Gastrointestinal Tract GI tract Hepatobiliary System

1
Gastrointestinal Tract (GI tract)Hepatobiliary
System
2
GI Tract

• Hepatobiliary
• liver
• gall bladder
• pancreas

• GI tract
• Esophagus
• Stomach
• Small and large intestine

3
Oropharynx

• Salivary gland
• Parotid
• Submanibular gland
• Sublingual gland

A Nasopharynx B Uvula C Hypopharynx D
Larynx E Tongue F Oropharynx
4
?????????(Chewing or Mastigation)

• ??????/????????? (????????)
• ???????
• ???????????????? (5-15??)
• ????????
• ??????????? (amylase)
• ??????????? 50-80??./???????!

5
??????? Swallowing

• ?????????????????????????????? (afferent)
• ?????????????????????? medulla lower pons
• ???????????????? (efferent)
• ???????? ?????????????????????????????
• ???????????????????? 10 (vagus) ??????????????
• ???????????????

6
??????? Swallowing

• Oral phase
• ???????????????????????????? (saliva) (1000/d)
• ????????????????????????????? ????????????????????
  ????? (hard palate)
• pharyngeal phase
• ??????????????????????????????????
• ????????????? ???????????????
• ????? upper esophageal sphincter ???????
• ??????????????????????????(?????????????)??????
• esophageal phase
• ?????????????????????? (??????????????????????????
  ??) ?????????
• ????????????? -? ???????????????

7
????????? (Esophagus)

• upper esophageal sphincter (UES)
• ????????????????
• ??????????????????
• ???????(mucosa)
• peristalsis lower esophageal sphincter (LES)

8
???????????? (Stomach)

• reservoir
• grinding
• mixing with digestive fluid
• continuous intestine filling

Lower EG sphincter
Fundus
Cardia
Pylorus
Body
Antrum
Duodenum
nerve control vago-vagus
9
Stomach Reservoir

• empty vol 50 ml- max vol 4L
• chyme settle to layers according to density
• large pieces leave last
• lipid... digest last
• fluid... bypass

10
Stomach

• Ginding and mixing
• Antrum peristalsis
• Retropulsis
• Filling the gut
• continuous processing by duodenum
• prevent duodenal injury by acid
• prevent bile reflux
• Emptying time3 hr

11
Stomach Secretion

• ?????????????? (HCl) 2L/d
• ?????????? (mucous)
• ???????????? pepsinogen ??????????
• ??????????????????????????????? 12
• ?????????????? (gut hormone)
• ????????????????????

12
????????? (Small intestine)

• ??????? 3-5 m
• duodenum 5 25cm.
• jejunum 40 1-1.5
• ileum 55 2-2.5
• ?????????????? duodenum ??? jejunum
• ????????????
• Disaccharidase ???? disaccharide ????
  monosaccharide
• Amino peptidase ??? carboxypeptidase's
  ???????????????????????????

13
Duodenum

• 25 cm
• Bunners gland ?????????
• ???????????????????????
• ???????????????????????????????????????????
• ?????????
• Disaccharidase ???? disaccharide ????
  monosaccharide
• Aminopeptidase ???? peptide ?????????????

14
Jejunum

• 1-1.5 m
• ?????????????????????????????
• ????????????????????
• ????? secretion

15
Ileum

• 2-2.5 m
• ?????????????? ??????????????
• ????? secreation

16
Large Intestine

• Parts
• ???????????????????????????????????? (1L) ?????
  lt200 ml
• ????????????????????????????????????????

Descending colon
sigmoid colon
Rectum
17
Accessory Organ

• ?????????? (Salivary gland)
• ??????? (pancreas)
• ??? (liver)

18
??????? (Pancreas)

• ???????????????
• ????????????
• Amylase ???????????????????????????????
• Lipase ????????? ??????? ???????? glycerol
• Esterase ???? cholesteryl ester
• Trypsin chymotrypsin ???????????????????????????
  ??

19
Liver and Biliary system

• ????????????????????????????
• ???????????????????????
• ???????????????????
• ?????
• ????????
• ??????????
• ???????????

20
???????? (Gall Bladder)???????? (Bile)

• ???????????????????????????????????????????
• ?????
• ??????????
• Bile pigment (bilirubin)
• Cholesterol
• ????????
• ???????????????
• ??????????????????
• ???????????????????? ??????????????????????
  ???????????

21
What Does the Liver Do?The liver does gt500 jobs.
Some of the jobs include

• Storage
• Storing energy
• Store vitamins A, D, E and K
• Detoxification
• Killing germs, helping keep the body healthy
• Keeping pollutants from hurting the body
• Filtering toxic chemicals from the body
• Remove waste products of nutrient breakdown
• Synthesis
• Stopping cuts from bleeding
• Break down the major nutrients in foods (protein,
  fats and carbohydrates)
• Build proteins
• Helping build muscles
• Make and secrete bile to help digest foods

22
Nutrient Digestion and Absorption

• Fat
• Carbohydrate
• Protein
• Vitamin
• minerals

23
CHO Absorption
24
Protein Absorption

• ??????????????????????????? ??? pepsin
• ??????????????????????????????????????????????????
  ???????????????????????????
• ???????????????????????
• 60-90 g/d

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Fat Digestion
Liver
Duodenum
BiliaryTransportand Storage
Jejunum
Ileum
Colon
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Fat Digestion
Triglycerides
DietaryCholesterol
Fatty Acids Monoglycerides
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Fat Absorption
Liver
Duodenum
BiliaryTransportand Storage
Jejunum
Lymphatic System
Ileum
Colon
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Vitamin Absorption

• Water soluble vitamin
• ??????????????????????????????????????? active
  transport ??? passive diffusion, ??? Jejunum ???
  Ileum
• Fat soluble vitamin
• ??????????????????
• B12
• ????????? ????????????????? intrincic factor
  ??????????????
• ??????????????
• ????????? terminal ileum

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????????
30
??????????????

• ???9L/d
• Reabsorption gt 90 reabsorbed, only 0.1 - 0.2
  litres are discarded in the faeces
• Upper small intestine
• 4 to 5 litres reabsorbed
• Ileum
• active transport of NaCl
• 3 to 4 litres reabsorbed
• Colon
• active transport of NaCl in exchange for K and
  HCO3-
• normally 700 - 1500 ml absorbed (up to 7 litres)
• regulated by mineracorticoids

31
??????? (Dietary Fiber)

• ????????? CHO ????????????????????????????
• ????????
• ????????
• ???????????
• ??????? all-natural cereals, whole-grain, beans,
  fruits, vegetables, nuts.
• ????????????????????????????????
• ????????? 25-30 g/d
• ????????????? ?????????????????
• ????????????? ???????? ?????????????
  ?????????????????????????

32
????????????????
33
Short Chain Fatty Acid (SCF)

• ?????????????????????????????
• ???????????????????????????
• ??????????????????????????????????????
• ???????????????????????????????
• ????????????????????
• ???????????????????????????
• ??????????????????????????

34
??????????????????????????????
35
?????????????????????????????????
36
Choking

• Prevent is no accident
• small pieces, chew slowly, avoid laughing,
  talking, heavy alcohol

• Conscious
• If cough, breath, speak, do not interfere
• If not, Heimlich maneuver until FB is expelled or
  victim unconscious

• Unconscious

37
Gastro esophageal Reflux Disease GERD

• Symptoms of GERD include
• Heartburn
• Water brash (reflex salivary hypersecretion in
  response to peptic esophagitis),
• Laryngitis
• Aspiration (passage of gastric fluid up the
  esophagus and down into the lungs)
• Wheezing 
• Night time awakening with choking

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???????? GERD

• ??????????? ????????????????
• ????????????????????? 45-64
• ?????
• ????????????????????????? GERD ??????????????????
• ????????
• ?????????????

39
????????????????????

• ???????????????????????????
• ???????????
• ????????????????????????????????????? ??????????
• ?????????

40
??????????????? GERD

• ??????????????? (ulcer)
• ???????????? (stenosis)
• ????????????????
• ??????????
• ??????
• Barretts esophagus

41
Peptic Ulcer Diseases
42
?????? ????????????????

• Aggressive factors
• HCl, pepsis
• Vagal stimulation stress
• NSAID
• H. pylori
• Bile reflux
• hypercalcemia

• Defensive factors
• Mucous
• HCO3
• Microcirculation
• Prostaglandin
• Mucosal barrier

43
PUD

• ?????
• ??????? ??????? ??????????????
• ???????????????????????
• GU ???????????????
• DU ??????????????? ???????????????????
  ??????????????
• ??????????????

• Alarm symptoms
• ?????????
• ???
• ????????
• ?????????????
• ?????????????????????????????

44
Alarm Symptoms

• ?????????
• ???
• ????????
• ??????????????????????
• ??????? ?????? ???? ?????? ???????? (melena)
  ???? ????????????????
• ???????? ?????????????

45
????????

• ????????
• ?????
• ?????????????????
• ????? H pylori

• ??
• ???????
• ????????????????????
• ??????? H pylori
• ?????????????
• ????????
• ??????
• ?????? NSAID

46
??????????? (Dyspepsia)

• ??????????????????????????????????????????????????
  ??????????????????? ?????????? ?????????? ??? ???
  ???????? ?????????? ???????? ???????
  ??????????????????
• ????????
• organic dyspepsia ??????????? ???? PUD, ????????
  ?????????????? ???????????????
• functional dyspepsia ??????????????
  ??????????????????????????????????????????????????
  ????

47
????????? Functional Dyspepsia

• ?????????????? ???????????????????????
• ??????????????????????????????????? ???????
  ?????????????????
• ??????????????

48
??????

• dysmotility like dyspepsia ??????? ????????
  ??????? ??? ???????? ???????
• ulcer like dyspepsia ????????????????? ??????????
  ??????????????????
• reflux like dyspepsia ?????????????????
  ?????????????????????

49
??????????????????????

• ???? gt45 ??
• ?? alarm symptoms
• ?????????
• ?????????????????????? melena, ????????????????
  ?????????????
• ??????
• ??????????
• ??????????????????

50
??????? (Constipation)

• ???????? ??????????? 3/???????-??????? 3/???
• ??????? ????????????????????????? (lt3/???????)
  ???????????????????????
• ????????
• ???????
• ????????? ????????
• physical inactivity

51
????????????????

• Organic disease
• ???????????????
• ????????
• ????????????????????
• ????????
• ???????????????
• ????????????????
• ???????
• ???????????
• ?????????????????????????????
• ??
• ????????
• ?????
• ???????????????????? calcium channel blocker
• ??????????????????, ????????????
• laxative abuse

• Functional
• ???????????????? irritable bowel syndrome (IBS)
• ignore the urge
• ?????
• ?????
• ???????????
• ?????????????????

52
???????????????????

• ????????????
• anal fissure (tear)
• hemorrhoid risk
• rectal prolapse
• ?????????????

53
????????

• Bulk forming ???????(fiber)
• wheat bran, psyllium
• Laxatives
• stool softener ELPco
• osmotic catharsis Milk of magnesia, MgSO4
• stimulant catharsis senna, prune juice, dulcolac
  
• Enough fluid at least 8 cup/d
• Exercise

54
???????

• laxatives can damage nerve cells in the colon and
  interfere with the colon's natural ability to
  contract
• regular use of enemas can also lead to a loss of
  normal bowel function

55
????????????????? (Acute Diarrhea)

• ??????
• Acute infectious diarrhea
• ????? ?????????
• Acute non infectious diarrhea
• ??
• Toxin
• Lactose intolerance

56
Acute Diarrhea
57
??????? (Vomiting)

• ??????????????????(nausea) ????????????????
• ???????????????????????????????????????????????
  ???????? ????????? ????
• ???????????(vomiting center)???????????????
• ???????????
• mechanical distension, ??????? ???????????
• ??????????????? ????? ?????????? ????????
• ?????????? ????????? ?????????
• reverse peristalsis
• ????????????? ???????????????
• ?????????????????????????
• LES, UES ???????

58
????????????????Irritable Bowel Syndrome (IBS)

• ???? functional problem ????????????
  ??????????????????????????????????????????????????
  
• ??????????
• ??????????????????
• ????????????????????????????????????????? painful
  diarrhea or constipation
• ???????
• ????????????????
• ????????????? ???????????(mucous)

59
Hepatitis

• ??? virus A, B, C
• ????? paracetamol ????????, ????????????
• ?????? ???????, ??????????????
• ????? ?????????? ??????????????? ????? ??????
  ?????????????????
• ?????? ?????? ?????????????????????????
• ??????????? ALT, AST, bilirubin ???
• ??????????????????
• ????????? virus A, B, ??, toxin
• ???????? virus B, C

60
???????

• rest
• ?????????????????? ??????????????????????? ??????
  ????????????? ??????? ??????????
• ??????????
• ???????????????????????????????
• ????????????? admit
• ???????????
• ?????????????????
• ??????????????????????
• ??????????????? acute liver failure

61
Cirrhosis

• ?????????????????????????????????????
  ??????????????????????????????????????????????????
  ???????????????????????

62
Cirrhosis

• ??????
• ?????????, ????? B, C0
• ???????????????? ????????????
• ?????
• ??????? ?????????
• ?????
• ??????? ?????
• ??????
• ????????????
• ???????????????????????????????????
• ??????????????????
• hepatic encephalopathy
• ?????????

63
???????????????????????? Liver function test (LFT)

• ??????????????????????????????????
• ????????????????????????????????????????
  (??????????????????)
• AST(SGOT), ALT(SGPT)
• ?????????????????????????????????????????????????
  
• alkaline phosphatase (ALP), GGT
• bilirubin
• ???????????????????????????? ?????????????
• albumin
• blood clotting factors

64
Case Study1

• ???????????? 45 ?? ???170 ??.??????? 87 ??.
  ???????????? ?????????????????????????
  ????????????????????? ?? 3 ?????
  ???????????????????????????????????????????
• ????????????? 3 ???? ????????? ???????????????????
  2 ?????
• ??????????????????????????????????????????
  ???????????????????

65
Case Study 2

• ???????????? 47 ?? ??????? ????????
  ??????????????????????????????????????????????????
  ?? 12 ?? ?????????? ??????????????
  ????????????????? ????????????????????? 3
  ????????? ??????????????????????? ??????? 5 ???
  ??????????? ???????????????? ?????????????????????
  ???????????