Breast Cancer and Pregnancy

Diseases of the Digestive Tract

The digestive tract is a twisting tube about 30 feet long. It starts at the mouth and ends at the anus. In between are the esophagus, stomach and bowels (intestines). The liver and pancreas aid digestion by producing bile and pancreatic juices which travel to the intestines. The gallbladder stores bile until the body needs it for digestion.
The digestive system breaks down food and fluids into much smaller nutrients. In this complex process, blood carries the nutrients throughout the body to nourish cells and provide energy. The GI tract is divided into two main sections: the upper GI tract and the lower GI tract.

· Upper GI tract — mouth, pharynx, esophagus and stomach. The stomach leads to the small intestine.

· Lower GI tract — intestines (bowel) and the anus. The bowel is made up of two sections:

o Small intestine — the duodenum, jejunum and ileum

o Large intestine — the cecum (where the appendix is attached), colon and rectum

In addition, the liver, pancreas and gallbladder produce digestive juices to aid the digestion of food.
Medical College of Wisconsin physicians, along with physician assistants, nurses and other specialized team members, provide care for patients with a wide range of complex diseases of the gastrointestinal tract. These diseases include:
General GI disorders
Pancreatobiliary diseases — disorders of the pancreas, gall bladder and bile ducts
Esophagus disease
Bowel disease
Stomach disease
Liver disease
Women's gastrointestinal health

General GI disorders

The following are general disorders of the gastrointestinal tract:
Undiagnosed abdominal pain

· Diarrhea — an increase in the frequency of bowel movements or looseness of stool.

· Constipation — the difficult passage of stools (bowel movements) or the infrequent (less than three times a week) or incomplete passage of stools, usually caused by inadequate fiber in the diet or a disruption of regular ativities or diet.

· Gas (flatulence) — the production of excess stomach or intestinal gas may have many causes, such as an inappropriate diet or various diseases.

· Heartburn — an uncomfortable feeling of burning and warmth occurring in waves rising up behind the breastbone toward the neck. It is usually due to gastroesophageal reflux disease (GERD), the rise of stomach acid back up into the esophagus.

· Fecal (stool) incontinence — the involuntary loss of stool (liquid or solid) sufficient enough to impair a person’s quality of life. Fecal incontinence has many causes and affects people of all ages.

· Hemorrhoids — swollen blood vessels that line the anal opening caused by excess pressure, such as straining during a bowel movement, persistent diarrhea or pregnancy.

Internal hemorrhoids are normal structures that cushion the lower rectum. When internal hemorrhoids fall into the anus (as a result of straining), they can become irritated and bleed.

External hemorrhoids are veins that lie under the skin outside of the anus. These veins can burst and a blood clot can form, causing a painful condition (pile).

· Nausea/vomiting — nausea and vomiting are symptoms of many other disorders such as digestive disease (gallbladder disease, infections, inflammation of the stomach lining, ulcers, cancers, food poisoning or overeating), brain injury, motion sickness, pregnancy, stress and other factors. While vomiting is often harmless, it may be a sign of a more serious illness.

· Motility disorders — motility refers to the contractions of the muscles in the digestive tract that enable food to progress from the mouth to the anus. People who suffer from heartburn, nausea, vomiting, abdominal pain, constipation or diarrhea may have a motility disorder.

· Melena — stool stained black by blood pigment or dark blood products. Bloody stool may indicate an injury or disorder in the digestive tract. The blood, which may come from anywhere in the digestive tract, can be detected visually or with a fecal occult blood test (FOBT).

Pancreatobiliary Diseases

(Disorders of the pancreas, gall bladder and bile ducts)

· Gallbladder disease — the gallbladder is a sac (located near the liver) that stores bile produced in the liver. Conditions that slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease, such as:

o Gallstones (cholelithiasis)

o Inflammation of the gallbladder (cholecystitis)

o Infection

o Obstruction

· Pancreas disease — the pancreas produces and releases insulin and glucagon into the bloodstream to keep blood sugar levels within a normal range. The pancreas also produces enzymes to aid in the digestion of fats, proteins and carbohydrates in the intestine. Disease of the pancreas include:

o Pancreatitis (acute and chronic inflammation of the pancreas)

o Solid tumors (malignant and non-malignant)

o Cystic tumors (may be benign, pre-malignant or malignant)

o Pseudocysts (a fluid collection of pancreatic enzymes)

o Strictures (blockages)

· Bile duct disease — bile ducts carry bile from the liver to the intestine, where it aids in the digestion of food. Bile duct diseases include:

o Stones (choledocholithiasis)

o Strictures (narrowing of a duct that prevents bile from draining)

o Tumors (malignant and non-malignant)

o Cysts

o Cholangitis, an infection of the bile ducts

Esophagus Disease

· Gastroesophageal Reflux Disease (GERD) — occurs when stomach acid backs up into the esophagus, causing a burning sensation (also called acid reflux disease). Symptoms typically occur two or more days a week for at least three months. GERD occurs because the valve separating the esophagus and stomach does not close properly. About 30 million Americans suffer daily from GERD.

People with chronic acid reflux may experience a variety of symptoms including heartburn, regurgitation of food, swallowing difficulties, excessive belching, hoarseness, sore throat, frequent throat clearing, non-cardiac chest pain, chronic cough, sleeping problems, sinusitis or breathing problems such as shortness of breath or wheezing.

The complications of GERD can extend beyond the esophagus. GERD can damage the lining of the esophagus, resulting in a narrowing (stricture) of the esophagus. This can affect the functioning of the esophagus. GERD can also lead to Barrett’s esophagus, a condition that alters the cells in the lining of the esophagus.

· Barrett’s Esophagus — develops in some people who have chronic GERD or inflammation of the esophagus (esophagitis). In Barrett’s esophagus, the normal (squamous) cells that line the esophagus turn into a type of cell called specialized columnar cells. Damage to the lining of the esophagus (by acid reflux) causes these abnormal changes. Once the cells have turned into columnar cells, they will not revert back to normal. Up to 1 percent of people with Barrett’s esophagus develop esophageal cancer.

· Dysphagia — difficulty in swallowing affects about one out of every 17 persons. The causes of dysphagia vary widely, and include:

o Lack of coordination of the esophageal muscular contractions

o Chronic heartburn, where the esophagus is damaged by excessive reflux of acid-containing stomach contents

o Tumors

o Central nervous system disorders such as stroke, multiple sclerosis and Parkinson’s disease

o Scar tissue or narrowing in the esophagus

o Pouches (diverticula) that protrude through the lining of the throat and esophagus

o Radiation or operative injury

o Drug-induced injury

o Infections

· Gastroesophageal motility disorders — weak or uncoordinated muscular contractions of the esophagus, interfering with the movement of food or fluid from the throat to the stomach. One such motility disorder is diffuse esophageal spasm, uncoordinated contractions of the esophagus that affect the movement of food to the stomach. It can cause difficulty swallowing, regurgitation and chest pain.

· Achalasia (“failure to relax”) — a disorder in which the esophagus is less able to move food toward the stomach, and the muscle from the esophagus to the stomach does not relax as much as it needs to during swallowing. As a result, people have difficulty swallowing food.

· Diffuse esophageal spasm — irregular contractions of the muscles in the esophagus; the spasms do not move food effectively to the stomach.

· Eosinophilic esophagitis — an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of eosinophils (white blood cells produced in bone marrow that actively promote inflammation, particularly inflammation caused by allergic reactions). The most common cause of eosinophilic esophagitis is acid reflux.

Disorders of the Bowel

Inflammatory Bowel Disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. Two common forms of IBD are:

· Crohn’s disease, a chronic disorder that causes inflammation of the digestive or gastrointestinal (GI) tract. It most commonly affects the small intestine and/or the colon. The lining of the bowel becomes inflamed and can become ulcerated. Eventually, the bowel may become narrowed or obstructed. Crohn’s often occurs in families. The body’s immune system, which normally protects the body against many different infections, is altered in Crohn’s disease.

· Ulcerative colitis, a chronic inflammatory condition that involves only the colon. It is similar to Crohn’s disease in that it involves an abnormal response by the body’s immune system. Cases that can’t be diagnosed as either ulcerative colitis or Crohn’s disease are called indeterminate colitis.

Other bowel disorders include:

· Diverticulosis/Diverticulitis — as people age, pressure within the colon causes bulging sacs of tissue that push out from the colon walls (one sac is a diverticulum, and more than one are diverticula). These sacs are most common near the end of the colon called the sigmoid colon. The condition of having diverticula in the colon is called diverticulosis, which may have few or no symptoms. If a diverticulum becomes infected and ruptures, it is called diverticulitis.

· Irritable bowel syndrome (IBS) — a disorder involving the movement of the bowel (intestines). In IBS, the nerves and muscles in the bowel are overly sensitive. The disorder is most often identified by its symptoms: abdominal pain or discomfort associated with a change in bowel pattern, such as loose or frequent bowel movements, diarrhea or constipation. IBS is a functional disorder, which means the bowel doesn’t function correctly (vs. a problem with the structure of the bowel).

· Celiac disease — an inherited disorder that causes damage to the small intestine and interferes with the absorption of nutrients. People who have celiac disease cannot tolerate gluten, a protein found in cereal grains such as wheat, rye and barley.

· Nutritional disorders — disorders that results from eating too little or too much food, or from eating too little or too much of a particular nutrient (vitamin or mineral). Nutritional disorders can also develop when the body can’t digest the nutrients it takes in (malabsorption).

Diseases of the Stomach

Diseases and disorders of the stomach include:

· Dyspepsia — a functional disorder of the stomach involving symptoms such as heartburn, nausea, pain or general discomfort (also called an upset stomach or indigestion). The cause is unknown. Symptoms include upper abdominal pain, bloating, a feeling of fullness (with little intake of food), nausea or belching. Symptoms are often provoked by eating. Many people who have dyspepsia may also have irritable bowel syndrome.

· Cyclical vomiting syndrome (CVS) — a condition involving recurrent, prolonged episodes of severe nausea and vomiting with no apparent cause, with normal periods of health in between. See Cyclical Vomiting Syndrome Clinic.

· Gastroparesis (stomach paralysis) — a disorder in which the stomach is unable to contract normally, and cannot move food into the small intestine. This occurs when nerves to the stomach are damaged or stop working. People with autoimmune nervous system dysfunction or diabetes may experience this disorder.

· Gastric outlet obstruction — a disease (e.g., a tumor) that obstructs the channel through which the stomach empties and thus prevents the normal emptying of the stomach.

· Gastritis — inflammation of the lining of the stomach (may be acute or chronic). It can have many causes, including prolonged use of nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin or ibuprofen, H. pylori infection or alcohol abuse. Symptoms include abdominal pain, belching, bloating, nausea, vomiting and a feeling of fullness or burning. Endoscopy is used to view the stomach lining to check for inflammation and possibly remove a tissue sample for testing.

· Hiatus (hiatal) hernia — a protrusion of the upper part of the stomach into the chest through a tear or weakness in the diaphragm

· Lymphoma — MALT (mucosa-associated lymphoid tissue) is a type of lymphoma (cancer that arises from the lymph tissue) found in the stomach. H. pylori bacterium are believed to be involved in causing MALT lymphoma. (H. pylori infection is usually acquired from contaminated food and water and through person to person spread.) Endoscopic ultrasound (EUS), along with other procedures, may be used to view the size and depth of the tumor. Treatment may include the use of antibiotics to wipe out the bacteria or radiation therapy.

· Ulcer — an open sore on the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer). Peptic ulcers occur in areas that come in contact with digestive juices from the stomach. They may be caused or worsened by prolonged use of over-the-counter, nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin or ibuprofen, or by a bacterial infection (H. pylori). (H. pylori infection is usually acquired from contaminated food and water and through person to person spread.)

· Stomach tumors — tumors (benign or malignant) that form in the lining of the stomach. Symptoms may include bleeding, obstruction and weight loss.

· Varicose veins — varicose veins are blood vessels that bulge and twist due to a defect in the valves. Varicose veins may be present in the esophagus or stomach as a result of liver disease or blood clots in the portal vein system. Large varicose veins in the esophagus or stomach can rupture and bleed.

Liver Disease

Many liver diseases and disorders can cause the liver to function improperly or stop functioning.

· Hepatitis B and C — inflammation of the liver caused by the hepatitis B virus or the hepatitis C virus, both blood-borne infections.

· Fatty liver — a buildup of fat in the liver cells, which may be caused by alcohol abuse, obesity, hepatitis C, diabetes or other causes.

· Cirrhosis — an irreversible scarring of the liver that may be caused by many conditions, including viral hepatitis B and C, excessive use of alcohol, non-alcoholic fatty liver disease, bile duct injury, metabolic conditions (e.g., iron and copper overload) and autoimmune inflammatory conditions; complications include bleeding in the intestine or varices (dilated blood vessels in the esophagus or stomach), jaundice (yellowing of the eyes), fluid accumulation in the abdomen (ascites) and accumulation of waste products (leading to mental confusion); patients with cirrhosis are also at increased risk of developing liver cancer

· Cancer from iron overload, viral hepatitis or cirrhosis

· Metabolic diseases — such as hemachromatosis (excess iron in the liver) and Wilson’s disease (a buildup of copper in the liver)

· Autoimmune disease — a disease in which the immune system inappropriately attacks liver cells including bile duct cells; this can result in liver failure, cirrhosis, liver cancer and the need for liver transplantation

· Drug-induced liver disease — drugs that injure the liver and disrupt its normal function; drugs may include prescribed medications, over-the-counter medications, vitamins, hormones, herbs, illicit drugs and environmental toxins

· Alcohol-induced liver disease — damage to the liver caused by excessive alcohol intake

· Disease of the bile ducts of the liver

· Abscesses — single or multiple collections of pus within the liver as a result of infection by bacteria or other agents

· End-stage liver disease — the last phase of progressive liver disease (terminal disease)

Breast Cancer and Pregnancy