Upper Gastrointestinal Diseases - PowerPoint PPT Presentation

About This Presentation
Title:

Upper Gastrointestinal Diseases

Description:

Upper Gastrointestinal Diseases Complications of PUD Bleeding Perforation Gastric outlet or duodenal obstruction Chronic anemia PUD Complications * Upper GI ... – PowerPoint PPT presentation

Number of Views:394
Avg rating:3.0/5.0
Slides: 35
Provided by: IqbalSi
Category:

less

Transcript and Presenter's Notes

Title: Upper Gastrointestinal Diseases


1
Upper Gastrointestinal Diseases
2
Upper GI Diseases
  • Esophagus
  • Stomach
  • Duodenum

3
Esophageal Diseases
4
Esophageal Diseases
  • Esophageal Symptoms
  • Esophageal Motility Disorders
  • Gastroesophageal Reflux

5
Esophageal Swallowing Disorders
  • Esophageal Symptoms
  • Dysphagia difficulty swallowing
  • oropharyngeal dysphagia difficulty initiating
    swallow or transferring food from mouth into
    esophagus. Can also experience nasopharyngeal
    regurgitation (comes out nose) or pulmonary
    aspiration.
  • esophageal dysphagia food gets stuck in
    esophagus after swallowing

6
Esophageal Motility Disorders
  • Achalasia (failure to relax)
  • Diffuse Esophageal Spasm (DES)

7
Achalasia
  • Most often results from post-ganglionic
    denervation of smooth muscle of esophagus absence
    of inhibitory neural input to LES ?? LES pressure
  • Functional esophageal obstruction ? can lead to
    esophageal dilatation
  • Similar disorder in Chagas disease (Trypanosoma
    cruzi causes injury to myenteric plexuses of
    esophagus)

8
Diffuse Esophageal Spasm (DES)
  • periodic chest pain dysphagia high amplitude,
    simultaneous, repetitive SM contractions
  • can be spontaneous or initiated by swallow
  • barium swallow ? corkscrew appearance to
    esophagus
  • pathogenesis unknown

9
Gastroesophageal Reflux (GER)
  • A little bit of GER is normal in all of us
  • Normally, thoraxic cavity has negative pressure
    during inspiration
  • GER would occur continuously without antireflux
    mechanisms
  • a portion of esophagus is below the diaphragm ?
    intra-abdominal pressure (5 mm Hg) can reinforce
    LES pressure (antireflux effect)
  • Loss of subdiaphragmatic LES ? correlation
    between esophageal hernia and GERD

10
Gastroesophageal Reflux (GER)Mechanisms
  • Incompetent anti-reflux mechanisms
  • Ineffective esophageal clearance
  • Decreased gastric emptying

11
Gastroesophageal Reflux (GER)Risk factors
  • Obesity
  • Pregnancy
  • Smoking
  • High-fat foods
  • Theophylline
  • Caffeine
  • Coffee
  • Chocolate
  • High levels of estrogen/progesterone

12
Gastroesophageal Reflux (GER)
  • Pyrosis
  • Dyspepsia
  • Regurgitation
  • Dysphagia

13
Gastroesophageal Reflux (GER)
  • Diagnosis of GER
  • Best test pH probe
  • checks for existence of acid reflux and
    association between esophageal acid and chest
    pain
  • Other tests
  • Barium swallow
  • Esophagoscopy
  • Esophagial biopsy

14
Gastroesophageal Reflux (GER)
  • Complications of GERD
  • Erosive esophagitis
  • Esophageal ulcer
  • Bleeding
  • Esophageal stricture
  • Intestinal metaplasia (Barretts)
  • Adencarcinoma from Barretts
  • Lung diseases

15
Gastritis and Ulcer Disease
16
Peptic Ulcer Disease Range of injury
  • Ulcer
  • A lesion on an epithelial surface (skin or
    mucous membrane) caused by superficial loss of
    tissue.
  • Erosion
  • A lesion on an epithelial surface (skin or
    mucous membrane) caused by superficial loss of
    tissue which is limited to the mucosa.

17
Peptic Ulcer Disease Location
  • Stomach
  • typically in antrum (distal stomach normally
    lined by columnar epithelium that does not
    secrete acid - more susceptible to peptic
    ulceration)
  • parietal cells located in body/fundus (proximal
    stomach - ulcers not found as often here)

18
Peptic Ulcer Disease Location
  • Duodenum
  • within duodenal bulb
  • can cause outlet obstruction
  • usually single
  • multiple/large/more distal ulcers
    (Zollinger-Ellison sdr.)

19
Gastric Mucosa Secretions
  • The defensive forces
  • Bicarbonate
  • Mucus layer
  • Mucosal blood flow
  • Prostaglandins
  • Growth factors
  • The aggressive forces
  • Helicobacter pylori
  • HCl acid
  • Pepsins
  • NSAIDs
  • Bile acids
  • Ischemia and hypoxia
  • Smoking and alcohol
  • When the aggressive factors increase or the
    defensive factors decrease, mucosal damage will
    result, leading to erosions and ulcerations.

20
Gastritis
21
Causes of Acute Gastritis
  • Alcohol
  • NSAIDs
  • Helicobacter
  • Stress/ICU associated

22
Mechanisms of Acute Gastritis
  • Drugs (non-steroidal anti-inflammatory drugs
    NSAID), alcohol cause acute erosion (loss of
    mucosa superficial to muscularis mucosae).Can
    result in severe haemorrhage
  • Acute Helicobacter infection has a prominent
    neutrophil infiltrate

23
Chronic Gastritis
  • A autoimmune
  • B bacterial (helicobacter)
  • C - chemical

24
Chronic Gastritis
  • Type A - Autoimmune (associated with vitamin B12
    malabsorption (pernicious anaemia)
  • Type B - Helicobacter pylori infection
  • Type C - Chemical damage (bile reflux, drugs)

25
Helicobacter Pylori
  • Adapted to live in association with surface
    epithelium beneath mucus barrier
  • Causes cell damage and inflammatory cell
    infiltration
  • In most countries the majority of adults are
    infected

26
Helicobacter Gastritis
  • Acute inflammation mediated by complement and
    cytokines
  • Polymorphisms infiltrate epithelium and may be
    partly responsible for its destruction
  • An immune response is also initiated (antibodies
    may be detected in serum)

27
Consequences of Gastritis
  • Peptic ulcer disease (Helicobacter)
  • Adenocarcinoma (all types)

28
Definitions
  • Peptic Ulcer
  • An ulcer of the alimentary tract mucosa, usually
    in the stomach or duodenum, and rarely in the
    lower esophagus, where the mucosa is exposed to
    the acid gastric secretion.
  • It has to be deep enough to penetrate the
    muscularis mucosa.

29
Etiology
  • The two most common causes of PUD are
  • Helicobacter pylori infection
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Other uncommon causes include
  • Gastrinoma (Gastrin secreting tumor)
  • Stress ulceration (trauma, burns, critical
    illness)
  • Viral infections
  • Vascular insufficiency

30
Etiology Helicobacter pylori
Helicobacter pylori
31
PUD Clinical Presentation
  • Symptoms of PUD
  • Pain
  • Epigastric pain
  • Hunger pain
  • Nocturnal pain
  • Other symptoms
  • Waterbrash
  • Heartburn
  • Vomiting
  • Asymptomatic
  • 1 - 3 adults endoscopy volunteers
  • 20 of complicated ulcers present without
    previous symptoms

32
Peptic Ulcer Disease - Diagnosis
  • Diagnosis of ulcer
  • Diagnosis of H. pylori

33
Diagnosis of H. pylori
  • Tests for Helicobacter pylori
  • Non-invasive
  • C13 or C14 Urea Breath Test
  • Stool antigen test
  • H. pylori IgG titer (serology)
  • Invasive
  • Gastric mucosal biopsy
  • Rapid Urease test

34
PUD Complications
  • Complications of PUD
  • Bleeding
  • Perforation
  • Gastric outlet or duodenal obstruction
  • Chronic anemia
Write a Comment
User Comments (0)
About PowerShow.com