Fisio Digestion

8/17/2019 Fisio Digestion

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Food

NutrientNutrient

Non NutrientNon Nutrient

AssimilatedAssimilated

EliminatedEliminated

DigestiveDigestive

systemsystem

Primary Functions of Digestive SystemPrimary Functions of Digestive SystemActivity necessary:Activity necessary:

MotilityMotility SecretioSecretio

nnDigestioDigestio

nnAbsorptioAbsorptio

nn


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Movement of food through tract ,includesingestion, mastication (cheing food andmi!ing ith saliva", deglutition(salloing" and #eristalsis (rh$thmiccontractions along %& tract that #ro#elfood" muscular contraction.muscular contraction.

Primary Functions of Digestive SystemPrimary Functions of Digestive SystemActivity necessary:Activity necessary:

MotilityMotility

SecretioSecretio

nn'ndocrine (secretion of hormones thatregulate digestive #rocess"'!ocrine (secretion of ater, enz$mes,acid, bicarbonate, into %& tract enz$me enz$me

other digestive juices.other digestive juices.


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H$drol$sis reactions that brea) ingested #ol$mers(large molecules" into their smaller subunits(monomers" brea)don of substances.brea)don of substances.

! #roteins into amino acids! fats into gl$cerol and free fatt$ acids

! com#le! sugars into monosaccharides

DigestioDigestionn

"ransfer of monomer subunits across #allof small intestine into blood or lymph transport modi$ed nutrients%transport modi$ed nutrients%

AbsorptioAbsorptio

nn


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&egulation&egulation''

"here are t#o (nerve nets) *ple+uses,in -. tract that contain neurons andinterneurons

! sub mucosal *Meissner,! Myenteric *Auerbach,

Ple+uses / brain of the gut

! stimulated by stretch *bolus of food,0chemicals0 and stomach content *localstimuli,

Activity of ple+uses can be modi$ed

Neural:Neural:


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Neural regulation via autonomic nervousNeural regulation via autonomic nervoussystemsystem! -. tract receives both-. tract receives both s$m#athetics$m#athetic andand #aras$m#athetic #aras$m#athetic innervationsinnervations

Parasympathetic via vagus nerve andParasympathetic via vagus nerve andspinal nerves in sacral region *to lo#erspinal nerves in sacral region *to lo#erportion of large intestine,portion of large intestine,→ stimulates motility and secretion' favorsstimulates motility and secretion' favors

digestiondigestion SympatheticSympathetic

→ reduces motility and secretory activity andreduces motility and secretory activity andstimulates sphincter contractionstimulates sphincter contraction


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Paracrine regulationParacrine regulation! production of hormone1li2e molecules thatproduction of hormone1li2e molecules that

are produced in one cell and travelare produced in one cell and travel

through interstitial 3uid *not bloodstream,through interstitial 3uid *not bloodstream,

to a4ect activity of nearby cellsto a4ect activity of nearby cells

5ormone regulation5ormone regulation! production of hormones that are releasedproduction of hormones that are released

into the bloodstream and carried to targetinto the bloodstream and carried to target

tissues #ithin digestive system #heretissues #ithin digestive system #herethey a4ect digestive activitythey a4ect digestive activity

5ormonal5ormonal%%


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Mout Mout

h*h*


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Teeth! grind and tear food into smaller pieces

! increases surface area upon which digestiveenzymes work

parotid gland parotid duct

sublingual gland submandibular gland

Mouth*Mouth*

Salivary glands

*parotid0 subma+illary0sublingual,secrete saliva

lubricates and softens

food' aids in s#allo#ingcontains amylase /en6yme that beginsbrea2do#n of

carbohydrates


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CONTROL OF SALIVARY SECRETION

cerebral cortex

salivary centre

in medulla

autonomic nerves

salivary glands

↑ salivary secretion

pressure receptors

and chemoreceptorsin the mouth

other inputs

7onditionedre3e+

simplere3e+


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8ropharyn+8ropharyn+

"o convey food "o convey foodinto theinto the

esophagus%esophagus%

.mportant role.mportant role

in s#allo#ing%in s#allo#ing%


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Esophagus%Esophagus%

5ollo# muscular tube5ollo# muscular tube

connecting pharyn+ andconnecting pharyn+ andstomach%stomach%

9ounded by sphincters%9ounded by sphincters%

ined #; strati$edined #; strati$ed

s


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+tomach all+tomach all


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StomachStomach::! "emporary "emporary stores ingested food%stores ingested food% sphincterssphincters

prevent bac2#ard 3o# of materials intoprevent bac2#ard 3o# of materials into

esophagus and regulate release of stomachesophagus and regulate release of stomachcontents into small intestinecontents into small intestine

! 7hurn0 mi+es food #ith gastric =uice%7hurn0 mi+es food #ith gastric =uice%! Mechanical and chemical brea2do#n of ingestedMechanical and chemical brea2do#n of ingested

materialmaterial

! Produces0 mucus0 57l and pepsinogen%Produces0 mucus0 57l and pepsinogen%! 57l converts pepsinogen into pepsin%57l converts pepsinogen into pepsin%! Sterili6ation of stomach contents by acidSterili6ation of stomach contents by acid! Pepsin digests proteins into peptide fragments%Pepsin digests proteins into peptide fragments%! Absorbs some #ater0 al2ohol0 glucose%Absorbs some #ater0 al2ohol0 glucose%! 9inds vit% 99inds vit% 9>?>? allo#s abs% in ileumallo#s abs% in ileum

+ecretionDigestion+ecretionDigestion


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-ontrol of Acid +ecretion

Secretion isdependent uponactivity of 50 C1A"Pasepump%

-astrin0 histamineand acetylcholineincrease numbers ofen6yme in plasma

membrane%Somatostatin inhibitsacid secretion%

Pepsinogen

Gastrin

H+K + ATP-ase


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Control of Acid Secretion

May be considered

as three separate

phases.1. Cephalic phase.

2. Gastric phase.

3. Intestinal phase.


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1. CEPHALIC PHASE

Siht" s#ell or

thouht of foo!

Parasy#$athetic acti%ation

of astric #otility & astric 'uice secretion

agus nerve


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/ood arrival causes

muscular re0e!es gastrin secretion b$ %

cells.

2. GASTRIC PHASE

Gastrin

GGFOODFOOD

%astrin stimulates secretion from both

chief


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Arri%al of foo! in !uo!enu# triers release of

hor#ones that inhiit astric #otility &secretions*

3. INTESTINAL PHASE

Circulation

Secretin

Cholecysto!inin "CC#$

Intestinal $haseIntestinal $hase!

signals come from intestine and have inhibitory e4ect i%e% slo#signals come from intestine and have inhibitory e4ect i%e% slo#the rate of gastric secretionthe rate of gastric secretion

! stretch of duodenum0 and increase in osmolality stimulate nervestretch of duodenum0 and increase in osmolality stimulate nervere3e+ that inhibits gastric motility and secretionre3e+ that inhibits gastric motility and secretion

! presence of fat in duodenum stimulates secretion of inhibitorypresence of fat in duodenum stimulates secretion of inhibitoryhormones *enterogastrones,hormones *enterogastrones,


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Hormones Released During the Intestinal Phase

When acidic chyme arrives, hormones are released by

the duodenum.

1. Secretin• stimulates pancreas to secrete bicarbonate ions

that neutralise stomach acid• inhibits gastric secretion and motility of stomach

2. Cholecystokinin (CCK)• stimulates production / release of pancreatic enzymes

• stimulates bile release from gallbladder

• inhibits gastric secretion and motility of stomach


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+mall+mall

&ntestine&ntestine

/unctions in digestion/unctions in digestion

! -H1 digestion resumes-H1 digestion resumesand is com#leted hereand is com#leted here

! Protein digestionProtein digestioncontinues and com#letescontinues and com#letesherehere

! /at digestion is initiated/at digestion is initiatedand com#leted hereand com#leted here

Also functions to absorb Also functions to absorbnutrients, 0uids, andnutrients, 0uids, andelectrol$teselectrol$tes

Divisions (2 34 feet long totalDivisions (2 34 feet long totallength"length" segments *>? ft long0 ?? ft incadaver,

duodenum 5 u##er #ortion (2 3duodenum 5 u##er #ortion (2 3

foot long" closest to stomachfoot long" closest to stomach

jejunum 5 middle section jejunum 5 middle section


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PhysiologyPhysiology

"#o primary function "#o primary function! DigestionDigestion! Absorption of nutrients and #aterAbsorption of nutrients and #ater

DigestionDigestion! Mainly in duodenum ! small intestine andMainly in duodenum ! small intestine and

pancreatic en6ymespancreatic en6ymes

! 9icarbonate from pancreas neutrali6es9icarbonate from pancreas neutrali6es

acidsacids

! Mucous protects from acidsMucous protects from acids

! 9ile emulsi$es fats9ile emulsi$es fats


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Hormones &m#ortant in +m.Hormones &m#ortant in +m.

&ntestine Digestive Activit$ &ntestine Digestive Activit$ +ecretin+ecretin

-holec$cto)inin (--6"-holec$cto)inin (--6" 'ntero)inase'ntero)inase

Pancreatic enz$mesPancreatic enz$mes

! 7i#ase, Am$lase, Pe#tidases,7i#ase, Am$lase, Pe#tidases,8r$#sinogen, 8r$#sin8r$#sinogen, 8r$#sin


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! Digestive en6ymesDigestive en6ymes

Salivary amylaseSalivary amylase PepsinPepsin Pancreatic en6ymes:Pancreatic en6ymes:

! "rypsin "rypsin

! 7hymotrypsin7hymotrypsin! 7arbo+ypeptidase7arbo+ypeptidase

! NucleasesNucleases

! Pancreatic lipasePancreatic lipase

! Pancreatic amylasePancreatic amylase

.ntestinal en6ymes:.ntestinal en6ymes:! PeptidasesPeptidases

! DisaccharidasesDisaccharidases

! ipaseipase

!NucleotidasesNucleotidases


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! 5ormones5ormones

7holecysto2inin ! secretion stimulated by7holecysto2inin ! secretion stimulated byfat in duodenumfat in duodenum

! 7ontraction of gall bladder7ontraction of gall bladder! Pancreatic secretion of en6yme rich materialPancreatic secretion of en6yme rich material

Secretin ! secretion stimulated by lo# p5Secretin ! secretion stimulated by lo# p5in duodenumin duodenum

! Secretion of bile from the liverSecretion of bile from the liver! Pancreatic secretion of 578Pancreatic secretion of 57811 rich =uice rich =uice


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AbsorptionAbsorption! Nutrients bro2en do#n into simple sugars0Nutrients bro2en do#n into simple sugars0

fatty acids and amino acidsfatty acids and amino acids

! Principle sites of absorptionPrinciple sites of absorption

Duodenum: iron0 calcium0 vitamins0 fats0 sugars0Duodenum: iron0 calcium0 vitamins0 fats0 sugars0amino acids0 vitaminsamino acids0 vitamins

e=unum: fat0 sugar0 amino acid *largely complete by e=unum: fat0 sugar0 amino acid *largely complete by

mid =e=unum,0 vitaminsmid =e=unum,0 vitamins .leum: vitamin 9.leum: vitamin 9>?>? and bile saltsand bile salts

! Most bile salts are absorbed and recirculated to theMost bile salts are absorbed and recirculated to the

liver ! important in maintaining bile poolliver ! important in maintaining bile pool


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Pancreatic 'nz$mesPancreatic 'nz$mes

Am$lase 9 brea)s -H1 starch to maltose, Am$lase 9 brea)s -H1 starch to maltose,maltriose, and small branched structuresmaltriose, and small branched structures

7i#ase 9 brea)s don trigl$cerides into7i#ase 9 brea)s don trigl$cerides intofatt$ acids and gl$cerolfatt$ acids and gl$cerol

Proteol$tic enz$mes brea) #e#tides donProteol$tic enz$mes brea) #e#tides donto amino acids and di#e#tide fragmentsto amino acids and di#e#tide fragments

8r$#sinogen8r$#sinogen! converted to tr$#sin b$ enz$me (entero)inase"converted to tr$#sin b$ enz$me (entero)inase"

located along inner all of small intestinelocated along inner all of small intestine

! tr$#sin converts other #ancreatic z$mogenstr$#sin converts other #ancreatic z$mogens(inactive forms" to their active forms ithin(inactive forms" to their active forms ithinthe small intestinethe small intestine


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Pancreatic 'nz$mesPancreatic 'nz$mes

(continued"(continued" Most #ancreatic enz$mes are #roducedMost #ancreatic enz$mes are #roduced

as inactive molecules 5 z$mogensas inactive molecules 5 z$mogens

Are trans#orted to small intestine in Are trans#orted to small intestine in z$mogen form z$mogen form

Protects the #ancreas from :selfProtects the #ancreas from :selfdigestion; digestion;


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7iver (continued"7iver (continued"

Digestive functionsDigestive functions! secretes bile 9 essential for digestion andsecretes bile 9 essential for digestion and

absor#tion of fatsabsor#tion of fats

! Function 1 overall is to $lter and processFunction 1 overall is to $lter and processnutrient1rich blood0 not =ust a digestive functionnutrient1rich blood0 not =ust a digestive function

regulates carbohydrate metabolism through glycogenregulates carbohydrate metabolism through glycogenstorage and releasestorage and release

regulates many aspects of lipid metabolism0 eg%0regulates many aspects of lipid metabolism0 eg%0

cholesterol synthesis and release of 2etonescholesterol synthesis and release of 2etones deto+i$es blooddeto+i$es blood

urea and bile synthesisurea and bile synthesis


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Non9digestive functionsNon9digestive functions! circulator$ functions> destro$s aged orcirculator$ functions> destro$s aged or

abnormal blood cells and #roduces clottingabnormal blood cells and #roduces clotting

factorsfactors

! converts #rotein metabolites to urea forconverts #rotein metabolites to urea for

elimination b$ )idne$selimination b$ )idne$s

! immune function (6u#?er cells"immune function (6u#?er cells"! functions as blood reservoir in regulation offunctions as blood reservoir in regulation of

blood volumeblood volume

7iver (continued"7iver (continued"


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%all


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brea)s large fat globules into

smaller fat dro#lets, #rovides greater surfacesmaller fat dro#lets, #rovides greater surfacearea on hich li#ase can act area on hich li#ase can act


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9ile Synthesis9ile Synthesis "his is the main digestive function of the liver' "his is the main digestive function of the liver'

Appro+imately > liter per day is producedAppro+imately > liter per day is produced

bile salts are cholesterol derivatives and function tobile salts are cholesterol derivatives and function toemulsify fatsemulsify fats

bile salts are recycled0 not e+cretedbile salts are recycled0 not e+creted

main bile pigment is bilirubin0 derived from &97main bile pigment is bilirubin0 derived from &97

hemeheme bile is synthesi6ed in the liver and stored in thebile is synthesi6ed in the liver and stored in the

gallbladdergallbladder

release is stimulated by cholecysto2inin and vagusrelease is stimulated by cholecysto2inin and vagus

nervenerve


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Intestinal Contractions and Motility

• 2 major types ofcontractions occur inthe small intestine: – Peristalsis:

• Slow movement.

• Pressure at thepyloric end ofsmall intestine isreater than atthe distal end.

– Sementation:

• Major contractileactivity of thesmall intestine.

• Contraction ofcircular smoothmuscle.

– Mi! chyme.

.nsert $g% >%>G


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Large

Intestine


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Anatomy andAnatomy and


Functions *convertsFunctions *convertschyme to feces,chyme to feces,

! Absorption of #ater andAbsorption of #ater andelectrolytes *mainly onelectrolytes *mainly onright side,right side, Absorbs HH ml #ater;dayAbsorbs HH ml #ater;day 7apacity >IHH1?HHH7apacity >IHH1?HHH

ml;day *#hen e+ceededml;day *#hen e+ceededresults in diarrhea,results in diarrhea,

! Sigmoid colon reservoirSigmoid colon reservoirfor dehydrated fecalfor dehydrated fecalmassmass J?HH g feces;dayJ?HH g feces;day

! Kater ! H1LHKater ! H1LH! Food residueFood residue! 9acteria9acteria! 7ells7ells! Unabsorbed mineralsUnabsorbed minerals


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Anatomy and PhysiologyAnatomy and Physiology! Secretes mucus *no en6ymes,Secretes mucus *no en6ymes,

! 9acteria produce vitamin C and several 9)s9acteria produce vitamin C and several 9)s

! Flatus *N5Flatus *N50 780 78??0 50 5??0 50 5??S0 75S0 75GG,, 7878?? produced #hen fatty acids and 57l areproduced #hen fatty acids and 57l are

neutrali6ed by bicarbonateneutrali6ed by bicarbonate

9acterial fermentation of carbohydrates9acterial fermentation of carbohydratesproduces 78produces 78??0 50 5??0 750 75GG

J>HHH ml e+pelled each dayJ>HHH ml e+pelled each day E+cess occurs #ith aerophagia and diets high inE+cess occurs #ith aerophagia and diets high in

indigestible carbohydratesindigestible carbohydrates

! &ectum and anus sites of some of most&ectum and anus sites of some of most

common disorders 2no#n to humanscommon disorders 2no#n to humans 7onstipation7onstipation 5emorrhoids5emorrhoids Abscesses and $stulasAbscesses and $stulas 7olon and rectal cancer7olon and rectal cancer


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9acteria live in the colon and9acteria live in the colon andstimulate the production of vitamin Cstimulate the production of vitamin C

and some of the 9 comple+ vitaminsand some of the 9 comple+ vitamins

Mucus is produced but no en6ymesMucus is produced but no en6ymesare secreted in the large intestineare secreted in the large intestine


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D.-ES".E A7"..".ES 8FD.-ES".E A7"..".ES 8F

A&-E .N"ES".NEA&-E .N"ES".NE

STRUCTURE ACTIVITY RESULT

Mucosa Secretesmucus

"u#ricates colon $protects mucosa

%#sor#s water Maintains water#alance& solidifiesfeces& a#sor#s

vitamins $ some ions


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"umen 'acterialactivity

'rea(s downundiestedcar#ohydrates)protein) $ amino acidsinto products that can#e e!pelled in feces

or a#sor#ed $deto!ified #y liver

Synthesi*es certain 'vitamins $ vitamin +


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Muscularis Massperistalsis

-orces contents intosimoid colon

efecationrefle!

/liminates feces #ycontractions in simoidcolon $ rectum


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Secretion &

H 2O

absorption

2000 ml – 150 ml = ?


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Ion & Vitamin

absorption


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Rectum

0he

efecation

1efle!


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Defecation processDefecation process

&e3e+ rela+ation of internal sphincter&e3e+ rela+ation of internal sphincter

alsalva maneouvre raisingalsalva maneouvre raising

intraabdominal pressureintraabdominal pressure &ela+ation of puborectalis *anorectal&ela+ation of puborectalis *anorectal

angle,angle,

oluntary rela+ation of e+ternaloluntary rela+ation of e+ternalsphinctersphincter

Defecation reflex


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Defecation reflex> 15 mm Hg


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Disorders of the -. tractDisorders of the -. tract

Mouth and throatMouth and throat! gingivitis 1 infection of the gum0 can leadgingivitis 1 infection of the gum0 can lead

to periodonititis involving the supportingto periodonititis involving the supporting

bone of the teethbone of the teeth! incent)s disease 1 a 2ind of gingivitisincent)s disease 1 a 2ind of gingivitis

caused by a spirochetecaused by a spirochete

! eu2opla2ia 1 characteri6ed by thic2enedeu2opla2ia 1 characteri6ed by thic2ened

#hite patches on the mucous membranes#hite patches on the mucous membranesof the mouth 1 common in smo2ers andof the mouth 1 common in smo2ers and

may be a precursor to cancermay be a precursor to cancer

Symptoms of esophageal disordersSymptoms of esophageal disorders


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Symptoms of esophageal disordersSymptoms of esophageal disorders

DysphagiaDysphagia! Sub=ective a#areness of an impairment ofSub=ective a#areness of an impairment of

s#allo#ings#allo#ing

! Ma=or symptom for diseases of the pharyn+ orMa=or symptom for diseases of the pharyn+ oresophagusesophagus

! 8ccurs in some non1esophageal disorders resulting8ccurs in some non1esophageal disorders resulting

from vascular or neurologic diseasefrom vascular or neurologic disease! May be of obstructive or motor originMay be of obstructive or motor origin 8bstructive causes8bstructive causes

! StrictureStricture

! "umors "umors

Motor causesMotor causes! .mpaired peristalsis.mpaired peristalsis! Dysfunction of UES or ESDysfunction of UES or ES

! 7ommon motor disorders ! achalasia0 scleroderma0 di4use7ommon motor disorders ! achalasia0 scleroderma0 di4useesophageal spasmesophageal spasm

Symptoms of esophageal disorders ! cont%Symptoms of esophageal disorders ! cont%


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Symptoms of esophageal disorders cont%Symptoms of esophageal disorders cont%

Pyrosis *heart burn,Pyrosis *heart burn,! 7aused by re3u+ of gastric acid or bile secretions7aused by re3u+ of gastric acid or bile secretions

! Persistent re3u+ caused by incompetent ESPersistent re3u+ caused by incompetent ES! results from e+cess stretching of the lo#erresults from e+cess stretching of the lo#er

esophagus' not due to hyperacidity of theesophagus' not due to hyperacidity of thestomachstomach

8dynophagia8dynophagia! Pain induced by s#allo#ingPain induced by s#allo#ing

&egurgitation&egurgitation! 9ac2 3o# into mouth9ac2 3o# into mouth

! E4ortless *as opposed to vomiting,E4ortless *as opposed to vomiting,

! 7ommon in infants7ommon in infants! &e3ects both ES incompetence and failure of UES&e3ects both ES incompetence and failure of UES

to serve as regurgitation barrierto serve as regurgitation barrier

Disorders of esophageal motilityDisorders of esophageal motility


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AchalasiaAchalasia! De$nition / uncommon hypomotility disorderDe$nition / uncommon hypomotility disorder

characteri6ed by #ea2 and uncoordinated peristalsischaracteri6ed by #ea2 and uncoordinated peristalsisor aperistalsis #ithin the body of the esophagus0or aperistalsis #ithin the body of the esophagus0

elevated ES pressure and failure of ES to rela+elevated ES pressure and failure of ES to rela+

completelycompletely

Foods and li


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Achalasia 1 cont%Achalasia 1 cont%! "reatment "reatment

Palliative0 measures to relieve obstruction ofPalliative0 measures to relieve obstruction of

lo#er esophaguslo#er esophagus! No #ay to restore peristalsisNo #ay to restore peristalsis

"#o forms of therapy "#o forms of therapy! Dilation of ES #ith pneumatic bag or mercuryDilation of ES #ith pneumatic bag or mercury

$lled bag *bougie,$lled bag *bougie,

! Surgery to open ES accompanied by pyloroplastySurgery to open ES accompanied by pyloroplasty

i d f h l ili


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Disorders of esophageal motility ! cont%Disorders of esophageal motility ! cont%

Di4use esophageal spasmDi4use esophageal spasm! De$nition / uncoordinated0 nonpropulsiveDe$nition / uncoordinated0 nonpropulsive

contractions in response to s#allo#ingcontractions in response to s#allo#ing

! 7ause un2no#n ! more common in patients O IH7ause un2no#n ! more common in patients O IH Fairly commonFairly common

! Usually asymptomaticUsually asymptomatic Sometimes dysphagia and odynophagia that areSometimes dysphagia and odynophagia that are

aggravated by cold foods0 large boluses and nervousaggravated by cold foods0 large boluses and nervoustensiontension

Sometimes chest pain that may be confused #ith anginaSometimes chest pain that may be confused #ith angina

! "reatment "reatment Avoid cold foods and large mealsAvoid cold foods and large meals Antacids0 sedatives0 nitroglycerineAntacids0 sedatives0 nitroglycerine Esophageal dilation is symptoms persistent andEsophageal dilation is symptoms persistent and

distressingdistressing

Disorders of esophageal motility ! cont%Disorders of esophageal motility ! cont%


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SclerodermaScleroderma!

Esophageal motor dysfunction occurs inEsophageal motor dysfunction occurs inO ?; of patients #ith progressiveO ?; of patients #ith progressive

systemic sclerosis *scleroderma,systemic sclerosis *scleroderma,

! Atrophy of smooth muscle in lo#erAtrophy of smooth muscle in lo#er

portion of esophagusportion of esophagus! .ncompetence of ES often leads to re3u+.ncompetence of ES often leads to re3u+

esophagitis and subse


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EsophagitisEsophagitis

De$nition / in3ammation of theDe$nition / in3ammation of the

esophageal mucosaesophageal mucosa May be acute or chronicMay be acute or chronic

! .nnocuous type follo#s ingestion of hot.nnocuous type follo#s ingestion of hot

li


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0he lower esophaus here shows sharply demarcated ulcerations that

have a #rownred #ase) contrasted with the normal pale white

esophaeal mucosa at the far left. Such 4punched out4 ulcers are

suestive of heres simle# in$e%"ion&



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7hronic re3u+ esophagitis and 5iatus7hronic re3u+ esophagitis and 5iatus

5ernia5ernia! Most common formMost common form

! 7ause ! incompetence of ES and re3u+ of7ause ! incompetence of ES and re3u+ of

gastric or intestinal =uice into esophagusgastric or intestinal =uice into esophagus often associated #ith hiatus herniaoften associated #ith hiatus hernia

! Mechanisms that prevent re3u+Mechanisms that prevent re3u+

"one of sphincter in ES "one of sphincter in ES

Angle of entry ! creates a 3ap valveAngle of entry ! creates a 3ap valve .ntra1abdominal pressure closes segment of.ntra1abdominal pressure closes segment of

esophagus belo# diaphragmesophagus belo# diaphragm

Esophagitis ! cont%Esophagitis ! cont%


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! 5iatus *hiatal, hernia5iatus *hiatal, hernia

5erniation of portion of stomach into chest5erniation of portion of stomach into chest

? types? types! Direct or sliding *most common,Direct or sliding *most common,

-astroesophageal =unctions slides into thoracic-astroesophageal =unctions slides into thoracic

cavitycavity

ES opens causing re3u+ES opens causing re3u+ 8ften asymptomatic8ften asymptomatic

! Paraesophageal or rollingParaesophageal or rolling

Part of fundus roles through hiatusPart of fundus roles through hiatus

ES remains competent and no re3u+ES remains competent and no re3u+

Ma=or complication is strangulationMa=or complication is strangulation

.mportant clinical consideration is if there is.mportant clinical consideration is if there isre3u+re3u+

Esophagitis ! cont%Esophagitis ! cont%


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"reatment of sliding hernia "reatment of sliding hernia

! -oal is to prevent re3u+ or neutrali6e-oal is to prevent re3u+ or neutrali6ere3u+re3u+

Fre


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StomachStomach! 5iatal hernia 1 a #ea2ness in the5iatal hernia 1 a #ea2ness in the

diaphragm at the point #here thediaphragm at the point #here the

esophagus connects allo#ing theesophagus connects allo#ing thestomach or other abdominal organsstomach or other abdominal organs

protrude up#ardsprotrude up#ards

! nausea and vomiting 1 caused by annausea and vomiting 1 caused by an

interruption of for#ard movement ofinterruption of for#ard movement ofnutrition' reverse peristalsisnutrition' reverse peristalsis


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Stomach0 continuedStomach0 continued! gastritis 1 in3ammation of the stomachgastritis 1 in3ammation of the stomach

mucosa' causes include irritation by spicymucosa' causes include irritation by spicy

food0 drugs0 alcohol0 or nicotinefood0 drugs0 alcohol0 or nicotine

! stomach cancer 1 males are morestomach cancer 1 males are more

susceptible than females' symptoms usuallysusceptible than females' symptoms usually

long standing indigestionlong standing indigestion

! peptic ulcer 1 most common ages H1GI'peptic ulcer 1 most common ages H1GI'causative factors include smo2ing0 drin2ing'causative factors include smo2ing0 drin2ing'

anti1in3ammatory drugs and bacterium0anti1in3ammatory drugs and bacterium0

5elicobacter pylori5elicobacter pylori

-astritis ! in3ammation or hemorrhagic-astritis ! in3ammation or hemorrhagicdi i f h


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condition of the mucosacondition of the mucosa

Acute super$cial gastritisAcute super$cial gastritis

! Erodes surface of epithelium in di4use orErodes surface of epithelium in di4use orlocali6ed patternslocali6ed patterns

! 7auses7auses Drugs ! NSA.DSDrugs ! NSA.DS

7hemicals ! alcohol0 bile acids0 pancreatic en6ymes07hemicals ! alcohol0 bile acids0 pancreatic en6ymes0ca4eine0 strong spicesca4eine0 strong spices 5elicobacter pylori5elicobacter pylori

! 7linical manifestations7linical manifestations ague abdominal discomfortague abdominal discomfort

Epigastric tendernessEpigastric tenderness 9leeding9leeding omitingomiting 5ematemesis5ematemesis


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0his is a typical a%u"e !as"ri"is with a diffusely hyperemic

astric mucosa. 0here are many causes for acute astritis:

alcoholism) drus) infections) etc.

-astritis ! in3ammation or hemorrhagic condition of the-astritis ! in3ammation or hemorrhagic condition of the

tmucosa cont


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mucosa 1 cont%mucosa 1 cont%

! Usually resolves #hen o4ending agentUsually resolves #hen o4ending agentremovedremoved

Antiemitic drugs to relieve nausea and vomitingAntiemitic drugs to relieve nausea and vomiting

May need to correct 3uids and electolytesMay need to correct 3uids and electolytes

Acid bloc2ers and antacidsAcid bloc2ers and antacids Sulcrafate to coat stomach liningSulcrafate to coat stomach lining

-astritis 1 cont%-astritis 1 cont%


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7hronic atrophic gastritis7hronic atrophic gastritis! Progressive atrophy of glandularProgressive atrophy of glandular

epithelium #ith loss of parietal and chiefepithelium #ith loss of parietal and chief

cellscells

Decreased 57l0 pepsin and intrisic factorDecreased 57l0 pepsin and intrisic factorproductionproduction

! 7aused mainly by 5% pylori7aused mainly by 5% pylori

More often in elderlyMore often in elderly

Alcohol0 hot tea and smo2ing may predisposeAlcohol0 hot tea and smo2ing may predispose

! May lead to gastric ulcers or carcinomaMay lead to gastric ulcers or carcinoma


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5astritis is often accompanied #y infection with 'eli%oba%"er ylori&

0his small curved to spiral rodshaped #acterium is found in the

surface epithelial mucus of most patients with active astritis. 0he rods

are seen here with a methylene #lue stain.


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0his of astric mucosa reveals the presence of many short) curved rodli(e oranisms

overlyin the mucosa. 0hese are 'eli%oba%"er ylori oranisms) whose home is theastric mucus. 0he incidence of ,. pylori infection increases with ae) with half of

%merican adults infected #y ae 67. ,. pylori oranisms #rea( down mucosal

lycoproteins and damae epithelial cells) leadin to inflammationa chronic astritis

that is asymptomatic in most cases. Peptic ulcer disease) particularly duodenal

ulceration) is stronly associated with ,. pylori infection) which may also play a role in

development of astric carcinoma. %nti#iotic treatment of ,. pylori reduces these

complications


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-astritis 1 cont%-astritis 1 cont%

! Symptoms generally varied andSymptoms generally varied and

vaguevague

Feeling of fullnessFeeling of fullness

Anore+iaAnore+ia ague epigastric distressague epigastric distress

! "reatment varies depending on "reatment varies depending on

causecause

AntibioticsAntibiotics

Avoid irritantsAvoid irritants

7orrect iron de$ciency if present7orrect iron de$ciency if present

itamin 9itamin 9>?>? supplementsupplement


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PA"8-ENES.S B "E&AP.PA"8-ENES.S B "E&AP.

-AS"&.".S DAN "UCAC-AS"&.".S DAN "UCACPEP".C PEP".C


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P+NDA,-L-AP+NDA,-L-A

NN enyebab gastritis dan tukak peptikenyebab gastritis dan tukak peptikadalah

dalah

multifaktor

ultifaktor

atofisiologi dasar adalah gangguan

atofisiologi dasar adalah gangguan

keseimbangan antara faktor-faktoreseimbangan antara faktor-faktor agresifgresif

dan faktor-faktor

an faktor-faktor

defensif

efensif

Sebagian penderita yang telah diobati

ebagian penderita yang telah diobati

dan sembuh ternyataan sembuh ternyata kambuhambuh lagilagi

Kualitas penyembuhan luka

ualitas penyembuhan luka

diduga

diduga

berperan penting dalam terjadinya

erperan penting dalam terjadinya

kekambuhan penyakit iniekambuhan penyakit ini

Pathophysiology of Peptic Ulceration


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I&I& (as"ri% a%id se%re"ion homeos"a"a"is and !as"roduodenal(as"ri% a%id se%re"ion homeos"a"a"is and !as"roduodenal

mo"ili"ymo"ili"yII&II& Ei"helial de$ense me%hanismEi"helial de$ense me%hanism

III&III& ')')

IV&IV& *SAID*SAID

V&V& O"her ul%ero!eni%O"her ul%ero!eni%

Multi$le causes of P-DMulti$le causes of P-D

NSAIDs -astric acid Stress

Defense

.n3ammation,* Pylori

Pathophysiology of Peptic Ulceration


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% 8 cm acute !as"ri% ul%er is shown here in the

upper fundus. 0he ulcer is shallow and sharply

demarcated) with surroundin hyperemia. It is

pro#a#ly #enin. ,owever) all astric ulcers should

#e #iopsied to rule out a malinancy.


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0he stronest association

with ,elico#acter pylori is

with duodenal e"i%

ul%era"ionover 96 of

duodenal ulcers. Seen

here is a penetratin acuteulceration in the duodenum

just #eyond the pylorus. %n

acute duodenal ulcer is

seen in two views on upper

endoscopy in the lowerpanels.

Peptic ulcer disease 1 cont%Peptic ulcer disease 1 cont%


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7omplications7omplications!

5emorrhage5emorrhage

Most freI1?HMost freI1?H

Most common in ulcers of the posterior #all of duodenalMost common in ulcers of the posterior #all of duodenalbulb due to pro+imity of arteriesbulb due to pro+imity of arteries

Symptoms depend on severitySymptoms depend on severity

! AnemiaAnemia! 8ccult blood in stool8ccult blood in stool

! 9lac2 and tarry stool9lac2 and tarry stool

! 5ematemesis5ematemesis

! Shoc2Shoc2 Mortality up to >H 1 higher for patients over IHMortality up to >H 1 higher for patients over IH

Peptic ulcer disease 1 cont%Peptic ulcer disease 1 cont%


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! PerforationPerforation

Appro+imately I of all ulcers perforate 1Appro+imately I of all ulcers perforate 1accounts for I of deaths from peptic ulcersaccounts for I of deaths from peptic ulcers

Usually on anterior #all of duodenum orUsually on anterior #all of duodenum orstomachstomach

"hought to be due to e+cess acid and often a "hought to be due to e+cess acid and often aresult of NSA.DSresult of NSA.DS

7haracteristic presentation7haracteristic presentation! Sudden onset of e+cruciating pain in upperSudden onset of e+cruciating pain in upper

abdomen ! chemical peritonitisabdomen ! chemical peritonitis

! Patient fears to move or breathPatient fears to move or breath

! Abdomen becomes silent to auscultationAbdomen becomes silent to auscultation

and board li2e rigidity to palpationand board li2e rigidity to palpation

"reatment ! immediate surgery "reatment ! immediate surgery

l b i


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Malabsorption !Malabsorption ! intestinal mucosalintestinal mucosalabsorption of single or multiple nutrients isabsorption of single or multiple nutrients is

impaired resulting in inade


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Stomach0 continuedStomach0 continued! pyloric stenosis 1 more common inpyloric stenosis 1 more common in

males than females0 causes persistentmales than females0 causes persistentvomiting because of the stricture in thevomiting because of the stricture in the

pyloric sphincter' re


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.ntestinal disorders.ntestinal disorders! diarrhea 1 abnormal fre


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.ntestinal obstruction.ntestinal obstruction

De$nition / an interference #ith theDe$nition / an interference #ith thenormal 3o# of intestinal contentsnormal 3o# of intestinal contents

through the intestinal tractthrough the intestinal tract

! May be acute or chronic0 partial or completeMay be acute or chronic0 partial or complete

7hronic obstruction usually involves colon as a7hronic obstruction usually involves colon as aresult of a tumorresult of a tumor

Most obstructions involve S.Most obstructions involve S.

7omplete is serious and re


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.ntestinal Disorders0 continued.ntestinal Disorders0 continued! 7olon cancer 1 one of the most common7olon cancer 1 one of the most common

types in the US 1 usuallytypes in the US 1 usually

adenocarcinomas that arise from theadenocarcinomas that arise from the

mucosal lining% 8ccurrence is e


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iver Disordersiver Disorders! 5epatitis 1 in3ammation of the liver by drugs05epatitis 1 in3ammation of the liver by drugs0

alcohol or infectionalcohol or infection

A 1 transmitted in fecal matter' rarely fatal' infectionA 1 transmitted in fecal matter' rarely fatal' infectiona4ords life1long immunity' accine availablea4ords life1long immunity' accine available

9 1 transmitted by direct e+change of blood or body 3uids'9 1 transmitted by direct e+change of blood or body 3uids'accine availableaccine available

7 1 primarily transmitted by direct e+change of blood'7 1 primarily transmitted by direct e+change of blood'

se+ual transmission can occur0 but limitedse+ual transmission can occur0 but limited

D 1 transmitted by direct e+change of blood0 only inD 1 transmitted by direct e+change of blood0 only inconcert #ith 5ep9 infectionconcert #ith 5ep9 infection

E 1 transmitted by fecal contamination of #aterE 1 transmitted by fecal contamination of #ater

i d f h


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iver Disorders0 continuediver Disorders0 continued! 7irrhosis 1 chronic disease in #hich active7irrhosis 1 chronic disease in #hich active

liver cells are replaced by inactive connectiveliver cells are replaced by inactive connective

tissue' most common cause is alcoholismtissue' most common cause is alcoholismcompounded #ith malnutrition% .n latercompounded #ith malnutrition% .n later

stages there is hampering of portal circulationstages there is hampering of portal circulation

causing congestion in the peritoneal cavity 1causing congestion in the peritoneal cavity 1

ascitesascites! 7ancer 1 the liver is a common site for7ancer 1 the liver is a common site for

metastasesmetastases

i d f h


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iver Disorders0 continuediver Disorders0 continued! aundice 1 yello# coloring of the s2in and aundice 1 yello# coloring of the s2in and

eyes' cause is damage to the livereyes' cause is damage to the liver

ma2ing it unable to con=ugate bilirubinma2ing it unable to con=ugate bilirubin

or a bloc2age in the bile ducts #ith bileor a bloc2age in the bile ducts #ith bile

pigment accumulation in the bloodpigment accumulation in the blood

Di d f h -.


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-allbladder-allbladder! -all stones *cholelithiasis, 1 formed from-all stones *cholelithiasis, 1 formed from

cholesterol and bloc2 the ducts' paincholesterol and bloc2 the ducts' pain

occurs #hen the stones prevent the 3o#occurs #hen the stones prevent the 3o#

of bile and hamper the digestive processof bile and hamper the digestive process

! 7holecystitis 1 .n3ammation of the gall7holecystitis 1 .n3ammation of the gall

bladderbladder


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i d f hDi d f th -. t t


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Digestive DisordersDigestive Disorders! Anore+ia 1 chronic loss of appetite' causesAnore+ia 1 chronic loss of appetite' causes

can be physical *heavy e+ercise, or mentalcan be physical *heavy e+ercise, or mental

*more li2ely to be emotional and;or social*more li2ely to be emotional and;or social

rather than physiological disruption in therather than physiological disruption in the

brain,% Anore+ia nervosa a4ects mostlybrain,% Anore+ia nervosa a4ects mostly

young #omenyoung #omen

! 9ulimia *binge1purge syndrome, 1 prevention9ulimia *binge1purge syndrome, 1 prevention

of the absorption of food because of induceof the absorption of food because of induce

vomiting or large doses of la+ativesvomiting or large doses of la+atives


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"han2 Qou "han2 Qou

Pencernaan di rongga mulut


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Pengaturan salivasi


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Struktur oesophagus


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Proses menelan


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oses e e a

Struktur !ungsi


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"ambung

Sekresi


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#erakan

"ambung

#erakan "ambung


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$untah


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$untah

%&omitus'

Pancreas


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Pengaturan


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sekresi pancreas

!ungsi Hati


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Hepar !esica


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&ellea


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Pengaturan

sekresi empedu

(sus Halus


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Physiology of Physiology of Digestion Digestion

Department of PhysiologyDepartment of Physiology

School of MedicineSchool of MedicineUniversity of Sumatera UtaraUniversity of Sumatera Utara

Dr% QudiDr% Qudi5erlambang5erlambang

Fisio Digestion

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