Diseases of the gastrointestinal tract (1).pptx

the diseaes in the stomach

1. Diseases of the gastrointestinal tract 1. Diseases of the salivary glands . 2. Diseases of the esophagus . Classification . 3. Acute and chronic gastritis , classification . 4. Peptic ulcer disease , morphology of acute and chronic ulcers . 5. Tumors of the esophagus and stomach . 6. Intestinal diseases : congenital anomalies , vascular diseases , non-specific ulcerative colitis Crohn's disease . 7. Diseases of the appendix of the cecum . 8. Intestinal tumors

2. Diseases of the esophagus Esophagitis - inflammation of the esophageal mucosa . Classification : Acute and chronic esophagitis . Etiology : chemical burns , thermal burns , microbial infections ( diphtheria ), allergies . Forms : catarrhal , ulcerative .

3. 2. Esophageal diverticulum - single blind protrusion of the wall , several protrusions – diverticulosis . a. True – all layers of the wall protrude . b. False – only the mucosal and submucosal layers . In gastroenterology , among the diverticula of the gastrointestinal tract , they account for about 50 %. More often , esophageal diverticula is diagnosed in men over 50 years of age , as a rule , suffering from other diseases of the digestive system – peptic ulcer , cholecystitis , GI

4. T rue diverticulum False diverticulum Esophageal diverticulum can be manifested by a feeling of tickling, a lump in the throat, dysphagia,putrid breath. Diverticulae are diagnosed by esophageal radiography and esophagoscopy .

5. Esophageal cancer - a malignant tumor that forms from the degenerated epithelium of the esophageal wall . Clinically manifested by progressive swallowing disorders , weight loss . The tumor is detected by X- ray , endoscopic examination , CT or ultrasound .

6. Stomach diseases Gastritis - inflammation of the gastric mucosa , accompanied by impaired secretion and motility . There are acute and chronic gastritis . forms of acute gastritis : Catarrhal ( simple ) gastritis - the gastric mucosa is thickened , swollen , hyperemic , its surface is abundantly covered with mucus .

7. Fibrinous gastritis - on the surface of the mucous membrane of the fibrinous film of yellow-brown color . Phlegmonous gastritis is a pronounced thickening of the mucous membrane and submucosal base , diffuse impregnation with purulent exudate . Necrotic ( corrosive ) gastritis occurs when strong acids , alkalis , cauterize and destroy the mucous membrane . Necrosis ends with the formation of erosions and ulcers .

8. Chronic atrophic gastritis. The gastric mucosa has smoothed folds, is thinned, pale, and grayish in color, with pinpoint hemorrhages and acute erosions.

9. Dystrophic changes in the superficial (pit) epithelium, edema, and inflammatory infiltration by lymphocytes, plasma cells, neutrophils, and occasional eosinophilic leukocytes of the lamina propria of the mucous membrane Chronic superficial antral gastritis.

10. Outcome of acute gastritis : recovery , or transition to chronic . There are two forms of chronic gastritis , which are both stages of the disease . Chronic superficial gastritis is characterized by dystrophy of the epithelium and glands without atrophy .

11. Chronic atrophic gastritis - it is expressed in atrophy of the mucous membrane , its glands . Connective tissue grows in place of atrophied glands . It is important to note that chronic atrophic gastritis is a precancerous disease of the stomach .

12. Peptic ulcer disease stomach and duodenum

13. The essence of gastric ulcer and the duodenum These are chronic recurrent diseases that are prone to progression and are manifested by disorders of the mucous and submucosal layers of the stomach and duodenum . 13

14. E tyology 1. Genetic predisposition . 2. The presence of chronic gastritis and duodenitis . 3. Infection with Helicobacter pylori and candida . 4. Eating disorders and unbalanced nutrition . 5. Abuse of medicinal products that have the following characteristics : ulcerogenic effects ( NSAIDs , corticosteroids ) 6. Smoking and drinking alcohol . Photo of a stomach ulcer that It is caused by smoking on an empty stomach. Alcoholic beverages even "top quality" - the enemy is not only the yolk, the whole body!

15. PATHOGENESIS Theory of occurrence Under the influence of meteorological factors, the functional state of the cerebral cortex is disturbed, as a result, the activity of the parasympathetic nervous system increases, the motility of the stomach and duodenum is disturbed, the secretion of gastric juice increases, the formation of mucus and a protective film on its surface is inhibited. A dystrophic process develops in the stomach and duodenum. This is facilitated by Helicobocter pylori.

16. Pathogenesis 16

17. PATHOGENESIS Pathogenesis of stomach ulcers

18. Helicobacter pylori in the lumen of the glands in chronic atrophic gastritis 18

19. C lassification by localization : I . Peptic ulcer disease of the stomach a ) defeat of the c a rdial part of the stomach ; b) small curvature ; c) large curvature d ) the pyloric part of the stomach . II . Duodenal ulcer disease a) bulb ulcer ; b) post-pubic ulcer ; c) ulcer of unspecified localization .

20. Forms of peptic ulcer disease in the course of : 1. Acute 2. Chronic Course : 1. Latent . 2. Rarely recurrent (1 time in 4-5 years ). 3. Moderately recurrent (1 time in 2-3 years ). 4. Often recurrent (1 time a year or more ).

21. Acute stomach ulcers 21

22. Acute stomach ulcer

23. Chronic stomach ulcer 23

24. Chronic stomach ulcer

25. Chronic duodenal ulcer Chronic stomach ulcer

26. Duodenal ulcer

27. Complications of peptic ulcer diseases: Bleeding . Perforation . Penetration ( germination ). Malignization . Stenosis. Reactive hepatitis . Reactive pancreatitis .

28. Duodenal examination

29. FGS-research

30. I. Malformations Diverticula and diverticular doubling . Diverticulae are often multiple . Diverticular doublings of the small and large intestines are located either in the mesentery of the intestine or have their own mesentery . They are usually complicated by diverticulitis or bleeding without obstruction , 

31. Atresia and stenosis Accompanied by the clinic of high small bowel obstruction (more often) and low colonic obstruction. A characteristic symptom of high atresia is vomiting with an admixture of bile and greens, which appears shortly after the birth of the child and then becomes repeated, occurring both after feeding and between   with them. With low atresia, vomiting and bloating appear on 2-3 days

32. stenosis

33. megacolon and megasigma Megacolon is a pathological enlargement of the colon . It is characterized by thickening of the walls , widening of the lumen and lengthening of the entire colon or any part of it ; subsequently , focal inflammation and atrophy of the mucous membrane develop . It is more common to expand the megasigma and at the same time lengthen it ( megadolichosigma ).

34. Megacolon

35. II. Inflammation Inflammation of the small intestine - enteritis , colon — colitis , and the entire intestine-enterocolitis . A. Depending on the localization of the pathological process , inflammation of the duodenum is distinguished - duodenitis , jejunum - eunit , ileum - ileit . Enteritis can be acute or chronic . Acute enteritis can be : - catarrhal with mucosal-serous exudate ; - fibrinous with fibrinous exudate croup or diphtheria

36. - purulent , when the intestinal wall is diffusely soaked with purulent exudate ; - necrotic-ulcerative . The chronic form begins as chronic enteritis without mucosal atrophy . Gradually , it develops into chronic atrophic enteritis , which is the next stage of chronic enteritis . Acute enteritis manifests itself as a frequent liquid watery stool with greens , which leads to dehydration of the body . Diarrhea is usually accompanied by loss of appetite , nausea . Complaints of abdominal pain , bloating and rumbling .

37. Colitis it is acute and chronic . Acute colitis is the result of infections ( bacteria , viruses ) and intoxication . Depending on the nature of exudate and destructive changes , the following forms of acute colitis are distinguished :: - catarrhal . - purulent ; - hemorrhagic ; - necrotic ; - gangrenous ; - ulcerative

38. Complications of acute colitis : bleeding , perforation and peritonitis , paraproctitis with pararectal fistulas . In some cases , acute colitis takes a chronic course . Chronic colitis , like chronic enteritis , initially proceeds without mucosal atrophy , and later it turns into chronic atrophic colitis and ends with mucosal sclerosis .

39. Аcute colitis is characterized by frequent scanty stools with an admixture of mucus and often blood ( the phenomenon of hemorrhagic colitis ), tenesmus , cramping abdominal pain . Spastic sigmoid colon is often palpated , and in young children - compliance or gaping of the anus .

40. Appendicitis - inflammation of the appendix of the cecum . It is a common disease of unclear etiology . It can be acute or chronic . Acute appendicitis has the following morphological forms : - simple ; - surface ; - destructive ( phlegmonous , phlegmonous-ulcerative , gangrenous ). Complications : perforation of the process wall and development of peritonitis , empyema of the process

41. Chronic appendicitis occurs after acute appendicitis and is characterized mainly by sclerotic and atrophic changes in the appendix wall .

42. Intestinal obstruction It can be dynamic : Paralytic obstruction   it is observed in acute peritonitis due to poisoning and soaking of the intestinal muscles with inflammatory exudate .  Spastic obstruction . It can be reflex , neurogenic , or toxic . This form is more rare and is based on a spasm , most often a limited area of the intestine . Spastic obstruction can become paralytic . 

43. Mechanical obstruction: Strangulation obstruction  ( twisting of the intestines , pinching ). Strangulation obstruction includes infringement by spikes , inversion and invagination .  Strangulation obstruction is more common in men than in women . Children are more likely to get invagination .  Symptoms of obstruction include gas retention , bowel movements , flatulence , lack of peristalsis , bloating , vomiting , and peritoneal phenomena . 

44. Intestinal tumors Benign and malignant diseases

45. There are no symptoms in the early stage of tumor development . After some time , you may notice the following signs of the disease :: Bleeding from the anus preceding the stool ; In the work of the intestine there are frequent failures . Feces is ribbon-shaped feces , sometimes involuntary self-ejaculation of feces can occur ; Relief after defecation does not appear , the patient feels a foreign body ; Often the whole body hurts ; The general condition is getting worse .

46. Pathology of the gallbladder Cholecystitis - acute and chronic Catarrhal Phlegmonous Gangrenous - inflammatory disease of the gallbladder . Women suffer from this disease 5 times more often than men . The average age of such women is 30 years and older . Especially susceptible to cholecystitis are people who are overweight .

47. 90% of all cases of cholecystitis are accompanied by stone formation, which makes the disease even more dangerous. The danger lies in the accumulation of cholesterol, calcium salts and bilirubin in the gallbladder cavity. They are deposited on the walls of the bladder in the form of calcifications. But over time, the deposits increase in size, interfering with the normal functioning of the organ. It is not uncommon for stones to enter the bile ducts, where they interfere with the outflow of bile from the bladder. All this leads first to discomfort and heaviness in the abdominal area, and then to inflammation and peritonitis.

48. Prerequisites for the development of cholecystitis create disorders of biliary tract motility-dyskinesia ( hypo and hyper )

49. Diseases of the pancreas Pancreatitis – acute and chronic . If the ducts are blocked by gallstones Sphincter spasm , often with C2H5 poisoning OH , begins to increase the activity of enzymes , enter the blood ( amylase and elastase ), lowering blood pressure , to purulent inflammation and necrosis . Chronic : atrophy and sclerosis predominate , with endocrine and exocrine stages .

50. Acute pancreatitis : Serous Hemorrhagic Purulent Necrotic   Chronic : atrophy and sclerosis predominate , with endocrine and exocrine stages . Cancer in the head causes mechanical jaundice .

51. Crohn's disease is a chronic non-specific , granulomatous inflammation of any parts of the gastrointestinal tract , with a predominant lesion of the terminal ileum and ileocolitis in 50% of cases ( granulomatous enteritis , regional enteritis , transmural ileitis )

52. Etiology The etiology of Crohn's disease is still unknown, and the following factors are currently being considered: Viral infections (measles virus) Bacterial infections (Chlamydia, listeria, mycobacteria) Environmental factors (early weaning, high socio-economic status, steroid contraceptives, non-steroidal anti-inflammatory drugs, titanium oxide toothpaste, tobacco smoking) Psychological factors

53. Pathogenesis Antigen in the gut phagocytosis by macrophages and dendrites presentation of the antigen on its surface activation of immune defense cells activation of pro-inflammatory cytokines is a violation of the balance between pro-and anti-inflammatory cytokines excessive activation of pro-inflammatory cytokines destruction of the intestinal mucosa

54. Localization Crohn's disease Ulcerative colitis Esophagus, stomach, duodenum 3-5 % Small and large intestine 40-55% Small intestine only 25-30 % Colon only 20-25 % Rectal lesion 11-26% Anorectal lesions (anal fistulas, anal fissures, abscesses resulting from periproctitis) 30-40 % Total colitis 18 % Left-sided lesion 28 % Proctochygmoiditis 54 %

55. Crohn's disease

56. Transverse colon Sigmoid colon Rectum

57. Ulcerative colitis

58. Differential diagnosis

59. Ulcerative colitis Crohn's disease

60. Extra-intestinal manifestations

61. Extra-intestinal complications

62. Extra-intestinal manifestations and complications of Crohn's disease