diseases of git& pancreas
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Diseases of GIT& Pancreas
Diseases of teeth, stomach &Duodenum, Large & small intestine &
pancreas, GI bleed, Inflammatorybowel disease
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Diseases of Teeth
Dentalcaries is a destructive disease of
the hard tissues of the teeth due to
infection with Streptococcus mutans and
other bacteria.
Artificial fluoridation of water to a level of 1
part per million, fluoride-containing
toothpastes, and topical fluorideadministration have reduced the incidence
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Dental Caries
If the carious lesion progresses, infection of the
dental pulp may occur, causing acute pulpitis. The
tooth may become sensitive to hot or cold. When
severe continuous throbbing pain ensues, pulp
damage is irreversible, and root canal therapy
becomes necessary. The contents of the pulp
chamber and root canals are removed, followed by
thorough cleaning, antisepsis, and filling with an inert
material. Alternatively, extraction of the tooth may be
indicated
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Pyorrhea
In adults, chronic destructive periodontal
disease (pyorrhea) is responsible for more
loss of teeth than caries,
The most common form of periodontal
disease starts as inflammation of the
marginal gingiva (gingivitis), which is
painless, although the gingiva may bleedon brushing.
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Systemic Disease
Systemic disease may give rise to pain thatsimulates pulpal disease.
Maxillary sinusitis is frequently manifested
as pain in the maxillary teeth, includingsensitivity to thermal changes andpercussion.
Angina pectorisAngina pectoris may result in painreferred to the lower jaw, probably throughthe vagus nerve.
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Dental Diseases
Enamel hypo plasiaEnamel hypo plasia of the primary and/orpermanent teeth, manifested by alterationsranging from white spots to gross defects in thesurface structure of the crowns, may be causedby disturbances of calcium and phosphatemetabolism such as are found in
Vitamin D-resistant rickets,itamin D-resistant rickets,
Hypo parathyroidismHypo parathyroidism, Gastroenteritisastroenteritis, and
Celiac diseaseCeliac disease.
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Dental Diseases
Premature birth or high fevers may also give rise to
enamel hypoplasia. TetracyclineTetracycline, when given during
the second half of pregnancy, in infancy, and in
childhood up to 8 years of age, causes both a
permanent discoloration of the teeth and enamel
hypoplasia. Daily ingestion of more than 1.5 mg
fluoridefluoride can result in enamel discoloration (mottling)
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Larger teeth are associated with maternal
diabetes, maternal hypothyroidism, and
large birth size.Tooth size is reduced in Down's
syndrome.
.
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GIT
We produce about 1 liter saliva per day
Small intestine is 21 feet & large intestine
is 6 feet long
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Stomach
Every 2 weeks Stomach produces a new
layer of mucus lining other wise stomach
will digest itself
Stomach contains about 35 million small
digestive glands
Stomach produces 2.5 liters of gastricjuice/day
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liver
Human liver performs 500 different functions
Liver is the largest & heaviest internal organ of the bodyweighing 1.6 Kg
Liver is only organ of the body which has capacity to
regenerate itself completely even after being removedalmost completely
Liver cells take several years to replace themselves
A healthy liver process 720 liters of blood per day.
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GIT
In an average person it takes 8 seconds
for food to travel down the food pipe,3-5
hours in small intestine & 3-5 days in large
intestine
Human body takes 6 hours to digest a
fatty meal & takes 2 hours for
carbohydrate meal
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Esophagus
2 main functions
1.Transport of food
2.Prevention of retrograde flow
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Diseases of Oesophagus
Symptoms:
A. Heart burn (pyrosis)
B.Dysphagia
C.Regurgitation
Diagnostic Procedures:A. Upper Endoscopy
B.Videoesophagography
C.Barium Esophagography
D. Esophageal ManometryE. Esophageal pH recording
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GERD
Heart burn
Endoscopy demonstrates abnormalities in
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GERD
Complications:1.Barretts Esophagus
2.Peptic stricture
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Caustic esophageal Injury
Acid or alkali ingestion-accidental or
suicidal
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Mallory-Weiss syndrome
(Mucosal laceration of LES)
Hemetemesis; usually self limited
H/O vomiting,retching in 50 %
Endoscopy establishes diagnosis
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Esophageal varices
Develop secondary to Portal HT &
cirrhosis. upper GI bleeding
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Malignant Oesophageal lesion
Progressive solid food dysphagia
Weight loss common
Endoscopy with biopsy establishesdiagnosis.
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Achalasia-Motility disorder
Progressive dysphagia
Loss of peristalsis of distal 2/3rd & impaired
relaxation of LES
Regurgitation of food
Treatment: injection of botulinium toxin in
LES
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Infectious esophagitis
Immunocompromised patient
Odynophagia,dysphagia & chest pain
Endoscopy with biopsy establishesdiagnosis
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Barrets esophagus
It is complication of severe reflux
esophagitis & is a risk factor for
oesophageal adenocarcinoma.
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Stomach
Peptic Ulcer disease: Despite the constant
attack on the gastro duodenal mucosa by a host
of noxious agents (acid, pepsin, bile acids,
pancreatic enzymes, drugs, and bacteria),integrity is maintained by an intricate system that
provides mucosal defense and repair.
Ulcers are defined as a break in the mucosal
surface >5 mm in size, with depth to the submucosa.
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PUD
H. pyloriand NSAID-induced injury account forthe majority of DUs.
Cigarette smoking has been implicated in thepathogenesis of PUD.
Psychological stress has been thought tocontribute to PUD
Complications
1 bleeding,
2 perforation, and
3 obstruction
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Gastritis & Gastropathy
Erosive & Hemorrhagic Gastritis: Alcoholic
, critically ill or pts on NSAID s (stress
gastritis). Prophylactic treatment is given
to all critically ill patients
Non-erosive Gastritis
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Zollinger Ellison
syndrome(Gastrinoma)Severe & atypical PUD
Gastric acid hyper secretion
Diarrhea common, relieved by nasogastric suction
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Tumor
Benign: Polyp
Malignant- Adeno carcinoma
LymphomaCarcinoid
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Small Intestine
Malabsorption-The lengths of the small intestine andcolon are ~300 cm and ~80 cm, respectively.However, the effective functional surface area isapproximately 600-fold greater than that of a hollow
tube as a result of the presence of folds, villi (in thesmall intestine), and microvilli. The functional surfacearea of the small intestine is somewhat greater thanthat of a doubles tennis court
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Small Intestine
The small and large intestine are anatomically
distinct in that villi are present in the small
intestine but are absent in the colon and
functionally distinct in that nutrient digestion andabsorption take place in the small intestine but
not in the colon.
Steatorrhea is caused by one or more defects in
the digestion and absorption of dietary fat
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Carbohydrates are absorbed only in thesmall intestine and only in the form of monosaccharides
calcium, iron, and folic acid are exclusivelyabsorbed by active transport processes inthe proximal small intestine, especially theduodenum; in contrast, the active transport
mechanisms for both cobalamin and bileacids are present only in the ileum
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> 1 liter Saliva
>2.5 liter/day Gastric juice
Stomach-acid & pepsin Duodenum Lipase, trypsin, Pancreatic
amylase degradation of food particles
Small intestine Absorption of nutrients Large Intestine- absorption of water
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Acute small Intestine Obstruction
Pain Abdomen
Tender distended abdomen
X-ray : Dilated loops of small bowel,Decreased air in colonn
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Acute paralytic ileus
Precipitating factors :Surgery, peritonitis,
electrolyte imbalance
Distention
Decreased bowel sound
X-ray-Gas & fluid distention in small &
large bowel.
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Chronic/ subacute intestinal
Obstruction
Ileo cecal/intestinal tuberculosis
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Upper GI Bleeding: Causes
Peptic Ulcer
Esophageal varices
Malorry Weiss Tear Erosive Gastritis
Malignancy
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Lower GI Bleeding: Intestine &
Colon
Diverticulosis
Ischemic Colitis
Inflammatory Bowel Disease
Acute Inflammatory diseases:shigellosis
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Hematemesis/Hemoptysis
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Hemodynamic Status
Systolic BP100,BP>100moderate acute blood
loss
Normal HR & BP suggests minor blood
loss
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Antibiotic associated collitis
Clostridium difficile
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Inflammatory Bowel Disease
Ulcerative colitis-chronic recurrent disease
characterized by diffuse mucosal inflammation
involving colon
Bloody diarrhea Lower abdominal cramps & fecal urgency
Anemia, low serum albumin
Sigmoidoscopy Extra intestinal:skin,joint,eye,liver