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