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Disturbances of Gastrointestinal Tract-GIT PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Disturbances of GastroIntestinal Tract (GIT)” by Alžbeta Králová Trancíková.

This medical PowerPoint presentation talks about disturbances of the gastrointestinal tract (GIT) which can involve any part of the digestive system, including the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. These disturbances can range from mild and self-limiting to severe and life-threatening.

Some common GIT disturbances include Gastroesophageal reflux disease (GERD), Peptic ulcer disease, Irritable bowel syndrome (IBS), Inflammatory bowel disease (IBD), Gastroenteritis, Gallstones, Diverticulitis, and Colon cancer.

Tags : Disturbances of GastroIntestinal Tract, Gastroesophageal reflux disease, GERD, Peptic ulcer disease, Irritable bowel syndrome, Inflammatory bowel disease, Gastroenteritis, Gallstones, Diverticulitis, Colon cancer, Gastroenterology, Gastroenterology PowerPoint presentation

Published on : Apr 26, 2023 | Views : 833 | Downloads : 3

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Disturbances of GastroIntestinal Tract (GIT) Alžbeta Kráľová Trančíková Department of Pathophysiology alzbeta.trancikova@jfmed.uniba.sk
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THE GASTROINTESTINAL TRACT - function
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THE GASTROINTESTINAL TRACT - function
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CARBOHYDRATE DIGESTION AND ABSORPTION
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PROTEIN DIGESTION AND ABSORPTION
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FAT DIGESTION AND ABSORPTION
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THE GASTROINTESTINAL TRACT - absorption
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THE GASTROINTESTINAL TRACT - structure
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DISORDERS OF THE DIGESTIVE SYSTEM Disorders of the digestive system have serious consequences for the activity of the organism as a whole Digestive system communicates with the external environment through the intake of fluids and food
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THE MOST COMMON DISORDERS of the digestive system
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CLINICAL MANIFESTATIONS of GI dysfunction Vomiting Dyspepsia Constipation Diarrhea Abdominal Pain Gastrointestinal Bleeding
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Clinical manifestations of GI dysfunction - VOMITING is the forceful emptying of stomach and intestinal contents through the mouth the vomiting center lies in the medulla oblongata and includes the reticular formation and tractus solitarius nucleus stimulation of the vomiting center occurs directly by irritants or indirectly. Cause of:
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frequently it is functional (non-ulcer) dyspepsia dyspepsia similar to ulcer symptomatology: pain predominates dyspepsia similar to dysmotility symptomatology: nausea, vomiting, bloating For individual diseases of the upper GI, these symptoms can be combined in various ways Clinical manifestations of GI dysfunction - DYSPEPSIA (malfunction of digestion)
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an increase in the frequency of defecation and the fluid content, volume, and weight of feces. Clinical manifestation - can be acute or chronic systemic effects of prolonged diarrhea – dehydration, electrolyte imbalance (hyponatremia, hypokalemia), metabolic acidosis, and weight loss manifestations of acute bacterial or viral infection - fever, with or without cramping pain, bloody stools Steatorrhea (fat in the stools) and diarrhea are common signs of malabsorption syndrome Clinical manifestations of GI dysfunction - DIARRHEA
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Clinical manifestations of GI dysfunction - DIARRHEA
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Clinical manifestations of GI dysfunction - DIARRHEA
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Osmotic diarrhea (large-volume diarrhea) non-absorbable substance in the intestine draws water into the lumen by osmosis => excess of water and the non-absorbable substance => large-volume diarrhea large oral doses of poorly absorbed ions, such as magnesium, sulfate, and phosphate, can increase intraluminal osmotic pressure osmotic diarrhea disappears when ingestion of the osmotic substance stops malabsorption related to lactase deficiency, pancreatic enzyme or bile salt deficiency, small intestine bacterial overgrowth, and celiac disease also cause diarrhea lactase deficiency lactose, milk sugar, is not digested by the intestine => high osmotic activity => binds water => increase in the intestine volume content Clinical manifestations of GI dysfunction - DIARRHEA
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Secretory diarrhea (large-volume diarrhea) caused by excessive mucosal secretion of chloride- or bicarbonate-rich fluid or inhibition of net sodium absorption infectious causes include viruses (e.g., rotavirus), bacterial enterotoxins (e.g., E. coli, Vibrio cholerae ), or exotoxins from overgrowth of Clostridium difficile following antibiotic therapy Clinical manifestations of GI dysfunction - DIARRHEA Small-volume diarrhea caused by an inflammatory disorder of the intestine, such as ulcerative colitis, Crohn disease, or microscopic colitis inflammation of the colon causes smooth muscle contraction, cramping pain, urgency, and frequency
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Motility diarrhea caused by resection of the small intestine (short bowel syndrome), surgical bypass of an area of the intestine – diarrhea predominant, diabetic neuropathy, hyperthyroidism, and laxative abuse excessive motility decreases transit time, mucosal surface contact, and opportunities for fluid absorption, resulting in diarrhea Clinical manifestations of GI dysfunction - DIARRHEA
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difficult or infrequent defecation it is associated with difficulty emptying of solid stool, which is usually painful Clinical manifestation (min. two of the following for at least 3 months) straining with defecation at least 25% of the time lumpy or hard stools at least 25% of the time sensation of incomplete emptying at least 25% of the time manual maneuvers to facilitate stool evacuation for at least 25% of defecations fewer than three bowel movements per week Clinical manifestations of GI dysfunction - CONSTIPATION less frequent defecation smaller stool volume hard stools blood in the stools difficulty passing stools (straining) feeling of bowel fullness and discomfort
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Clinical manifestations of GI dysfunction - CONSTIPATION
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often the result of a large number of diseases Clinical manifestations of GI dysfunction - GASTROINTESTINAL BLEEDING
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sudden and intense bleeding in the GIT is life threatening and manifests the presence of blood in the stool or vomit Clinical manifestations of GI dysfunction - GASTROINTESTINAL BLEEDING
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malabsorption syndromes interfere with nutrient absorption historically malabsorption disorders have been classified as maldigestion or malabsorption Small intestine excretes certain digestive enzymes and is also the most important area for the absorption of nutrients Resorption area depends on the construction of normal mucosa, which is shaped into the villi. Clinical manifestations of GI dysfunction - MALABSORPTION SYNDROMES
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Incomplete digestion of food can occur at several levels GIT due to malfunction of secretion of digestive juices Clinical manifestations of GI dysfunction - MALABSORPTION SYNDROMES
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celiac and lactose intolerance are considered to be primary diseases of malabsorption in our geographical area. Celiac – malabsortion of proteins - caused by the the allergic response in the small intestine to gluten - a protein present in different cereals - resulting inflammation of the mucosa results in villus atrophy => significantly reduced resorption area/capacity of the small intestine Lactase Deficiency – malabsorption of sugar - Lactase - lack of activity - enzyme which degrades lactose (milk sugar) => after the ingestion of milk, lactose present in the small intestine as an osmotically active agent (binds H2O => greatly increases the volume of the intestinal contents. In addition, lactose is decomposed by intestinal bacteria to gas and substances that irritate the mucous membranes. This results in abdominal cramps, bloating and diarrhea often. Clinical manifestations of GI dysfunction - MALABSORPTION SYNDROMES
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Disorders of the GastroIntestinal Tract Esophagus Dysphagia Achalasia Gastroesophageal reflux Stomach Gastritis Peptic Ulcer Gastric Cancer Intestinal system inflammatory bowel disease Crohn disease Ulcerative colitis Colon Cancer Ileus
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Dysphagia is characterized as swallowing disorders, which may be due to mechanical obstruction of the esophagus, or functional disorder that impairs esophageal motility Mechanical obstruction - intrinsic - tumor, strictures - extrinsic - originate outside the esophageal lumen and narrow the esophagus by pressing inward on the esophageal wall. The most common cause of extrinsic mechanical obstruction is tumor Disorders of the GIT - DYSPHAGIA Functional dysphagia - caused by neural or muscular disorders that interfere with swallowing or peristalsis. - typical causes of functional dysphagia in the upper esophagus - dermatomyositis (a muscle disease) and neurologic impairments caused by stroke, MS, PD, ALS
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Achalasia is a primary esophageal motility disorder characterized by an inability of the lower esophageal sphincter to relax and is constantly contracted Food accumulates in the upper part of the esophagus, which gradually dilates, Food is degraded bacteria and occasionally there is a regurgitation Disorders of the GIT - ACHALASIA
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Gastroesophageal reflux disease (GERD) is the reflux of acid and pepsin from the stomach to the esophagus that causes esophagitis. HCl, pepsin and bile - induce mucosal inflammation, erosion and ulceration It is a consequence of weaken function of the lower esophageal sphincter, delayed gastric emptying with an increase in the pressure of its content and weaken clearing function of the esophagus (lack of saliva, poor esophageal peristalsis, and decreased production of the esophageal mucosal glands). Disorders of the GIT - GASTROESOPHAGEAL REFLUX DISEASE (GERD)
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Clinical manifestation: heartburn, chronic cough, asthma attacks abdominal pain (within 1 hour after meals, repeating) symptoms may worsen if the individual lies down, or in the case of increasing intra-abdominal pressure (as a result of coughing, vomiting, or of hard stool) symptoms may be present even if the acid is not present in the esophagus heartburn can be seen as chest pain, which requires the exclusion of cardiac ischemia alcohol or foods that contain acid (citrus fruits) can cause discomfort and worsen the syptoms GASTROESOPHAGEAL REFLUX DISEASE (GERD)
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GASTROESOPHAGEAL REFLUX DISEASE (GERD)
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is a result of imbalance between the mucosal defense mechanisms in the esophagus, stomach and duodenum, and gastric mucosa-damaging mechanisms relates to digestion of mucous membrane and lower parts of the stomach, duodenum, and lower esophagus by HCl and pepsin Disorders of the GIT – PEPTIC ULCER
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PEPTIC ULCER Risk factors for peptic ulcer disease: genetic predisposition H.pylori infection of the gastric mucosa age greater than 65 years psychologic stress (mechanism unknown) excessive use of alcohol smoking acute pancreatitis chronic obstructive pulmonary disease obesity cirrhosis
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PEPTIC ULCER
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PEPTIC ULCER
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Types of Peptic Ulcers: acute - quickly heal by the mucosa regeneration chronic - penetrate deeper into the tissue, healing takes several weeks or months Special types of ulcers: Cushing - traumatic origin, or after surgery CNS (irritation of n. Vagus -> hypersecretion HCl)Curling - traumatic origin, after burns (↑ levels of histamin -> hypersecretion HCl)Zollinger - Ellison Syndrome - ↑ production of gastrin -> stimulates the secretion of HCl)Stress ulcers - mucosal perfusion defect PEPTIC ULCER
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PEPTIC ULCER
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Mucus-bicarbonate barrier smooth adhesive mucus layer pH gradient (lumen – epithelial surfice) bicarbonate secretion by epithelial cells H+ disposal in gastric wall mucoid barrier damage back diffusion of H+ into the wall mucosal blood flow Proliferation and epithelial repair mitosis and cell migration along the basal membrane mucoid cap after epithelial damage EPITHELIAL GASTRODUODENAL BARRIER
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LUMEN MUCUS - EPITEL EPITHELIAL GASTRODUODENAL BARRIER
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Mucus - bicarbonate layer - protects the mucosa from autodigestion- on the surface of the mucosa -> layer of mucus – non-permeable layer for acid and pepsin -> and prevent the intake of the hydrogen ion (H+) to the mucosal tissue which causes damage to the cells and subsequent digestion with pepsin- in mucosa itself, a large amount of bicarbonate ions (HCO3-) is produced - buffering H+ ions that penetrate mucosa- good blood flow Hlien – bikarbonátova vrstva - EPITHELIAL GASTRODUODENAL BARRIER
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Mucoid cap mechanisms associated with rapid repairing of the damage area mucus with fibrin - form "fibrin cap" - strongly adhere to erosion - gives the condition of regeneration of the epithelium under it (preventing further penetration of aggressive agents) EPITHELIAL GASTRODUODENAL BARRIER
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Mitosis and the cell migration along the basal layer EPITHELIAL GASTRODUODENAL BARRIER
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Disorders of the GIT – PEPTIC ULCER
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Appendicitis is an inflammation of the vermiform appendix, which is a projection from the apex of the cecum Clinical manifestation: pain is initially diffuse and poorly localizable (visceral pain), later when the inflammation transit to the parietal peritoneum, patients localize the pain in the right hypogastrium (somatization visceral pain) the pain may be vague at first, increasing in intensity over 3 to 4 hours right lower quadrant pain is associated with extension of the inflammation to the surrounding tissues nausea, vomiting, and anorexia follow the onset of pain, and fever is common diarrhea occurs in some individuals, particularly children; others have a sensation of constipation perforation, peritonitis, and abscess formation are the most serious complications of appendicitis Disorders of the GIT – APPENDICITIS
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The exact cause of appendicitis is controversial. obstruction of the lumen with stool, tumors, or foreign bodies with consequent increased intraluminal pressure, ischemia, bacterial infection, and inflammation is a common theory regardless of the cause - intraluminal pressure increases (secretion of mucus and fluids continues), propagation of bacteria and leukocytes continues the increased pressure decreases mucosal blood flow, and the appendix becomes hypoxic the mucosa ulcerates, promoting bacterial or other microbial invasion with further inflammation and edema. inflammation may involve the distal or entire appendix Disorders of the GIT – APPENDICITIS
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Disorders of the GIT – INFLAMMATORY BOWEL DISEASE Ulcerative colitis and Crohn disease are chronic, relapsing inflammatory bowel diseases (IBDs) of unknown origin both diseases are associated with genetic factors, alterations in epithelial cell barrier functions, immunopathology related to abnormal T-cell reactions to microflora and other luminal antigens, and varying phenotypes
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Disorders of the GIT – INFLAMMATORY BOWEL DISEASE Crohn disease - any part of the digestive tract - the most common - terminal part of the ileum - inflammatory process affects all layers of the wall of the digestive tract -> ulcerations in the wall, the formation of fistulas and abscesses Ulcerative colitis - affects colon a rectum - the process of fibrosis is not intensified
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is an idiopathic inflammatory disorder that affects any part of the gastrointestinal tract from the mouth to the anus the distal small intestine and proximal large colon are most commonly affected by the disease inflammation healing scars can lead to narrowing of the lumen and obstruction of the intestinal tract -> fibrosis INFLAMMATORY BOWEL DISEASE - Crohn disease characteristic symptoms are abdominal pain and diarrhea malabsorptions are the result of loss of functional mucosal absorptive surface most often it is deficit of several food components and dehydration
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is a chronic inflammatory disease that causes ulceration of the colonic mucosa and extends proximally from the rectum into the colon although the cause is unknown, dietary, infectious, genetic, and immunologic factors are all suggested causes (less common in smokers) in oppposite to Crohn disease, the fibrosis process is not intensified the primary lesions are continuous with no skip lesions, are limited to the mucosa, and are not transmural the mucous layer is thinner than normal - impairment of the epithelial barrier INFLAMMATORY BOWEL DISEASE - Ulcerative Colitis the inflammation damages the epithelial mucosal barrier with leak of fluids into the gut the clinical symptoms are diarrhea, weight loss, abdominal pain and loss of blood in the faeces
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INFLAMMATORY BOWEL DISEASES
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ABDOMINAL EMERGENCY
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Pathogenesis – stagnation od the content, absorption and secretion, bacterial overgrowth, and hypoxia intestinal wall Clinical manifestation vary according to the type of obstruction and its location in the intestinal system may be colic pain (obstruction of the lumen) or permanent vomiting and abdominal distension Disorders of the GIT – ILEUS
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ILEUS – Mechanical Ileus
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interruption of intestinal passage through the lumen - strangulation of the of blood vessels with an interruption of the blood circulation, impaired nutrition of the intestinal wall (ischemia, ischemic necrosis of the intestinal wall) - arising from the adhesions in abdominal surgery, herniation, intussusception (intestinal segment is inserted into an adjacent segment) ILEUS – Mechanical Ileus
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ILEUS – Dynamic ileus
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INTESTINAL OBSTRUCTION