Digestive System Introduction

Prof. Ji yao Wang

Common, Adults

GERD: 7%

Peptic ulcer: 10%

HP+: >50%

FD:10%

IBS: 8%

Gastric cancer: 2nd

Liver cancer:3rd

HBsAg +: 10%(7.8%)

CHB:3500万

Cirrhosis & HCC: 100万

IBD

Carcinoma of colon

Acute pancreatitis

Carcinoma of pancreas

Assimilation of

nutrients

Elimination of

waste

Structure and functions

Structure and functions

The two activities

under voluntary

control are swallowing

and defecation.

Characteristics of Digestive System

Many normal GI reflexes

involve extrinsic vagus or

splanchnic nerve

pathways.

An active brain-gut axis

further alters function in

regions

Immune organ

Gastrointestinal-associated lymphoid

tissue, (GALT)

Characteristics of Digestive System

• Not only a digestive organ but also

endocrine organ

pancreas gastrin (胃泌素)

glucagon(胰高糖素)

somatostatin( 生长抑素)

VIP(血管活性肠肽)

insulin(胰岛素)

Characteristics of Digestive System

Structure /function and diseases

The biggest

organ Homeostasis

Synthesis Excretion

Filter

Defense

symptoms

signs Death

inflammation(炎症)

Ulcer (溃疡)

bleeding(出血)

perforation (穿孔)

neoplasm (肿瘤)

functional disturbances(功能失调 )

Common Lesions of Digestive System

Classification of GI Diseases

• Impaired Digestion and Absorption

(Biliary obstruction, Chronic pancreatitis)

• Altered Secretion

(Zollinger-Ellison syndrome, duodenal ulcer,

Chronic pancreatitis)

• Altered Gut Transit

(Pylori/bowel obstruction, Achalasia,

constipation, diarrhea)

• Immune Dysregulation

(ulcerative colitis, Crohn’s disease)

• Impaired Gut Blood Flow

(intestinal and colonic ischemia)

• Neoplastic Degeneration

(Esophageal, gastric, colon, pancreatic, biliary cancer)

• Disorders without Obvious Organic Abnormalities (IBS)

• Genetic Influences

Classification of Liver Diseases

• Viral Hepatits

• Nonalcoholic fatty liver

• Alcoholic liver disease Cirrhosis

• autoimmune liver diseases

• Drug-induced liver disease

• Genetic liver diseases

• Mass lesions HCC

• Vascular injury

• Liver involvement in systemic diseases

Laboratory tests

History +Symptoms

+Signs

Imaging

studies

EVALUATION OF PATIENT WITH GI DISEASE

The diagnosis drives predominantly from the

patient’s history

The physician must identify the timing,

type,location and severity of the symptoms,

when and where they occur, aggravating and

alleviating factors, and any associated

symptoms.

History & symptoms

Cardinal Symptoms of GI diseases

•Abdominal pain ( GI and extra GI)

(peptic ulcer,appendicitis, IBD)

•Heartburn (gastroesophageal reflux disease, GERD)

•Nausea & Vomiting

•Altered bowel habits ( constipation, diarrhea, steatorrhea)

•GI bleeding (melena/hematemesis/hematochezia)

• Jaundice (Choledocholithiasis, cholangitis, pancreas, pancreatic cancer)

Cardinal symptoms of liver diseases

• Fatigue: most common, intermittent &

variable

• Nausea & vomiting: most severe liver dis.

• Right upper quadrant discomfort/liver

pain

• Itching: acute hepatitis, primary biliary

cirrhosis (PBC), sclerosing cholangitis

• Jaundice: hemolytic, hepatocellular

damage, cholestasis

History & symptoms

Detailed history:

alcohol use medications

personal habits sexual activity

exposure to jaundiced

person travel

injection drug use, recent surgery

blood transfusions, occupation

accidental exposure familial history to blood or needlestick, of liver disease

The history and physical examination remain the bases of evaluation.

Diagnosis of Digestive System diseases

A directed physical

examination can refine

the differential

diagnosis

Female 50 yr

• Severe diarrhoea(200-300ml X 15-20/day) for 3 months

• Dehydration and severe malnutrition (body weight 25 kg)

• Hypoalbuminemia

• Intermittent fever

Malabsorption (primary)

(PAS positive)

Whipple Disease

C A

D

B

A

B

C

D

1

1

2

2

334.3

120.2 138.0

a 336.3

120.1 138.1

b

1 2

c

d

Laboratory Test Blood routine tests: HB, RBC, WBC+DC,

Platelet

Stool sample: routine, occult blood. parasites

liver function test (TB.CB. ALT.AST. A.G. ALP. PT)

ANA, AMA, IgG, IgM, serum ceruloplasmin

Virus markers (hepatitis . ABCDE. etc)

Tumor markers (AFP, CEA, CA19-9, CA125…)

Analysis of ascites fluid

Esophageal pH testing

Diagnostic Imaging

Radiology:

plain film

barium meal examination

barium enema

small-bowel contract radiology

small-bowel contract CT

Angiogram, DSA

Diagnostic Imaging

US (ultrasound)

CT (computed tomograpy)

MRI (magnetic resonance imaging)

MRCP (MR cholangiopancreatography)

ERCP (endoscopic retrograde CP)

PET (positron emission tomography)CT

Isotope examination: biliary excretion gastric

emptying, 13c. 14c-UBT

Endoscopies (diagnosis & treatment)

upper endoscopy: dyspepsia, upper GI bleeding

Colonoscopy: lower GI bleeding, diarrhea, cancer screening

ERCP (therapeutic): jaundice, gallstone pancreatitis, pancreas/biliary/ampulla disorders

endoscopic ultrasound: staging of malignancy, submucosal mass

Double bloom intestinal endoscopy: lower GI bleeding , Crohn’s ileitis

Minilaparoscopy

ESD(endoscopic submucosal dissection)

& EMR(endoscopic mucosal resection)

A Biopsy of a Pancreatic Mass

Guided by Endoscopic

Ultrasonography

the Placement of a Stent into

a Malignant Bile-Duct Stricture

with Endoscopic Retrograde

Cholangiopancreatography

Reasonable application of examination

• Indication

• The strength and weakness of every

examination

• Not the more up-to-the-minute the better

General treatments:

modifications in dietary intake and

lifestyle/nutrition/psychology

Pharmacotherapy :

Etiologic

Chain of pathegenesis (PU,EVB)

Symptomatic

Principles of Treatment

Principles of Treatment

Interventional Endoscopy and

Radiology: sclerotherapy, EVL, dilation/stenting, angiographic embolization, PTCD

Surgery: cure or control symptoms

Tumor resection,

liver transplantation

Advances & Perspective

1. Etiologic therapy change the natural history of disease

2. Early diagnosis and treatment for digestive tract tumor

3. Liver transplantation

4. Diagnosis of intestinal diseases

5. Treatment for severe acute pancreatitis

6. Targeting biological therapy

7. Changes of digestive diseases spectrum

Thank you