PATHOPHYSIOLOGY OF GASTROINTESTINAL DISEASES
II

PATHOPHYSIOLOGY OF GASTROINTESTINAL DISEASES

BASIC DISSORDERS OF GI DISEASES :

a. morphology

b. functional

c. etiology : * infection

* malignancy

PROBLEMS SOLVING ORIENTED

MAIN PROBLEMS OF GI DISEASE

NAUSEA AND VOMITING

DYSPHAGIA

DIARRHEA

RECCURRENT ABDOMINAL PAIN

ABDOMINAL COLIC

PASSAGE DISORDERS

GASTROINTESTINAL BLEEDING

NAUSEA,VOMITING & DYSPHAGIA

NAUSEA :

* unpleasant, abdominal sensation

* subjective scale, accompanied by autonomic

changes :

- low gastric tone

- secretion

- salivation

- sweeting

- tacchycardi,

- change respiratory rhythm

* followed by retrograde peristaltik RETCHING

VOMITINGThe forceful expulsion of the stomach content through the mouthProtective reflex :

* removing toxic

* relieving preassure

Preceded by nausea and retching

DIFFERENTIAL DIAGNOSIS OF VOMITING

ANATOMIC LOCUS :

* proximate sources of the afferent stim.

- cortex - chemoceptive trig. zone

- vestibular - peripheral organ

AGE : newborn, infant, child & adultSUGGESTIVE ASSOCIATED SYMPTOMES :

- content - periodic

- force - food

- time - GI & other organ sympt.

ANATOMIC LOCUS

CORTEX CEREBRI:

* intracranial hypertension & infection

VESTIBULAR :

* OMA , vestibular disorders

CHEMOCEPTIVE TRIGER ZONE :

* toxic chemical content in the blood :

alcohol, ureum, billirubin

PERIPHERAL ORGAN :

* cardiovascular

* GI.system : - meteorism, infection/diarrhea

- ileus, torsi, invagination

- hepatitis (icteric)

D.D. OF VOMITING BY AGE

NEONATAL PERIOD:

* congenital malformation

obstruction

INFANT PERIOD :

* diarrhea, food (prot) allergy, over

feeding, GER, IC hyp, syst.inf.

CHILDREN AND ADULESCENTS :

* diarrhea, toxic ingestion, sys.inf,

appendicitis, IC.hyp, OMA, malrot.

VOMITING CENTER

REGURGITATION

NOT VOMITING, RATHER PASSIVE

NONFORCEFUL EJECTION OF GASTRIC CONTENTS

REFLUX OF LOWER ESOPHAGEAL SPHINCTER

INFANTS < 3 MONTHS OF AGE

ETIOLOGY OF DYSPHAGIA

STRUCTURAL :

a. intrinsic : stenosis, web, stricture

b. extrinsic : vascular ring, thyroid

FUNCTIONAL :

* cerebral palsy * neuropathy

* myopathy * achalasia

MISCELLANOUS :

* pharyngitis, esophagitis * cicatric

* foreign body * psychogenic

DIAGNOSIS EVALUATION :

BARIUM FLUOROSCOPY :

a. Structural and obstructing deffect

b. dysmotility : tounge, palate,

oropharynx

c. aspiration

ENDOSCOPY : a. structural, mucosal

b. therapeutic

MANOMETRY : a. tension

b. duration

c. provocation

DIARRHEA

DIFINITION :

* a change in the bowel habit

* increase of frequency and/or volume or

consistency

ACCOMPAINED :

* nausea or vomiting

* vomiting

* abdominal pain

ACUTE & CHRONIC DIARRHEA

ACUTE DIARRHEA : < one week

PROLONGED DIARRHEA

CHRONIC DIARRHEA : > 2 weeks

prolonged mucosal injuries

changes intraintestinal ecology

* chemical

* microbial

DYSBIOSIS

COMMON CAUSES OF
ACUTE DIARRHEA

A. BACTERIAL

B. VIRUS

C. PROTOZOA AND PARASITE

VIRAL AGGRESSION

ENTEROTOXICOGENIC ORGANISM AGGRESSION

INVASIVE BACTERIA AGGRESSION

PATHOPHYSIOLOGY OF GASTROENTERITIS

ACUTE GE.IS MOSTLY INFECTION

AGENTS :

1. Adherence enterotoxin functional impair

2. Adherence invasive cytotoxin

* cell destruction & inflammatory diarrhea

* cell penetration invade blood stream across

lamina propria enteric fever

CONSTIPATION/ENCOPRESIS

CONSTIPATION : INFREQUENT PASSAGE OF HARD, DRY STOOL

less of bowel movement

infection

voluntary withholding/functional cnstip.

ENCOPRESIS : SOILING BY FORMED STOOL

embarrassment due to constipation

unable to sense the need to defecate

CAUSES OF CONSTIPATION

INTESTINAL:

anal fisuure / stenosis

Hirschprung

pseudo obstruction/stricture post NEC

DRUGS:

lead, narcotic, anti depressant

METABOLIC:

dehydration, hypothyroid, hypo K / Cal

NEUROMUSCULAR:

myotonic dystrophy, spina bifida

ACID PEPTIC DISEASE

GASTRIC SECRETION DISS. DUE

HELICO BACTER PYLORI (urea splitting bactaria)

GASTRITIS :

acute epigastric pain, acute gastritis followed by aspirin or NSID , viral

GASTRIC / DUODENAL ULCER :

epigastric pain, bloody vomiting

PSYCHOEMOSSIONAL AND ENVIRO MENTAL HYGIENE

PYLORIC STENOSIS

THE FIRST 2 MONTHS OF LIFE, MOST CONGENITAL ANOMALI ARE INGUINAL HERNIA AND PYLORIC HYPERTROPHY

PYLORIC SPASM HYPERTROPH

CLINICAL :

- nonbillous vomiting more frequent

and projectile

- olive shape mass to the right of umbil.

- weight loss

- USG

ABDOMINAL PAIN

NATURE OF PAIN :

* spasm (colic): intestine, duct, vesicle

* dull: inflamation/infection, tension

* burning: inflamation/infection

LOCATION : correlate with the organ (abdominal quadrant)

- epigastric: lever, bile, gatric

- periumbillical: gastric, pancreas, biledu.

- lower right: appendict, urine trac

- lower left: colon, urine tract

ABDOMINAL COLIC

CORRELATED WITH OTHER SIGNS AND SYMPTOMES

LOOK AT THE PRE OR POST LOCALIZATION

PROFILE AND LOCALIZATION

cramp condition due to:

* irritation, inflamation, infect.

* passage dissorders

RECCURENT ABDOMINAL PAIN

DEFINITION :

* at least 3 episodes in 3 months

* interferes with normal condition

* school age (5 15 yrs)

* localized periumbilical pain due

to bowel muscle tension

ETIOLOGY & PATHOPHISIOLOGY :

* poorly understood

* not synonyme with immaginary

PATHOPHYSIOLOGY

Bowel motility disturbance :

* distension or spasm

* increased muscle tension

* pain origin from nerves ending in mucosa,

muscle and serosa

FACTORS INFLUENCE ON RECCURENT ABDOMINAL PAIN

* LOWERED THRESHOLD OF PAIN

* ENVIROMENTAL INFLUENCES :

respons of familymembers

* physically

* psychologically

MEDIATORS OF R.A.P.

PSYCHOLOGICALPHYSIOLOGICALStress factorOperant conditionRole modellingDepressionFamily enmeshmentsomatizationAutonomic instabilityLactose intolerenceGut dysmotilityConstipationEndogenous opiate

CLINICAL MANIFESTATION

* AGE RANGE 5 14 YEARS

* CHRONIC (AT LEAST 3 EPIDSODES IN 3 MONTHS

PERIOD)

* EPISODES ALTERNATING WITH PAIN FREE PERIOD

* PERIUMBILLICAL LOCATION, NO RADIATION

* VARIABLE SEVERITY (mild to severe)

* NATURE OF PAIN(cramping, dull, burning)

* INCONSISTENT RELATIONSHIP TO MEAL, BOWEL

MOVEMENT AND GENERAL ACTIVITY

* DISTURBENCE OF NORMAL ACTIVITY

ABDOMINAL COLIC

CORRELATED WITH OTHER SIGNS AND SYMPTOMES

LOOK AT THE PRE OR POST LOCALIZATION

PROFILE AND LOCALIZATION

ANATOMIC LOCALISATION OF ABDOMINAL

GI.PASAGE DISSORDERS

MAIN SYMPTOMES :

* vomiting

* meteorism abd. distention

* bloody stool

MORPHOLOGY OF DISSORDERS:

* strangulation * tumor tension

* invagination * intestinal cont.

* kinking

GASTROINTESTINAL BLEEDING

HEMATEMESIS:

- blood stain emesis : prox.of lig.Treitz

- coffe ground emesis : gastric

MELENA:

- black /dark color stool : oropharynx

prox.intest. with stassis in right colon

HEMATOCHEZIA:

- bright red or maroon color stool massive GI bleeding

- blood coating the stool rectal/anal

OCCULT BLEEDING: on going bleeding

D.D. OF G.I.BLEEDING

INFANTCHILD/ADOLESCENTSwallowed material bloodAnal fissure Milk allergyN.C.E.IntussupceptionBacterial enteritisVolvulusHemorrhagic dis.of new bornMeckel diverticulumAnal fissureGastritis/gastric ulcerIntussupceptionForeign bodyPolyps/teleangiectasiaCoagulopathyHemolytic uremic syndHenoch Scholein purpuraMeckel diverticulumhemorrhoid