Module 5 - Gastroenterology

Gastroenterology is the branch of medicine concerned with diseases affecting

the gastrointestinal tract, which includes the organs from mouth to anus.
Gastroenterology is not the same as gastroenterological surgery or of colon and
rectal surgery, which are specialty branches of general surgery. Important
advances have been made in the last fifty years, contributing to rapid expansion
of its scope.
Hepatology, or hepatobiliary medicine, encompasses the study of the liver,
pancreas, and biliary tree, and is traditionally considered a sub-specialty.
Conditions
The following list of diseases or medical conditions are some of the medical
problems that may be treated by the gastroenterologist:
Achalasia - a condition in which the muscles of the lower part of the
oesophagus fail to relax, preventing food from passing into the stomach.
Acute colonic diverticulitis - Colonic diverticulosis is among the most
common diseases in developed Western countries. In the United States,
diverticulosis occurs in approximately one third of the population older
than age 45 and in up to two thirds of the population older than 85
years and it also affects a significant proportion of younger adults.
Acute pancreatitis - (AP) is an inflammatory condition of the pancreas
that can extend to extrapancreatic tissues. AP is broadly classified
as mild or severe.
Aganglionic megacolon - Hirschsprung's disease is a disorder of the
abdomen that occurs when part or all of the large intestine or antecedent
parts of the gastrointestinal tract have no nerves and therefore cannot
function.
Anal abscess and anal fistula - Anorectal abscess is an abscess
adjacent to the anus. It arises from an infection at one of the anal sinuses
which leads to inflammation and abscess formation. Anal fistula, or
fistula-in-ano, is an abnormal connection between the epithelialised
surface of the anal canal and the perianal skin. Anal fistulae originate
from the anal glands, which are located between the two layers of the
anal sphincters and which drain into the anal canal.
Angiodysplasia of the colon - occurs when blood vessels in
the colonenlarge. They may become fragile and result in occasional
bleeding in the gastrointestinal (GI) tract.
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Anal atresia - An imperforate anus or anorectal malformations are birth

defects in which the rectum is malformed. ARMs are a spectrum of
different congenital anomalies in males and females, that varies from
fairly minor lesions, as well as complex anomalies.
Anal fissure - An anal fissure or rectal fissure is a break or tear in the
skin of the anal canal. Anal fissures may be noticed by bright red anal
bleeding on toilet paper, sometimes in the toilet. If acute they may cause
pain after defecation but with chronic fissures pain intensity is often less.
Anal rectal abscess An anal abscess is a painful condition in
which a collection of pus develops near the anus. Most anal abscesses
are a result of infection from small anal glands.
The most common type of abscess is a perianal abscess. This often
appears as a painful boil-like swelling near the anus. It may be red in
colour and warm to the touch. Anal abscesses located in deeper tissue
are less common and may be less visible.
Surgical incision and drainage is the most common treatment for all types
of anal abscesses and is usually successful.
After an abscess has been drained, however, about 50% of patients will
develop a complication called a fistula. A fistula is a small tunnel that
makes an abnormal connection between the site of the abscess and the
skin.
In some cases, an anal fistula causes persistent drainage. In other
cases, where the outside of the tunnel opening closes, the result may be
recurrent anal abscesses. Surgery is needed to cure almost all anal
fistulas.
Anal rectal fistula - or fistula-in-ano, is an abnormal connection between
the epithelialised surface of the anal canal and (usually) the perianal skin.
Anal fistulae originate from the anal glands, which are located between
the two layers of the anal sphincters and which drain into theanal canal. If
the outlet of these glands becomes blocked, an abscess can form which
can eventually point to the skin surface. The tract formed by this process
is the fistula.
Abscesses can recur if the fistula seals over, allowing the accumulation
of pus. It then points to the surface again, and the process repeats.
Anal fistulas per se do not generally harm, but can be very painful, and
can be irritating because of the pus-drain (it is also possible for formed
stools to be passed through the fistula); additionally, recurrent abscesses
may lead to significant short term morbidity from pain, and create a nidus
for systemic spread of infection.

Surgery is considered essential in the decompression of acute

abscesses; repair of the fistula itself is considered an elective procedure
which many patients elect to undertake due to the discomfort and
inconvenience associated with a draining tract.
Anorectal abscess - An anorectal abscess is a collection of pus in the
area of the anus and rectum.
Anorectal malfunction - Anorectal malformations are birth defects
where the anus and rectum (the lower end of the digestive tract) do not
develop properly.
During a bowel movement, stool passes from the large intestine to the
rectum and then to the anus. Muscles in the anal area help to control
when a bowel movement occurs. Nerves in the area help the individual
sense the need for a bowel movement and also stimulate muscle activity.
With an anorectal malformation, several abnormalities can occur,
including the following: The anal passage may be narrow.
A membrane may be present over the anal opening.
The rectum may not connect to the anus (imperforate anus).
The rectum may connect to a part of the urinary tract or the
reproductive system through an abnormal passage called a fistula.
Anorexia nervosa - an emotional disorder characterized by an
obsessive desire to lose weight by refusing to eat.
Arteriovenous malformations of the colon - (AVM) is an abnormal
connection between arteries and veins, bypassing the capillary system.
This vascular anomaly is widely known because of its occurrence in the
central nervous system, but can appear in any location. Although many
AVMs are asymptomatic, they can cause intense pain or bleeding or lead
to other serious medical problems.
AVMs are usually congenital and belong to the RASopathies. The genetic
transmission patterns of AVM, if any, are unknown. AVM is not generally
thought to be an inherited disorder, unless in the context of a specific
hereditary syndrome.
Barrett's oesophagus - occurs due to chronic inflammation. The
principal cause of the chronic inflammation is gastroesophageal reflux
disease, GERD (UK: GORD). In this disease, acidic stomach, bile, small
intestine and pancreatic contents cause damage to the cells of the
lower esophagus.

Biliary colic - is the term used to describe a type of pain related to the
gallbladder that occurs when a gallstone transiently obstructs the cystic
duct and the gallbladder contracts.
Bulimia nervosa - an emotional disorder characterized by a distorted
body image and an obsessive desire to lose weight, in which bouts of
extreme overeating are followed by fasting or self-induced vomiting or
purging.
Calculus of gallbladder - A concretion in the gallbladder or in a bile
duct, composed chiefly of cholesterol, calcium salts, and bile pigments.
Also called biliary calculus, cholelith. A small, hard, abnormal mass
composed chiefly of cholesterol, calcium salts, and bile pigments, formed
in the gallbladder or in a bile duct.
Cancer of the rectum - The rectum is the portion of the large bowel that
lies in the pelvis, terminating at the anus. Cancer of the rectum is the
disease characterized by the development of malignant cells in the lining
or epithelium of the rectum. Malignant cells have changed such that they
lose normal control mechanisms governing growth. These cells may
invade surrounding local tissue or they may spread throughout the body
and invade other organ systems.
Cancer, oropharyngeal - is a disease in which malignant cells form in
the tissue of oropharynx. Oropharynx is a middle part of the throat which
includes the base of the tongue, the tonsils, the soft palate, and the walls
of the pharynx. Oropharyngeal cancers can be divided into two types,
HPV-positive, which are related to human papillomavirus infection, and
HPV-negative cancers, which are usually linked to alcohol or tobacco
use.
Cancer, throat - Throat cancer refers to cancerous tumours that
develop in your throat (pharynx), voice box (larynx) or tonsils.
Your throat is a muscular tube that begins behind your nose and ends in
your neck. Your voice box sits just below your throat and is also
susceptible to throat cancer. The voice box is made of cartilage and
contains the vocal cords that vibrate to make sound when you talk.
Throat cancer can also affect the piece of cartilage (epiglottis) that acts
as a lid for your windpipe. Tonsil cancer, another form of throat cancer,
affects the tonsils, which are located on the back of the throat.
Canker sores - an ulceration of a mucous membrane, especially of the
mouth. A small painful ulcer of the mucous membrane of the mouth; an
aphtha. Also called aphthous stomatitis, recurrent aphthous ulcers,
ulcerative stomatitis.
Celiac disease - A disorder resulting from an immune reaction to gluten,
a protein found in wheat and related grains, and present in many foods.

Celiac disease causes impaired absorption and digestion of nutrients

through the small intestine.
Cholangitis - Primary sclerosing (skluh-ROHS-ing) cholangitis (koh-lanJIE-tis) is a disease of the bile ducts in your liver. The term "cholangitis"
in primary sclerosing cholangitis refers to inflammation of the bile ducts,
while the term "sclerosing" describes the hardening and scarring of the
bile ducts that result from chronic inflammation.
Primary sclerosing cholangitis is a progressive disease that leads to liver
damage and, eventually, liver failure. Liver transplant is the only known
cure for primary sclerosing cholangitis, but transplant is typically reserved
for people with severe liver damage.
Cholecystitis - (ko-luh-sis-TIE-tis) is inflammation of the gallbladder.
Your gallbladder is a small, pear-shaped organ on the right side of your
abdomen, just beneath your liver. The gallbladder holds a digestive fluid
called bile that's released into your small intestine.
In most cases, cholecystitis is caused by gallstones that block the tube
leading out of your gallbladder. This results in a buildup of bile that can
cause inflammation. Other causes of cholecystitis include bile duct
problems and tumors.
Cholecystolithiasis - the presence of gallstones in the gallbladder. The
condition affects about 20% of the population above 40 years of age and
is more prevalent in women and in persons with cirrhosis of the liver.
Many patients complain of unlocalized abdominal discomfort, eructation,
and intolerance to certain foods. Others have no symptoms. In patients
with severe attacks of biliary pain associated with cholelithiasis,
cholecystectomy is recommended to prevent such complications as
cholecystitis, cholangitis, and pancreatitis. Also called chololithiasis.
Choledocholithiasis - refers to the presence of one or more gallstones
in the common bile duct. Usually, this occurs when a gallstone passes
from the gallbladder into the common bile duct
Cholelithiasis - Presence of gallstones in other parts of the biliary tract
can cause obstruction of the bile ducts, which can lead to serious
conditions such as ascending cholangitis or pancreatitis. Either of these
two conditions can be life-threatening and are therefore considered to be
medical emergencies.
Cholera
- An infectious, sometimes fatal disease of the small
intestine caused by the bacterium Vibrio cholerae. It is spread from
contaminated water and food and causes severe diarrhoea, vomiting,
and dehydration.
Cirrhosis, liver - Cirrhosis is scarring of the liver caused by many forms
of liver diseases and conditions, such as hepatitis and chronic alcohol
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abuse. The liver carries out several essential functions, including

detoxifying harmful substances in your body, cleaning your blood and
making vital nutrients.
Cirrhosis occurs in response to damage to your liver over many years.
The liver damage done by cirrhosis can't be undone. But if liver cirrhosis
is diagnosed early and the cause treated, further damage can be limited.
As cirrhosis progresses, more and more scar tissue forms, making it
difficult for the liver to function. Advanced cirrhosis can be lifethreatening.
Colitis, ulcerative - A bowel disease that is characterized by
inflammation with ulcer formation in the lining of colon (large intestine).
Its cause is unknown. The end of the colon (the rectum) is generally
involved.
Colon cancer - is cancer of the large intestine (colon), the lower part of
your digestive system. Rectal cancer is cancer of the last several inches
of the colon. Together, they're often referred to as colorectal cancers.
Most cases of colon cancer begin as small, noncancerous (benign)
clumps of cells called adenomatous polyps. Over time some of these
polyps become colon cancers.
Complete prolapsed - is defined as protrusion of the full thickness of the
rectal wall through the anus; it is the most commonly recognized type.
Mucosal prolapse, in contrast, is defined as protrusion of only the rectal
mucosa (not the entire wall) from the anus. Internal intussusception may
be a full-thickness or a partial rectal wall disorder, but the prolapsed
tissue does not pass beyond the anal canal and does not pass out of the
anus.
Congenital megacolon or megarectum - Hirschsprung disease is a
congenital abnormality (birth defect) of the bowel in which there is
absence of the ganglia (nerves) in the wall of the bowel. Nerves are
missing starting at the anus and extending a variable distance up the
bowel. This results in megacolon (massive enlargement of the bowel)
above the point where the nerves are missing.
Constipation - infrequent bowel movements (typically three times or
fewer per week) difficulty during defecation (straining during more than
25% of bowel movements or a subjective sensation of hard stools), or.
the sensation of incomplete bowel evacuation.
Crohn's disease - is a chronic inflammatory disease affecting the
intestines. This disease is a repetitive disorder that continues for long
periods of time. It results in inflammation of the digestive tract.
Diarrhoea - is a condition that involves the frequent passing of loose or
watery stools - it is the opposite of constipation and can have many
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causes, which may be infectious or non-infectious. Diarrhoea comes from

the Greek word diarrhoea.
Diverticulitis - is a common digestive disease which involves the
formation of pouches (diverticula) within the bowel wall. This process is
known as diverticulosis, and typically occurs within the large intestine, or
colon, although it can occasionally occur in the small intestine as well.
Drug-induced hepatitis - Drug-induced hepatotoxicity is a frequent
cause of liver injury. The predominant clinical presentation is acute
hepatitis and/or cholestasis, although almost any clinical pathological
pattern of acute or chronic liver disease can occur. The pathogenesis of
drug-induced liver disease usually involves the participation of the parent
drug or metabolites that either directly affect the cell biochemistry or elicit
an immune response. Each hepatotoxin is associated with a
characteristic signature regarding the pattern of injury and latency.
However, some drugs may exhibit signature. Susceptibility to druginduced hepatotoxicity is also influenced by genetic and environmental
risk factors. Unpredictable, low-frequency, idiosyncratic reactions often
occur on a background of a higher rate of mild asymptomatic liver injury
and, although difficult to predict, they may be detected by monitoring
serum alanine aminotransferase levels. Recent and future advances in
toxicogenomics and pro-teomics should improve the identification of risk
factors and the understanding of idiosyncratic hepatotoxicity.
Duodenal ulcer - A crater (ulcer) in the lining of the beginning of the
small intestine (duodenum). Ulcer formation is caused by infection with
Helicobacter pylori. Other factors predisposing a person to ulcers include
anti-inflammatory medications and cigarette smoking. Ulcer pain may not
correlate with the presence or severity of ulceration. Diagnosis is made
with barium X-ray or endoscopy. Complications of ulcers include
bleeding, perforation, and blockage. Treatment involves using antibiotics
to eradicate H. pylori, eliminating risk factors, and preventing
complications.
Dyspepsia - Dyspepsia can be defined as painful, difficult, or disturbed
digestion, which may be accompanied by symptoms such as nausea and
vomiting, heartburn, bloating, and stomach discomfort.
Entero-entereal fistula
- A gastrointestinal fistula is an abnormal
opening that allows the contents of the stomach or intestines to leak. If it
leaks through to a part of the intestines, it is called an entero-enteral
fistula. If it leaks to through to the skin, it is called an enterocutaneous
fistula.
Enterocutaneous fistula - A gastrointestinal fistula is an abnormal
opening that allows the contents of the stomach or intestines to leak.
Escherichia coli infection - infection is caused by a bacteria. It is the
leading cause of bloody diarrhoea. This type of infection may need
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medical attention. Contact your doctor if you think you may have it. This
infection is caused by some types of the E. coli bacterium.
Encopresis - is repeatedly having bowel movements in places other
than the toilet after the age when bowel control can normally be
expected.
Faecal incontinence - also called faecal incontinence, bowel
incontinence, anal incontinence, or accidental bowel leakage, is a lack of
control over defecation, leading to involuntary loss of bowel contents
including flatus (gas), liquid stool elements and mucus, or solid faeces. FI
is a sign or a symptom, not a diagnosis. Incontinence can result from
different causes and might occur with either constipation or diarrhoea
Food allergy - is an immune system reaction that occurs soon after
eating a certain food. Even a tiny amount of the allergy-causing food can
trigger signs and symptoms such as digestive problems, hives or swollen
airways.
Food poisoning - a toxic condition resulting from the ingestion of food
contaminated by certain bacteria. Acute infectious gastroenteritis caused
by various species of Salmonella is characterized by fever, chills,
nausea, vomiting, diarrhoea, and general discomfort beginning 8 to 48
hours after ingestion and continuing for several days. Similar symptoms
caused by Staphylococcus, usually S. aureus, appear much sooner and
rarely last more than a few hours. Food poisoning caused by the
neurotoxin of Clostridium botulinum is characterized by GI symptoms,
disturbances of vision, weakness or paralysis of muscles, and, in severe
cases, respiratory failure
Gallbladder cancer - is a relatively uncommon cancer. It has peculiar
geographical distribution being common in central and South America,
central and eastern Europe, Japan and northern India; it is also common
in certain ethnic groups e.g. Native American Indians and Hispanics. If it
is diagnosed early enough, it can be cured by removing the gallbladder,
part of the liver and associated lymph nodes. Most often it is found after
symptoms such as abdominal pain, jaundice and vomiting occur, and it
has spread to other organs such as the liver
Gallstones - A gallstone is a solid crystal deposit that forms in the
gallbladder, which is a pear-shaped organ that stores bile salts until they
are needed to help digest fatty foods. Gallstones can migrate to other
parts of the digestive tract and cause severe pain
Gastric ulcer - A hole in the lining of the stomach corroded by the acidic
digestive juices which are secreted by the stomach cells. Ulcer formation
is related to H. pyloridus bacteria in the stomach, anti-inflammatory
medications, and smoking cigarettes

Gastritis - describes a group of conditions with one thing in common:

inflammation of the lining of the stomach. The inflammation of gastritis is
most often the result of infection with the same bacterium that causes
most stomach ulcers.
Gastro-oesophageal reflux disease - is a condition in which the
stomach contents leak backwards from the stomach into the esophagus
(the tube from the mouth to the stomach). This can irritate the esophagus
and cause heartburn and other symptoms
Giardiasis - A condition in which the intenstines are infected with the
protozoan Giardia lamblia. Also called lambliasis. An intestinal infection
caused by the protozoan Giardia lamblia. It is usually asymptomatic in
humans but can cause diarrhea, nausea, and abdominal cramping.
Gilbert's syndrome - A common but harmless genetic condition in which
UDP-glucuronosyltransferase, a liver enzyme that is essential to the
disposal of bilirubin, is abnormal. Mutations in the same gene cause the
Crigler-Najjar syndrome, which is a more severe and dangerous form of
hyperbilirubinemia (high bilirubin in the blood). Also known as
hyperbilirubinemia type 1.
Heartburn - Also called cardialgia, pyrosis. A burning sensation, usually
centered in the middle of the chest near the sternum, caused by the
reflux of acidic stomach fluids that enter the lower end of the esophagus.
Also called acid reflux.
Hemorrhoids - are blood vessels located in the smooth muscles of the
walls of the rectum and anus. They are a normal part of the anatomy and
are located at the junction where small arteries merge into veins.
Hernia, inguinal - a common type of hernia in which a loop of the
intestine protrudes directly through a weak area of the abdominal wall in
the groin region.
Hepatitis - is a medical condition defined by the inflammation of the liver
and characterized by the presence of inflammatory cells in the tissue of
the organ
Hiatus hernia - An anatomical abnormality in which part of the stomach
protrudes up through the diaphragm into the chest.
Normally, the esophagus passes down through the chest, crosses the
diaphragm, enters the abdomen through a hole in the diaphragm called
the esophageal hiatus and joins the stomach just below the diaphragm.
When there is a hiatal hernia, the opening of the esophageal hiatus is
larger than normal and a part of the stomach slips up or passes
(herniates) through the hiatus and into the chest.

Hirschprung-Galant infantilism - Hirschsprung disease is a congenital

abnormality (birth defect) of the bowel in which there is absence of the
ganglia (nerves) in the wall of the bowel. Nerves are missing starting at
the anus and extending a variable distance up the bowel. This results in
megacolon (massive enlargement of the bowel) above the point where
the nerves are missing. (The nerves are needed to assist in the natural
movement of the muscles in the lining of the bowels that move bowel
contents through.)
Hirshprungs disease - Hirschsprung's disease is a blockage of the
large intestine. It occurs due to poor muscle movement in the bowel. It is
a congenital condition, which means it is present from birth.
Hyperbilirubinemia - An elevated level of the pigment bilirubin in the
blood. A sufficient elevation of bilirubin produces jaundice.
Hyperemesis gravidarum - Extreme, excessive, and persistent vomiting
in early pregnancy that may lead to dehydration and malnutrition. It is
usually associated with weight loss of more than 5 percent of the
woman's prepregnancy weight.
IBD Ischemic bowel disease - is a group of inflammatory conditions of
the colon and small intestine. Crohn's disease and ulcerative colitis are
the principal types of IBD. It is important to note that not only does
Crohn's disease affect the small intestine and large intestine, it can also
affect the mouth, oesophagus, stomach and the anus
IBS Irritable bowel syndrome - is a common disorder that affects the
large intestine (colon). Irritable bowel syndrome commonly causes
cramping, abdominal pain, bloating, gas, diarrhoea and constipation
Ileitis - a chronic inflammatory disease of the intestine involving only the
end of the small intestine (the terminal ileum).
Indigestion - which is sometimes called dyspepsia, is a general term
covering a group of nonspecific symptoms in the digestive tract. It is often
described as a feeling of fullness, bloating, nausea, heartburn, or gassy
discomfort in the chest or abdomen. The symptoms develop during
meals or shortly afterward. In most cases, indigestion is a minor problem
that often clears up without professional treatment
Inflammation of the pancreas - is a disease in which the pancreas
becomes inflamed. Pancreatic damage happens when the digestive
enzymes are activated before they are released into the small intestine
and begin attacking the pancreas.
Inflammatory bowel disease - A group of chronic intestinal diseases
characterized by inflammation of the bowel -- the large or small intestine.
The most common types of inflammatory bowel disease (IBD) are
ulcerative colitis and Crohn disease.
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Crohn disease favours the ileum (the lower part of the small intestine) but
can occur anywhere along the intestinal tract while, by contrast,
ulcerative colitis affects the colon (the large intestine) alone. The
inflammation in Crohn disease involves the entire thickness of the bowel
wall, whereas in ulcerative colitis the inflammation is confined to the
mucosa (the inner lining) of the intestine.
Irritable colon - (IBS) is a common disorder that affects the large
intestine (colon). Irritable bowel syndrome commonly causes cramping,
abdominal pain, bloating, gas, diarrhoea and constipation. IBS is a
chronic condition that you will need to manage long term.
Even though signs and symptoms are uncomfortable, IBS unlike
ulcerative colitis and Crohn's disease, which are forms of inflammatory
bowel disease doesn't cause changes in bowel tissue or increase your
risk of colorectal cancer
Lactose intolerance - Lactose intolerance refers to the inability of the
body to digest lactose.
Mechanical bowel obstruction - A mechanical bowel obstruction is a
partial or complete blockage in the intestine, which is also called the
bowel. Blockages can occur at any point along the small or large bowel.
They are more common in the small bowel. When the bowel is blocked,
food and liquid cannot pass through. Over time, food, liquid, and gas
build up in the area above the blockage.
Necrotizing enterocolitis - Necrotizing enterocolitis is the death of
tissue in the intestine. It occurs most often in premature or sick babies
Norovirus - A group of viruses that are a common cause of food
poisoning and acute gastroenteritis ("stomach flu") that can strike quickly
with force and make a person feel very sick but which typically resolves
within 2-3 days. The characteristic symptoms are nausea, vomiting,
diarrhoea, and abdominal cramping. The diarrhoea is not bloody. Fever, if
present, is low-grade. Dehydration is the main complication, especially in
infants and the elderly, and may need medical attention.
Ogilvies syndrome - distension of the colon that is similar to that
occurring as a consequence of bowel obstruction but in which no
physical obstruction exists and that occurs especially in seriously ill
individuals and as a complication of abdominal surgery
Pancreatic cancer - a malignant neoplastic disease of the pancreas
characterized by anorexia, flatulence, weakness, dramatic weight loss,
epigastric or back pain, jaundice, pruritus, a palpable abdominal mass,
recent onset of diabetes, and clay-colour stools if the pancreatic and
biliary ducts are obstructed. Symptoms depend on the location of the
tumour within the pancreas or in metastatic sites. Diagnostic measures
include barium radiographic studies of the stomach and duodenum,
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transhepatic cholangiography (endoscopic retrograde

cholangiopancreatography), laboratory evaluation of liver function, celiac
arteriography, computed axial tomography, and magnetic resonance
imaging.
Pancreatitis - is an inflammation of the pancreas. It has several causes
and symptoms and requires immediate medical attention. It occurs when
pancreatic enzymes (especially trypsin) that digest food are activated in
the pancreas instead of the small intestine.
Parotitis - is an inflammation of one or both parotid glands, the major
salivary glands located on either side of the face, in humans. The parotid
gland is the salivary gland most commonly affected by inflammation.
Peptic ulcer - An ulcer in the lining of the stomach, duodenum, or
esophagus. Peptic ulcers affect millions of people in the US yearly. Ulcer
formation is related to Helicobacter pylori bacteria in the stomach, use of
anti-inflammatory medications, and cigarette smoking. Peptic ulcer pain
may not correlate with the presence or severity of ulceration.
Complications of peptic ulcers include bleeding, perforation, and
blockage of the stomach (gastric obstruction). Diagnosis is made via
barium X-ray or endoscopy. Treatment involves use of antibiotics to
eradicate H. pylori, elimination of risk factors, and prevention of
complications
Rectal cancer - A malignant tumour arising from the inner wall of the
final part of the large intestine -- the rectum. Although colon cancer and
rectal cancer share many features, there are important differences
between these two diseases including, especially, the tendency for rectal
cancer -- but not colon cancer -- to recur locally. Local recurrence of
rectal cancer is common (15-45%) after standard surgery and is often
catastrophic. It is difficult to cure, and the associated symptoms are
debilitating. Accordingly, preventing local recurrence is one of the main
treatment goals with rectal cancer.
Rectal prolapsed - Rectal prolapse is protrusion of rectal tissue through
the anus to the exterior of the body. The rectum is the final section of the
large intestine.
Rectovaginal fistula - Rectovaginal fistula is an abnormal connection
between the rectum and the vagina. Gas or stool may leak from the
bowel into the vagina.
Reflux oesophagitis - Inflammation of the lower oesophagus from
regurgitation of acid gastric contents, characterized by substernal pain
and usually due to malfunction of the lower oesophageal sphincter. Also
called peptic esophagitis .
Rotavirus - A virus that is a leading cause of severe diarrhoea and
dehydration in young children.
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Hirschsprung disease - is a congenital abnormality (birth defect) of the

bowel in which there is absence of the ganglia (nerves) in the wall of the
bowel. Nerves are missing starting at the anus and extending a variable
distance up the bowel. This results in megacolon (massive enlargement
of the bowel) above the point where the nerves are missing. (The nerves
are needed to assist in the natural movement of the muscles in the lining
of the bowels that move bowel contents through.)
Sialadenitis - Inflammation of a salivary gland.
Small bowel obstruction - means the small intestine is partially or
totally blocked. When this happens, the contents of the intestine cannot
properly get out of the body. Stools, fluid, and gas build up inside the
intestine. This is a potentially serious condition that requires urgent
medical care.
Spastic colon - A term sometimes used to refer to irritable bowel
syndrome (IBS). Although the term "spastic" colon implies the occurrence
of muscle contractions, or spasms, in the large bowel, this may not hold
true for all cases of IBS. See also irritable bowel syndrome.
Stomach cancer - (also known as gastric cancer) is a disease in which
the cells forming the inner lining of the stomach become abnormal and
start to divide uncontrollably, forming a mass called a tumour.
Stomach ulcer - A peptic ulcer is an open sore or raw area in the lining
of the stomach or intestine.A gastric ulcer occurs in the stomach. A
duodenal ulcer occurs in the first part of the small intestine.
Ulcer, duodenal - A crater (ulcer) in the lining of the beginning of the
small intestine (duodenum). Ulcer formation is caused by infection with
Helicobacter pylori. Other factors predisposing a person to ulcers include
anti-inflammatory medications and cigarette smoking. Ulcer pain may not
correlate with the presence or severity of ulceration. Diagnosis is made
with barium X-ray or endoscopy. Complications of ulcers include
bleeding, perforation, and blockage. Treatment involves using antibiotics
to eradicate H. pylori, eliminating risk factors, and preventing
complications.
Ulcer, gastric - A hole in the lining of the stomach corroded by the acidic
digestive juices which are secreted by the stomach cells. Ulcer formation
is related to H. pyloridus bacteria in the stomach, anti-inflammatory
medications, and smoking cigarettes. Ulcer pain may not correlate with
the presence or severity of ulceration. Diagnosis is made with barium xray or with the use of a viewing tube slipped through the throat to the
stomach (endoscopy).
Ulcer, peptic - A hole that goes all the way through the stomach or
duodenum is called a perforation. A perforation is a medical emergency.
The most common cause of ulcers is infection of the stomach by bacteria
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called Helicobacter pylori (H.pylori). Most people with peptic ulcers have
these bacteria living in their digestive tract.
Ulcerative colitis - A bowel disease that is characterized by
inflammation with ulcer formation in the lining of colon (large intestine).
Its cause is unknown. The end of the colon (the rectum) is generally
involved. When limited to the rectum, the disease is called ulcerative
proctitis. The inflammation may extend to varying degrees into the upper
parts of the colon. When the entire colon is involved, it is referred to as
pancolitis or universal colitis. Symptoms include intermittent rectal
bleeding, crampy abdominal pain, and diarrhoea. Many patients
experience long remissions, even without medication. Ulcerative colitis
may mysteriously resolve after a long history of symptoms.

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Module 5 - Procedures, therapies

and investigations
(carried out by Gastroenterologist OR General Surgeon)
ENDOSCOPIC PROCEDURES
Rigid oesophagoscopy

Diagnostic gastroscopy

Therapeutic gastroscopy with bougie

dilatation

Therapeutic gastroscopy with

insertion of prosthesis

Percutaneous endoscopic
jejunostomy

Injection sclerotherapy for

oesophageal varices

Oesophageal physiology studies

(including pH measurement and
manometry)

Ileoscopy via stoma with therapy

Capsule endoscopy

Rigid sigmoidoscopy including biopsy

Diagnostic flexible sigmoidoscopy,

includes forceps biopsy

Therapeutic sigmoidoscopy with

snare loop biopsy or excision of
lesion

Diagnostic colonoscopy, includes

forceps biopsy of colon and ileum

Therapeutic colonoscopy with snare

loop biopsy or excision of lesion

Fibreoptic colonoscopy and

recanalisation of tumour)

Diagnostic enteroscopy

Endoscopic ultrasound for tumour

staging diagnosis/transmucosal
biopsy

OESOPHAGUS
Oesophagectomy/Oesophagogastrectom
y with anastomosis in chest

Sub-total oesophagectomy with

anastomosis in neck

Total oesophagectomy and interposition

Endoscopically assisted
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of intestine

oesophagectomy

Open excision of lesion of oesophagus

VATS excision lesion of

oesophagus

Bypass of oesophagus

Repair of ruptured oesophagus

Oesophagocardiomyotomy (Heller's
operation)

Thorascopic oesophagogastric
myotomy

Injection sclerotherapy for oesophageal

varices

Transthoracic fundoplication

Transthoracic fundoplication &

gastroplasty

Transthoracic repair of
paraoesophageal hiatus hernia

Transthoracic repair of diaphragmatic

hernia (acquired)

Transabdominal repair of hiatus

hernia

Laparoscopic repair of hiatus hernia with

anti-reflux procedure (e.g. fundoplication)

Transabdominal repair of
diaphragmatic hernia

Transabdominal anti-reflux operations

Revision of anti-reflux operations

Repair of congenital oesophageal atresia

Laparoscopic
vagotomy/seromyotomy

PERITONEUM
Laparotomy for post-operative
haemorrhage

Laparotomy and repair of multiple

visceral trauma

Open drainage of subphrenic

abscess

Operations on omentum

Retroperitoneal tumour

Retroperitoneal abscess

Presacral tumour

Freeing of adhesions of peritoneum

Laparoscopic adhesiolysis (including

biopsy)

Open adhesiolysis (including biopsy)

Paracentesis abdominis for ascites

Suprapubic drainage of pelvic

abscess

STOMACH

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Proximal gastric vagotomy

Highly selective vagotomy

Vagotomy with pyloroplasty

Total gastrectomy and excision of

surrounding tissue

Partial gastrectomy

Partial gastrectomy and excision of

surrounding tissue

Gastro-jejunostomy

Revision of gastro-jejunostomy

Laparoscopic biliary gastric bypass

Gastrostomy

Closure of gastrostomy

Closure of perforated ulcer of

stomach

Laparoscopic closure of peptic ulcer

Pyloromyotomy

Pyloroplasty
DUODENUM
Open excision of lesion of duodenum

Bypass of duodenum

Closure of perforated ulcer of

duodenum

Open excision of congenital lesion of

duodenum including mal-rotation

SMALL INTESTINE
Excision of jejunum

Open formation of jejunostomy

Laparoscopically assisted resection

of small intestine

Bypass of jejunum

Intubation of jejunum for

decompression of intestine (without
laparotomy)

Bypass of ileum

Ileoanal anastomosis and creation of

pouch

Open formation of ileostomy

Laparoscopic ileostomy

Revision of ileostomy - local

Revision of ileostomy - laparotomy

Closure of ileostomy

Open operations on ileum (including

reduction of intussusception)

Surgery for correction of congenital

intestinal atresias
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LARGE INTESTINE
Appendicectomy

Laparoscopic appendicectomy

Drainage of abscess of appendix or

drainage of intra-abdominal abscess

Total excision of colon and ileorectal

anastomosis

Extended excision of right hemicolon

Other excision of right hemicolon

Laparoscopically assisted right

hemicolectomy

Excision of transverse colon

Excision of left hemicolon

Excision of sigmoid colon

Excision of lesion of colon

(transabdominal)

Bypass of colon

Closure of colostomy

Laparoscopic colostomy and stoma

formation (including revision)

Open formation of colostomy

Intra abdominal manipulation of colon

(including reduction of
intussusception)

Laparoscopically assisted left colon

resection

Radiological reduction of
intussusception of colon using barium
enema

RECTUM / ANUS
Ileoanal anastomosis and creation of
pouch

Panproctocolectomy and ileostomy

Rigid sigmoidoscopy including biopsy

Abdominoperineal pull through

resection with colo-anal anastomosis
+/- colonic pouch and associated
stoma

Abdominoperineal resection of
rectum and anus

Laparoscopic abdominoperineal
resection

Hartmanns procedure

Colectomy and colostomy and

preservation of rectum

Partial excision of rectum and

sigmoid colon for prolapse

Open excision of lesion of rectum and

colon

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Laparoscopic rectopexy

Transanal resection for rectal cancer

Perianal excision of lesion of rectum

(including sigmoidoscopy

Perineal repair of prolapse of rectum

Dilation of stricture of rectum

Repair of faecal fistula

Excision of lesion of anus

Destruction of lesion of anus

Repair of anal sphincter (including

sigmoidoscopy)

Repair of anal trauma

Haemorrhoidectomy (including
sigmoidoscopy)

Injection of sclerosing substance into

haemorrhoids

Banding of haemorrhoids

Circular stapling haemorrhoidectomy

Haemorrhoidal artery ligation

Anorectal stretch

Laying open of low anal fistula

(including sigmoidoscopy)

Laying open of high anal fistula

(including sigmoidoscopy)

Lateral sphincterotomy of anus

Excision of anal fissure

Drainage through perineal region

Excision of pilonidal sinus and

suture/skin graft

Laying open of pilonidal sinus

Faecal disimpaction

Abdominal revision of restorative

proctocolectomy

Abdominal operation for Hirshprungs

disease (e.g. Duhamel, Save and
Surcuson operations)

Module 5 - Commonly prescribed

drugs in gastroenterology
Aciphex (rabeprazole sodium)
Alinia (nitazoxanide)
Aloxi (palonosetron)
Amitiza (lubiprostone)
Asacol (mesalamine)
Avastin (bevacizumab)
Axid AR (nizatidine
Canasa (mesalamine)
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Cimetidine
Cipro (ciprofloxacin)
Colazal (balsalazide disodium)
Entereg (alvimopan)
Entocort EC (budesonide)
Erbitux (cetuximab)
Lotronex (alosetron HCL)
Nexium
Orfadin (nitisinone)
Oxytrol
Pancreaze (pancrelipase)
Pepcid Complete
PREVACID(R) (lansopraxole)
Prilosec (omeprazole)
Prochloroperazine
Protonix (pantoprazole sodium)
Ranitidine
Rebetol (ribavirin)
Vimovo (Visicol Tablet
Visipaque (iodixanol)
Zantac
Zuplenz

Module 5 - Glossary of terms used in

gastroenterology
Achalasia - Failure of the lower esophageal sphincter, a valve that separates
the stomach and the esophagus, to open.
Achlorhydria - Absence of hydrochloric acid secretion in the stomach
Acholia- Absence of bile
Adhesions - Fibrous tissue formation causes abnormal joining of two organ
surfaces. Aerophobia Ingestion of air.
Anal fissure - Painful crack in the mucous membrane of the anus
Anastomosis, intestinal - Reattachment of two portions of bowel together
Antispasmodics - Drugs that inhibit smooth muscle contraction in the
gastrointestinal tract.

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Appendicitis - Inflammation of the appendix of the intestines

Ascites - Free fluid in the peritoneal cavity
Biliary tract - Gall bladder and the bile ducts.
Borborygmi - Audible rumbling abdominal sounds due to gas gurgling with
liquid as it passes through the intestines.
Celiac disease - An allergic reaction of the lining of the small intestine in
response to the protein gliadin (a component of gluten).
Cholecystitis -inflammation of the gallbladder.
Choledocholithiasis - Condition of stones in the bile duct.
Clostridium difficult (C. difficult) - A gram-positive anaerobic bacterium.
Colectomy - Removal of part or the entire colon.
Colitis - Inflammation of the colon.
Colon - The large intestine.
Colonoscopy - is a fibreoptic (endoscopic) procedure in which a thin, flexible,
lighted viewing tube (a colonoscope) is threaded up through the rectum for the
purpose of inspecting the entire colon
Colostomy - A surgically created opening of the colon to the abdominal wall,
allowing the diversion of faecal waste.
Constipation - Reduced stool frequency, or hard stools, difficulty passing
stools, or painful bowel movements
Diverticulitis - Occurs when a diverticulum becomes infected or irritated.
Diverticula (diverticulosis) - Small pouches in the colon.
Endoscope - A thin, flexible tube with a light and a lens on the end used to look
into the esophagus, stomach, duodenum, small intestine, colon, or rectum.
Endoscopy - A procedure that uses an endoscope to diagnose or treat a
condition.
Enteritis - An irritation of the small intestine.
Gastritis - An inflammation of the stomach lining.
Gastroenteritis - An infection or irritation of the stomach and intestines
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Helicobacter pylori (H. pylori) - A bacterium that can damage stomach and
duodenal tissue, causing ulcers and stomach cancer.
Hemorrhoids - Veins around or inside the anus or lower rectum that are
swollen
Hiatus hernia - A small opening in the diaphragm that allows a part of the
stomach to move up into the chest.
Ileostomy - A surgically created opening of the abdominal wall to the ileum,
allowing the diversion of faecal waste.
Ileum -The lower third of the small intestine, adjoining the colon.
Inflammatory bowel disease (IBD) -A set of chronic diseases characterized by
irritation and ulcers in the gastrointestinal tract.
Interstitial cystitis - A long-lasting condition also known as painful bladder
syndrome or frequency-urgency-dysuria syndrome.
Jejunostomy (J-tube) - A method of enteral feeding in which a tube is
surgically placed in the small intestine.
Laparoscopy - The insertion of a thin, lighted tube (called a laparoscope)
through the abdominal wall to inspect the inside of the abdomen and remove
tissue samples.
Manometry - A test that measures pressure or contractions in the
gastrointestinal tract
Peptic ulcer - A sore in the lining of the esophagus, stomach, or duodenum,
usually caused by most commonly by the bacterium Helicobacter pylori (H.
pylori) or use of NSAID medications.
Perineum - The area of the body between the anus and the vulva in females,
and between the anus and the scrotum in males.
Prokinetic - Drugs that enhance propulsion of contents through the gut
Proton pump inhibitor (PPI) - The strongest class of drugs for inhibiting acid
secretion in the stomach
Scintigraphy - An imaging method in which a mild dose of a radioactive
substance is swallowed to show how material moves through the GI tract.
Sigmoid colon - The S-shaped section of the colon that connects to the
rectum.
Sigmoidoscopy - Examination of the inside of the sigmoid colon and rectum
using an endoscope -- a thin, lighted tube (sigmoidoscope).
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Ulcerative colitis - A form of inflammatory bowel disease that causes ulcers

and inflammation in the inner lining of the colon and rectum.
Villi - Tiny finger-like projections on the surface of the small intestine that help
absorb nutrients.
Visceral hypersensitivity - Enhanced perception, or over-responsiveness
within the gut -- even to normal events.

Module 5 - Assignment
Welcome to your Module 5 Assignment.
Please note that all your work for this assignment should be saved in one document and it
should follow the following title requirements:
Medical Secretary_ Module 5_Your Name
PART 1:
For this assignment you are required to research all the common side effects of all the
Commonly prescribed drugs described in this module, using the Module 2 Assignment
document uploaded in your reference materials.
PART 2:
An assignment based on a hospital. 4 hospital departments to be named. An outline of the
work of any 2 departments to be given. Name and explain briefly, tests carried out in
these departments.
Investigate and report on the role of the medical secretary in one department. Assignment
should show evidence of research and should be supported by visual aids where
appropriate.

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Please read below before submitting your assignment:

1. You must ensure that you have COMPLETED the assignment and all the requirements before
submitting your work.
2. In order to successfully complete your module you are required to achieve a minimum pass
mark of 75%.
3. By submitting your assignment you indicate that you have understood the following statements:
This assignment is my own original work, except where I have appropriately cited the original
source ( References for text or images used )
This assignment has not previously been submitted for assessment in this or any other subject.
If it is deemed that my assignment includes unoriginal work that is not referenced, my assignment
will be failed with no option to resubmit.

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