ANATOMY AND PHYSIOLOGY OF THE GI TRACT AND GI DISEASES

[Lux]

The gastrointestinal tract or digestive tract, (to call) ______________also the GI tract or the alimentary canal [ke’nael] or the gut. The gastrointestinal tract (to be) _______ the system of organs. It (to take) _________ in food. It (to digest ) ______________ it to extract energy and nutrients, and (to expel) _________ the remaining waste.
In a normal human adult male, the GI tract (to be) _____ approximately 7 and a half metres long (25 feet). It (to consist) _______________ of the following components: the upper gastrointestinal tract and the lower gastrointestinal tract.

The upper gastrointestinal tract (to include)
•   The mouth (the cavity; the salivary glands, mucosa, the teeth and the tongue)
•   The pharynx
•   The esophagus
•   The stomach

The mouth, or the oral cavity, (to be) _____ the opening through which a human (to take) __________ in food and water. It (to locate) __________________ in the head.
The human mouth (to cover) ________________ by an upper and lower lip. They (to play) ___________ an important role in speech, facial expression, kissing, drinking (especially with a straw), and smoking. According to etiquette [‘etiket] the mouth (to keep) _____________ closed, especially when chewing.

The stomach (to be) _____ a bean-shaped hollow muscular organ of the gastrointestinal tract.It (to  involve) ____________________ in the second phase of digestion. The stomach (to be) ____ usually a highly acidic environment. Such an environment (to break) _________ down large molecules (such as from food) to smaller ones so that they can eventually (to absorb) __________________ from the small intestine. The stomach can (to produce) __________  and (to secrete) _____________ about 2 to 3 liters of gastric acid per day. Other functions (to include) ____________ absorbing water, some ions, and some lipid soluble compounds such as alcohol, aspirin, and caffeine.

The lower gastrointestinal tract (to consist) ____________ of the small intestine and the large intestine.
•   The bowel or the intestine:
o   The small intestine, which has three parts:
   duodenum
   jejunum
   ileum
o   large intestine, which has three parts:
   caecum (the vermiform appendix (to attach) _____________ to the caecum).
   colon (ascending colon, transverse colon, descending colon and sigmoid flexure)
   rectum
•   anus
The liver (to secrete) ________ bile into the small intestine via the biliary system, employing the gallbladder as a reservoir. The pancreas (to secrete) ____________  fluid containing bicarbonate [bai’ka:bonit] and several enzymes. Both these secretory organs (to aid) _____________ in digestion.

Gastritis (to be) ____ inflammation of the gastric mucosa.
The following (to be) ____ known causes of gastritis:
Bacterial infection (most often by Helicobacter pylori and other Helicobacter bacteria)
Fungal infection (most often in people with AIDS)
Parasitic infection (most often from poorly cooked seafood)
Viral infection
Bile reflux
NSAIDs
Cigarette smoke
Autoimmune disorders
Excessive alcohol consumption
Certain allergens
Certain types of radiation
The following symptoms can (to be) ____ a result of gastritis or can (to relate) _______________to the underlying cause:
Upper abdominal pain or discomfort
Gastric hemorrhage
Appetite loss
Belching
Nausea
Vomiting
Fever
Fatigue

Diagnosis. A doctor may (to order) _________ a gastroscopy or, less frequently, a barium meal to investigate suspected gastritis and related conditions such as peptic ulcer disease and gastric cancer. The appearances at endoscopy, with or without histological examination of biopsy specimens, can (to use) ___________ to determine the cause of the gastritis. However, a relevant patient history (to be) _____ also very important, particularly with regard to smoking, alcohol intake and medication use. In most cases, a biopsy from the gastric antrum (to take) ______________ to detect the presence of Helicobacter pylori. Alternatively, a non-invasive method to detect Helicobacter such as a urea breath test or stool antigen test may (to consider) ____________________, particularly in younger patients and those without more worrying symptoms such as weight loss or bleeding.

Treatment usually (to consist) _____________ of removing the irritant or the infection. In the case of Helicobacter infection, a doctor may (to prescribe) ______________ antibiotics.

Peptic ulcer (to be) ______ usually a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). About 4 % of gastric ulcers (to cause) __________ by malignant tumour. Duodenal ulcers (to be) _______ non-malignant. Most instances (to know) _______________ to be associated with Helicobacter pylori. It (to be) ________ a spiral-shaped bacterium. It (to live) ___________ in the acid environment of the stomach. These ulcers can also (to cause) ___________________ or (to worsen) ______________ by drugs such as Aspirin and other NSAIDs.
Symptoms of a peptic ulcer can (to be) ________:
•   Abdominal pain;
•   Vomiting blood;
•   Tarry stool;
•   Weight loss;
•   Rarely, an ulcer can (to lead) _____________ to a gastric or duodenal perforation. This (to be) _________ extremely painful and (to require) ___________ immediate surgery.
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can (to raise) ________________ the suspicion for peptic ulcer. Medicines associated with peptic ulcer (to be)  _________ NSAID (non-steroid anti-inflammatory drugs).
The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal
The diagnosis of Helicobacter pylori can (to be) _____ by:
•   Biopsy;
•   Breath testing;
•   Direct culture from a biopsy specimen;
•   Measurement of antibody levels in blood.
A major causative factor (90% of gastric and 75% of duodenal ulcers) (to be) ______ chronic inflammation due to Helicobacter pylori.
Another major cause (to be) ______ the use of NSAIDs.
Stress in the psychological sense (not to influence) _________________ the development of peptic ulcers. Burns and head trauma, however, can (to lead) ___________ to "stress ulcers".
Smoking (to lead) ___________ to atherosclerosis and vascular spasms. It (to cause) ___________ vascular insufficiency and (to promote) _________________the development of ulcers through ischemia.
A family history (to be) ________ often present in duodenal ulcers, especially when blood group O (to be) ______ also present. Inheritance (to appear) ____________ to be unimportant in gastric ulcers.
When H. pylori infection (to be) ______ present, the most effective treatments (to be) ________ antibiotics.

Appendicitis (to be) ______ a condition characterized by inflammation of the appendix. Most (to require) ____________ removal of the inflamed appendix, either by laparotomy or laparoscopy. If untreated, mortality (to be) ____ high, mainly due to peritonitis and shock.
The causes of appendicitis (to be) _______ generally unknown. The leading theory (to be) _____ that obstruction of the appendix (to be)  _______ the risk factor. Viral infections, which can (to cause) _________ ulceration of the lining, can also (to lead) _________ to obstruction of the appendix
Appendicitis can (to classify)  __________________ into two types, typical and atypical. There (to be) ____ typically pain and tenderness in the right iliac fossa in both typical and atypical appendicitis.
Diagnosis (to base) _______________ on history and physical examination. Diagnosis (to back) ___________________ by blood tests and imaging.
The classical physical finding in appendicitis (to be) __________ diffuse pain in the umbilical [, mbi’laikel] region. This point (to locate) ________________ on the right-hand side of the abdomen.
Other physical findings (to include) ______________  right-side tenderness on a digital rectal exam.
Ultrasonography and Doppler sonography also (to provide) _____________ useful means to detect appendicitis, especially in children.
In places where it (to be) ______ readily available, CT scan (to become) ___________ the diagnostic test of choice, especially in adults. A properly performed CT scan with modern equipment (to have) ___________ a detection rate (sensitivity) of over 95%.
Appendicitis can (to treat) ______________ by removal of the appendix through a surgical procedure. This procedure (to call) __________________ an appendectomy. Traditionally, appendectomy (to involve) __________ an open laparotomy incision.
Often now the operation can (to perform) ____________________ via a laparoscopic approach, or via small incisions with a camera to visualize the area of interest in the abdomen. Antibiotics (to give) ______________ often intravenously to help kill remaining bacteria and thus reduce the inflammation.
Most appendicitis patients (to recover) _________________ easily with treatment, but complications can (to occur) _______________ if treatment (to delay) ________________ or if peritonitis (to occur) __________.
Recovery time (to depend) _________________  on age, condition, complications, and other circumstances but usually (to be) _______ between 10 and 28 days.

Gastroenteritis (to be) ________ an inflammation of the gastrointestinal tract. It (to be) _______ an illness of fever, diarrhea and vomiting. Gastroenteritis (to cause) _______________ by an infectious virus, bacterium or parasite [‘paeresait]. It usually (to be) __________ of acute onset, normally lasting less than 10 days and self-limiting. It (to call) ________________ often the stomach flu or gastric flu even though it (not to relate ) ____________ to influenza.
The most common viral causes of acute gastroenteritis (AGE) in children <5 years of age in both developed countries as well as developing countries (to be) ________ rotavirus group A (up to 50% of the cases), noroviruses (the most common cause of outbreaks of AGE in all age groups), adenoviruses type 40 and 41, astrovirus, and sapovirus. Bacterial causes (to be) ________  less common in developed countries.
Parasites can (to cause) ______________ dehydrating diarrhoea in infants.
The main symptoms (to include) ___________ poor feeding in infants, vomiting and fever, usually rapidly followed by diarrhoea. Viral diarrhoea usually (to cause) _____________ frequent watery stools.
The main treatment of diarrhoeal illness in both children and adults is rehydration. This can (to do) _______orally with commercial or home-made rehydration fluids, or through intravenous delivery.
Loperamide (to use) ______________ for treatment of diarrhoea.
Loperamide (not to recommend) ______________________ in children, especially in children younger than 2 years of age, as it may (to cause) _________________ toxicity.
Antibiotics (to be) ________ of little or no use.
Dehydration (to be) _______ the most concerning complication of the diarrhoea caused by gastroenteritis.
Febrile convulsions (to be) ______ not uncommon in children.
Sugar malabsorption (to be) ______ the most common complication, especially in infants.

Stomach cancer (also called gastric cancer) can (to develop) __________________ in any part of the stomach. Gastric cancer may (to spread) _________ throughout the stomach and to other organs. The cancer may (to grow) _____________ along the stomach wall into the esophagus or small intestine. It also may (to extend) ______________ through the stomach wall. It may (to spread) ____________  to nearby lymph nodes and to organs such as the liver, pancreas, and colon. Stomach cancer also may (to spread) ______________ to distant organs, such as the lungs, the lymph nodes above the collar bone, and the ovaries. Stomach cancer (to be) ________ more prevalent in China, Japan, Korea, and other countries in Asia and South America, than in the United States. Infection with H. pylori (to be) ______ the main risk factor in about 80% or more of gastric cancers.
Stomach cancer can (to be) ______ hard to find early. Often there (to be) ________ no symptoms in the early stages. Stomach cancer can (to cause) __________ the following:
•   Indigestion or a burning sensation (heartburn)
•   Discomfort or abdominal pain
•   Nausea and vomiting
•   Diarrhea or constipation
•   Bloating of the stomach after meals
•   Loss of appetite
•   Weight loss
•   Weakness and fatigue
•   Bleeding (vomiting blood or having blood in the stool)
To find the cause of symptoms, the doctor (to ask) ____________ about the patient's medical history, (to do) _________  a physical exam, and may (to order) __________ laboratory studies. The patient may also (to have) __________ one or all of the following exams:
•   Fecal occult blood test
•   Upper GI series
•   Gastroscopic exam
A biopsy, with subsequent histological analysis, (to be) _______ the only sure way to confirm the presence of cancer cells. Because stomach cancer can (to spread) ________ to the liver, the pancreas, and other organs near the stomach as well as to the lungs, the doctor may (to order) _________ a CT scan, an ultrasound exam, or other tests to check these areas. Treatment (to depend) ____________ on the size, location, and extent of the tumor, the stage of the disease, the patient's general health and other factors. Treatment for stomach cancer may (to include) ___________ surgery, chemotherapy, and/or radiation therapy. A patient may (to have) __________ one form of treatment or a combination of treatments. Surgery (to be) _______ the most common treatment for stomach cancer. The operation (to call) _______________ gastrectomy. The surgeon (to remove) _____________ part (subtotal or partial gastrectomy) or all (total gastrectomy) of the stomach, as well as some of the tissue around the stomach. Gastrectomy (to be) major surgery. For the first few days after surgery, the patient (to feed) ____________ intravenously (through a vein). Endoscopic resection (to be) _______ a treatment for early gastric cancer. It (to pioneer) ____________________________ in Japan. It (to be) _______ available in the United States at some centers. Some gastrectomy patients (to have) _____________ cramps, nausea, diarrhea, and dizziness shortly after eating because food and liquid (to enter) ____________ the small intestine too quickly. Chemotherapy (to be) _______ the use of drugs to kill cancer cells. Most anticancer drugs (to give) _______________ by injection; some (to take) _______________ by mouth. The doctor may (to use) ___________ one drug or a combination of drugs. Chemotherapy (to give) _____________ in cycles. The side effects of chemotherapy (to include) _______________ more frequent infections. Patients  may (to bruise or to bleed) ______________________ easily, and may (to have) ______________ less energy. Patients may (to have) ___________ side effects such as loss of appetite, nausea, vomiting, hair loss, or mouth sores.Radiation therapy (also called radiotherapy) (to be) _______ the use of high-energy rays to damage cancer cells and stop them from growing. Radiation therapy (to give) _______________ sometimes  after surgery to destroy cancer cells that may (to remain) _________________ in the area.


The liver (to be) ____ an organ in humans. It (to play) _______ a major role in metabolism and (to have) _____ a number of functions in the body. The main functions of the liver (to include) ______ first, drug detoxification, second, glycogen storage, third, plasma protein synthesis, and fourth, bile production. The adult human liver normally (to weigh) _______ between 1.0 and 2.5 kilograms. The abnormal liver may (to weigh) ____________ 16 kilograms and even 20 kilograms. The liver (to be) _____ a soft, pinkish-brown "boomerang shaped" organ. The liver (to be) _____ the second largest organ. The largest organ (to be) _____ the skin. The liver (to locate) _________________ under the diaphragm on the right side of the upper abdomen. The liver (to lie) __________ on the right of the stomach. The liver (to make) __________ a kind of bed for the gallbladder. The gallbladder (to store) _______ bile. The liver (to supply) __________________ by two major blood vessels on its right lobe. These two vessels (to be) ______ the hepatic artery and the portal vein. The liver (to be) _____ capable of natural regeneration of lost tissue. 25% of remaining liver can (to regenerate) _____________ into a whole liver again.
The liver (to cover) ____________ by visceral peritoneum [,perite’niem]. The peritoneum (to be) ______ a thin, double-layered membrane. It (to reduce) _________ friction against other organs. The liver (to divide) _________ into four lobes.

The various functions of the liver (to carry) _______________out by the liver cells or hepatocytes.
•   The liver (to produce) ___________ and (to excrete) ____________ bile. Bile (to require) ________________for food digestion. Some of the bile (to drain) ___________ directly into the duodenum, and some (to store) ___________ in the gallbladder.
o   The liver (to perform) _____________ several roles in carbohydrate metabolism
•   The liver also (to perform) __________ several roles in lipid metabolism:
•   The liver (to produce) ________________ coagulation factors.
•   The liver (to break) ______________ down hemoglobin, toxic substances and most medicinal products.
•   The liver (to convert) ______________ ammonia to urea.
•   The liver (to store) _____________ a multitude of substances, including glucose in the form of glycogen, vitamin B12, iron, and copper.
Many diseases of the liver (to accompany) _______________ by jaundice.
•   Hepatitis (to be) _______ inflammation of the liver. Hepatitis (to cause) ________mainly by various viruses. Hepatitis may also (to result) ___________ from some poisons, autoimmunity or hereditary conditions.
•   Cirrhosis (to be) ______ the formation of fibrous tissue in the liver, replacing dead liver cells. The death of the liver cells can for example (to cause) ___________ by viral hepatitis, alcoholism or contact with other liver-toxic chemicals
•   Hemochromatosis (to be) ______ a hereditary disease. This disease (to cause) _____________  the accumulation of iron in the body. Hemochromatosis eventually (to lead) ____________ to liver damage.
•   Cancer of the liver (to be) _________ a malignant disease.

Hepatitis (to be) ____ inflammation of the liver. The clinical signs, prognosis, and treatment (to depend) ______________ on the cause.

Symptoms (to include) ________________ malaise, joint aches, abdominal pain, vomiting 2-3 times per day for the first 5 days, defecation, loss of appetite, dark urine, fever, hepatomegaly (enlarged liver) and jaundice (yellowing of the eyes and skin). Some chronic forms of hepatitis (to show) _________ very few of these signs and (to be) _____ only present when the longstanding inflammation (to lead) _______________________________ to the replacement of liver cells by connective tissue; this disease process (to refer) ________________to as cirrhosis of the liver. Certain liver function tests can also indicate hepatitis.

Most cases of acute hepatitis (to be) ______ due to viral infections:
•   Hepatitis A
•   Hepatitis B
•   Hepatitis C
•   Hepatitis B with D
•   Hepatitis E
•   Hepatitis F
•   Hepatitis G
•   In addition to the hepatitis viruses (please note that the hepatitis viruses are not all related) other viruses can also (to cause) _______________ hepatitis, including cytomegalovirus, Epstein-Barr virus, yellow fever, etc.
Hepatitis A or infectious jaundice (to cause) ____________________by a picornavirus. It (to transmit) ___________________ by the orofecal route. It (to transmit) _________________________ to humans through methods such as contaminated food. It (to cause) ______________ an acute form of hepatitis and (not to have) ____________________ a chronic stage. The patient's immune system (to make) ____________ antibodies against hepatitis A that (to confer) ___________________ immunity against future infection. People with hepatitis A (to  advise) _________________________ to rest, stay hydrated and avoid alcohol. A vaccine (to be) ____ available that (to prevent) ______________ infection from hepatitis A for life. Hepatitis A can (to spread) _____________through personal contact, consumption of raw sea food or drinking contaminated water. This (to occur) ____________ primarily in third world countries. Strict personal hygiene and the avoidance of raw and unpeeled foods can (to help) ___________ prevent an infection. Infected persons already (to begin) _____________ excreting the hepatitis A virus with their stool two weeks after the appearance of the first symptoms. The time between the infection and the start of the illness can (to run) ________________ from 15 to 45 days, and approximately 15% of sufferers may (to experience) ____________ relapsing symptoms from six months to a year following initial diagnosis.

Hepatitis B (to cause) ________________ by a hepadnavirus, which can (to cause) _____________ both acute and chronic hepatitis. Identified methods of transmission (to include) _____________ blood (blood transfusion, now rare), tattoos (both amateur and professionally done), sexually (through sexual intercourse or through contact with blood or bodily fluids), or in utero (from mother to her unborn child, as the virus can (to cross) ________________ the placenta). However, in about half of cases the source of infection can (not determine) _____________________________. Blood contact can (to occur) _____________ by sharing syringes in intravenous drug use, shaving accessories such as razor blades, or touching wounds on infected persons. Needle-exchange programs (to create) _________________________________ in many countries as a form of prevention. Hepatitis B infections (to result) ____________________ in 500,000 to 1,200,000 deaths per year worldwide due to the complications of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis B (to be) _____ endemic in a number of (mainly South-East Asian) countries, making cirrhosis and hepatocellular carcinoma big killers. There (to be) ______ three FDA-approved treatment options available for persons with a chronic hepatitis B infection: alpha-interferon, adefovir and lamivudine. About 45% of persons on treatment (to achieve) _____________ a sustained response.

Hepatitis C (originally "non-A non-B hepatitis") can (to transmit) __________________ through contact with blood (including through sexual contact where the two parties' blood (to mix) ______________. Hepatitis C may (to lead) ______________ to a chronic form of hepatitis, culminating in cirrhosis. It can (to remain) _________________ asymptomatic for 10-20 years. No vaccine (to be) ______ available for hepatitis C. Patients with hepatitis C (to be) _____ prone to severe hepatitis if they (to contract) ____________ either hepatitis A or B, so all hepatitis C patients should (to immunize) ____________________ against hepatitis A and hepatitis B if they (not to be) _________ already immune. However, hepatitis C itself (to be) _____ a very lethal virus, and it can (to result) _______________ in death; 10 percent of hepatitis C diagnosed patients (to die) _____________. The virus can (to cause) _________________ cirrhosis of the liver. The virus, if detected early on, can (to treat) __________________ by a combination of interferon and the antiviral drug ribavirin.
Hepatitis E produces symptoms similar to hepatitis A, although it can take a fulminant course in some patients, particularly pregnant women; it is more prevalent in the Indian subcontinent.

Alcoholic Hepatitis
Ethanol, mostly in alcoholic beverages, (to be) ______ an important cause of hepatitis. Usually alcoholic hepatitis (to come) ________________ after a period of increased alcohol consumption. Alcoholic hepatitis (to characterize) _________________________________by a variable symptoms, which may (to include) _______________ feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can (to vary) _______________ from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases (to characterize) __________________ by either dulled consciousness or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories (to be) ______50% within 30 days of onset.
Alcoholic hepatitis (to be) _____ distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can (to occur) ________________ in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself (not to lead) ____________________ to cirrhosis, but cirrhosis (to be) _______ more common in patients with long term alcohol consumption. Patients who (to drink) _________ alcohol to excess (to find) ______ also more often than others _____________ to have hepatitis C. The combination of hepatitis C and alcohol consumption (to accelerate) ________________________ the development of cirrhosis in Western countries.