HMM 4401– Gastrointestinal disease - Universitetet i oslo · Main gastrointestinal diseases •...
Transcript of HMM 4401– Gastrointestinal disease - Universitetet i oslo · Main gastrointestinal diseases •...
HMM 4401–Gastrointestinal disease
Ett sykehus - nær deg og dine
Admissions to inpatient hospital, > 70 yrs
Main diagnoses Blefjell hospital, all dep Patient admissions
Cancer and cancer related 500
Cardiovascular 1500
Lung, COPD 600
Digestion, hepatology 500
Gynecology, urology 300
Trauma 800
Cerebrovascular disease 460
Main gastrointestinal diseases?
• What diseases have you heard of?• Know someone with?• Worry about?
Main gastrointestinal diseases
• Swallowing problems, dry mouth, loss of appetite• Heart burn, esophagitis, reflux• Stomach ache, gastritis, dyspepsia, ulcer• Digestion, malabsorbtion, sprue• Liver diseases, gall bladder diseases, jaundice• Pancreas diseases, pancreatitis• Inflammatory bowel disease, Crohn, ulcerative colitis• Diverticulitis• Cancer
The digestive system
Mouth
Esophagus
Stomach
Intestine
Liver/gall bladder
Pancreas
Large intestine
Function of the gastrointestinal system
• What is a metaphor for the gastrointestinal system?• Mouth• Esophagus• Stomach
• Small intestine• Liver• Pancreas
• Large intestine
Function of the gastrointestinal system
• What is a metaphor for the gastrointestinal system?• Mouth• Esophagus• Stomach• Small intestine• Liver• Pancreas• Large intestine
Grinder, mechanical kneading, portioning into dudoenum
Absorption of nutrients, excretion oftoxins, adjusting blood sugar
Absorbing water, keeping it untiltoilet is available,
Function of the upper GI
• Mouth• Chewing, saliva
• Esophagus• Tube with muscles• Peristalsis, gravity
• Stomach• Gastric acid HCl• Gastrin• Other enzymes
Function of middle GI
• Duodenum• Small intestine
• Jejunum• Ileum
• Liver• Gall bladder• Pancreas
Function of lower GI
• Large intestine• Rectum• Anus
Upper GI diseases
• Swallowing problems, dry mouth, loss of appetite
• Heart burn, esophagitis, reflux
• Stomach ache, gastritis, dyspepsia, ulcer
Esophagus, esophagitis
• Heart burn, esophagitis, reflux
Upper GI diseases
• Stomach ache, gastritis,
• dyspepsia, • ulcer
Upper GI diseases
• Why do pepleget ulcer?
• Nerves?• Psychosomatic• Coffee?• Wine?• Tobacco?
Bad habits
Nerves
Blood type
Genetic
Helicobacter pylori! – bacteria
Ulcer disease
• Helicobacter pylori• Nobel price 2005• 90% of duodenal
ulcers• Antibiotic treatment
• No ulcer withoutacid
• Anticids help, but antibiotic cures
Ulcer disease
• Do you know any antacids?
Ulcer can perforate stomach - emergency
pause
Clinical services
• Internal medicine in general hospital – common diseases• General medical and surgical wards• “Organ block” or close relation surgeon/physician• Diagnostics often outpatient service• Cancer is a possibility in many cases• Endoscopy universal test – supplemented by X-ray etc.• Hepatology very difficult – very internal medicine• Endoscopy is practical – more like surgery
Stethoscopy and clinical examination
• Listen to two different stomachs, what do you hear?• Where is the appendix?• Where is the liver?• Where is the spleen?• Where is the stomach?• Where is the gall bladder?• Where are the kidneys?• Percussion – palpation - auscultation
The digestive system
Stomach
Intestine
Liver/gall bladder
Pancreas
Appendix
Large intestine
Endoscopy
Endoscopy – what do you see?
Endoscopy – what do you see?
Endoscopy
Try the endoscope –
pretend to be a gastroenterologist
Diagnostic and therapeutic tool
• See upper and lower GI with own eyes• Video and photographs• Biopsies• Removing small tumors• Stopping bleeding• Banding varices
Ulcerative colitis and Crohns disease
• See upper and lower GI with own eyes• Video and photographs• Biopsies• Removing small tumors• Stopping bleeding• Banding varices
Ulcerative colitis and Crohns disease
• Inflammatory bowel diseases• Often life long, start young• Medication helps, but
no cure• Diarrhea, blood, pain• End up with emergency
surgery• Cancer risk with UC• Remicade and other
expensive medication
Pancreas, liver, gall bladder
Pancreas
Liver
gall bladder
Function of the pancreas – sugar and fat
Pancratitis - causes
Pancratitis - causes
Function of the gall bladder
• Liver makes cholesterol “soap” and other things in bile• Bile is stored in gall bladder and released after meals• Red blood cells are destroyed and liver takes care of
bilirubin – Is also part of bile• Bilirubin makes feces brown and urine yellow• If blocked gall duct or liver failure – you get yellow
“jaundice” • Cholecystitis – acute abdomen!• Gall bladder can be removed – you still live
Gall bladder stones!
• ?????
Function of liver – detoxify us
• Alcohol• Methanol• Mushroom• Pills• Drugs• Red blood cells• M.m.
Too much toxins – liver failure
• Liver cirrhosis• Fat liver• Ascites• Flappy hands• Mental confusion• Acute and
chronic
Hepatitis B – world wide disease
Hepatitis A, food etc, not dangerous
Hepatitis B, killer and chronic
Hepatitis C, chronic, may give cancer
Acute abdomen – surgical emergency
• Reflux, heart burn – may feel like heart attack• Ulcer – may bleed a lot, may feel like heart attack• Pancreatitis – very painful, shock, • Hepatitis – virus, toxins• Cholecystitis – “fat female at forty” – and everybody else• Appendicitis – all ages• Diverticulitis• Crohn and ulcerative colitis• Ischemia and trauma of all organs
Future advances
• Even more specific and costly intervention• Genetic therapy• Infection/Antibiotic theories• Immunology – tailor made medication• More technology• Better decentralized care and diagnostics• MRI, PET scan, etc.
Summary
• Stomach pain, indigestion, constipation etc normal• Cancer in GI may give such symptoms• Ulcer and dyspepsia have good treatments• Hepatitis world wide killer and problem – vaccine• Liver disease and alcohol• Pancreas, diabetes, obesity, life style
Main gastrointestinal diseases
• Swallowing problems, dry mouth, loss of appetite• Heart burn, esophagitis, reflux• Stomach ache, gastritis, dyspepsia, ulcer• Digestion, malabsorbtion, celiac disease• Liver diseases, gall bladder diseases, jaundice• Pancreas diseases, pancreatitis• Inflammatory bowel disease, Crohn, ulcerative colitis• Diverticulitis• Cancer