toxin in beans. While this toxin
occurs in many hard bean varieties (navy, pinto, brown, kidney), the kidney bean
contains the highest amount of toxin. Eating beans that have been undercooked leads
to the condition commonly called “bean poisoning” Symptoms occur within one to
three hours of ingesting the undercooked beans and include extreme nausea and pro
fuse vomiting. The severity of the symptoms is directly related to the amount of beans
eaten. Hospitalization and intravenous fluids may be needed, but usually the symptoms
resolve as soon as all the bean matter has been vomited out of the stomach. Although
the symptoms are of short duration, they are usually extreme in nature. To avoid bean
poisoning, one should soak beans for at least five hours, pour away the water, and make
sure all beans are briskly boiled for at least 10 minutes.
Source: Helmenstine (2021)
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Digestive System Diseases and Disorders 231
Figure 11-23 (A) Colon polyps. (B) Colon polyps: internal view.
through the colon. Antibiotics might be needed if acute
diverticulitis develops.
■ Prevention. A high-fiber diet can aid in prevention
of diverticulosis. Some believe that avoiding any foods
with seeds and nuts is helpful, although this concept has
not been proven.
Colon Polyps
■ Description. A polyp (PAH-lip) is an inward projec
tion of the mucosal lining of the colon (Figure 11-23).
■ Etiology. Polyps can be due to an inflammatory reac
tion or caused by a benign or malignant neoplasm.
■ Symptoms. Colon polyps can cause rectal bleeding,
but most commonly, they are asymptomatic.
■ Diagnosis. These growths are often diagnosed during
a routine colonoscopy (colon = colon, oscopy = proce
dure to look into) or sigmoidoscopy (sigmoid = sigmoid
portion of the colon).
■ Treatment. Suspicious polyps can be excisionally
biopsied during these procedures. Cancerous polyps
are removed by excisional biopsy or surgical resection,
depending on the number and type of polyps present.
■ Prevention. Colon polyps might not be preventable,
but making healthy lifestyle changes and lowering cer
tain risk factors is helpful. Preventive activities include
the following: eat healthy, limit fat intake, limit alcohol
consumption, stop smoking, maintain a healthy body
weight, and exercise.
Carcinoma of the Colon and Rectum
■ Description. Commonly called colorectal cancer,
this classification covers a variety of carcinomas that
arise in the colon and rectum. These tumors are usu
ally adenocarcinomas that arise from the mucosal lin
ing. Colorectal cancer commonly affects both sexes
(Figure 11-24).
■ Etiology. The cause of colorectal cancer is unknown.
Some identified predisposing factors include ulcerative
colitis, familial polyposis (many colon polyps), and a
diet high in red meat and low in fiber.
■ Symptoms. Signs and symptoms of colorectal cancer
depend on the site of the malignancy. Common symp
toms can include a change in bowel habits (diarrhea or
constipation), pencil-sized stools, blood in the stools,
anemia (due to tumor bleeding), abdominal discomfort,
and obstruction.
Figure 11-24 Colon cancer.
232 Chapter 11
Adenocarcinomas (the most common type found
in colorectal cancer) tend to grow slowly. Eventually,
the tumor can grow large enough to obstruct the lumen
and spread through the colon wall. After it has spread
through the colon wall, it can gain access to the lym
phatic and vascular systems and spread throughout the
body. The most common site of metastasis is the liver.
Prognosis is good if the carcinoma is detected before
metastasis; after metastasis, prognosis is poor.
■ Diagnosis. Diagnosis of colorectal cancer can be
made by stool examinations for occult blood, colonos
copy, and barium enema. Some rectal tumors also can
be palpated by digital examination.
■ Treatment. Colorectal carcinoma is one of the lead
ing causes of death from cancer in the United States. If
detected early, it is potentially curable by surgical resec
tion (Figure 11-25).
Other treatments for colon cancer include chemo
therapy and radiation. These can be used in conjunc
tion with surgery or used separately, depending on the
treatment plan and prognosis.
■ Prevention. Prevention of colorectal cancer focuses
on dietary changes. These include a decrease in red meat
consumption and an increase in the consumption of
fiber. It is also recommended that stool examination be
performed on individuals annually, beginning at age 50.
Ascending colostomy Transverse colostomy
Descending colostomy Sigmoid colostomy
Figure 11-25 Colostomy locations (blue section may be surgically removed if colostomy is permanent).
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Digestive System Diseases and Disorders 233
Rectum
Anal canal
(A)
External hemorrhoid
Internal
hemorrhoid
Courtesy
Figure 11-26 Hemorrhoids. (A) Location. (B) Hemorrhoids: internal protruding to outside. (C) Hemorrhoid: external.
Diseases of the Rectum
The rectum is the terminal or end part of the digestive
system. The most common rectal problem is hemor
rhoids. Rectal fissures and other minor problems can
also occur, but cancer of the rectum is one of the most
serious diseases of the rectum. Cancer of the rectum is
more commonly diagnosed in the older adult than at
any other age.
Hemorrhoids
■ Description. Hemorrhoids are varicose veins, either
internal or external, in the rectum (Figure 11-26). Inter
nal hemorrhoids can be examined by a physician using
a proctoscope (procto = rectum, scope = instrument
used to view). Internal hemorrhoids are located on the
rectal wall; external hemorrhoids are located externally
around the anus.
Internal hemorrhoids cannot be seen unless they
prolapse or get pushed through the anal opening. Exter
nal hemorrhoids are the ones commonly known as
hemorrhoids and can be viewed around the anal open
ing. External hemorrhoids are bluish in color and might
bleed with straining during bowel movements.
■ Etiology. Factors that increase the risk of developing
hemorrhoids include any activity that increases pressure
in the anal area such as straining to have a bowel move
ment, frequent bouts of constipation, prolonged stand
ing, prolonged sitting, pregnancy, and childbirth. Other
causes can be related to heredity and loss of muscle tone.
■ Symptoms. The most common symptoms are itching,
bleeding with bowel movements, and rectal pain.
■ Diagnosis. External hemorrhoids are easily diag
nosed by physical examination including a digital rectal
exam. During this exam, the physician uses a gloved,
Healthy Highlight
Screening Tests for dults aged 50 to 75 should be screened for colon cancer. This can be done by a
fecal occult blood test, by a sigmoidoscopy or colonoscopy or CT colonogra-
Colon
Cancer phy. The U.S. Preventative Services Task Force recommends that adults age 76-85 be
screened if their physician deems it is necessary. Screening before age 50 is recom
mended if the individual has had colorectal polyps or cancer or has had a close relative
with these conditions, has an inflammatory bowel disorder, or has a genetic syndrome
that would increase the risk of colon cancer.
Source: Centers for Disease Control and Prevention (2020)
234 Chapter 11
lubricated finger to feel for abnormalities. Internal
hemorrhoids might need visual inspection with an ano
scope (lighted tube to examine the anus) or proctoscope
(lighted tube to examine the rectum).
■ Treatment. Treatment of hemorrhoids can include
medications and warm sitz baths to ease the pain. Man
ual reduction, cryosurgery, and hemorrhoidectomy can
be optional treatments, depending on the severity of the
disease.
■ Prevention. Preventive measures are focused on
softening the stool (which decreases constipation and
straining with bowel movements). These measures
include good bowel habits (defecating when reflexes
are strong), adequate fluid intake, increased fiber intake,
exercise, and avoiding laxative use.
Carcinoma of the Rectum
See “Carcinoma of the Colon and Rectum.”
Trauma
Trauma to the Mouth
Trauma to the mouth can be due to motor vehicle acci
dents, falls, abuse, burns, or any other blunt or perforat
ing injury. The result can be broken teeth or jawbones
or lesions and lacerations. Depending on the severity
of the injury and the treatment needed, the individual
might have difficulty eating. If the jaw is broken, the
individual might need to have the jaw wired and closed
for a period of time, requiring a special liquid nutrition
program to maintain adequate intake of fluids, vitamins,
and minerals. Burns and lacerations also interfere with
the normal oral intake of fluid and food. The individual
might need alternate feeding methods such as paren
teral (intravenous) or enteral (tube feeding) nutrition.
Consider This...
Humans can live without food for approx
imately a month, but only a week or so
without water.
Trauma to the Stomach and Intestines
Trauma to the digestive system other than to the mouth
is usually due to perforation (a hole through the organ),
which can be the result of a stabbing, gunshot wound,
or piercing by some other kind of object. This is a med
ical emergency because the contents of the stomach or
intestines can spill out into the abdominal cavity, causing
peritonitis. Commonly, the wound is surgically repaired
and the individual is given antibiotics for the infection.
Rare Diseases
Achalasia
Achalasia (eh-cha-LAY-see-ah) is a disorder of the
esophagus that causes pain with swallowing. The peri
staltic movement of the lower portion of the esophagus
does not function properly. The cause of the disorder
is unknown. Treatment might involve surgery, drug
therapy, or both.
Gluten-Induced Enteropathy
This disease is also called celiac disease and is an
immune problem that sensitizes the individual to glu
ten proteins. These proteins are found mainly in wheat
and rye products, but also in oat and barley foods.
Individuals with gluten-induced enteropathy have
impaired absorption of some vitamins and proteins,
fats, and carbohydrates. Gluten-induced enterop
athy is treated by a dietary measure, restricting all
gluten-containing foods.
There has been a fourfold increase in celiac disease
in the last 50 years. This rapid increase is being ques
tioned by many researchers. Many feel there is a true
increase in celiac disease due to the growing amount of
processed gluten products in the American diet. Others
feel there is a false increase in the condition related to
marketing of the benefits of gluten-free diets coupled
with self-diagnosis. People who suffer the side effects
of abdominal bloating, tiredness, and irregular bowel
movements often find relief with gluten-free diets and
thus self-diagnose as having celiac disease.
Intestinal Polyps
Intestinal polyps are benign (noncancerous) tumors
found along the lining of the intestine. Although they
usually do not cause any symptoms for the individual,
they are often surgically removed as a preventive treat
ment because polyps can increase the risk of cancer.
Effects of Aging on the System
Disorders of the digestive system are common in
the aging population, so the incidence of problems
increases with age. Some of the problems occurring
with age in the system are caused by changes in the
cardiovascular or neurologic system, which causes
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Digestive System Diseases and Disorders 235
disruptions in the functioning of the digestive sys
tem. In the upper digestive system, the most common
problem with aging is related to loss of teeth. Preven
tive dentistry has lessened teeth and gum problems in
recent years, but it is still a significant factor in the older
adult. Further, the sense of taste becomes less sensitive,
and the motility in the esophagus decreases and can
cause some distress, but it is generally asymptomatic.
Changes in the lining of the stomach and decreased
secretion of hydrochloric acid increase the likelihood of
digestive disorders in the older adult. Decreased circula
tion to the stomach increases the incidence of ulcer disease.
Lower digestive disorders are common in the
older adult. The lower intestinal lining is affected
much like the stomach lining. Absorption of some
nutrients such as vitamin B
12
and fats can decrease.
Decreased circulation to the intestines can cause
ischemia and pain in the abdomen, and decreased
motility can contribute to constipation problems.
The development of inflammatory disease and hem
orrhoids is common to the aging process but also can
be caused by earlier problems or other predisposing
factors.
T
he digestive system is a long, hollow tube that extends from the mouth to the anus. Its purpose is the ingestion,
digestion, and absorption of fluids and nutrients and elimination of wastes. Accessory organs of the digestive sys
tem include the liver, pancreas, and gallbladder. The most common diseases of the system are infections, ulcers, and
cancer. Physiologic and lifestyle changes in older adults put them at higher risk for diseases of the digestive system.
Review Questions
Short Answer
1. What are the functions of the digestive system?
2. Which signs and symptoms are associated with common digestive system disorders?
3. Which diagnostic tests are most commonly used to determine type and cause of the digestive system disorders?
236 Chapter 11
Matching
4. Match the disorders listed in the left column with the
Pharyngitis
Gastritis
Hemorrhoids
Periodontal disease
Regional enteritis
_____ IBS
correct region of the digestive system in the right column:
a. Small intestine
b. Mouth
c. Colon
d. Throat or esophagus
e. Rectum
f. Stomach
Multiple Choice
5. Which of the following behaviors might contribute to digestive system problems? (Select all that apply.)
a. Eating four to six small meals per day
b. Improperly cooking food
c. Failure to wash hands after toileting
d. Poor dietary habits
e. Straining with bowel movements
f. Drinking plenty of fluids daily
g. Frequent use of laxatives and enemas
True or False
6. T F The alimentary canal is a continuous tube from the mouth to the anus.
7. T F Strep throat should always be treated because it can lead to rheumatic heart disease.
8. T F The main function of the large intestine (colon) is the digestion of food.
9. T F The Helicobacter bacteria are contributing factors in the development of peptic ulcers.
10. T F The effects of aging put the older adult at an increased risk for digestive system problems.
11. T F An exacerbation is a recurrence or flare up of symptoms.
12. T F An ileus is a section of the colon.
13. T F It is normal to find occult blood in the stool.
14. T F Motility refers to movement in the digestive system.
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