Transcript Lecture 24. Clinical pathophysiology of the digestive system

Clinical pathophysiology of the
digestive system
Disorder of stomach secretory
function
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According to mechanism:
Organic disturbances of stomach glands
Change I functional activity of secretory cells
According to kind of disturbance
Hypersecretion
Hyposecretion
Key-points for hypersecretion
The four inputs
to parietal cells
that regulate
acid secretion
by controlling
the transfer of
the H,K-ATPase
pumps in
cytoplasmic
vesicle
membranes to
the plasma
membrane.
Gastritis
Gastritis
Disorder of stomach motor function
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Hypercinesis – increased motility
Hypertonus – increased degree of contraction
Hypocinesis - decreased motility
Hypotonus - decreased degree of contraction
Pathological reflexes
• Nausea
• Vomiting
• Belching
Gastric Juice Secretion, Mucosal
Protection and Risk of Ulcer
Gastric Juice Secretion, Mucosal
Protection and Risk of Ulcer
Gastric Juice Secretion, Mucosal
Protection and Risk of Ulcer
Disorders After Stomach Surgery
Disorders After Stomach Surgery
Disorder of digestion in intestine
• Disorders of the pick out of bile and pancreatic juice
are accompanied by disorders of all types of digestion,
development of putrefaction and fermentation in the
intestine (at closing, or squeezing the excretory ducts
of glands in cystic fibrosis mucoviscidosis, because of
pancreatic cancer, acute and chronic pancreatitis and
duodenitis, violating the neurohumoral mechanisms of
regulation of secretion, particular functions of the
vagus nerve, the allocation of secretin, cholecystokinin,
pancreatic polypeptide).
• Disorders of digestion of nutrients combined in
maldigestion syndrome.
• Malabsorption of substances in the gut combined into
a syndrome, which is characterized by diarrhea, weight
loss, protein deficiency, signs of hypovitaminosis.
Causes of Acute Pancreatitis
Consequences of Acute Pancreatitis
Causes of Chronic Pancreatitis
Consequences of Chronic Pancreatitis
Causes of Constipation
Consequences of Constipation and (Pseudo-)Obstruction
Etiology and pathogenesis of liver
insufficiency
• Infectious agents (hepatitis B virus, tuberculosis
bacillus, helmints)
• Hepatotropic poison (drugs - tetracycline, sulfonamides,
industrial poisons - carbon tetrachloride, arsenic,
chloroform, vegetable poisons - aflatoxin, muscarine)
• Physical impacts (ionizing radiation)
• Biological drugs (vaccines, serums)
• Violation of blood circulation (thrombosis, embolism,
venous congestion)
• Endocrine pathology (diabetes mellitus,
hyperthyroidism)
• Tumors
• Hereditary ensymopathy
Causes of Liver Failure
Consequences of Liver Failure
Fibrosis and Cirrhosis of the Liver
Fibrosis and Cirrhosis of the Liver
Clinical syndromes in liver injury
Lack of liver disorders manifested
its functions lesion:
• metabolic (involved in carbohydrate, fat, protein
metabolism, metabolism of vitamins, hormones,
biologically active substances)
• protection (phagocytic and antitoxic)
• digestive and excretory (the formation and
release of bile)
• hemodynamic (involved in maintaining systemic
circulation).
Cholelithiasis: Abnormal Cholesterol
to Bile Salt Ratio
Clinical syndromes of jaundice
• Acholia associated with non-receipt of bile in the
intestine due to violations of the formation and
outflow of bile. Acholia manifested disorders of
digestion and absorption of fats, hypovitaminosis A, E,
K, decreased intake of unsaturated fatty acids of
phospholipids to build cell membranes, intestinal
motility violation, increasing decay and fermentation.
• Dyscholia - violation of the physical-chemical
properties of bile, causing it acquires the ability to form
stones (due to genetic predisposition, poor nutrition,
metabolic disorders, infectious-inflammatory
processes, cholestasis).
Cholelithiasis: Abnormal Cholesterol
to Bile Salt Ratio
Etiology and pathogenesis of jaundice
• Jaundice - a syndrome caused by an increase in blood
bilirubin (hemolytic, parenchymal, mechanical).
• In hemolytic jaundice due to destruction of a large
number of red blood cells accumulate indirect, protein
bound bilirubin.
• When parenchymal jaundice disturbed capture, and
excretion of bilirubin in hepatocytes due to their
injuries.
• In mechanical jaundice occurs outflow obstruction of
bile, compression of biliary tract tumor or scar, closing
within a stone, worms, thick bile.
Mechanisms and Consequences of Cholestasis
Methods of experimental study of liver
pathology
• hepatic-cell failure simulating full or partial
removal of the liver, the introduction of
poisons (carbon tetrachloride, chloroform,
trinitrotoluene);
• cholestatic model obtained by squising bile
ducts by ligature;
• hepatic vascular insufficiency simulating by
overlapping portocaval anastomosis, ligation
portal vein, hepatic vein, hepatic artery.