digestive system disorders 1 · digestive system disorders 1 lecture 11 pathology and clinical...
TRANSCRIPT
Digestive System Disorders 1
Lecture 11
Pathology and Clinical
Science 1 (BIOC211)
Department of BioscienceText Reference:
Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: concepts
of altered health states, (9th ed.). Philadelphia, U.S.A. Walters Kluwer
Health - Lippincott, Williams & Wilkins.
© endeavour.edu.au
© Endeavour College of Natural Health endeavour.edu.au 2
Session Learning Outcomes
This session aims to understand:
o The normal function of the GIT
o Common diagnostic tests for GIT disorders
o The common clinical features relating to the GIT
o The causation, clinical features, treatment aims and
prognosis for the following conditions:
• Disorders of mouth and neck
• Disorders of pharynx and oesophagus and
duodenum
© Endeavour College of Natural Health endeavour.edu.au 4
DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p922), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
© Endeavour College of Natural Health endeavour.edu.au 5
DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p924), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
© Endeavour College of Natural Health endeavour.edu.au 6
DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p938), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
© Endeavour College of Natural Health endeavour.edu.au 7
DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p934), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
© Endeavour College of Natural Health endeavour.edu.au 8
Diagnostic Tests
o X-rays - plain and contrast (barium)
o Ultrasound, fluid filled lesion eg. cholecystitis, appendicitis, aortic aneurysm
o CT scan, thickened bowel walls, mesentery, retro-peritoneal structures and aorta, staging of tumours
o MRI - abscesses and fistulas, hepatobiliary and pancreatic disorders
© Endeavour College of Natural Health endeavour.edu.au 9
Diagnostic Tests
o Endoscopy - gastroscopy, colonoscopy, sigmoidoscopy, Endoscopic retrograde cholangio-pancreatography (ERCP), Magnetic resonance cholangiopancreatography (MRCP)
o Stool Cultures
o Radio isotope tests, Urea breath Test, leukocyte labeling
o Blood and serology tests
© Endeavour College of Natural Health endeavour.edu.au 10
Diagnostic Tests
www.medicine.cu.edu.eg/.../xray/intestine/28.htm
commons.wikimedia.org/wiki/File:Stomach_endos...
© Endeavour College of Natural Health endeavour.edu.au 11
Common Clinical Features
o Dyspepsia / indigestion – collective term
for many symptoms
o Heartburn (pyrosis), acidity,
o Dysphagia
o Nausea & Vomiting (bloody -
haematemesis)
o GIT bleeding
o Malabsorption /Malnutrition
© Endeavour College of Natural Health endeavour.edu.au 12
Common Clinical Features
o Flatulence - belching or flatus
o Diarrhoea - watery and bloody (melaena)
o Constipation - hard difficult to pass
o Pruritus ani
o Abdominal pain - site, intensity, duration
site and frequency aggravation and relief
from, differentiate upper from lower
o Weight loss often from anorexia
© Endeavour College of Natural Health endeavour.edu.au 13
Disorders of Mouth and Throat
o Aphthous Ulceration
- 30% population
- Minor = 10mm
- Major = 10mm
- Nutritional
iron/ B12/ folate deficiency
- Systemic
Crohn’s/ UC/ Coeliac/ SLE
Immune deficiency
Dermatology conditions
viral/ drugs/ trauma
o Mouth Lesions
- White patches
(candidiasis)
- Leukoplakia
(idiopathic white patches)
tobacco
alcohol
pre-malignant
© Endeavour College of Natural Health endeavour.edu.au 14
Disorders of Mouth, Throat
www.drpaulose.com/general/apthous-ulcers-mout...
Mouth UlcerationLeukoplakia
Candidiasis
© Endeavour College of Natural Health endeavour.edu.au 15
Oesophageal Symptoms
http://www.clivir.com/pictures/hb/GERD.jpg
o Dysphagia -
Difficulty
Swallowing
o Heartburn / Sub-
sternal Discomfort
o Acid Regurgitation
o Odynophagia -
Painful Swallowing
© Endeavour College of Natural Health endeavour.edu.au 16
Gastro Oesophageal Reflux Disorder(GORD)
Normal anti reflux mechanism lost due to:
• loss of Lower oesophageal sphincter (LOS) resting tone
• transient LOS relaxation
• increase in oesophageal mucosa to acid
• delayed oesophageal clearance
• large hiatus hernia
• delayed gastric emptying
• Increased intra-abdominal pressure
• Dietary / environmental factors eg chocolate, coffee
© Endeavour College of Natural Health endeavour.edu.au 17
Gastro Oesophageal Reflux Disorder
http://img2.ranker.com/list_img/1/335721/full/gastroesophageal-reflux-
disease-symptoms.jpg?version=1319284871000
Red, inflamed, excoriated
oesophagus
Clinical Features
o Heartburn, burning pain
o Regurgitation food and acid
• aggravated by lying stooping and bending, hot drinks & alcohol
• relieved by antacids
o Waterbrash (sour taste)
o Odynophagia, dysphagia
Diagnosis
o Barium swallow, oesophagoscopy
o Oesophageal pH monitoring
o Acid suppression trials
© Endeavour College of Natural Health endeavour.edu.au 18
Gastro Oesophageal Reflux Disorder
www.drbhandari.com/Patient_Education/GERD.htm
© Endeavour College of Natural Health endeavour.edu.au 19
Gastro Oesophageal Reflux Disorder
Treatment
o antacids, alginate antacids,
o raising head of bed,
o weight loss, reduction alcohol (OH), smoking
o drugs - H2 receptor antagonists, proton pump inhibitors, prokineticagents
o Avoid large meals
Complications
o Oesophagitis
o Barretts oesophagus
o Anaemia
o Strictures
o Oesophageal cancer
© Endeavour College of Natural Health endeavour.edu.au 20
Complications of GORD
http://www.gastrolab.net/y0528.jpg
http://www.patient.co.uk/images/OM1207a.jpg
http://www.gastrolab.net/g4g041.jpg
http://4.bp.blogspot.com/_vT13IccOEqM/TLNMaf1iZOI/AAAAAAAAANc/oxLowh3l8hQ/s1600/61.jpg
1. Oesophagitis
2. Barrett’s
Oesophagus
3. Oesophageal
stricture
(endoscopy)
4. Oesophageal
stricture
(Barium meal)
1.
2
3
4
© Endeavour College of Natural Health endeavour.edu.au 21
Barrett's Oesophagus
www.barrx.com/.../index.cfm/10
o Changes to
oesophageal cells from
oesophageal reflux
o Squamous cell
replacement with
metaplastic columnar
cells
o May progress to
oesophageal cancer
© Endeavour College of Natural Health endeavour.edu.au 22
Oesophagitis
http://www.wjgnet.com/1948-5190/full/v2/i7/WJGE-2-252-g003.jpg
Aetiology
• GORD
• Candidiasis
• Ingestion
corrosives
• Medications eg
NSAIDS
© Endeavour College of Natural Health endeavour.edu.au 23
Hiatus Hernia
http://www.cardiachealth.org/sites/default/files/images/stories/Chestpain/esophagushh.bmp
Protrusion of part of
stomach through diaphragm
opening into thoracic cavity
o Types
Sliding hernia - stomach and
gastro-oesophageal junction
move upward (most Common)
Rolling or para-oesophageal
hernia - part of fundus of
stomach moves upward
o Cause
Short oesophagus,
weak diaphragm,
increases abdominal
pressure
o Clinical Features -
as for GORD
© Endeavour College of Natural Health endeavour.edu.au 24
Hiatus Hernia
www.axiomllc.com/monthly_topic_2003-05.html
© Endeavour College of Natural Health endeavour.edu.au 25
Hiatus Hernia
Treatment
- Similar to GORD
- Surgery
repair diaphragm
From Porth’s Pathophysiology: concepts of altered health states, (9th ed., p. 1174) by Grossman, S.C. &
Porth, C.M. (2014). Philadelphia, U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins
Complications
- GORD
- Barrett’s oesophagus
- Oesophagitis
© Endeavour College of Natural Health endeavour.edu.au 26
Readings and ResourcesResources:
o Set Textbooks:
Colledge, N.R., Walker, B.R. & Ralston S.H. (2014). Davidson’s Principles and Practice of Medicine, (22nd ed.). Edinburgh.
Churchill Livingstone.
Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: concepts of altered health states, (9th ed.). Philadelphia,
U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins.
o Additional textbooks:
Davies, A. & Moores, C. (2010). The respiratory system: basic science and clinical conditions, (2nd ed.). Edinburgh. Churchill,
Livingstone, Elsevier.
Field, M., Pollock, C., Harris, D. (2010). Systems of the Body: The Renal System; Basic Science and Clinical Conditions. (2nd
ed.). United Kingdom: Churchill Livingstone.
Jamison, J.R. (2006) Differential Diagnosis for Primary Care: a handbook for health care practitioners. (2nd ed.). Edinburgh.
Churchill Livingstone.
Lee, G. & Bishop, P. (2013). Microbiology and Infection Control for Health Professionals, (5th ed.). Frenchs Forest, NSW.
Pearson Education.
McCance, K.L. & Huether, S.E. (2014). Pathophysiology: the biological basis for disease in adults and children, (7th ed.). St.
Louis, MO. Elsevier.
Murphy, K. (2011). Janeway’s immunobiology, (8th ed.). New York. Garland Science.
Noble, A., Johnson, R. & Bass, P. (2010). The cardiovascular system: basic science and clinical conditions, (2nd ed.).
Edinburgh. Churchill, Livingstone, Elsevier.
Pagana, K.D. & Pagana, T.J. (2013). Mosby’s diagnostic and laboratory test reference, (11th ed.). St. Louis, MO. Elsevier.
Smith, M.E. & Morton, D.G. (2010). The digestive system: basic science and clinical conditions, (2nd ed.). Edinburgh.
Churchill, Livingstone, Elsevier.
VanMeter, K.C. & Hubert, R. (2014). Gould’s pathophysiology for health professions, (5th ed.). St. Louis, MO. Elsevier.
© Endeavour College of Natural Health endeavour.edu.au 27
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
WARNING
This material has been reproduced and
communicated to you by or on behalf of
the Endeavour College of Natural Health pursuant to
Part VB of the Copyright Act 1968 (the Act).
The material in this communication may
be subject to copyright under the Act.
Any further reproduction or
communication of this material by you
may be the subject of copyright
protection under the Act.
Do not remove this notice.