Diseases of GIT& Pancreas

8/14/2019 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

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Diseases of GIT& Pancreas

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