Diseases Of Git& Pancreas

Diseases of GIT& Pancreas Diseases of teeth, stomach & Duodenum, Large & small intestine & pancreas, GI bleed, Inflammatory bowel disease

Diseases of Teeth • Dental caries 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 fluoride administration have reduced the incidence

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

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 bleed on brushing.

Systemic Disease Systemic disease may give rise to pain that simulates pulpal disease. • Maxillary sinusitis is frequently manifested as pain in the maxillary teeth, including sensitivity to thermal changes and percussion. • Angina pectoris may result in pain referred to the lower jaw, probably through the vagus nerve.

Dental Diseases • Enamel hypo plasia of the primary and/or permanent teeth, manifested by alterations ranging from white spots to gross defects in the surface structure of the crowns, may be caused by disturbances of calcium and phosphate metabolism such as are found in • Vitamin D-resistant rickets, • Hypo parathyroidism, parathyroidism • Gastroenteritis, astroenteritis and • Celiac disease. disease

Dental Diseases • Premature birth or high fevers may also give rise to enamel hypoplasia. Tetracycline, Tetracycline 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 fluoride can result in enamel discoloration (mottling)

•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

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 gastric juice/day

liver • Human liver performs 500 different functions • Liver is the largest & heaviest internal organ of the body weighing 1.6 Kg • Liver is only organ of the body which has capacity to regenerate itself completely even after being removed almost completely • Liver cells take several years to replace themselves • A healthy liver process 720 liters of blood per day.

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

Esophagus • 2 main functions 1.Transport of food 2.Prevention of retrograde flow

Diseases of Oesophagus • Symptoms: A. Heart burn (pyrosis) B.Dysphagia C.Regurgitation Diagnostic Procedures: A. Upper Endoscopy B.Videoesophagography C.Barium Esophagography D. Esophageal Manometry E. Esophageal pH recording

GERD • Heart burn • Endoscopy demonstrates abnormalities in <50% patients • Factors contributing GERD: Incompetent LES(<10 mmHg) Irritant effects of refluxate Abnormal esophageal clearance Delayed Gastric emptying

GERD • Complications:1.Barrett’s Esophagus 2.Peptic stricture

Caustic esophageal Injury • Acid or alkali ingestion-accidental or suicidal

Mallory-Weiss syndrome (Mucosal laceration of LES) • Hemetemesis; usually self limited • H/O vomiting,retching in 50 % • Endoscopy establishes diagnosis

Esophageal varices • Develop secondary to Portal HT & cirrhosis.→ upper GI bleeding

Malignant Oesophageal lesion • Progressive solid food dysphagia • Weight loss common • Endoscopy with biopsy establishes diagnosis.

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

Infectious esophagitis • Immunocompromised patient • Odynophagia,dysphagia & chest pain • Endoscopy with biopsy establishes diagnosis

Barret’s esophagus • It is complication of severe reflux esophagitis & is a risk factor for oesophageal adenocarcinoma.

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 sub mucosa.

PUD • H. pylori and NSAID-induced injury account for the majority of DUs. • Cigarette smoking has been implicated in the pathogenesis of PUD. • Psychological stress has been thought to contribute to PUD • Complications 1 bleeding, 2 perforation, and 3 obstruction

Gastritis & Gastropathy • Erosive & Hemorrhagic Gastritis: Alcoholic , critically ill or pt’s on NSAID’ s (stress gastritis). Prophylactic treatment is given to all critically ill patients • Non-erosive Gastritis

Zollinger Ellison syndrome(Gastrinoma) Severe & atypical PUD Gastric acid hyper secretion Diarrhea common, relieved by naso gastric suction

Tumor • Benign: Polyp • Malignant- Adeno carcinoma Lymphoma Carcinoid

Small Intestine • Malabsorption-The lengths of the small intestine and colon are ~300 cm and ~80 cm, respectively. However, the effective functional surface area is approximately 600-fold greater than that of a hollow tube as a result of the presence of folds, villi (in the small intestine), and microvilli. The functional surface area of the small intestine is somewhat greater than that of a doubles tennis court

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 and absorption 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

• Carbohydrates are absorbed only in the small intestine and only in the form of mono saccharides • calcium, iron, and folic acid are exclusively absorbed by active transport processes in the proximal small intestine, especially the duodenum; in contrast, the active transport mechanisms for both cobalamin and bile acids 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

Acute small Intestine Obstruction • Pain Abdomen • Tender distended abdomen • X-ray : Dilated loops of small bowel, Decreased air in colonn

Acute paralytic ileus • Precipitating factors :Surgery, peritonitis, electrolyte imbalance • Distention • Decreased bowel sound • X-ray-Gas & fluid distention in small & large bowel.

Chronic/ subacute intestinal Obstruction • Ileo cecal/intestinal tuberculosis

Upper GI Bleeding: Causes • • • • •

Peptic Ulcer Esophageal varices Malorry Weiss Tear Erosive Gastritis Malignancy

Lower GI Bleeding: Intestine & Colon • • • •

Diverticulosis Ischemic Colitis Inflammatory Bowel Disease Acute Inflammatory diseases:shigellosis

Hematemesis/Hemoptysis

Hemodynamic Status • Systolic BP<100 irrespective of HR→high risk patient with severe bleeding • HR>100,BP>100→moderate acute blood loss • Normal HR & BP suggests minor blood loss

Antibiotic associated collitis • Clostridium difficile

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