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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.
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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
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DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p922), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p924), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p938), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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DIGESTIVE SYSTEM
From Principles of anatomy and physiology, (14th ed., p934), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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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
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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
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Diagnostic Tests
www.medicine.cu.edu.eg/.../xray/intestine/28.htm
commons.wikimedia.org/wiki/File:Stomach_endos...
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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
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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
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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
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Disorders of Mouth, Throat
www.drpaulose.com/general/apthous-ulcers-mout...
Mouth UlcerationLeukoplakia
Candidiasis
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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
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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
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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
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Gastro Oesophageal Reflux Disorder
www.drbhandari.com/Patient_Education/GERD.htm
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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
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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
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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
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Oesophagitis
http://www.wjgnet.com/1948-5190/full/v2/i7/WJGE-2-252-g003.jpg
Aetiology
• GORD
• Candidiasis
• Ingestion
corrosives
• Medications eg
NSAIDS
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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
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Hiatus Hernia
www.axiomllc.com/monthly_topic_2003-05.html
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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
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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.
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