GIT disorders. (Subject 16)

Gastric mucosal barrier

tight cellular junctions
presence of a protective mucus layer
bicarbonate ions

Acute gastritis

Causes
Diet and personal habits (excessive alcohol, smoking, malnutrition).
Infections:
bacterial

Gastritis pathogenesis

Reduced blood flow ?mucosal hypo-perfusion? ischemia.
Increased acid secretion (in H.pylori

Types of chronic gastritis

Type A Gastritis (Autoimmune gastritis).
antibodies against parietal

Types of chronic gastritis

Type AB Gastritis (environmental)
gastric atrophy
caused by environmental factors.
Type

Peptic ulcer disease

Ethiology:
H pylori infection
NSAIDs (aspirin - the most ulcerogenic)
Lifestyle factors
Severe

Stress ulceration

High level of glucocorticoids and adrenaline (stress hormones) causes:
? mucus

Clinical manifestations

affection of one or all layers of stomach
remissions and exacerbation

Complications

Hemorrhage
bleeding from granulation tissue
erosion of an ulcer into an

Complications

Obstruction
edema, spasm or contraction of scar.
epigastric fullness, vomiting of

Therapy principles

Eradication of Helicobacter pylori with antibiotics
Inhibition of gastric secretion
H2

Intestinal obstruction

Mechanical obstruction
Causes:
external hernia
postoperative adhesions.
strictures,
tumor, foreign bodies

Intestinal obstruction

Paralytic, or adynamic, obstruction
after abdominal surgery
inflammatory conditions of

Intestinal obstruction pathogenesis

Intestinal autointoxication

poisoning of the organism by toxic substances from the

Intestinal autointoxication

General symptoms
? ABP and pain sensitivity,
? glycogen amount in the

Liver pathology

Normal bilirubin metabolism

Jaundice

Yellowish discoloration
of the skin, mucosal surfaces
and deep tissues

Prehepatic jaundice

Reason - ? hemolysis of red blood cells:
Hemolytic blood

Hepatic jaundice

Synonym – intrahepatic or hepatocellular jaundice
Hepatitis, cirrhosis, cancer of

Hepatic jaundice

Hereditary disorders:
? bilirubin uptake (Gilbert’s syndrome);
? of enzymes supporting conjugation

Posthepatic jaundice

Synonym – mechanical, obstructive, cholestatic jaundice
Reasons – obstruction of bile

Cholemia - bile in blood

? levels of cholesterol, bile acids and

Acholia

? or absence of bile secretion into the intestines
Clinical

Hepatic failure

severe impairment of the liver functions
Acute failure (fulminant hepatitis)
Chronic

Hepatic failure

Hematologic Disorders.
anemia due to
blood loss,
excessive destruction or

Hepatic failure

Endocrine Disorders –impaired steroid hormones metabolism
Skin Disorders.
telangiectases
palmar erythema
clubbing

Hepatic failure

Hepatic Encephalopathy
Stages I - IV (from irritability to coma)
flapping

Hepatic failure

Hepatorenal Syndrome
Acute liver failure? kidneys hypoperfusion? reduction in glomerular filtration

Portal hypertension

? resistance to flow in the portal venous system

Portal hypertension

Intrahepatic portal hypertension:
liver cirrhosis.
infestation of the liver with schistosomes
polycystic

Complications of portal hypertension

Complications of portal hypertension

Portosystemic Shunts.
caput medusae - dilated veins around