Pathological physiology of digestive system
Department of pathological physiology– 2018
General etiology of digestive system diseases
alimentary factors (dry and hard, hot and cold, un-gualitativefood, ets.); physical factors (ionizing radiation, ets); chemical factors (salts of heavy metals, poisons, ets.); biological factors (pathogens of typhoid, dysentery, warm invasion, Helicobacter pylori, ets psychic factors (negative emotion, stress, ets.); social factors (bad habits, ets.); congenital abnormalities of digestive tract; tumors, endocrinopathies, after operation states, ets.
Disturbances of appetite
Anorexia
Hyperrexia
Parorexia
Disturbance of digestion in oral cavityDisturbance of chewing
Absence or damage of teeth (caries, periodontitis, periodontosis, ets.); Disturbance of lower mandibular nervous-muscular apparatus (myositis, bulbar
paralysis, neuritis, ets); Damage of mandibular joint and mandibular bone, ets; Inflammation of oral cavity and mucous membrane of palate (stomatitis, gingivitis,
ets); Damage of tongue muscle, ets..
Disturbance of function of salivary gland
Reasons of hypersalivation: Excitation of salivary gland center in
medulla oblongata (bulbar paralysis); Irritation of receptors of mucous membrane
of oral cavity, esophagus and stomach (under action of food mass); ,
Inflammatory processes in oral cavity (gingivitis, stomatitis, pulpitis);
Irritation of parasympathetic nerves, innervating of salivary glands (action of some drugs, toxins, vegetative poisons-pylocarpine, fizostigmin, encephalitis, neurosis, ets);
Exogenous (mercury, nicotine) and endogenous (uremia, toxicosis of pregnancy) intoxications, warm invasions, ets.
Results: Maceration of skin of lip, Hyperosmolar hypohydration, Excretion of different toxic products of
metabolism with saliva.
HyposalivationReasons:
Damage of salivary glands (inflammation, operative intervention, radiation disease, radiotherapy, ets.);
Obturation of lumen of salivary gland with stones, or compression from outside with edematic fluid,, tumor, scar;
Disturbance of neurohumoral regulation of excretion of salivary glands (damage of cerebral cortex, hypothalamus and nervous plexus, innervating the gland);
Action of some vegetative poisons- atropine, scopolamine;
Hyperthyroidism, diabetes mellitus, ets; Prolonged term hypohydration (severe
perspiration, diarrhea, ets).
Results: Food mass does not mix completely with saliva,
Difficulty in chewing and swallowing act,
Dryness of mucous membrane of oral cavity (xerostomia),
On the surface of toung and gingiva forms plaque, which consist of dead epithelial cells.
Favorable condition form for stomatitis, gingivitis, glossitis, caries.
Dysphagia. Disturbance of motor function of esophagus.
İntra-esophageal tumor of esophagusInflammationAction of different drugsAcute and chronic esophagitisSpasm of esophagus
Extra-esophageal tumorsMetastases to the lunges and mediastinumTumors and cysts of diaphragmDilation of cardiac cavitiesSclerotic processes during tuberculosis in lungesHiatal herniaDiverticula
İntra-esophageal Extra-esophageal
Pathology of esophagusAchalasia of esophagus Scleroderma
Hypertone and spasm of lower sphincter esophagus
Difficulty of passage of
food into stomach
Decreasing of body mass
Pain
Esophagitis
Pneumonia
Hypotony of lower
sphincter of
esophagus
Muscular atrophy
Disappearing of
peristalsis
Gastro-esophageal
reflux
Reasons of gastro-esophageal reflux
Acetylcholine, alpha-
adrenergic agonists,
hormones, food, which reach
with proteins, histamine, high
intra-abdominal
pressure,PGF2, ets.
Esophagus
High pressure in
esophageal sphincter
Inhibits the reflux
VIP, beta adrenergic
agonists, hormones,
dopamine, NO, PGI2,
PGE2, increasing acidity of
stomach juice, smocking,
ets
DiaphragmLow pressure in
esophageal sphincter
Lead to reflux
Disturbance of secretory function of stomach
Quantitative changes of secretion of stomach juice
Increasing secretion of stomach juice-hypersecretion,
Decreasing secretion of stomach juice-hyposecretion,
Qualitative changes of secretion of stomach juice
Increasing of general acidity of stomach juice-hyperacidity,
Decreasing of general acidity of stomach juice-hypoacidity,
Increasing amount of free HCl-hyperchlorhydria,
Decreasing amount of free HCl-hypochlorhydria,
Absence of HCL and pepsin in stomach juice-achilia.
Factors, acting to the secretion of stomach juice
Secretion of stomach juice
Gastrin
Acetylcholine,
bombazine
Secretin,
somatostatin,
glucagon,
HCL,VIP,GIP
HCL PEPSIN
Acetylcholine, histamine, bombazine, AKTH, insulin, glucocorticoids,met-enkephakin, serotonin
Somatostatin, VIP, motilin, calcitonin, enterogastron, GIP, mineralocorticoid, glucagon, prostaglandins
Acetylcholine, histamine, secretin, AKTH, met-enkephalin, cholecystokinin, glucocorticoids, serotonin, thyrotrop hormone
Somatostatin,
GIP, VIP,
motilin
Disturbance of motor function of stomach
early satiety syndrome
burning
eructation hiccup
nausea
vomiting Dumpingsyndrome
Burning
Burning – is accompanied by burning on epigastria and retrosternum. It is connectedwith food, passing into esophagus from stomach (reflux). This case may observedduring increasing concentration of HCl or lactic acid in stomach juice, atony of lowerpart esophagus. Continues of this process for a long time lead to development ofesophagitisContinues of this process for a long time lead to development of esophagitis (damage ofmucous membrane of esophagus).
Macro-preparate of lower part of esophagus during chronicesophagitis (during prolonged term gastro-esophageal reflux).
Ulcerative mucous membrane
EructationEsophagus
Stomach
Liver
Small intestine
Large intestine
ЗАГЛАТЫВАНИЕ
ВОЗДУХАeructation
Vomiting
Contraction of pyloric sphincter
Relax of cardial sphincter
Relax of stomach fundus
Passage of stomach
content into esophagus
Dilatation of esophagus
Pharyngeal valve goes to the lower, pharynx goes to
the higher, pharyngeal valve closes
Soft palate rises Voice shelf closesr
Contraction of diaphragm
Contraction of abdominal press
Dumpung syndrome
Resected stomach
Tail of duodenum
Pancreas
Small intestines
Gastroenteroanastomosis
Destruction of carbohydrates and absorption a large number of glucose into blood
Stimulation of nsulin apparatus
Secretion of insulin
Hypoglycemia
Ulcer disease of stomach and duodenum
Esophagus
Ulcer in
esophagus
Stomach
Stomach
ulcer
Small
intestine
Ulcer of
duodenum
MECHANISM OF DEVELOPMENT OF STOMACH ULCER
Result of ulcer
Development of scar tissue
Perphoration Bleeding Malignancy
Result of ulcer disease
Mechanism of development of pancreatitis
Duodenum Pancreas
Duodenal
ampoule
Inflammatory
focus
Malabsorption syndromeReasons:
Disturbances structures of microvillus, decreasing their amount (dysentery, xholera);
Hereditary (Chartnap disease and Lou syndrome) and acquired (chronic enteritis) insufficiency of enzymes, participating in membrane digestion;
Disturbances of intestinal peristalses. For ex: during Vippl disease, Cron disease, ets;
Insufficient destruction of food in intestinal cavity.
Signs: Changes in hematopoetic system: iron, B12 and folic
acid deficiency anemia, hemorrhages, developing a aresult of deficiency of vitamin- K;
Changes in skeletal-muscle system: decreasing of body mass, osteoporosis, osteomalacia, tetany;
Changes in endocrine system: amenorrhea, infertility, hyperparathyroidism ;
Changes in skin: purpura and petechiae, dermatitis and hyperkeratosis;
Changes in nervous system: peripheral neuritis;
Peripheral edema (as a result of hypoproteinemia).
Disturbance of motor function of intestine
•diarrheaIncreasing of
intestinal peristalses
•constipationWeakening of
intestinal peristalses
Types of diarrhea
• Hyperosmolar diarrhea
• Hypersecretory diarrhea
• Hypo- və hyperkinetik diarrhea
Types of constipation
Atonic
Spastic
Mechanic
Rectal
Intestinal obstruction
Intestinal obstruction
MexanikiMechanical
obturation strangulation
Dynamic
spastic paralytic