PATHOPHYSIOLOGY OF

GASTROINTESTINAL
DISEASES
II

PATHOPHYSIOLOGY OF
GASTROINTESTINAL DISEASES
BASIC DISSORDERS OF GI DISEASES :
a. morphology
b. functional
c. etiology : * infection
* malignancy
PROBLEMS SOLVING ORIENTED

MAIN PROBLEMS OF GI DISEASE

NAUSEA AND VOMITING

DYSPHAGIA
DIARRHEA
RECCURRENT ABDOMINAL PAIN
ABDOMINAL COLIC
PASSAGE DISORDERS
GASTROINTESTINAL BLEEDING

NAUSEA,VOMITING & DYSPHAGIA

NAUSEA :
* unpleasant, abdominal sensation
* subjective scale, accompanied by autonomic
changes :
- low gastric tone
- secretion
- salivation
- sweeting
- tacchycardi,
- change respiratory rhythm
* followed by retrograde peristaltik RETCHING

VOMITING

The forceful expulsion of the stomach content

through the mouth
Protective reflex :
* removing toxic
* relieving preassure
Preceded by nausea and retching

DIFFERENTIAL DIAGNOSIS OF
VOMITING

ANATOMIC LOCUS :
* proximate sources of the afferent stim.
- cortex
- chemoceptive trig. zone
- vestibular - peripheral organ
AGE : newborn, infant, child & adult
SUGGESTIVE ASSOCIATED SYMPTOMES :
- content
- periodic
- force
- food
- time
- GI & other organ sympt.

ANATOMIC LOCUS

CORTEX CEREBRI:
* intracranial hypertension & infection
VESTIBULAR :
* OMA , vestibular disorders
CHEMOCEPTIVE TRIGER ZONE :
* toxic chemical content in the blood :
alcohol, ureum, billirubin
PERIPHERAL ORGAN :
* cardiovascular
* GI.system : - meteorism, infection/diarrhea
- ileus, torsi, invagination
- hepatitis (icteric)

D.D. OF VOMITING BY AGE

NEONATAL PERIOD:
* congenital malformation
obstruction
INFANT PERIOD :
* diarrhea, food (prot) allergy, over
feeding, GER, IC hyp, syst.inf.
CHILDREN AND ADULESCENTS :
* diarrhea, toxic ingestion, sys.inf,
appendicitis, IC.hyp, OMA, malrot.

VOMITING CENTER

REGURGITATION

NOT VOMITING, RATHER PASSIVE

NONFORCEFUL EJECTION OF GASTRIC
CONTENTS
REFLUX OF LOWER ESOPHAGEAL
SPHINCTER
INFANTS < 3 MONTHS OF AGE

ETIOLOGY OF DYSPHAGIA
STRUCTURAL :
a. intrinsic : stenosis, web, stricture
b. extrinsic : vascular ring, thyroid
FUNCTIONAL :
* cerebral palsy
* neuropathy
* myopathy
* achalasia
MISCELLANOUS :
* pharyngitis, esophagitis * cicatric
* foreign body
* psychogenic

DIAGNOSIS EVALUATION :

BARIUM FLUOROSCOPY :
a. Structural and obstructing deffect
b. dysmotility : tounge, palate,
oropharynx
c. aspiration
ENDOSCOPY : a. structural, mucosal
b. therapeutic
MANOMETRY : a. tension
b. duration
c. provocation

DIARRHEA

DIFINITION :
* a change in the bowel habit
* increase of frequency and/or volume or
consistency
ACCOMPAINED :
* nausea or vomiting
* vomiting
* abdominal pain

ACUTE & CHRONIC DIARRHEA

ACUTE DIARRHEA : < one week

PROLONGED DIARRHEA
CHRONIC DIARRHEA : > 2 weeks
prolonged mucosal injuries
changes intraintestinal ecology
* chemical
DYSBIOSIS
* microbial

COMMON CAUSES OF
ACUTE DIARRHEA
A. BACTERIAL
B. VIRUS
C. PROTOZOA AND PARASITE

VIRAL AGGRESSION

ENTEROTOXICOGENIC ORGANISM
AGGRESSION

INVASIVE BACTERIA AGGRESSION

PATHOPHYSIOLOGY OF
GASTROENTERITIS

ACUTE GE.IS MOSTLY INFECTION

AGENTS :
1. Adherence enterotoxin functional impair
2. Adherence invasive cytotoxin
* cell destruction & inflammatory diarrhea
* cell penetration invade blood stream across
lamina propria enteric fever

CONSTIPATION/ENCOPRESIS

CONSTIPATION : INFREQUENT PASSAGE OF

HARD, DRY STOOL
less of bowel movement
infection
voluntary withholding/functional cnstip.
ENCOPRESIS : SOILING BY FORMED STOOL
embarrassment due to constipation
unable to sense the need to defecate

CAUSES OF CONSTIPATION

INTESTINAL:
anal fisuure / stenosis
Hirschprung
pseudo obstruction/stricture post NEC
DRUGS:
lead, narcotic, anti depressant
METABOLIC:
dehydration, hypothyroid, hypo K / Cal
NEUROMUSCULAR:
myotonic dystrophy, spina bifida

ACID PEPTIC DISEASE

GASTRIC SECRETION DISS. DUE

HELICO BACTER PYLORI (urea splitting bactaria)
GASTRITIS :
acute epigastric pain, acute gastritis followed by
aspirin or NSID , viral
GASTRIC / DUODENAL ULCER :
epigastric pain, bloody vomiting
PSYCHOEMOSSIONAL AND ENVIRO MENTAL
HYGIENE

PYLORIC STENOSIS

THE FIRST 2 MONTHS OF LIFE, MOST

CONGENITAL ANOMALI ARE INGUINAL
HERNIA AND PYLORIC HYPERTROPHY
PYLORIC SPASM HYPERTROPH
CLINICAL :
- nonbillous vomiting more frequent
and projectile
- olive shape mass to the right of umbil.
- weight loss
- USG

ABDOMINAL PAIN
NATURE OF PAIN :
* spasm (colic) : intestine, duct, vesicle
* dull
: inflamation/infection, tension
* burning
: inflamation/infection
LOCATION : correlate with the organ (abdominal
quadrant)
- epigastric
: lever, bile, gatric
- periumbillical : gastric, pancreas, biledu.
- lower right
: appendict, urine trac
- lower left
: colon, urine tract

ABDOMINAL COLIC

CORRELATED WITH OTHER SIGNS AND

SYMPTOMES
LOOK AT THE PRE OR POST LOCALIZATION
PROFILE AND LOCALIZATION
cramp condition due to:
* irritation, inflamation, infect.
* passage dissorders

RECCURENT ABDOMINAL PAIN

DEFINITION :
* at least 3 episodes in 3 months
* interferes with normal condition
* school age (5 15 yrs)
* localized periumbilical pain due
to bowel muscle tension
ETIOLOGY & PATHOPHISIOLOGY :
* poorly understood
* not synonyme with immaginary

PATHOPHYSIOLOGY

Bowel motility disturbance :

* distension or spasm
* increased muscle tension
* pain origin from nerves ending in mucosa,
muscle and serosa

FACTORS INFLUENCE ON
RECCURENT ABDOMINAL PAIN
* LOWERED THRESHOLD OF PAIN
* ENVIROMENTAL INFLUENCES :
respons of familymembers
* physically
* psychologically

MEDIATORS OF R.A.P.
PSYCHOLOGICAL
Stress factor
Operant condition
Role modelling
Depression
Family enmeshment
somatization

PHYSIOLOGICAL
Autonomic instability
Lactose intolerence
Gut dysmotility
Constipation
Endogenous opiate

CLINICAL MANIFESTATION
* AGE RANGE 5 14 YEARS
* CHRONIC (AT LEAST 3 EPIDSODES IN 3 MONTHS
PERIOD)
* EPISODES ALTERNATING WITH PAIN FREE PERIOD
* PERIUMBILLICAL LOCATION, NO RADIATION
* VARIABLE SEVERITY (mild to severe)
* NATURE OF PAIN(cramping, dull, burning)
* INCONSISTENT RELATIONSHIP TO MEAL, BOWEL
MOVEMENT AND GENERAL ACTIVITY
* DISTURBENCE OF NORMAL ACTIVITY

ABDOMINAL COLIC

CORRELATED WITH OTHER SIGNS AND

SYMPTOMES
LOOK AT THE PRE OR POST LOCALIZATION
PROFILE AND LOCALIZATION

ANATOMIC LOCALISATION OF
ABDOMINAL

GI.PASAGE DISSORDERS

MAIN SYMPTOMES :
* vomiting
* meteorism abd. distention
* bloody stool
MORPHOLOGY OF DISSORDERS:
* strangulation * tumor tension
* invagination
* intestinal cont.
* kinking

GASTROINTESTINAL BLEEDING

HEMATEMESIS:
- blood stain emesis : prox.of lig.Treitz
- coffe ground emesis : gastric
MELENA:
- black /dark color stool : oropharynx
prox.intest. with stassis in right colon
HEMATOCHEZIA:
- bright red or maroon color stool massive GI bleeding
- blood coating the stool rectal/anal
OCCULT BLEEDING: on going bleeding

D.D. OF G.I.BLEEDING
INFANT

CHILD/ADOLESCENT

Swallowed material blood

Anal fissure
Milk allergy
N.C.E.
Intussupception
Bacterial enteritis
Volvulus
Hemorrhagic dis.of new
born
Meckel diverticulum

Anal fissure
Gastritis/gastric ulcer
Intussupception
Foreign body
Polyps/teleangiectasia
Coagulopathy
Hemolytic uremic synd
Henoch Scholein purpura
Meckel diverticulum
hemorrhoid