Transcript Module 7 - GI Health

460 ~ 4 April 2006
• Still no handout / notes from: Saw
Palmetto: McDonagh to Persico ?
• Module VII – Integrative
Approaches re Common Health
Issues:
~ GI system today
~ chronic fatigue &
oncology next day
Tomorrow …
• … Wednesday of this week, at two
minutes and three seconds after
1:00 in the morning, the time and
date will be 01:02:03 04/05/06
That won't ever happen again
You are what you eat, Or,
You are what you ingest, And
. . . what you can’t ingest ?
Bodily
Systems
GI Groups
1. Abu-Romeh to
6. Jagielnik to
Blanchette
Korczynski
2. Blommers to Connor
7. Kusmider to Mazur
3. Crowther to Eastwood 8. McDonagh to Persico
4. Fabian to Geddis
9. Pone to Sklazeski
5. Girvan to Hudders
10. Snider to Zettler
Groups 1 – 3 What is the GI system, how does it work ?
Groups 4 – 6 How do we care for it & what goes wrong ?
Groups 7 – 10 What are possible CAM
preventions/therapies ?
GI Components
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Esophagus
Stomach
Duodenum
Small bowel
Colon
Liver and biliary system
Spleen
Pancreas
GI - Other
Functions of GI System
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Broadly: ingest, digest, absorb food
Immune surveillance & response
Detoxification
Neuro-endocrine regulation
gland
Esophagus
Stomach
Small Intestine
Large Intestine
Digestive function support by
• Mastication
• Peristalsis
• Enzymes & secretions that facilitate
enzymes’ functions
Absorptive function facilitated by
– Immense surface area of
small intestine (villi and
microvilli)
– Active transport and
diffusion (transmucosal,
energy-driven processes)
along entire lengths of small
and large intestines
•diseases
•radiological findings,
•differential-diagnosis
lists
•pertinent anatomy,
pathology, and
physiology
Esophageal Issues
“every centimeter
of GI tract is
colonized by
bacteria…every
meal bathes this
surface with
antigens, organisms,
& active substances
derived from food &
drink” [text]
The GI’s Strategy of Digestion
Sudbury’s Science North
GI Slide:
• Kids can slide and
crawl through a
giant 3D model of
the digestive
system from
mouth to large
intestine. This
exhibit is 8’ high
and over 30’ long
A brief travel
thru main
components of
GI tract . . .
The
Oesophagus
The Stomach
The Stomach
Histology
The Small Intestine
• Duodenum
• Jejunum
• Ileum
The Small
Intestine ~
The Jejunum
The Pancreas
• structurally, the pancreas has four sections; head, neck,
body and tail; the tail stretches back to just in front of the
spleen.
• The pancreas consists mainly of exocrine glands that
secrete enzymes to aid in the digestion of food in the small
intestine. the main enzymes produced are lipases,
peptidases and amylases for fats, proteins and
carbohydrates respectively. These are released into the
duodenum via the duodenal ampulla, the same place that
bile from the liver drains into
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Pancreatic exocrine secretion is hormonally regulated, and
the same hormone that encourages secretion
(cholesystokinin) also encourages discharge of the gall
bladder's store of bile
• As bile is essentially an emulsifying agent, it makes fats
water soluble and gives the pancreatic enzymes lots of
surface area to work on
The Large
Intestine
What goes wrong ?
• Cancers of GI tract [ some 21% of all cancers
are GI ones ]
• Eating too much
• Drinking too much
• Diarrhea
• Anorexia, nausea, vomiting, pain
• Acid reflux
• Gas, bloating, flatulence, heartburn
• Irritable bowel syndrome
• Dyspepsia
• Ulcers
• GI toxicity from NSAIDs
• Hemorrhoids
Medline Plus is a
terrific allopathic
source of GI
issues & treatments
Allopathy and your
gastroenterologist ?
Gastroenterology:
• The branch of medicine dealing with
the study of disorders affecting the
stomach, intestines, and associated
organs
Gastroenterology – complex
field of medicine:
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CPT Codes
ICD-9 Codes
HCPCS Supply Codes
Modifiers
RBRVS Values
CCI Edits
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Medicare Guidelines
Documentation Requirements
National Coverage Decisions
Local Medicare Review
Policies
Anatomy & Terminology
Reference
Evaluation & Management
Guidelines
Learn proven tips for correctly coding and billing dozens of Gastroenterology
procedures and services including:
Diagnostic Sigmoidoscopy
Therapeutic Colonoscopy
Diagnostic & Therapeutic Esophagogastroduodenoscopy (EGD)
Endoscopic Examination--Upper Gastrointestinal Tract
Modified Barium Swallow Studies
Telemetric Gastrointestinal Capsule Imaging
Gastric Bypass Surgery for Morbid Obesity
Complex area is this system –
consider allopathic text re drugs
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Pharmacology in Nursing Practice · Introduction · Drugs Affecting the
Immune System · Antivirals and Antifungals · Biologic Response Modifiers
and Immunosuppressants · Antineoplastics · Drugs Affecting the Nervous
System · Sympathetic Nervous System Agents · Parasympathetic Nervous
System and Antiparkinsonism Agents · Central Nervous System Stimulants
and Skeletal Muscle Relaxants · Anticonvulsants · Anesthetics · Anxiolytics,
Antidepressants, Mood Stabilizers, and Antipsychotics · Drugs Affecting the
Hematologic System · Agents Affecting Coagulation, Bleeding and Blood
Formation · Drugs Affecting Blood Pressure and Blood Flow ·
Antihypertensives · Antilipidemics · Drugs Affecting the Cardiac System
Agents Affecting Cardiac Output · Antiarrhythmics · Drugs Affecting the
Respiratory System · Agents Affecting Upper Respiratory Disorders ·
Antihistamines · Antiasthmatics and Bronchodilators · Drugs Affecting the
Endocrine System · Thyroid, Parathyroid Agents · Anterior Pituatory
Hormones, Glucocorticoids, Mineralcorticoids, and Adrenal Hormone
Inhibitors · Antidiabetics · Drugs Affecting the Gastrointestinal System ·
Agents Affecting Hyperacidity, Gastric Mucosa, Motility and Flatulance ·
Antiemetics, Emetics and Agents Used for Digestive Problems · Laxatives and
Antidiarrheals · Drugs Affecting the Genitourinary Tract and Renal Disorders
· Agents Used in Urinary Tract Alterations and to Improve Renal Output ·
Agents used in Renal Failure · Drugs Affecting the Reproductive System ·
Male and Female Hormones · Agents Affecting Uterine Motility, Fertility, and
Infertility · Drugs Affecting the Musculoskeletal System · Anti-Inflammatory
Agents · Drugs Affecting Nutrition · Agents Used for Nutritional Imbalances ·
Drugs Affecting the Sensory System · Ophthalmics and Otics · Dermatologics
· Analgesics for Pain Relief
Aspirin
• BMJ 2000;321:1170-1171 ( 11 November
2001 ):
• Aspirin, like all other drugs, is a poison:
“We do not know who should be given
what dose and for how long”
• Long term use has resulted in severe GI
hemorrhaging
• Enteric or coated aspirin
Solutions from Sci North
Burp Man
• A larger than life cartoon
character drinks from a
three-foot pop can pumped
by visitor
• The stomach pressure
increases until the
character releases a giant
burp, while a second
interactive exhibit shows
how the sphincter works
Solutions from Sci North
Gas Attack!
• Everyone loves to play
pinball
• Two custom pinball games
are positioned in front of
an animated pig sitting
atop a pile of poop
• The games are customized
to teach children which
foods create more gas in
their bodies
• The animated pig says
funny quips at the start
and end of each game
Text & Integrative Approaches to
GI System
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Complex terminology?
Know concepts, not host of medical terms
Concept of dysbiosis or dys-symbiosis
Dysbiosis is re indigenous “flora” of the
gut start to promote illness [ NOT infection
]
• Discusses regulation of GI flora by diet,
motility, secretions like HCl, immunity,
antibiotics, and probiotics
Text & Intestinal Permeability &
Gut Barrier Function
• Nutrient absorption
• How nutritional deficiencies affect
absorption
• Treatment of increased permeability
(hyper-permeability) by removing
the cause [ex: NSAIDs ] then
nourishing the gut
• Problems of fiber supplements
Text and specific GI Disorders
• discusses multi-component, integrative,
evidence-based approaches to:
~ Inflammatory bowel disease
~ Crohn’s disease
~ Ulcerative colitis
~ “functional bowel disorders”
• examines integrative therapies for
Irritable Bowel Syndrome by asking
series of questions
• Finishes by looking at Acid-Peptic
diseases like ulcers and the use of
acupuncture, herbs, dietary regulation
Next Day . . .
• Chronic Fatigue
• Oncology