Pathological physiology of digestive system

Department of pathological physiology– 2018

General etiology of digestive system diseases

alimentary factors (dry and hard, hot and cold, un-gualitativefood, ets.); physical factors (ionizing radiation, ets); chemical factors (salts of heavy metals, poisons, ets.); biological factors (pathogens of typhoid, dysentery, warm invasion, Helicobacter pylori, ets psychic factors (negative emotion, stress, ets.); social factors (bad habits, ets.); congenital abnormalities of digestive tract; tumors, endocrinopathies, after operation states, ets.

Disturbances of appetite

Anorexia

Hyperrexia

Parorexia

Disturbance of digestion in oral cavityDisturbance of chewing

Absence or damage of teeth (caries, periodontitis, periodontosis, ets.); Disturbance of lower mandibular nervous-muscular apparatus (myositis, bulbar

paralysis, neuritis, ets); Damage of mandibular joint and mandibular bone, ets; Inflammation of oral cavity and mucous membrane of palate (stomatitis, gingivitis,

ets); Damage of tongue muscle, ets..

Disturbance of function of salivary gland

Reasons of hypersalivation: Excitation of salivary gland center in

medulla oblongata (bulbar paralysis); Irritation of receptors of mucous membrane

of oral cavity, esophagus and stomach (under action of food mass); ,

Inflammatory processes in oral cavity (gingivitis, stomatitis, pulpitis);

Irritation of parasympathetic nerves, innervating of salivary glands (action of some drugs, toxins, vegetative poisons-pylocarpine, fizostigmin, encephalitis, neurosis, ets);

Exogenous (mercury, nicotine) and endogenous (uremia, toxicosis of pregnancy) intoxications, warm invasions, ets.

Results: Maceration of skin of lip, Hyperosmolar hypohydration, Excretion of different toxic products of

metabolism with saliva.

HyposalivationReasons:

Damage of salivary glands (inflammation, operative intervention, radiation disease, radiotherapy, ets.);

Obturation of lumen of salivary gland with stones, or compression from outside with edematic fluid,, tumor, scar;

Disturbance of neurohumoral regulation of excretion of salivary glands (damage of cerebral cortex, hypothalamus and nervous plexus, innervating the gland);

Action of some vegetative poisons- atropine, scopolamine;

Hyperthyroidism, diabetes mellitus, ets; Prolonged term hypohydration (severe

perspiration, diarrhea, ets).

Results: Food mass does not mix completely with saliva,

Difficulty in chewing and swallowing act,

Dryness of mucous membrane of oral cavity (xerostomia),

On the surface of toung and gingiva forms plaque, which consist of dead epithelial cells.

Favorable condition form for stomatitis, gingivitis, glossitis, caries.

Dysphagia. Disturbance of motor function of esophagus.

İntra-esophageal tumor of esophagusInflammationAction of different drugsAcute and chronic esophagitisSpasm of esophagus

Extra-esophageal tumorsMetastases to the lunges and mediastinumTumors and cysts of diaphragmDilation of cardiac cavitiesSclerotic processes during tuberculosis in lungesHiatal herniaDiverticula

İntra-esophageal Extra-esophageal

Pathology of esophagusAchalasia of esophagus Scleroderma

Hypertone and spasm of lower sphincter esophagus

Difficulty of passage of

food into stomach

Decreasing of body mass

Pain

Esophagitis

Pneumonia

Hypotony of lower

sphincter of

esophagus

Muscular atrophy

Disappearing of

peristalsis

Gastro-esophageal

reflux

Reasons of gastro-esophageal reflux

Acetylcholine, alpha-

adrenergic agonists,

hormones, food, which reach

with proteins, histamine, high

intra-abdominal

pressure,PGF2, ets.

Esophagus

High pressure in

esophageal sphincter

Inhibits the reflux

VIP, beta adrenergic

agonists, hormones,

dopamine, NO, PGI2,

PGE2, increasing acidity of

stomach juice, smocking,

ets

DiaphragmLow pressure in

esophageal sphincter

Lead to reflux

Disturbance of secretory function of stomach

Quantitative changes of secretion of stomach juice

Increasing secretion of stomach juice-hypersecretion,

Decreasing secretion of stomach juice-hyposecretion,

Qualitative changes of secretion of stomach juice

Increasing of general acidity of stomach juice-hyperacidity,

Decreasing of general acidity of stomach juice-hypoacidity,

Increasing amount of free HCl-hyperchlorhydria,

Decreasing amount of free HCl-hypochlorhydria,

Absence of HCL and pepsin in stomach juice-achilia.

Factors, acting to the secretion of stomach juice

Secretion of stomach juice

Gastrin

Acetylcholine,

bombazine

Secretin,

somatostatin,

glucagon,

HCL,VIP,GIP

HCL PEPSIN

Acetylcholine, histamine, bombazine, AKTH, insulin, glucocorticoids,met-enkephakin, serotonin

Somatostatin, VIP, motilin, calcitonin, enterogastron, GIP, mineralocorticoid, glucagon, prostaglandins

Acetylcholine, histamine, secretin, AKTH, met-enkephalin, cholecystokinin, glucocorticoids, serotonin, thyrotrop hormone

Somatostatin,

GIP, VIP,

motilin

Disturbance of motor function of stomach

early satiety syndrome

burning

eructation hiccup

nausea

vomiting Dumpingsyndrome

Burning

Burning – is accompanied by burning on epigastria and retrosternum. It is connectedwith food, passing into esophagus from stomach (reflux). This case may observedduring increasing concentration of HCl or lactic acid in stomach juice, atony of lowerpart esophagus. Continues of this process for a long time lead to development ofesophagitisContinues of this process for a long time lead to development of esophagitis (damage ofmucous membrane of esophagus).

Macro-preparate of lower part of esophagus during chronicesophagitis (during prolonged term gastro-esophageal reflux).

Ulcerative mucous membrane

EructationEsophagus

Stomach

Liver

Small intestine

Large intestine

ЗАГЛАТЫВАНИЕ

ВОЗДУХАeructation

Vomiting

Contraction of pyloric sphincter

Relax of cardial sphincter

Relax of stomach fundus

Passage of stomach

content into esophagus

Dilatation of esophagus

Pharyngeal valve goes to the lower, pharynx goes to

the higher, pharyngeal valve closes

Soft palate rises Voice shelf closesr

Contraction of diaphragm

Contraction of abdominal press

Dumpung syndrome

Resected stomach

Tail of duodenum

Pancreas

Small intestines

Gastroenteroanastomosis

Destruction of carbohydrates and absorption a large number of glucose into blood

Stimulation of nsulin apparatus

Secretion of insulin

Hypoglycemia

Ulcer disease of stomach and duodenum

Esophagus

Ulcer in

esophagus

Stomach

Stomach

ulcer

Small

intestine

Ulcer of

duodenum

MECHANISM OF DEVELOPMENT OF STOMACH ULCER

Result of ulcer

Development of scar tissue

Perphoration Bleeding Malignancy

Result of ulcer disease

Mechanism of development of pancreatitis

Duodenum Pancreas

Duodenal

ampoule

Inflammatory

focus

Malabsorption syndromeReasons:

Disturbances structures of microvillus, decreasing their amount (dysentery, xholera);

Hereditary (Chartnap disease and Lou syndrome) and acquired (chronic enteritis) insufficiency of enzymes, participating in membrane digestion;

Disturbances of intestinal peristalses. For ex: during Vippl disease, Cron disease, ets;

Insufficient destruction of food in intestinal cavity.

Signs: Changes in hematopoetic system: iron, B12 and folic

acid deficiency anemia, hemorrhages, developing a aresult of deficiency of vitamin- K;

Changes in skeletal-muscle system: decreasing of body mass, osteoporosis, osteomalacia, tetany;

Changes in endocrine system: amenorrhea, infertility, hyperparathyroidism ;

Changes in skin: purpura and petechiae, dermatitis and hyperkeratosis;

Changes in nervous system: peripheral neuritis;

Peripheral edema (as a result of hypoproteinemia).

Disturbance of motor function of intestine

•diarrheaIncreasing of

intestinal peristalses

•constipationWeakening of

intestinal peristalses

Types of diarrhea

• Hyperosmolar diarrhea

• Hypersecretory diarrhea

• Hypo- və hyperkinetik diarrhea

Types of constipation

Atonic

Spastic

Mechanic

Rectal

Intestinal obstruction

Intestinal obstruction

MexanikiMechanical

obturation strangulation

Dynamic

spastic paralytic