pathophysiology of git diseases ii
DESCRIPTION
git diseasesTRANSCRIPT
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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
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MAIN PROBLEMS OF GI DISEASE
NAUSEA AND VOMITING
DYSPHAGIA
DIARRHEA
RECCURRENT ABDOMINAL PAIN
ABDOMINAL COLIC
PASSAGE DISORDERS
GASTROINTESTINAL BLEEDING
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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.
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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)
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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.
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VOMITING CENTER
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REGURGITATION
NOT VOMITING, RATHER PASSIVE
NONFORCEFUL EJECTION OF GASTRIC CONTENTS
REFLUX OF LOWER ESOPHAGEAL SPHINCTER
INFANTS < 3 MONTHS OF AGE
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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
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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
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DIARRHEA
DIFINITION :
* a change in the bowel habit
* increase of frequency and/or volume or
consistency
ACCOMPAINED :
* nausea or vomiting
* vomiting
* abdominal pain
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ACUTE & CHRONIC DIARRHEA
ACUTE DIARRHEA : < one week
PROLONGED DIARRHEA
CHRONIC DIARRHEA : > 2 weeks
prolonged mucosal injuries
changes intraintestinal ecology
* chemical
* microbial
DYSBIOSIS
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COMMON CAUSES OF
ACUTE DIARRHEAA. BACTERIAL
B. VIRUS
C. PROTOZOA AND PARASITE
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VIRAL AGGRESSION
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ENTEROTOXICOGENIC ORGANISM AGGRESSION
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INVASIVE BACTERIA AGGRESSION
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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
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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
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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
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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
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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
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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
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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
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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
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PATHOPHYSIOLOGY
Bowel motility disturbance :
* distension or spasm
* increased muscle tension
* pain origin from nerves ending in mucosa,
muscle and serosa
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FACTORS INFLUENCE ON RECCURENT ABDOMINAL PAIN
* LOWERED THRESHOLD OF PAIN
* ENVIROMENTAL INFLUENCES :
respons of familymembers
* physically
* psychologically
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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
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ABDOMINAL COLIC
CORRELATED WITH OTHER SIGNS AND SYMPTOMES
LOOK AT THE PRE OR POST LOCALIZATION
PROFILE AND LOCALIZATION
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ANATOMIC LOCALISATION OF ABDOMINAL
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GI.PASAGE DISSORDERS
MAIN SYMPTOMES :
* vomiting
* meteorism abd. distention
* bloody stool
MORPHOLOGY OF DISSORDERS:
* strangulation * tumor tension
* invagination * intestinal cont.
* kinking
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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
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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