The digestive system Medicine and technology

• Normal structure and function • Diagnostic methods • Example diseases and therapies

The digestive system An overview (1)

Oesophagus

Stomach

Duodenum

Small intestine

Large intestine

Rectum

Liver (hepar)

Pancreas

Biliary system

Mucosa

Inner muscle layer Outer muscle layer

Mesentery

Nerve plexa

The digestive system An overview (2)

The digestive system Blood flow

The digestive system Nerve supply

The digestive system The four basic functions

• Motility • Secretion • Digestion • Absorption

Regulation

Motility

Secretion og absorption

Digestion and absorption

Regulation

Endocrine Nervous Paracrine

Luminal

The digestive system Main diagnostic methods

• Basic clinical examination • Radiology • Endoscopies • Other methods

Gastrointestinal radiology - basic (1)

CT upper abd-normal Ultrasound upper abd-normal

Gastrointestinal radiology - basic (2)

Gastrointestinal endoscopy - basic (1)

Biopsy forceps Snare Hemoclip

Gastrointestinal endoscopy - basic (2)

Gastrointestinal endoscopy - Taking a biopsy -

Gastrointestinal endoscopy – the diatermy principle

Coagulation mode

Cutting mode • Continous current • Sinus mode

Both mono- and bipolar systems can be used for cutting or coagulation or as mixed modes

• Interrupted current (50-100) • Square pulses

“Other” methods – one example (1a) Small intestinal examination - enterocapsule

“Other” methods – another example (1b) Small intestinal examination – ballon enteroscope

“Other” methods – yet another example (2a) Manometry and pH in the oesophagus

“Other” methods – the latest for pH (2b) Wireless logging of pH in the oesophagus

Oesophagus, stomach and

duodenum

Oesophagus (1) - normal

Oesophagitis Barrett Stenosis

Oesophagus (2) – reflux oesophagitis

Oesophagus (3) – reflux oesophagitis - Laparoscopic surgery -

Oesophagus (4) – reflux and stricture - Endoscopic dilatation -

Oesophagus (5) - cancer

Oesophagus (6) - cancer - Staging by endoscopic ultrasound -

M

SM

MP S

Normal ultrasound image Lymph node metastasis

Oesophagus (7) - cancer - Palliative stenting -

Stomach – normal anatomy

Stomach – normal endoscopy

Gastric ulcer (1)

Gastric ulcer (2) The major complications

• Bleeding • Perforation • Obstruction

Gastric ulcer (3) – bleeding Arterial bleeding Injection therapy

The hemoclip

Gastric ulcer (4) – argon plasma

Gastric ulcer (5) - perforation

Gastric ulcer (6) - obstruction

The cause of the classic peptic ulcer Helicobacter pylori

Eradication (A) or not (B)

Gastric cancer (1) - diagnosis

Gastric cancer (2) - therapy

Duodenum (normal)

Duodenum (ulcer)

Duodenum (what is this?)

The small intestine

The normal small intestine Barium double contrast X-ray

Crohn’s disease of the small intestine

Barium X-ray Enteroscopy

Diagnosis by capsule endoscopy

Bleeding Stricture

Patient with weight loss and diarrhea (1)

Healthy person This patient

Patient with weight loss and diarrhea (2)

Healthy person

Large intestine and

rectum

Large intestine – normal anatomy

Rectum – normal anatomy

The appendix

Laparoscopic appendectomy An example of minimally invasive surgery

Ulcerative colitis

Polyps of the colon and polypectomy

Cancer of the colon

Colonoscopy X-ray

Cancer of the colon – surgical assessment

Liver and the biliary system

Liver (1) normal

Liver (2) normal

Liver (cirrhosis)

Liver (portal hypertension)

Endoscopy Schematic Band ligation

Regional anatomy of the Duodenum-pancreas-biliary system

Ultrasound gallbladder

Papilla Vateri

From above From below

Endoscopic findings - papilla Vateri

Hemobilia Cancer Cholangitis

Biliary cannulation through the papilla Vateri

Endoscopic papillotomy (1)

Endoscopic papillotomy (2)

Cannulation Incision

Stone extraction

ERCP, papillotomy, stone extraction

Stent - malignant obstruction of the bile ducts (1)

Stent - malignant obstruction of the bile ducts (2)