Transcript Ladd`s Procedure

Gastro Intestinal
Rebecca, Jennifer,
Kenny, Michael
Purpose of GI Tract
• Simplest form- tube from mouth to anus
• Digestion, absorption, removal of waste
 large molecules
 small molecules
 absorbed into blood
Mouth
• Chewing breaks down
food
• Saliva:
– Moistens food
– amylase enzyme
starts digestion by
breaking down starch
Esophagus
• Simple tube connecting mouth to stomach
• Peristalsis: muscle contractions that push food
down through the esophagus
Stomach
•Sphincter: muscular ring that closes end of
esophagus to prevent food and fluid from traveling
back up
Stomach
• An empty adult stomach has a volume of 1/5
cup, but after a large meal, it can expand to
more than 8 cups
• Stomach muscles mix food with acids and
enzymes to break it down
• Glands in the stomach lining produce 3 quarts
of digestive juices a day
Stomach cells
• Chief cells in Glands: produce
pepsinogen, a precursor of the enzyme
pepsin
• Parietal cells: secrete the hydrochloric acid
of the gastric juice
• Stomach epithelium: columnar cells
– Mucus-producing
Chyme
• Food ready to leave the stomach is a thick
liquid called chyme
• The pylorus, a small muscular valve,
keeps chyme in the stomach until it’s
ready to go
Specialized Cells
Upper Tract:
• Serous- glandular epithelial cells
specialized for exocrine enzyme secretion
• Mucous- secrete mucous
• Taste Buds- columnar epithelial sensory
cells in clusters for tasting
Small Intestine
• Three parts of small
intestine:
– Duodenum: first part,
C-shaped
– Jejunum: coiled middle
– Ileum: leads to large
intestine
Villi
-cover inner wall of
small intestine
-microscopic
-finger-like
-used for absorbing
nutrients
Large Intestine
•
•
•
•
Functions:
Absorb water
Bacterial fermentation
Feces formation
Parts:
•caecum
•appendix
•colon
•rectum
Caecum
• Small pouch, first part of the large intestine
• Accepts and stores processed material
from the small intestine and moves it
towards the colon.
• Mixture of processed material contains:
– undigested food (fibre)
– a little bit of water
– some vitamins
– some minerals or salts
Appendix
• small projection sticking out
from caecum
• has no known function in
humans
– Left over from evolution?
• Appendicitis: appendix
becomes infected or inflamed
– removed by surgery
Colon
• Shaped like an upsidedown 'U‘
• longest part of the large
intestine.
• 4 Sections:
– Ascending colon: starts at
the caecum…
– Transverse colon
– Descending colon
– Sigmoid colon: S-shaped,
connects descending
colon and rectum.
Colon Function
• Mixture = feces
– fiber
– small amounts of water
– vitamins
– mucus
– bacteria
• Colon absorbs most of the water, some vitamins and
minerals
• Bacteria break down materials to support cells lining the
colon
• Colon muscular movement  feces stored in rectum
Specialized Intestinal Cells
• Absorptive
• Goblet
• Enteroendocrine
• Stem cells (present
throughout GI tract)
Liver
The liver is the largest gland in the body
Function
• Blood flows from hepatic
artery (oxygen-rich) and
portal vein (contains food)
• The liver then produces
substances for a variety of
functions
Specialized Liver Cells
• Hepatocytes
– form bile
– Regulate blood glucose
– Get energy from
cholesterol and fat
– detoxify certain drugs
and poisons
– process certain
hormones and vitamin
D
Specialized Liver Cells
• Kupffer- clean blood
• Fenestrated- “full of
holes,” permit blood
plasma flow in certain
areas
Pancreas
Functions
• Neutralizes acid
• Breaks down
macromolecular
nutrients
Gall Bladder
• storage stop between the liver and the small
intestine.
• fills with bile (holds ¼ cup), thickens it
Bile
• yellowish-green,
pasty liquid
• contains water, bile
salts and acids,
pigments,
cholesterol,
phospholipids, and
electrolytes
• Breaks up fat
Other Enzymes
• Pepsin (stomach): breaks down proteins
• Pancreatic amylase
• Pancreatic lipase
• Small Intestine disaccharidases
Peptic Ulcers
What are Peptic Ulcers?
Peptic Ulcers are open sores in the lining of
the esophagus, stomach, or duodenum.
Stomach =
Gastric Ulcer
Duodenum =
Duodenal Ulcer
Esophagus =
Esophageal Ulcer
What are Peptic Ulcers?
Peptic Ulcers are open sores in the lining of
the esophagus, stomach, or duodenum.
Stomach =
Gastric Ulcer
Duodenum =
Duodenal Ulcer
Esophagus =
Esophageal Ulcer
1) H. Pylori bacterium reaches to the mucosal cells, which
secrete mucus.
2) Releases ammonia to neutralize the acid so the
bacterium can survive
3) H. Pylori bacteria gather and infect the area
4) The bacteria digs itself in the mucosal cells, damaging
them so that it cannot produce mucus. The acid is then
able to flow and damage the lining of the stomach or
duodenum, causing an ulcer
Other Etiologies
• NSAIDs (Non-steroidal anti-inflammatory
drugs) such as aspirin and ibuprofen,
interferes with the stomach to produce
mucus
• Smoking – Nicotine in cigarettes cause
the stomach to produce more acid
• Alcohol – Wears down mucus lining
• Caffeine stimulates acid secretion
• Stress and spicy food can also worsen
ulcers
What are some signs to
look out for?
• If there is pain or discomfort near the
abdominal area.
• Heartburn, bloating, vomiting
Symptoms that need immediate
medical attention
- Difficulty swallowing, loss of weight, and
blood in vomit, nausea, sudden severe
pain in abdominal area.
How do you treat Peptic Ulcers?
• If the ulcer was caused by H. Pylori,
treatments will include antibiotics that will
destroy the bacterium so the ulcer can
heal.
– Amoxicillin, tetracycline
• Acid Suppressors
Other treatments
– Proton pump inhibitors (PPIs)• A Proton Pump is molecules that pumps hydrogen
ions into the stomach, making the stomach
contents acidic (stomach acid).
• PPIs block the proton pump from “pumping” the
hydrogen ion into the stomach, creating a less
acidic environment for the ulcer to heal.
• Stomach Protector
- Pepto Bismol- Coats the stomach and protects the
ulcer from acid so it can heal. Pepto Bismol can also
kill bacteria, including the H. Pylori bacteria.
Crohn’s Disease
What is it?
• Crohn's disease is a form of Inflammatory
Bowel Disease (IBD). Crohn’s disease is
a chronic inflammatory disease of the
intestines. It mainly causes ulcerations, or
breaks in the lining, of the small and large
intestines. Crohn’s disease can also affect
other parts of the digestive system
anywhere from the mouth, all the way
down to the anus.
What is it?
• Crohn's disease is a form of Inflammatory
Bowel Disease (IBD). Crohn’s disease is
a chronic inflammatory disease of the
intestines. It mainly causes ulcerations, or
breaks in the lining, of the small and large
intestines. Crohn’s disease can also affect
other parts of the digestive system
anywhere from the mouth, all the way
down to the anus.
What’s the cause of Crohn’s disease?
Unknown
What do scientists believe?
• Some scientists believe
the disease is caused
by an infection of
certain bacteria, but
there is not enough
convincing evidence to
prove that the disease
is caused by an
infection.
• Some also believe it is
a genetic disease.
Main Symptoms
• Common
- abdominal pain
-diarrhea
-weight loss
• Less Common
-poor appetite
-fever
-night sweats
-rectal pain
-rectal bleeding
Treatments
• Treatments can vary
depending on the
patient’s symptoms
and the severity of the
disease. If the
symptoms are mild or
absent, the patient
may not need
treatment at all.
Treatment Goals
• 1) induce remissions
• 2) maintain
remissions
• 3) minimize side
effects of treatment
• 4) improve the
quality of life
What types of medicine?
• Anti-inflammatory
agents such as 5ASA compounds,
corticosteroids, or
topical antibiotics
• Immunomodulators
• Other medications.
Abnormalities/Diseases
Of the Gastrointestinal System
Abnormalities and Diseases
• The gastrointestinal system can be
affected by various diseases and
abnormalities.
• These can include colorectal cancer,
gastroenteritis (stomach flu), giardiasis,
inflammatory bowel disease, intestinal
malrotation, irritable bowel system, and
pancreatis.
Intestinal Malrotation
• Results as birth defect
where the intestines are
not properly positioned
during fetus development
and the intestines become
blocked.
• Can lead to other
complications such as the
formation of Ladd’s bands.
Why it happens.
• 1 in 500 babies affected.
• When the bowel is misaligned during fetal development.
• Occurs if the bowel is not properly moved and fails to
return to peritoneal cavity in the normal sequence.
What does it do?
• Causes a volvulus
which is an intestinal
twisting that can lead
to blockage.
• Intestinal blockage
can cause death of
certain sections of the
intestines.
• Can cause formation
of Ladd’s bands.
• Is life threatening if
not treated.
Affected Organs
• Large and Small
Intestines – become
twisted
• Ladd’s Bands (blue) –
band of tissue formed
attaching cecum to
abdominal wall
• Cecum (black) –
becomes displaced
(pouch which is
beginning of large
intestine)
Symptoms
•
•
•
•
•
•
Swollen abdominal
Diarrhea or bloody waste
Fever
Little or no urine
Pain or crying not stopping
Rapid heart rate and/or breathing
Treatment
• Surgery to correct malrotation (varies)
• Ladd’s Procedure (most common)
– Ladd’s bands divided, cut
– Intestines untwisted and repositioned
– Appendix removed usually, to prevent future
problems
Ladd’s Procedure
A) Abdomen cut open.
B) Move small intestines out.
C) Intestines rotated.
D) Intestines repositioned,
Ladd’s Band cut.
E) End Result
Giardiasis
• Also known as “backpacker’s diarrhea” or
“beaver fever.”
• Parasitic disease
• Both human and animals.
• Common disease throughout world.
• Often among campers and people who
drink from open water supplies.
What Causes it?
• Giardia lamblia
• Parasite infects
host.
• Lives in intestines.
Moves through
stool (feces)
• Absorbs nutrients
and releases toxins
in small intestines.
Gardia lamblia
•
•
•
•
Microscopic parasite.
Reproduces asexually.
Spreads through feces.
Life cycle consists of 4
stages.
– 1. Enters body as cyst.
– 2. Cysts turns into
trophozoite in stomach
– 3. Attach to intestinal walls,
absorb nutrients and
reproduce.
– 4. New parasites form into
cysts and pass through with
feces. Cycle starts again.
Insert Life
cycle pic here
Effects of Giardiasis
• Presence of parasite
causes immune
response.
• Body attempts to
“flush” out of system.
• Result is explosive
diarrhea.
• Can be difficult to
permanently remove
from body. Lingers
around for long time.
Symptoms
•
•
•
•
•
•
•
Loss of appetite
Fever
Stomach cramps or pain
Flatulence
Explosive diarrhea
Watery stools
Symptoms may be mistaken for peptic
ulcer.
Treatments
• Immune system may defeat Gardia
Lamblia on its own.
• Medicine and drugs used to defeat
infection.
• Drugs used include metronidazole,
albendazole and quinacrine.
– Metronidazole is taken in by infectious
organism and upset its DNA helical structure
as it is broken down.
sources
•
•
•
•
•
•
•
•
•
•
•
•
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/basics/gi_microan
atomy.html
http://kidshealth.org/parent/general/body_basics/digestive.html
http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/yrdd/
http://www.gesa.org.au/digestive-system/large_intestine.cfm
http://www.siumed.edu/~dking2/erg/gicells.htm
https://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=2470
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bile.html
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/pancreas/index.ht
ml
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/G/GITract.html#liver
http://www.mamashealth.com/organs/liver.asp
http://www.nutraingredients.com/Research/Colon-bacteria-need-fibre-tofeed-healthy-digestion
Sources
•
•
•
•
•
•
•
http://www.netdoctor.co.uk/medicines/100002038.html
http://heartburn.about.com/cs/articles/a/Ulcer_Treated.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/
http://hcd2.bupa.co.uk/fact_sheets/html/Peptic_ulcer.html#4
http://en.wikipedia.org/wiki/Peptic_ulcer
http://heartburn.about.com/cs/articles/a/Ulcer_Causes.htm
http://www.emedicinehealth.com/peptic_ulcers/page3_em.htm#Pepti
c%20Ulcers%20Symptoms
• http://heartburn.about.com/cs/articles/a/Ulcer_Symptoms.htm
• http://heartburn.about.com/od/medsremedies/a/protonpumpPPIs.htm
• http://en.wikipedia.org/wiki/Proton_pump_inhibitor#Clinical_use
Sources
• http://en.wikipedia.org/wiki/Giardiasis
• http://en.wikipedia.org/wiki/Giardia_lamblia
• http://www.cdc.gov/ncidod/dpd/parasites/G
iardiasis/factsht_giardia.htm#transmission
• http://www.fpnotebook.com/GI/ID/GrdLmbl
.htm
• http://en.wikipedia.org/wiki/Metronidazole
Sources
• http://www.medicinenet.com/crohns_disea
se/article.htm
• http://library.med.utah.edu/WebPath/TUTO
RIAL/IBD/IBD.html
Sources
• http://kidshealth.org/parent/medical/digesti
ve/malrotation.html
• http://en.wikipedia.org/wiki/Intestinal_malr
otation
• http://www.pedisurg.com/PtEduc/Malrotati
on.htm