1. Lecture – 10 Dr. Zahoor Ali Shaikh 1

2. GIT APPLIED/CLINICAL ASPECTS  We will look at some important conditions/diseases that can affect GIT.  This lecture will introduce you to the applied/clinical aspects, details of these conditions you will do later. 2

3. APPLIED ASPECTS  Topics  Vomiting  Hunger Contraction  Gastro Oesophagal Reflux Disorder  Peptic Ulcer  Jaundice  Hepatitis [Viral]  Liver Transplant  Pancreatitis  Celiac Disease [Gluten Entropathy]  Irritable Bowel Syndrome  Inflammatory Bowel Disease  Food Poisoning  Traveler's Diarrhea  Parasitic Infections of Intestine 3

4. VOMITING  It is forceful expulsion of gastric contents through mouth.  Major force of expulsion comes from contraction of diaphragm and abdominal muscles.  There is vomiting center in Medulla, it co-ordinates the act of vomiting.  Contracting diaphragm descends downwards on the stomach. 4

5. VOMITING (cont)  At the same time, abdominal muscles compress the abdominal cavity and increase the intra-abdominal pressure.  Stomach is squeezed between the diaphragm above and compressed abdominal cavity below.  The gastric contents are forced upwards through relaxed sphincter and esophagus, out through the mouth. 5

6. CAUSES OF VOMITING  Touching the back of throat e.g. seeing the throat using the tongue depressor.  Distension of stomach.  Increased intracranial pressure e.g. head injury causing intra cerebral hemorrhage. 6

7. CAUSES OF VOMITING (cont)  Motion sickness.  Drugs.  Renal Failure.  Psychogenic e.g. emotional factors 7

8. HUNGER CONTRACTION  Gastric Contraction can sometimes be felt and may be mildly painful [peristaltic wave].  Hunger Contraction are associated with sensation of hunger and play role in regulation of appetite. 8

9. Gastro Esophagal Reflux Disorder [GERD]  Patient with reflux has persistent symptoms.  It occurs when lower Esophagal sphincter tone fails to increase when patient is lying down or when intro- abdominal pressure increases.  Patient complains of heart burn. 9

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12. PEPTIC ULCER  Duodenal Ulcer [D.U] are more common than Gastric Ulcer.  10 - 15% of population may suffer from D.U.  Patient complains of epigastric pain, relationship of pain with food is variable and may not be helpful in diagnosis. 12

13. PEPTIC ULCER (cont)  D.U pain is more when patient is hungry.  If long standing symptoms investigation like test for H.Pylori and Endoscopy can be done. 13

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15. JAUNDICE  We have already discussed three types of Jaundice. (i). Prehepatic or Hemolytic Jaundice (ii). Hepatic e.g. Viral (iii). Post-hepatic or Obstructive e.g. Gall stones 15

16. HEPATITIS-VIRAL 16

17. LIVER TRANSPLANT  It is established treatment for number of diseases.  Acute Liver Failure.  Chronic Liver Failure. 17

18. GALL STONES  We have already discussed Gall Stones.  Ultrasound is helpful in diagnosis.  Cholecystectomy – Laparoscopic is done now in requires 48hours stay in hospital. 18

19. 19 Image showing Normal Gall bladder

20. 20 Gallstones

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22. 22 Ultrasound showing normal gallbladder

23. 23 Ultrasound showing gallstones

24. PANCREATITIS  Patient complains of pain in epigastric region.  Pain radiates to back.  Acute Pancreatitis can be due to gall stones, alcohol, viral infection e.g. mums, hyperlipidaemia.  Chronic Pancreatitis can be due to alcohol, hypercalcaemia. 24

25. PANCREATITIS (cont)  Investigation which help in Diagnosis  Blood test e.g. Serum Amylase will be raised.  Abdominal ultrasound. 25

26. Celiac Disease [Gluten Entropathy]  We have discussed Celiac Disease. 26 Jejunal mucosa normal villi Subtotal villous atrophy in Coeliac disease

27. Irritable Bowel Syndrome  It is functional Bowel disorder.  More common in female than male.  Anxiety factor is common. 27

28. Irritable Bowel Syndrome (cont)  Patient gives history of - Abnormal Stool Frequency – more than 3/day. - Abnormal Stool Form – watery, loose or hard stool. - Feeling of incomplete evacuation. - Passage of mucus. - Abdominal Distension. 28

29. Inflammatory Bowel Disease [IBD]  Two major diseases are - Crohn’s Disease [CD] – it can affect any part of GIT. - Ulcerative Colitis [UC] – it affects large intestine. 29

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31. Inflammatory Bowel Disease 31

32. FOOD POISONING 32

33. Traveler's Diarrhea [TD] 33

34. Parasitic Infections of Intestine  GIT Parasites - Entamoeba Histolytica – Amoebiasis - Giardiasis  Intestinal Worms - Thread worm – Entrobius Vermicularis - Round worm – Ascaris Lumbricoides - Hook worm – Ancylostoma Duodenal 34

35. Parasitic Infections of Intestine 35

36. Thank you 36