Algri Wijaya

7/23/2019 Algri Wijaya

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Algri Wijaya

405070108









PHYSIOLOGY OF

DIGESTIVE TRACT





O!TH

Sali"a#$Gla%&'# (ar)*i&+ ',-li%g,al. ',-/a%&i-,lar$i%)r gla%&# ,al$2235 HO+ 035 (r)*6i%a/yla'6+ /,,'+ ly')y/6+

. 6l6*r)ly*69

F,%*i)%'#$A/yla'6#()li'a:ari&6 &i''a:ari&6$,,'# l,-ria*i)%+ ;))&$

)%&6%'i%g$ar*i,la*i)%$Hygi6%6$HCO<$ %6*ralii%g ai& ;r)/;))&' = -a*6ria (r6"6%*ari6'



O*:6r i%(,*# *a%(a ra%g'a%ga% )ral+ *:# -6r(i>ir+ /6li:a*+ /6/-a,i+/6%&6%gar













Vomiting• V)/i*i%g i' a-%)r/al 6/(*yi%g ); '*)/a: a%&

,((6r (ar* ); i%*6'*i%6 "ia 6')(:ag,' *:r),g:/),*:3

• Ca,'6'#13 Irri*a*i)% i% GIT3 6:a%ial '*i/,la*i)% ); (:ary%?<3 Pr6g%a%y43 Al):)l53 S*i/,la*i)% ); la-yri%*: ); 6ar 6g '6a 'i>6%6''+

/),%*ai% 'i>6%6''

@3 A,*6 GI i%;6*i)%73 6*a-)li &i')r&6r'83I%r6a'6 I%*rara%ial Pr6'',r6



Pa*:)(:y'i)l)gy );E/6'i'



Emesis mechanismEmesis mechanism



Emesis mechanismEmesis mechanism





C)/(lia*i)%' ); E/6'i'

E?6''i"6 )r r6(6a*6& ")/i*i%g a% a,'6 &6:y&ra*i)%a%& /ay l6a& *) '6"6r6 &i'*,r-a%6' i% *:6 6l6*r)ly*6a%& ai&$-a'6 -ala%6 i% *:6 -)&y3

• Dehydration &,6 *) l)'' ); Ba*6r ;r)/ *:6 GI *ra*3• Hypokalaemia &,6 *) l)'' ); *:6 ()*a''i,/ i)%' i% GI

'6r6*i)%'• Hypochloremia &,6 *) l)'' ); :l)ri&6 i)%' i% *:6

")/i*,'• Alkalosis $ &,6 *) l)'' ); H= i)%' i% *:6 ")/i*,'• Aspiration syndrome

• Malnutrition and failure to thrive• Peptic oesophagitis• Mallory-Weiss tear 6r)'i)%' *) *:6 6')(:ag,' )r '/all *6ar' i% *:66')(:ag6al /,)'a



GERD

• Ga'*r)6')(:ag6al r6,? GER9 i' a )//)%+ '6l;$li/i*6& (r)6'' i% i%;a%*' *:a* ,',ally r6')l"6' -y'i? *) 1 /)%*:' ); ag63 T:6 (r6"al6%6 ); GER(6a>' -6*B66% 1 4 /) ); ag6 – I; )/(lia*i)%' &6"6l)( )r r6g,rgi*a*i)% (6r'i'*'+ GER i'

)%'i&6r6& (a*:)l)gi )%'i&6r6& a' ga'*r)6')(:ag6alr6,? &i'6a'6+ GERD9 ra*:6r *:a% /6r6ly &6"6l)(/6%*al. &6'6r"6' ;,r*:6r 6"al,a*i)% . *r6a*/6%*

•

GERD )r ai& r6,?+ i' a )%&i*i)% i% B:i: *:6li,i& )%*6%* ); *:6 '*)/a: r6g,rgi*a*6' -a>',( )r r6,?6'9 i%*) *:6 6')(:ag,'



Cla''i;yi%g GERD

Ga'*r)6')(:ag6alR6,?

P:y'i)l)gialGa'*r)6')(:ag6al R6,? $GER

Ga'*r)6')(:ag6al R6,?Di'6a'6 GERDSy/(*)/a*i9

Pri/ary GERD#)*ili*y (r)-l6/A6*i%g l)B6rE')(:ag6al '(:i%*6r

S6)%&ary GERD#E?*6r%al ;a*)r a,'i%g*ra%'i6%* r6la?a*i)%' );l)B6r E')(:ag6al '(:i%*6r

6g3 F))& all6rgy9





E?a/i%a*i)%

• Endoscopy

• Biopsies

• -rays

• E!amination of the throat and laryn!

• Esophageal acid testing

• Acid perfusion test



Tr6a*/6%*"reatment

Li;6 '*yl6/)&ia*i)%

El6"a*i)% ); *:6 ,((6r -)&y a* %ig:* g6%6rally i' r6)//6%&6& ;)r all(a*i6%*' Bi*: GERD

GERD Di6* T:6'6 ;))&' ':),l& -6 a")i&6& a%& i%l,&6# C:))la*6+ (6((6r/i%*+ al):)l . a6i%a*6& &ri%>' Fa**y ;))&' B:i: ':),l& -6 &6r6a'6&9 a%& '/)>i%g B:i: ':),l&-6 '*)((6&9 al') r6&,6 *:6 (r6'',r6 i% *:6 '(:i%*6r a%& (r)/)*6

r6,? C:6Bi%g g,/ '*i/,la*6' *:6 (r)&,*i)% ); /)r6 -iar-)%a*6$)%*ai%i%g 'ali"a a%& i%r6a'6' *:6 ra*6 ); 'Ball)Bi%g3

A%*ai&' A%*ai&' %6,*rali6 *:6 ai& i% *:6 '*)/a: ') *:a* *:6r6 i' %) ai& *)r6,?*:6y &) ') ;)r )%ly a ':)r* (6ri)& ); *i/6

T:6 -6'* Bay *) *a>6 a%*ai&'+ *:6r6;)r6+ i' a((r)?i/a*6ly )%6 :),r

a;*6r /6al' )r j,'* -6;)r6 *:6 'y/(*)/' ); r6,? -6gi% a;*6r a /6al3Si%6 *:6 ;))& ;r)/ /6al' 'l)B' *:6 6/(*yi%g ;r)/ *:6 '*)/a:+ a%a%*ai& *a>6% a;*6r a /6al '*ay' i% *:6 '*)/a: l)%g6r a%& i'66*i"6 l)%g6r

Hi'*a/i%A%*ag)%i'*

T:6 r'* /6&ia*i)% &6"6l)(6& ;)r /)r6 66*i"6 a%& )%"6%i6%**r6a*/6%* ); ai&$r6la*6& &i'6a'6'+ i%l,&i%g GERD+ Ba' a :i'*a/i%6a%*ag)%i'*+ '(6ially i/6*i&i%6 Taga/6*9

Hi'*a/i%6 i' a% i/()r*a%* :6/ial -6a,'6 i* '*i/,la*6' ai&(r)&,*i)% -y *:6 '*)/a:

http://www.medicinenet.com/script/main/art.asp?articlekey=839




"reatment

Pr)*6i% P,/(I%:i-i*)r

T:6 '6)%& *y(6 ); &r,g &6"6l)(6& '(6ially ;)r ai&$r6la*6&&i'6a'6'+ ',: a' GERD+ Ba' a (r)*)% (,/( i%:i-i*)r PPI9+'(6ially+ )/6(ra)l6 Pril)'69

T:6 a&"a%*ag6 ); a PPI )"6r a% H a%*ag)%i'* i' *:a* *:6 PPI

':,*' ) ai& (r)&,*i)% /)r6 )/(l6*6ly a%& ;)r a l)%g6r (6ri)&); *i/6Fi"6 &i6r6%* PPI' ar6 a((r)"6& ;)r *:6 *r6a*/6%* ); GERD+i%l,&i%g )/6(ra)l6 Pril)'69+ la%')(ra)l6 Pr6"ai&9+ra-6(ra)l6 Ai(:6?9+ (a%*)(ra)l6 Pr)*)%i?9+ a%& 6')/6(ra)l6J6?i,/93 A ;*: PPI (r)&,* )%'i'*' ); a )/-i%a*i)% );)/6(ra)l6 a%& ')&i,/ -iar-)%a*6 6g6ri&93 PPI' 6?6(* ;)r6gari&9 ar6 -6'* *a>6% a% :),r -6;)r6 /6al'

Pr) )*ili*y Dr,g Pr)$/)*ili*y &r,g' B)r> -y '*i/,la*i%g *:6 /,'l6' ); *:6ga'*r)i%*6'*i%al *ra*+ i%l,&i%g *:6 6')(:ag,'+ '*)/a:+ '/alli%*6'*i%6+ a%&K)r )l)%3 O%6 (r)$/)*ili*y &r,g+ /6*)l)(ra/i&6R6gla%9Pr)$/)*ili*y &r,g' i%r6a'6 *:6 (r6'',r6 i% *:6 l)B6r 6')(:ag6al'(:i%*6r a%& '*r6%g*:6% *:6 )%*ra*i)%' (6ri'*al'i'9 ); *:66')(:ag,'

F)a/ arri6r' F)a/ -arri6r' ar6 *a-l6*' *:a* ar6 )/()'6& ); a% a%*ai& a%& a;)a/i%g ag6%*3

T:6r6 i' )%ly )%6 ;)a/ -arri6r+ B:i: i' a )/-i%a*i)% );al,/i%,/ :y&r)?i&6 g6l+ /ag%6'i,/ *ri'ilia*6+ a%& algi%a*6Ga"i')%93

S,rg6ry T:6 ',rgial (r)6&,r6 *:a* i' &)%6 *) (r6"6%*

r6,? i' *6:%ially >%)B% a' ;,%&)(lia*i)% a%& i'all6& r6,? ',rg6ry )r a%*i$r6,? ',rg6ry













What is #astritis$• A% i%a//a*i)%+ irri*a*i)% )r 6r)'i)%

); *:6 '*)/a: li%i%g3 Ca% -6 );a,*6 )r a :r)%i )/(lai%*3

• A,*6 ga'*ri*i' );*6% &,6 *) :6/iali%j,ry al):)lK&r,g'9

• C:r)%i ga'*ri*i'# H3 Pyl)ri i%;6*i)%+:6/ial+ a,*)i//,%63



Etiology• il6 r6,? Dr,g'

– JSAID'+ ',: a' a'(iri%+ i-,(r);6%+ a%&

%a(r)?6% – C)ai%6 – Ir)% – C)l:ii%6+ B:6% a* *)?i l6"6l'+ a' i% (a*i6%*'

Bi*: ;aili%g r6%al )r :6(a*i ;,%*i)% – ay6?ala*6 – C:6/)*:6ra(6,*i ag6%*'+ ',: a' /i*)/yi% C+

5$,)r)$$&6)?y,ri&i%6+ a%& )?,ri&i%6• P)*6%* al):)li -6"6rag6'+ ',: a' B:i'>y+ ")&>a+ a%& gi%•

a*6rial i%;6*i)%' – H pylori /)'* ;r6,6%*9 – H heilmanii rar69 – S*r6(*))i rar69



Etiology• F,%gal i%;6*i)%'

–Ca%&i&ia'i'

– Hi'*)(la'/)'i' – P:y)/y)'i'

• Para'i*i i%;6*i)% 6g+ a%i'a>i&)'i'9

• A,*6 '*r6'' ':)>9• Ra&ia*i)%• All6rgy a%& ;))& ()i')%i%g• S(iy ;))&•

S/)>i%g• Viral i%;6*i)%' 6g+ CV9



Acute #astritis• A,*6 ga'*ri*i' a% -6 -r)>6% &)B%

i%*) a*6g)ri6'# – 6r)'i"6 6g+ ',(6rial 6r)'i)%'+ &66(

6r)'i)%'+ :6/)rr:agi 6r)'i)%'9

– %)%6r)'i"6 g6%6rally a,'6& -yHelicobacter pylori93



Erosive #astritis

• A,*6 6r)'i"6 ga'*ri*i' a% r6',l* ;r)/*:6 6?()',r6 *) a "ari6*y ); ag6%*' )r;a*)r'3 T:i' i' r6;6rr6& *) a' r6a*i"6ga'*ri*i'3

• T:6'6 ag6%*'K;a*)r' i%l,&6%)%'*6r)i&al a%*i$i%a//a*)ry/6&ia*i)%' JSAID'9+ al):)l+ )ai%6+'*r6''+ ra&ia*i)%+ -il6 r6,?+ a%&i':6/ia3

• T:i' r6',l*' ;r)/ )ral )r 'y'*6/ia&/i%i'*ra*i)% ); *:6'6 ag6%*' 6i*:6r i%*:6ra(6,*i &)'6' )r i%',(ra*:6ra(6,*i &)'6'3



%hronic #astritis

• A,*)i//,%6

• a*6rial H3 Pyl)ri9

• C:6/ial JSAID'9

• C:r)%i %)%i%;6*i),' gra%,l)/a*),'ga'*ri*i'

• Ly/(:)y*i ga'*ri*i'

•

E)'i%)(:ili ga'*ri*i'• I':6/i ga'*ri*i'

• Ra&ia*i)% ga'*ri*i'



PEP"&% '(%E) D&*EA*E



De+nition• P6(*i ,l6r' ar6 &6;6*' i% *:6 ga'*ri )r

&,)&6%al /,)'a *:a* 6?*6%& *:r),g: *:6/,',lari' /,)'a

• P6(*i ,l6r &i'6a'6 P!D9 i' )%6 ); *:6 /)'*)//)% &i'6a'6' a6*i%g *:6

ga'*r)i%*6'*i%al GI9 *ra*3• I* a,'6' i%a//a*)ry i%j,ri6' i% *:6 ga'*ri

)r &,)&6%al /,)'a+ Bi*: 6?*6%'i)% -6y)%&*:6 ',-/,)'a i%*) *:6 /,',lari' /,)'a3



Epidemiology

• T:6 i%i&6%6 ); D!' &6li%6&'*6a&ily ;r)/ 12@0 *) 1280 a%&:a' r6/ai%6& '*a-l6 'i%6 *:6%3

• Gastric Ulcers G!' *6%& *) ),rla*6r i% li;6 *:a% &,)&6%al l6'i)%'+Bi*: a (6a> i%i&6%6 r6()r*6& i%*:6 'i?*: &6a&63

• )r6 *:a% :al; ); G!' ),r i%/al6'



Etiology• H. pylori i%;6*i)%

• NSAIDs

• Cigar6**6 '/)>i%g

• G6%6*i (r6&i'()'i*i)%

• -l))& gr),( O

• P'y:)l)gial '*r6''

• T:6 /aj)ri*y ); G!' a% -6 a**ri-,*6& *) 6i*:6rH. pylori )r JSAID$i%&,6& /,)'al &a/ag63

• T:6 /aj)ri*y ); D!' a% -6 a**ri-,*6& *) H. pylori

Pr6&)/i%a%* a,'6

%ampylo,acter



%ampylo,acterpyloridis

• I* i' S$':a(6& 035 M < ,/ i% 'i69

a%& )%*ai%' /,l*i(l6 ':6a*:6&ag6lla3

• I*' a-ili*y *) )l)%i6 *:6 ga'*ri

/,)'a a%& (r)&,6 /,)'al i%j,ry3• a gra/$%6ga*i"6 /ir)a6r)(:ili

• T:i' ra*6 ); )l)%ia*i)% i%r6a'6'

Bi*: ag6+ Bi*: a-),* 50 );i%&i"i&,al' ag6 50 -6i%g i%;6*6&3



Fig,r6 1# Helicobacter pylori i%"a&i%g 6(i*:6lial6ll'3

%ampylo,acter



%ampylo,acterpyloridis

•

Tra%'/i''i)% ); H. pylori ),r';r)/ (6r')% *) (6r')%+ ;)ll)Bi%ga% )ral$)ral )r ;6al$)ral r),*63

•



O S O OG



PATHOPHYSIOLOGY H. pylori

PA"HPH.*&(#.



PA"HPH.*&(#./*A&Ds

PA"HPH.*&(#.



PA"HPH.*&(#./*A&Ds



%(&/&%A( 0EA"')E*• Epiastric pain a% -6 (r6'6%* i% -)*: D! a%& G!3

• Pai% (a**6r% i% D! ),r' !" min to # h a$ter ameal a%& i' ;r6,6%*ly r6li6"6& -y antaci%s or$oo%.

• Pai% *:a* aBa>6' *:6 (a*i6%* ;r)/ 'l66( -6*B66%/i&%ig:* a%& < A339 i' *:6 /)'* &i'ri/i%a*i%g

'y/(*)/+ Bi*: *B)$*:ir&' ); D! (a*i6%*'&6'ri-i%g *:i' )/(lai%*3

• G! &i')/;)r* /ay a*,ally -6 (r6i(i*a*6& -y;))&3

•

Ja,'6a a%& B6ig:* l)'' ),r /)r6 )//)%ly i%G! (a*i6%*'3

• H6/a*6/6'i'



• O*:6r 'y/(*)/' ar6 # – l)'i%g B6ig:*

– %)* ;66li%g li>6 6a*i%g

– :a"i%g (ai% B:il6 6a*i%g

– ;66li%g 'i> *) y),r '*)/a:

– ")/i*i%g

%(&/&%A( 0EA"')E*



)elated %omplications

• Gastrointestinal &lee%in

• Per$oration

• Gastric O'tlet Obstr'ction

"



"reatment



#A*")&% ADE/%A)%&/MA

E id i l



Epidemiology

• Ga'*ri a%6r i%i&6%6 :a'

&6r6a'6& B)rl&Bi&6 -,* r6/ai%' :ig:i% Na(a%+ C:i%a+ C:il6+ a%& Ir6la%&3

• T:6 ri'> ); ga'*ri a%6r i' gr6a*6r

a/)%g l)B6r ')i)6)%)/i la''6'3



Etiology



PA"HPH.*&(#.

• Ga'*ri ari%)/a' '(r6a& -y &ir6*6?*6%'i)% *:r),g: *:6 ga'*ri Ball *)*:6 (6riga'*ri *i'',6'+ )a'i)%allya&:6ri%g *) a&ja6%* )rga%' ',: a'

*:6 (a%r6a'+ )l)%+ )r li"6r3• T:6 &i'6a'6 al') '(r6a&' "ia ly/(:a*i'

)r -y '66&i%g ); (6ri*)%6al ',r;a6'3

• T:6 li"6r i' *:6 /)'* )//)% 'i*6 ;)r:6/a*)g6%),' '(r6a& ); *,/)r3

%li i l 0 t



%linical 0eatures

• ,((6r a-&)/i%al &i')/;)r*

• A%)r6?ia

• 'lig:* %a,'6a a%& ")/i*i%g

•

W6ig:* l)''• Dy'(:agia a,'6& -y l6'i)%' );

*:6 ar&ia9

•

ir)%$&6i6%y a%6/ia• ),l* -l))& i% *:6 '*))l



")EA"ME/"• Ga'*r6*)/y

',-*)*al ga'*r6*)/y i' *:6*r6a*/6%* ); :)i6 ;)r (a*i6%*' Bi*:&i'*al ari%)/a'+ *)*al )r %6ar$*)*al

ga'*r6*)/i6' ar6 r6,ir6& ;)r /)r6(r)?i/al *,/)r'3

• chemotherapy )/-i%6& Bi*:

ra%iation *:6ra(y :a' -66% ':)B% *)r6&,6 *:6 r6,rr6%6 ra*6 a%&(r)l)%g ',r"i"al

Algri Wijaya

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