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PATHOLOGY GIS

Aanisah F 14.103
Common Symptoms & Signs
1. Dysphagia
2. Odynophagia
3. Dyspepsia
4. Nausea & vomitting
5. Constipation
6. Diarrhea
7. Malabsorption
8. Jaundice
9. GI bleeding
Dysphagia
Mechanical narrowing
Inflammatory stricture
Carcinoma
Mucosal ring (Schatzkis ring)
Motor disorders
Esophageal spasm
Achalasia
Non esophageal (neuromuscular disease)
Odynophagia
Pain on swallowing
Infections of esophagus (esophagitis), due to
Candida albicans or Herpes virus
Dyspepsia
Acute, chronic, or recurrent pain or discomfort
centered in the upper abdomen.
Bloating, early satiety, nausea, and vomiting.
Nausea & Vomitting
Nausea is an unpleasant sensation characterized
by sickness accompanied by expectant vomiting.
Vomiting is the forceful expulsion by mouth of
stomach contents that is accompanied by intense
contraction of the abdominal wall muscles.
Constipation
Having fewer than three bowel movements a
week.
Persistent symptoms of difficult evacuation,
including straining, stools that are excessively
hard, unproductive urges, infrequency, and a
feeling of incomplete evacuation.
Diarrhea
Daily stool volume in excess of 250 mL (stool
weight >250 g).
Classification:
Acute
Non inflammatory
Inflammatory
Chronic
Osmotic
Secretory
Inflammatory
Functional
Malabsorption
Impaired delivery of ingested nutrients to the
blood stream.
It is either the result of maldigestion or
malabsorption itself.
Maldigestion: a defect in the processing and
enzymatic splitting within the gastrointestinal
tract.
Fat
Emulsifikasi
Llipolisis
Miselisasi
Carbohydrate
Protein
Vitsmin & minerals
Jaundice
The normal plasma concentration of bilirubin is
maximally 17mol/L (1mg/dL). If it rises to more
than 30mol/L, the sclera become yellow; if the
concentration rises further, the skin turns yellow
as well.
Types of jaundice:
Prehepatic jaundice
Intrahepatic jaundice
Posthepatic jaundice
GI Bleeding
Upper GI bleeding
Presents as hematemesis/melena
Lower GI bleeding
Occur below the ligament of Treitz.
The left colon is the source of bright red blood per rectum,
while the right colon is the source of LGIB presenting as
melena.
Diagnostic Tools Upper GIT
Barium Esophagography
A radiographic barium study to differentiate
between mechanical lesions and motility
disorders, providing important information about
the latter in particular.
Upper Endoscopy
The study of choice for evaluating persistent
heartburn, dysphagia, odynophagia, and
structural abnormalities detected on barium
esophagography.
It allows biopsy of mucosal abnormalities and of
normal mucosa.
Esophageal Manometry
Esophageal motility may be assessed using
manometric techniques
Esophageal pH Recording
There are two kinds of systems in use:
Catether-based
Wireless
Peptic Ulcer
An ulcer is a localized mucosal breach of the
stomach or duodenum that penetrates the
muscularis mucosa
Pathogenesis
An imbalance between protective mechanisms
(mucus, bicarbonate and mucosal circulation) and
offensive agents (acid,pepsin,and H. pylori) is
necessary to injure the mucosa.
Protective Mechanism
Preepithelial
A gel like mucus film (glycoprotein lipid)
Epithelial
Secreted HCO3-
Restitution: EGF, TGF-, FGF
Subepithelial
Mucosal blood flow
Angiogenesis: FGF, VEGF
Prostaglandin
Offensive Agents
Helicobacter pylori
Strains producing the virulence factor, cytoxin
associated gene A (CagA), are associated with
increased epithelial damage.
More likely to cause ulcers in the antrum and
duodenum.
Damages the D cells leading to decreased
somatostatin production.
Produces urease, proteases and phospholipases.
Binds to class II MHC (gastric epithelial)
apoptosis.
NSAIDs
Gastric ulcer Duodenal ulcer

Epigastric pain occurring shortly Epigastric pain occur before


after meals meals and at night (hunger pain)

Anorexia, nausea and vomiting, The pain is relieved by antacids


and weight loss are more likely and food

Epigastric tenderness is the most Epigastric tenderness is the most


frequent finding on physical frequent finding on physical
examination examination
Diagnosis
Upper endoscopy is the test of choice to establish
the diagnosis.
If a duodenal ulcer is discovered, antral biopsies
to establish the presence of H. pylori are
indicated.
If a gastric ulcer is found, biopsies from the edges
of the ulcer are necessary to rule out malignancy
and to investigate the presence of H. pylori.
References
Schmitz, Paul G. Internal Medicine. McGraw-Hill
eBook.
Silbernagl, Stefan. Color Atlas of Pathophysiology.
Thieme.
Harrisons Principles of Internal Medicine 16th
Edition
Thank You