1 / 34

Upper Gastrointestinal Diseases

Upper Gastrointestinal Diseases. Upper GI Diseases. Esophagus Stomach Duodenum. Esophageal Diseases. Esophageal Diseases. Esophageal Symptoms Esophageal Motility Disorders Gastroesophageal Reflux. Esophageal Swallowing Disorders. Esophageal Symptoms

herrod-shaw
Download Presentation

Upper Gastrointestinal Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Upper Gastrointestinal Diseases

  2. Upper GI Diseases • Esophagus • Stomach • Duodenum

  3. Esophageal Diseases

  4. Esophageal Diseases • Esophageal Symptoms • Esophageal Motility Disorders • Gastroesophageal Reflux

  5. Esophageal Swallowing Disorders Esophageal Symptoms • Dysphagia = difficulty swallowing • oropharyngealdysphagia= difficulty initiating swallow or transferring food from mouth into esophagus. Can also experience nasopharyngeal regurgitation (comes out nose) or pulmonary aspiration. • esophageal dysphagia= food gets stuck in esophagus after swallowing

  6. Esophageal Motility Disorders • Achalasia (failure to relax) • Diffuse Esophageal Spasm (DES)

  7. Achalasia • Most often results from post-ganglionicdenervation of smooth muscle of esophagus absence of inhibitory neural input to LES ↑ LES pressure • Functional esophageal obstruction  can lead to esophageal dilatation • Similar disorder in Chagas disease (Trypanosomacruzi causes injury to myenteric plexuses of esophagus)

  8. Diffuse Esophageal Spasm (DES) • periodic chest pain & dysphagia high amplitude, simultaneous, repetitive SM contractions • can be spontaneous or initiated by swallow • barium swallow  “corkscrew” appearance to esophagus • pathogenesis unknown

  9. Gastroesophageal Reflux (GER) • A little bit of GER is normal in all of us • Normally, thoraxic cavity has negative pressure during inspiration • GER would occur continuously without antireflux mechanisms • a portion of esophagus is below the diaphragm  intra-abdominal pressure (+5 mm Hg) can reinforce LES pressure (antirefluxeffect) • Loss of subdiaphragmatic LES  correlation between esophageal hernia and GERD

  10. Gastroesophageal Reflux (GER)Mechanisms • Incompetent anti-reflux mechanisms • Ineffective esophageal clearance • Decreased gastric emptying

  11. Gastroesophageal Reflux (GER)Risk factors • Obesity • Pregnancy • Smoking • High-fat foods • Theophylline • Caffeine • Coffee • Chocolate • High levels of estrogen/progesterone

  12. Gastroesophageal Reflux (GER) • Pyrosis • Dyspepsia • Regurgitation • Dysphagia

  13. Gastroesophageal Reflux (GER) Diagnosis of GER • Best test: pH probe • checks for existence of acid reflux and association between esophageal acid and chest pain • Other tests • Barium swallow • Esophagoscopy • Esophagial biopsy

  14. Gastroesophageal Reflux (GER) • Complications of GERD • Erosive esophagitis • Esophageal ulcer • Bleeding • Esophageal stricture • Intestinal metaplasia (Barrett’s) • Adencarcinoma from Barrett’s • Lung diseases

  15. Gastritis and Ulcer Disease

  16. Peptic Ulcer Disease – Range of injury • Ulcer: A lesion on an epithelial surface (skin or mucous membrane) caused by superficial loss of tissue. • Erosion: A lesion on an epithelial surface (skin or mucous membrane) caused by superficial loss of tissue which is limited to the mucosa.

  17. Peptic Ulcer Disease – Location • Stomach: • typically in antrum (distal stomach – normally lined by columnar epithelium that does not secrete acid - more susceptible to peptic ulceration) • parietal cells located in body/fundus (proximal stomach - ulcers not found as often here)

  18. Peptic Ulcer Disease – Location • Duodenum: • within duodenal bulb • can cause outlet obstruction • usually single • multiple/large/more distal ulcers (Zollinger-Ellison sdr.)

  19. Gastric Mucosa & Secretions • The defensive forces • Bicarbonate • Mucus layer • Mucosal blood flow • Prostaglandins • Growth factors • The aggressive forces • Helicobacter pylori • HCl acid • Pepsins • NSAIDs • Bile acids • Ischemia and hypoxia • Smoking and alcohol • When the aggressive factors increase or the defensive factors decrease, mucosal damage will result, leading to erosions and ulcerations.

  20. Gastritis

  21. Causes of Acute Gastritis • Alcohol • NSAIDs • Helicobacter • Stress/ICU associated

  22. Mechanisms of Acute Gastritis • Drugs (non-steroidal anti-inflammatory drugs NSAID), alcohol cause acute erosion (loss of mucosa superficial to muscularis mucosae).Can result in severe haemorrhage • Acute Helicobacter infection has a prominent neutrophil infiltrate

  23. Chronic Gastritis • A – autoimmune • B – bacterial (helicobacter) • C - chemical

  24. Chronic Gastritis • Type A - Autoimmune (associated with vitamin B12 malabsorption (pernicious anaemia) • Type B - Helicobacter pylori infection • Type C - Chemical damage (bile reflux, drugs)

  25. Helicobacter Pylori • Adapted to live in association with surface epithelium beneath mucus barrier • Causes cell damage and inflammatory cell infiltration • In most countries the majority of adults are infected

  26. Helicobacter Gastritis • Acute inflammation mediated by complement and cytokines • Polymorphisms infiltrate epithelium and may be partly responsible for its destruction • An immune response is also initiated (antibodies may be detected in serum)

  27. Consequences of Gastritis • Peptic ulcer disease (Helicobacter) • Adenocarcinoma (all types)

  28. Definitions • Peptic Ulcer An ulcer of the alimentary tract mucosa, usually in the stomach or duodenum, and rarely in the lower esophagus, where the mucosa is exposed to the acid gastric secretion. It has to be deep enough to penetrate the muscularis mucosa.

  29. Etiology • The two most common causes of PUD are: • Helicobacter pylori infection • Non-steroidal anti-inflammatory drugs (NSAIDS) • Other uncommon causes include: • Gastrinoma (Gastrin secreting tumor) • Stress ulceration (trauma, burns, critical illness) • Viral infections • Vascular insufficiency

  30. Etiology – Helicobacter pylori Helicobacter pylori

  31. PUD – Clinical Presentation Symptoms of PUD • Pain • Epigastric pain • Hunger pain • Nocturnal pain • Other symptoms • Waterbrash • Heartburn • Vomiting • Asymptomatic • 1% - 3% adults endoscopy volunteers • 20% of complicated ulcers present without previous symptoms

  32. Peptic Ulcer Disease - Diagnosis • Diagnosis of ulcer • Diagnosis of H. pylori

  33. Diagnosis of H. pylori Tests for Helicobacter pylori Non-invasive • C13 or C14 Urea Breath Test • Stool antigen test • H. pylori IgG titer (serology) Invasive • Gastric mucosal biopsy • Rapid Urease test

  34. PUD – Complications Complications of PUD • Bleeding • Perforation • Gastric outlet or duodenal obstruction • Chronic anemia

More Related