Gastrointestinal Tract Pathologies

 

 

Oesophagitis

  • Can be caused by the reflux of acid from the stomach through the cardiac sphincter initially causing heartburn, but long-term reflux causes bleeding, ulcer formation and scarring. The scarring can cause the narrowing of the oesophageal passage which results in problems swallowing

Hiatus Hernia

  • Sometimes called a sliding hiatus hernia happens when part of the stomach slides through the diaphragmatic opening that the oesophagus passes through, and can worsen with age as the cardiac sphincter weakens. The treatments of this and reflux include antacids, eating small meals of relatively blend foods and no caffeine. Sleeping with the head elevated and not wearing tight clothing helps surgery is not usually recommended
  • Usually related to cirrhosis of the liver are oesophageal varices that develop to relieve portal hypertension. The veins of the oesophagus become enlarged and tortuous. The blood from the liver uses other channels to get to the heart and uses the veins of the oesophagus, causing the swelling of the blood and cause bulging into the oesophageal lumen
  • The vessel may rupture and may a medical emergency. Treatments include the reduction of BP through surgery or medication and using stool softening to prevent straining when defecating.

 

Upper Gi Tract Anatomy Massive Upper Gastrointestinal Bleeding Hemorrhage Doctor Stock


Gastritis 

  • The stomach is the sight for many disorders ranging from mild through to cancers
  • Gastritis has a lot of causes and can be acute or chronic
  • Acute can be caused by a high-risk lifestyle and will usually resolve themselves
  • Acute haemorrhagic gastritis is associated with the use of aspirin, NSAIDs and alcohol – the damage the mucosa and can penetrate deeper to form an ulcer sometimes with haemorrhage as well
  • Also implicated is a serious physiological complication that results in surgical and medical intervention making the mucosa more susceptible
  • stress is a factor in all situations
  • Hypersecretion of gastric acid
  • Hyposecretion of mucus from the mucous neck cells

Chronic Gastritis

  • This is the chronic inflammatory disease of the stomach that affects the gastric mucosa. It is divided into two forms fundal and Helicobacter. Fundal inflammation happens where the cells that produce acid are located causing atrophic gastritis and no HCL production there is also no intrinsic factors that are produced as the parietal cells not only produce HCL but also IF. If binds to B12 in the stomach and is absorbed in the ileum. The resulting deficiency causes pernicious anaemia because B12 is needed for erythropoiesis. This age-related so there is a cure but avoiding things you know causes irritation is recommended and antacids are needed
  • Helicobacter pylori are the bacteria that is associated with both chronic gastritis and peptic ulcer formation. The bacteria is present in many of the affected individuals. The prevalence of infection increases with age
  • Peptic ulcer- disease shows breaks in the stomach and small intestine mucosa. In practical terms, this disease affects the distal part of the stomach and the proximal part of the duodenum, those peptic ulcers in the stomach are called gastric ulcers, those in the small intestine are called duodenal ulcers
  • The major complication with these ulcers are bleeding, perforation through the abdomen cavity and obstruction of the passage of partly digested food
  • As with gastric gastritis, the contributing factors are smoking stress, and drugs plus the presence of H, pylori
  • To allow the mucosa to heal antacids which reduce acidity are given and antibiotics to get rid of H. pylori. Surgery is also necessary if there is blockage, perforation or risk of bleeding

The SMALL INTESTINE

  • Consists of  ILEUM, DUODENUM, JEJUNUM  is where the majority of the nutrients are absorbed and so the various syndromes of malabsorptions happen
  • Various organs of the GI are linked to the small intestine so any malfunction of this can cause malabsorption( liver, gallbladder and pancreas) for example is the enzymes from the exocrine glands deficient or blocked complete digestion cannot happen so malabsorption occurs
  • Gastroenteritis is the inflammation of both the small intestine and the stomach that can be caused by bacteria, viruses, parasites, food drugs and allergies or lactose intolerance
  • Endotoxins that are released from the bacteria can affect the mucosa resulting in the ulceration of the columnar pathology such that they can not absorb water and foodstuffs. the result is diarrhoea containing fluids and electrolytes often along with mucus
  • Gastroenteritis can be acute with cramping, vomiting and nausea or milder
  • You generally treat the symptoms

Crohns Disease

  • The disease presents as chronic inflammation, which is discontinuous usually the small intestine can be anywhere in the GI involving all the layers of the Gut
  • As the disease becomes more chronic the whole Gut wall weakens, narrowing the lumen
  • Symptoms range from flatulence to anorexia
  • treatment involves the management of the symptoms

 

large intestine

  • Obstruction of the large intestine may be a result of blockage or the colon pushes into its self this, is called an INTUSSUSCEPTION, or twits in the mesentery both blocking and cutting the blood supply ( volvulus)
  • The blockage may also be due to complete and reduction in peristalsis( Ileus) it happens as a result of peritonitis or following surgery. In all cases, the symptoms will vary from nausea to severe pain in the abdomen accompanied by distension and vomiting
  • Surgery is usually accompanied to reduce obstruction

Ulcerative colitis :

  • This is the chronic inflammation of the colon this is called inflammatory bowel disease until the disease s confirmed the symptoms are chronic diarrhoea and rectal bleeding with a relapsing-remitting pattern that can cause serious complication
  • This affects both the colon and the rectum, with ulcers developing in the mucosa, that coalesce to form areas of ulceration
  • Although the cause is not known an individual with this disorders are at high risk than normal of developing colon cancer

Appendicitis

  • This is the inflammation of the vermiform appendix found normally attached to the caecum. Although it is composed of the usual four layers of the GIT it has a large proportion of associated lymphoid tissue
  • It is usually infection and obstruction that causes the disease with its anatomical positions meaning faeces can pass through it easily carrying bacteria. An inflammatory response causes swelling which may lead to ischemia as blood vessels can be compressed. The wall of the organs thins and can rapture spilling the contents into the abdominal cavity causing peritonitis and the infection of the whole cavity. Surgical removal is necessary. The symptoms are general abdominal pain that moves to the right quadrant with nausea vomiting and fever

Irritable Bowel Syndrome

  • Does involve inflammation or ulceration but ulceration in GUT motility accompanied by pain in the abdomen with attacks of diarrhoea and constipation or both

Diverticulosis

  • Diverticular are out pockets from the colon that usually have no symptoms until the diverticular become full of faeces causing irritation and inflammatory response resulting in pain in the abdomen with cramps and fever
  • Increase with age and is linked with the lack of roughage in diet and lack of exercise
  • The condition worsens diarrhoea is common and can lead to bleeding and perforation of the bowel and obstruction
  • It is treated by diet and antibiotics but can result in the removal of part of the bowel in some cases

Liver Disorders

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  • The liver has a number of roles in the body among them is detoxification of the number of substances that enter the bloodstream, this can result in a disorder called hepatitis which is the inflammation of the liver
  • It is also the site of viral infection which results in s disorder called viral hepatitis
  • Viral hepatitis is the common disease of the liver. There are five types of type A-E. some types of viral hep can lead to liver cancer( principally carriers of Hep c who develop cirrhosis of the liver will develop HEPATOCELLULAR CARCINOMA
  • When the symptoms do occur the first to show is the yellowing of the skin called JAUNDICE. Which is called by the high levels of circulating Bilirubin? Bilirubin is the by-product when the liver catabolises erythrocytes, high levels of this indicate poor liver function
  • Hepatomegaly which is the enlargement of the liver may occur
  • Complications are chronic fulminant Hep( inflammation and necrosis for 6 months or more, which can lead to cirrhosis

FULMINANT HEPATITIS  is an acute form of hepatitis that results in the necrosis of the liver tissue with symptoms ranging from fever to bleeding from mucous membranes to coma and death 90% fatal even with treatments

Cirrhosis of the liver

Cirrhosis of the liver is the chronic and irreversible end stage of the chronic liver disease. The normal structure of the liver is replaced by a fibrous connective tissue and blood flow and function is severely affected. the most common causes are alcoholic liver disease and chronic active hepatitis

Complications:

  • Oesophageal varies
  • Enlargement of the spleen as a result of increased pressure due to portal hypertension. This results in the increase in RB breakdown followed by anaemia and thrombocytopenia and leukopenia
  • ASCITIS this is fluid in the abdominal cavity as portal hypertension causes the fluid to leave the portal system
  • Oedema of the lower limbs because the liver does to produce albumin that gives blood its osmotic pressure,( pulling fluid back into the vascular system)
  • Jaundice
  • Feminization of male ( testicular atrophy, gynecomastia, female body hair pattern) because in males the liver inactivates oestrogen secreted by the adrenals also in females but not in cirrhotic liver
  • Hepatic encephalopathy leading to delirium tremens because the liver has lost its ability to remove nitrogenous wastes. These substances affect the brain and the niveous system with the resulting confusion, stupor and tremor and hallucination. This can further progress to coma and death

Urinary Tract Disorders

  • Glomerulonephritis is the inflammation of the glomeruli by an antibody-antigen reaction, not an infection can be acute or chronic
  • The antibody-antigen complex happens 1-4 week after throat or skin infection by beta-haemolytic streptococci antigens from the strep and antibodies form the complex in the cardiovascular system with becoming trapped in the glomeruli resulting in an inflammatory response
  • Vascular flow from the nephron is reduced so urine production is less. Glomeruli degenerates and those that become permeable allowing substances usually filtered to pass through
  • CYSTIS – is the inflammation of the bladder manly caused by E.coli infection which is more common in women
  • Can develop after sex if the bacteria is present around the vaginal opening
  • Symptoms include increased frequency of urination accompanied by burning
  • Treatments are antibiotics depending on the kind of bacterial

 

Sources

Morson, B. C., & Dawson, I. M. P. (1972). Gastrointestinal pathology. Blackwell scientific publications.

Silverberg, S. G. (1997). Gastrointestinal Tract Pathology.

Treuting, P. M., Arends, M. J., & Dintzis, S. M. (2017). Upper Gastrointestinal Tract. In Comparative Anatomy and Histology (Second Edition) (pp. 191-211).

Kumar, V., Abbas, A. K., & Aster, J. C. (2017). Robbins basic pathology e-book. Elsevier Health Sciences.

 

Disclaimer: This the above article is purely for educational purposes and should not be used as a diagnostic tool.
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