Digestive Diseases |
After completing this course you will be able to:
Learning Objectives
To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.
1.Basics
v Facts and Fallacies About Digestive Diseases
Ulcers |
Heartburn |
Celiac Disease |
Bowel Regularity |
Constipation |
Irritable Bowel Syndrome |
Diverticulosis |
Inflammatory Bowel Disease |
Cirrhosis |
Ostomy Surgery |
v Digestive Diseases Statistics |
Specific Diseases |
Additional Data |
Glossary |
v Your Digestive System and How It Works |
Why is digestion important? |
How is food digested? |
Movement of Food Through the System |
Production of Digestive Juices |
Absorption and Transport of Nutrients |
How is the digestive process controlled? |
Hormone Regulators |
Nerve Regulators |
v Smoking and Your Digestive System |
Harmful Effects |
Heartburn |
Peptic Ulcer |
Liver Disease |
Crohn’s Disease |
Gallstones |
Can the damage be reversed? |
For more information |
2. Foodborne Illness |
v Bacteria and Foodborne Illness |
Causes |
Symptoms |
Risk Factors |
Complications |
Diagnosis |
Treatment |
Prevention |
Food Irradiation |
Links to Other Disorders |
Common Sources of Foodborne Illness |
Points to Remember |
v Viral Gastroenteritis |
Symptoms |
Causes |
Transmission |
Diagnosis |
Treatment |
Prevention |
Points to Remember |
3. Common Digestive Problems |
v Indigestion |
v What I Need to Know About Constipation |
Disease Definition |
Clinical Presentation and Natural History |
What is constipation? |
What can I do about constipation? |
Points to Remember |
v Constipation in Children |
v Lactose Intolerance |
What is lactose intolerance? |
How is lactose intolerance diagnosed? |
How is lactose intolerance treated? |
How is nutrition balanced? |
What is hidden lactose? |
Summary |
v Gas in the Digestive Tract |
What causes gas? |
Swallowed Air |
Breakdown of Undigested Foods |
Which foods cause gas? |
What are some symptoms and problems of gas? |
Belching |
Flatulence |
Abdominal Bloating |
Abdominal Pain and Discomfort |
What diagnostic tests are used? |
How is gas treated? |
Diet |
Nonprescription Medicines |
Prescription Medicines |
Reducing Swallowed Air |
Conclusion |
Points to Remember |
v Bleeding in the Digestive Tract |
What causes bleeding in the digestive tract? |
What are the common causes of bleeding in the digestive tract? |
Esophagus |
Stomach |
Small Intestine |
Large Intestine and Rectum |
How is bleeding in the digestive tract recognized? |
How is bleeding in the digestive tract diagnosed? |
Endoscopy |
Other Procedures |
How is bleeding in the digestive tract treated? |
How do you recognize blood in the stool and vomit? |
What are the symptoms of acute bleeding? |
What are the symptoms of chronic bleeding? |
For more information |
v Fecal Incontinence |
Causes |
Constipation |
Muscle Damage |
Nerve Damage |
Loss of Storage Capacity |
Diarrhea |
Pelvic Floor Dysfunction |
Diagnosis |
Treatment |
Dietary Changes |
Medication |
Bowel Training |
Surgery |
What to do about anal discomfort |
Emotional Considerations |
Everyday Practical Tips |
Fecal Incontinence in Children |
Why children get constipated |
Hope Through Research |
For more information |
v Infectious Diarrheas |
Summary |
Definition and Diagnosis |
Risk Factors and High-Risk Groups |
Child Day-Care Centers |
Bacterial Diarrheas |
Salmonellosis |
Shigellosis |
E. Coli 0157:h7–Hemorrhagic Colitis |
Viral Diarrheas |
4. Miscellaneous Disorders |
v Appendicitis |
Causes |
Symptoms |
People With Special Concerns |
Diagnosis |
Medical History and Physical Examination |
Laboratory Tests |
Imaging Tests |
Treatment |
Surgery |
Antibiotics and Other Treatments |
Complications |
Prevention |
Points to Remember |
v Hemorrhoids |
Clinical Epidemiology of Hemorrhoids |
What are hemorrhoids? |
What are the symptoms of hemorrhoids? |
How common are hemorrhoids? |
How are hemorrhoids diagnosed? |
Diagnosis |
What is the treatment? |
How are hemorrhoids prevented? |
v Gallstones |
Diet and Alcohol |
What are gallstones? |
What causes gallstones? |
Cholesterol Stones |
Pigment Stones |
Other Factors |
Who is at risk for gallstones? |
What are the symptoms? |
How are gallstones diagnosed? |
What is the treatment? |
Surgery |
Nonsurgical Treatment |
Don’t people need their gallbladders? |
Points to Remember |
v Diverticulosis and Diverticulitis |
Summary |
Definitions |
Current Means of Diagnosis |
Natural History |
Prevention |
Diverticulum, diverticulosis, diverticulitis |
What causes diverticular disease? |
What are the symptoms? |
Diverticulosis |
Diverticulitis |
What are the complications? |
Bleeding |
Abscess, Perforation, and Peritonitis |
Fistula |
Intestinal Obstruction |
How does the doctor diagnose diverticular disease? |
What is the treatment for diverticular disease? |
Diverticulosis |
Diverticulitis |
When is surgery necessary? |
Points to Remember |
Additional Readings |
v Wilson’s Disease |
v Gastroparesis and Diabetes |
What is gastroparesis? |
Signs and Symptoms |
Complications of Gastroparesis |
Major Causes of Gastroparesis |
Diagnosis |
Treatment |
Insulin for Blood Glucose Control |
Medication |
Meal and Food Changes |
Feeding Tube |
Parenteral Nutrition |
New Treatments |
Hope Through Research |
Points to Remember |
v Rapid Gastric Emptying |
v Gastritis |
v Proctitis |
v Pancreatitis |
Acute Pancreatitis |
Symptoms |
Diagnosis |
Treatment |
Complications |
Gallstones and Pancreatitis |
Chronic Pancreatitis |
Symptoms |
Diagnosis |
Treatment |
Pancreatitis in Children |
Points To Remember |
Hope Through Research |
v Short Bowel Syndrome |
v Inguinal Hernia |
v Intestinal Adhesions |
Symptoms |
Diagnosis |
Treatment |
Prevention |
v Cyclic Vomiting Syndrome |
The Four Phases of CVS |
Triggers |
CVS and Migraine |
Symptoms |
Diagnosis |
Treatment |
Complications |
Points to Remember |
v Hirschsprung’s Disease |
What is Hirschsprung’s disease? |
Why does HD cause constipation? |
What causes HD? |
If I have more children, will they have HD too? |
What are the symptoms? |
Symptoms in Newborns |
Symptoms in Young Children |
Symptoms in Teenagers and Adults |
How does the doctor find out if HD is the problem? |
Barium Enema X Ray |
Manometry |
Biopsy |
What is the treatment? |
Pull-through Surgery |
Colostomy and Ileostomy |
What will my child’s life be like after surgery? |
Ostomy |
Adjusting After Pull-through |
Diet and Nutrition |
Infection |
Points to Remember |
Acknowledgments |
v Clostridium Difficile Infection |
For more information |
5. Hepatitis |
v Viral Hepatitis: A Through E and Beyond |
Symptoms of Viral Hepatitis |
Hepatitis A |
Hepatitis B |
Hepatitis C |
Hepatitis D |
Hepatitis E |
Other Causes of Viral Hepatitis |
Hope Through Research |
v Autoimmune Hepatitis |
Autoimmune Disease |
Symptoms |
Diagnosis |
Treatment |
Side Effects |
Other Treatments |
Hope Through Research |
Points to Remember |
v What I Need to Know About Hepatitis A |
What is hepatitis A? |
What causes hepatitis A? |
How could I get hepatitis A? |
Who can get hepatitis A? |
What are the symptoms? |
How is hepatitis A treated? |
How can I protect myself? |
v What I Need to Know About Hepatitis B |
What is hepatitis B? |
What causes hepatitis B? |
How could I get hepatitis B? |
What are the symptoms? |
What are the tests for hepatitis B? |
v Vaccinations for Hepatitis A and B |
Candidates for Hepatitis A Vaccination |
Routine Vaccination |
High-Risk Populations |
Postexposure Prophylaxis |
Candidates for Hepatitis B Vaccination |
Routine Vaccination |
High-Risk Populations |
Postexposure Prophylaxis |
Combination Vaccine |
References |
v What I Need to Know About Hepatitis C |
What is hepatitis C? |
What causes hepatitis C? |
How could I get hepatitis C? |
Could I get hepatitis C from a blood transfusion? |
What are the symptoms? |
What are the tests for hepatitis C? |
How is hepatitis C treated? |
How can I protect myself? |
v Chronic Hepatitis C: Current Disease Management |
Introduction |
Risk Factors and Transmission |
Maternal-Infant Transmission |
Sexual Transmission |
Sporadic Transmission |
Unsafe Injection Practices |
Clinical Symptoms and Signs |
Clinical Features of Cirrhosis |
Extrahepatic Manifestations |
Serologic Tests |
Enzyme Immunoassay |
Recombinant Immunoblot Assay |
Direct Assays for HCV RNA |
Quantification of HCV RNA in Serum |
Genotyping and Serotyping of HCV |
Biochemical Indicators of Hepatitis C Virus Infection |
Normal Serum ALT Levels |
Liver Biopsy |
Serum Markers of Hepatic Fibrosis |
Diagnosis |
Acute Hepatitis C |
Chronic Hepatitis C |
Differential Diagnosis |
Treatment |
Who Should Be Treated? |
Who Should Not Be Treated? |
Side Effects of Treatment |
Options for Patients Who Do Not Respond to Treatment |
Hope Through Research |
Basic Research |
Diagnostic Tests |
New Treatments |
Prevention |
Selected Review Articles and References |
v Cirrhosis of the Liver |
Causes |
Symptoms |
Complications of Cirrhosis |
Diagnosis |
Treatment |
v Primary Biliary Cirrhosis |
v Primary Sclerosing Cholangitis |
v Nonalcoholic Steatohepatitis |
Diagnosis |
Symptoms |
Causes |
Treatment |
Hope Through Research |
Points to Remember |
v What I Need to Know About Liver Transplantation |
What does my liver do? |
What are the signs of liver problems? |
What is liver transplantation? |
What are the reasons for needing a liver transplant? |
How will I know whether I need a liver transplant? |
Can anyone with liver problems get a transplant? |
How long does it take to get a new liver? |
Where do the livers for transplants come from? |
Health insurance |
What happens in the hospital? |
During Surgery |
After Surgery |
What is rejection? |
How is rejection prevented? |
Do immunosuppressants have any side effects? |
What are the signs of rejection? |
What are the other problems that can damage the liver transplant? |
What if the transplant doesn’t work? |
How do I take care of my liver after I leave the hospital? |
Can I go back to my daily activities? |
Glossary |
6. Diagnostic Tests |
v ERCP (Endoscopic Retrograde Cholangiopancreatography) |
Preparation |
v Liver Biopsy |
Preparation |
Procedure |
Recovery |
v Colonoscopy |
Preparation |
v Virtual Colonoscopy |
VC Procedure |
Advantages of VC |
Disadvantages of VC |
v Flexible Sigmoidoscopy |
Preparation |
v Lower GI Series |
Preparation |
v Upper GI Series |
Preparation |
v Upper Endoscopy |
Preparation |
7. Gastroesophageal Reflux Disease |
v Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD) |
What are the symptoms of GERD? |
GERD in Children |
What causes GERD? |
How is GERD treated? |
Lifestyle Changes |
Medications |
What if symptoms persist? |
Surgery |
Implant |
What are the long-term complications of GERD? |
Points to Remember |
Hope Through Research |
v Gastroesophageal Reflux in Children and Adolescents |
Symptoms |
Diagnosis |
Treatment |
Points to Remember |
Hope Through Research |
v Gastroesophageal Reflux in Infants |
Symptoms |
Diagnosis |
Treatment |
Specific Instructions for Infants With GER |
Points to Remember |
For more information |
8. Barrett’s Esophagus |
Normal Function of the Esophagus |
GERD |
GERD and Barrett’s Esophagus |
Barrett’s Esophagus and Cancer of the Esophagus |
Diagnosis and Screening |
Treatment |
Surveillance for Dysplasia and Cancer |
Treatment for Dysplasia or Esophageal Adenocarcinoma |
Hope Through Research |
Points to Remember |
For more information |
9. Inflammatory Bowel Diseases |
Summary |
Diagnosis |
v Ulcerative Colitis |
What causes ulcerative colitis? |
What are the symptoms of ulcerative colitis? |
How is ulcerative colitis diagnosed? |
What is the treatment for ulcerative colitis? |
Drug Therapy |
Hospitalization |
Surgery |
Research |
Is colon cancer a concern? |
Hope Through Research |
v Collagenous Colitis and Lymphocytic Colitis |
Symptoms |
Diagnosis |
Treatment |
v Ileostomy, Colostomy, and Ileoanal Reservoir Surgery |
v Crohn’s Disease |
What causes Crohn’s disease? |
What are the symptoms? |
How is Crohn’s disease diagnosed? |
What are the complications of Crohn’s disease? |
What is the treatment for Crohn’s disease? |
Drug Therapy |
Nutrition Supplementation |
Surgery |
Can diet control Crohn’s disease? |
Is pregnancy safe for women with Crohn’s disease? |
Hope Through Research |
For more information |
10. Celiac Disease |
What is celiac disease? |
What are the symptoms? |
How is celiac disease diagnosed? |
Screening |
What is the treatment? |
The Gluten-Free Diet |
What are the complications of celiac disease? |
How common is celiac disease? |
Diseases Linked to Celiac Disease |
Dermatitis Herpetiformis |
Points to Remember |
For more information |
11. Ostomy |
v Key Ostomy Terms |
Types of Ostomies and Continent Procedures |
Types of Pouching Systems |
Types of Accessories |
Psychosocial Issues |
Patient’s Concerns About Surgery |
Body Image/Self-Esteem Concerns |
Self-Care Concerns |
Relationship Concerns |
Phases of Psychological Adaptation |
v Sex and the Male Ostomate |
Making Love |
Ostomy Management |
Psychological Problems Following Surgery |
Sexual Difficulty |
Organic Problems Following Surgery |
Seek Professional Advice |
v Sex and the Female Ostomate |
Making Love |
Potential Problems |
Factors Which Influence Sexual Intimacy |
Talking About Sex |
Seek Professional Advice |
v Sex and the Single Ostomate |
So You Have an Ostomy |
Sharing the News |
Preparing For Sex |
Physical Sexual Limitations |
Additional Concerns |
Seek Professional Advice |
v Frequently Asked Questions |
Who should I tell? What should I say about my surgery? |
Will I be able to continue my daily activities once I recover from surgery? |
What about showering and bathing? Should I bathe with or without my pouch? |
What can I eat? Will I need to change my diet? |
Will I be able to wear the same clothes as before? |
What about sex and intimacy? Will I be able to get pregnant after surgery? |
Is travel possible? |
What about medications? Can I take vitamins? |
Will I always be wearing the same size and type of pouch? |
Got any tips on emptying the pouch? |
How often should I change the pouch? |
What should I do if hospitalized again? |
Where can I purchase supplies? |
Does insurance cover the cost of ostomy supplies? |
When should I seek medical assistance? |
v Ostomy Products |
Suppliers |
Selection Considerations, Problems, and Customized Options |
How to Handle Problems |
Custom-Fitted Pouching Systems |
Major Manufacturers |
Evaluating Suppliers |
Locating a Supplier |
Choosing the Right Supplier |
12. Hemochromatosis |
v Hemochromatosis |
Causes |
Risk Factors |
Symptoms |
Diagnosis |
v Diagnosis–How Do You Find Out |
Treatment and Maintenance |
Chelation |
Maintenance |
Venous Access |
Treatment–Patient Information |
Phlebotomy |
When Tests Indicate You Have Iron Overload |
Where Phlebotomy Treatments Are Done |
Keep Good Records |
The Procedure |
Screening for Hemochromatosis |
v Hemochromatosis and Anemia Diet |
v Objections to Genetic Testing |
Hope Through Research |
13. Peptic Ulcer |
v H. pylori and Peptic Ulcer |
What is a peptic ulcer? |
What is H. pylori? |
How does H. pylori cause a peptic ulcer? |
What are the symptoms of an ulcer? |
Emergency Symptoms |
How is an H. pylori-related ulcer diagnosed? |
Diagnosing an Ulcer |
Diagnosing H. pylori |
How are H. pylori peptic ulcers treated? |
Drugs Used to Treat H. pylori |
Can H. pylori infection be prevented? |
Why don’t all doctors automatically check for H. pylori? |
Points to Remember |
Complications |
Disability and Mortality |
v Environmental Risk Factors |
Smoking |
NSAIDs and Peptic Ulcers |
Alcohol |
Stress |
Social Class and Occupational Energy Expenditure |
14. Cancers of the Digestive System |
v Cancer of the Esophagus |
Introduction |
The Esophagus |
Understanding the Cancer Process |
Risk Factors |
Recognizing Symptoms |
Diagnosing Esophageal Cancer |
Staging the Disease |
Treatment and Prognosis |
Side Effects of Treatment |
Nutrition for Cancer Patients |
The Importance of Follow-up Care |
Providing Emotional Support |
Questions for Your Doctor |
Diagnosis |
Treatment |
Side Effects |
Follow-up |
The Health Care Team |
Resources |
v Stomach Cancer |
Introduction |
The Stomach |
Stomach Cancer |
Symptoms |
Causes of Stomach Cancer |
Diagnosis |
Staging |
Treatment |
Getting a Second Opinion |
Methods of Treatment |
Clinical Trials |
Side Effects of Treatment |
Surgery |
Chemotherapy |
Radiation Therapy |
Biological Therapy |
Nutrition for Cancer Patients |
Support for Cancer Patients |
Vitamins, Anti-Bacterials May Prevent Stomach Cancer |
Other Booklets |
Booklets About Cancer Treatment |
v Cancer of the Colon and Rectum |
Facts and Figures |
New Cases |
Deaths |
Risk Factors |
Early Detection |
Treatment |
Survival |
The Colon and Rectum |
Understanding Cancer |
Colorectal Cancer |
Colorectal Cancer: Who’s at Risk? |
Risk Factors |
Screening |
Are new tests under study for colorectal cancer screening? |
Symptoms |
Diagnosis |
Staging |
Treatment |
Getting a Second Opinion |
Preparing for Treatment |
Methods of Treatment |
Surgery |
Chemotherapy |
Radiation Therapy |
Treatment for Colon Cancer |
Treatment for Rectal Cancer |
Side Effects of Cancer Treatment |
Surgery |
Chemotherapy |
Radiation Therapy |
Nutrition |
Rehabilitation |
Follow-up Care |
Support for People with Colorectal Cancer |
The Promise of Cancer Research |
v Pancreatic Cancer |
Diagnosis |
Selected References |
15. Rare Diseases |
v Whipple’s Disease |
v Zollinger-Ellison Syndrome |
v Porphyria |
v Ménétrier’s Disease |
Symptoms |
Diagnosis |
Treatment |
v Portal Hypertension |
What causes portal hypertension? |
What are the symptoms of portal hypertension? |
How is portal hypertension diagnosed? |
What are the treatment options for portal hypertension? |
First Level of Treatment |
Dietary and Lifestyle Changes |
Second Level of Treatment |
What tests are required before the TIPS and DSRS procedures? |
More About the TIPS Procedure |
Potential Complications of the TIPS Procedure |
More About the DSRS Procedure |
Follow-up Care After the TIPS or DSRS Procedures |
16. Digestive Diseases and Nutrition: Questions and Answers |
Fiber Content of Foods |
I know it’s good to eat a lot of fiber to stay regular, but sometimes I eat too much fiber and have painful gas or even diarrhea. What’s the best way to strike a healthy balance? |
If fiber doesn’t protect against colon cancer, why should I continue to eat foods high in fiber? |
What foods should a person avoid if he or she has heartburn, GERD, or Barrett’s esophagus? |
What are some common foods that may contain gluten? |
My son has just been diagnosed with celiac disease and needs to follow a gluten-free diet. |
How important is nutrition for people with inflammatory bowel disease (IBD)? |
What should I do to maintain proper nutrition? |
I am concerned that my child, who has been diagnosed with inflammatory bowel disease (IBD), is not getting the nutrition he needs. What’s the relationship between IBD and nutrition in children? |
I recently had the pelvic pouch surgery, and diarrhea (up to 15 loose bowel movements |
Should I be taking a vitamin or mineral supplement if I have a gastrointestinal disease? |
I am confused about the diet for diverticulitis . They say more fiber, even fruit with skin, but other information I’ve read states that people with diverticulitis cannot tolerate seeds, skins, raw vegetables, etc. Can you give me direction on exactly what is digestible for people with this condition? Sure hope to get some help, I’m in a panic. |
17. Directory of Digestive Diseases Organizations for Patients |
"This was a great course & I really learned a lot!" - M.G., RN, FL
"Very comprehensive & well explained." - Y.M., RN, CA
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