GIT APPLIED/CLINICAL ASPECTS

1. Lecture – 10 Dr. Zahoor Ali Shaikh GIT APPLIED/CLINICAL ASPECTS

2. GIT APPLIED/CLINICAL ASPECTS • We will look at some important conditions/diseases that can affect GIT. • This lecture will introduce you to the applied/clinical aspects, details of these conditions you will do later.

3. APPLIED ASPECTS • Topics • Vomiting • Hunger Contraction • Gastro Oesophagal Reflux Disorder • Peptic Ulcer • Jaundice • Hepatitis[Viral] • Liver Transplant • Pancreatitis • Celiac Disease [Gluten Entropathy] • Irritable Bowel Syndrome • Inflammatory Bowel Disease • Food Poisoning • Traveler's Diarrhea • Parasitic Infections of Intestine

4. VOMITING • It is forceful expulsion of gastric contents through mouth. • Major force of expulsion comes from contraction of diaphragm and abdominal muscles. • There is vomiting center in Medulla, it co-ordinates the act of vomiting. • Contracting diaphragm descends downwards on the stomach.

5. VOMITING (cont) • At the same time, abdominal muscles compress the abdominal cavity and increase the intra-abdominal pressure. • Stomach is squeezed between the diaphragm above and compressed abdominal cavity below. • The gastric contents are forced upwards through relaxed sphincter and esophagus, out through the mouth.

6. CAUSES OF VOMITING • Touching the back of throat e.g. seeing the throat using the tongue depressor. • Distension of stomach. • Increased intracranial pressure e.g. head injury causing intra cerebral hemorrhage.

7. CAUSES OF VOMITING (cont) • Motion sickness. • Drugs. • Renal Failure. • Psychogenic e.g. emotional factors

8. HUNGER CONTRACTION • Gastric Contraction can sometimes be felt and may be mildly painful [peristaltic wave]. • Hunger Contraction are associated with sensation of hunger and play role in regulation of appetite.

9. Gastro Esophagal Reflux Disorder [GERD] • Patient with reflux has persistent symptoms. • It occurs when lower Esophagal sphincter tone fails to increase when patient is lying down or when intro-abdominal pressure increases. • Patient complains of heart burn.

12. PEPTIC ULCER • Duodenal Ulcer [D.U] are more common than Gastric Ulcer. • 10 - 15% of population may suffer from D.U. • Patient complains of epigastric pain, relationship of pain with food is variable and may not be helpful in diagnosis.

13. PEPTIC ULCER (cont) • D.U pain is more when patient is hungry. • If long standing symptoms investigation like test for H.Pylori and Endoscopy can be done.

15. JAUNDICE • We have already discussed three types of Jaundice. (i). Prehepatic or Hemolytic Jaundice (ii). Hepatic e.g. Viral (iii). Post-hepatic or Obstructive e.g. Gall stones

16. HEPATITIS-VIRAL

17. LIVER TRANSPLANT • It is established treatment for number of diseases. • Acute Liver Failure. • Chronic Liver Failure.

18. GALL STONES • We have already discussed Gall Stones. • Ultrasound is helpful in diagnosis. • Cholecystectomy – Laparoscopic is done now in requires 48hours stay in hospital.

19. Image showing Normal Gall bladder

20. Gallstones

22. Ultrasound showing normal gallbladder

23. Ultrasound showing gallstones

24. PANCREATITIS • Patient complains of pain in epigastric region. • Pain radiates to back. • Acute Pancreatitis can be due to gall stones, alcohol, viral infection e.g. mums, hyperlipidaemia. • Chronic Pancreatitis can be due to alcohol, hypercalcaemia.

25. PANCREATITIS (cont) • Investigation which help in Diagnosis • Blood test e.g. Serum Amylase will be raised. • Abdominal ultrasound.

26. Celiac Disease [Gluten Entropathy] • We have discussed Celiac Disease. Subtotal villous atrophy in Coeliac disease Jejunal mucosa normal villi

27. Irritable Bowel Syndrome • It is functional Bowel disorder. • More common in female than male. • Anxiety factor is common.

28. Irritable Bowel Syndrome (cont) • Patient gives history of - Abnormal Stool Frequency – more than 3/day. - Abnormal Stool Form – watery, loose or hard stool. - Feeling of incomplete evacuation. - Passage of mucus. - Abdominal Distension.

29. Inflammatory Bowel Disease [IBD] • Two major diseases are - Crohn’s Disease [CD] – it can affect any part of GIT. • Ulcerative Colitis [UC] – it affects large intestine.

31. Inflammatory Bowel Disease

32. FOOD POISONING

33. Traveler's Diarrhea [TD]

34. Parasitic Infections of Intestine • GIT Parasites - Entamoeba Histolytica – Amoebiasis - Giardiasis • Intestinal Worms - Thread worm – Entrobius Vermicularis - Round worm – Ascaris Lumbricoides - Hook worm – Ancylostoma Duodenal

35. Parasitic Infections of Intestine

36. Thank you