gastrointestinal tract dysfunction obesity - … · faeces collected last 3 days ... formation of...
TRANSCRIPT
![Page 1: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/1.jpg)
Gastrointestinal Tract Dysfunction
&Obesity
Reuben KM Wong
Associate Professor
Friendly Gut Doctor!
![Page 2: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/2.jpg)
Learning Objectives
▪ Understand common GI disorders
that arise from disturbance of physiology
▪ Appreciate in clinical case scenarios the
application of physiology, systems biology and
human structure
▪ See the connection from textbook to patient
▪ Whet your appetite to learn!
![Page 3: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/3.jpg)
Functions of the GI Tract
• Ingestion of food, Digestion, Absorption and Excretion
• Metabolism
• Synthesis
▪Mouth, Pharynx,
Oesophagus, Stomach,
Small & Large Bowel
▪Liver, Pancreas
![Page 4: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/4.jpg)
Normal function
PHYSIOLOGY
DISEASE
SYMPTOMS
HEALTH
Disordered function
PATHOPHYSIOLOGY
Normal & Disordered GI Function
![Page 5: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/5.jpg)
Some Common GI Disorders:
▪ Dysphagia
▪ Gastric Ulcers and bleeding
▪ Derangements of gastric acid secretion
▪ Malabsorption
▪ Jaundice, gallstones
▪ Liver failure
▪ Constipation and colon obstruction
▪ Obesity
![Page 6: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/6.jpg)
Normal functions
• Saliva (ptyalin, anti-bacterial factors)
• Taste
• Mastication
?
MOUTH
Normal & Disordered GI Function
Disordered function
![Page 7: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/7.jpg)
Normal functions
• Saliva (ptyalin, anti-bacterial factors)
• Taste
• Mastication
• Xerostomia & dental caries
• Ageusia
• Problems with chewing (edentulous, stroke, etc)
MOUTH
Normal & Disordered GI Function
Disordered function
![Page 8: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/8.jpg)
Normal functions
• Swallowing
• Peristalsis
• Sphincter relaxation
Disordered function
• Dysphagia
• Aperistalsis ,obstruction
• Achalasia
OESOPHAGUS
Normal & Disordered GI Function
![Page 9: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/9.jpg)
Case Scenario
A 72 year old woman presents in the hospital clinic complaining of difficulty in swallowing for the past 4 weeks. She has trouble swallowing food or drink. She feels food gets ‘stuck’ and reports regurgitation of meals.
• What is the cause ?
• How would you find out ?
• How would you treat this ?
![Page 10: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/10.jpg)
DYSPHAGIA
“Difficulty in swallowing”
A symptom, not a disease
Need to establish cause
Recognize the altered physiology
![Page 11: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/11.jpg)
![Page 12: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/12.jpg)
CAUSES OF DYSPHAGIA
OROPHARYNGEAL DYSPHAGIA
• Neuromuscular diseases, eg CVA, Parkinson’s disease
• Local mechanical lesions, eg neoplasm, pharyngeal mass
• Upper esophageal sphincter (UES) disorders
ESOPHAGEAL DYSPHAGIA
• Intrinsic Mechanical lesions, eg carcinoma or stricture
• Extrinsic mechanical lesions, eg vascular compression by
vascular abnormality or mediastinal mass.
• Motility disorders, eg achalasia
![Page 13: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/13.jpg)
Imaging
Barium Swallow
![Page 14: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/14.jpg)
Imaging
Computed Tomography Scan
R L
![Page 15: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/15.jpg)
Endoscopy
![Page 16: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/16.jpg)
![Page 17: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/17.jpg)
![Page 18: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/18.jpg)
Normal functions
• Secretion of acid, pepsin, IF
• Gastric mucus & mucosal barrier
• Storage of food & controlled release into duodenum
- peristalsis
- pyloric sphincter
relaxation
Disordered function
• Disorders of acid secretion
• Gastric ulcers
• Dumping
• Gastroparesis
• Pyloric stenosis & vomiting
STOMACH
Normal & Disordered GI Function
![Page 19: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/19.jpg)
Case Scenario
A 55 year old man presents at the hospital Emergency Dept with vomiting of blood. He also has passed black tarry stools twice in the past 24 hours. He feels faint. He is pale and his blood pressure is 90/50 mm Hg.
• What is the cause ?
• How would you treat him ?
![Page 20: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/20.jpg)
Recognize the altered physiology
• vomiting of blood, black tarry stools= break in mucosal barrier with vascular compromise
• feels faint. He is pale and his blood pressure is 90/50 = hypotension, due to blood loss
![Page 21: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/21.jpg)
Gastric Mucosal BarrierD
efe
ndin
g F
acto
rs
![Page 22: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/22.jpg)
Endoscopy
![Page 23: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/23.jpg)
Actively Bleeding Gastric Ulcer
![Page 24: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/24.jpg)
Gastric Ulcer
![Page 25: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/25.jpg)
![Page 26: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/26.jpg)
What Causes Peptic Ulcers ?
Acid,
Pepsin
Attacking FactorsNSAIDS
H pylori
![Page 27: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/27.jpg)
Helicobacter pylori
![Page 28: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/28.jpg)
Normal functions
• Gastric Secretionacid, pepsin, IF
• Gastric mucus & mucosal barrier
• Storage of food & controlled release into duodenum
- peristalsis
- pyloric sphincter
relaxation
Disordered function
• Disorders of acid secretion
• Gastric ulcers
• Dumping
• Gastroparesis
• Pyloric stenosis & vomiting
STOMACH
Normal & Disordered GI Function
![Page 29: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/29.jpg)
Secretion of HCL by the Parietal Cell
![Page 30: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/30.jpg)
Treatment for Peptic Ulcers
• Drugs
–Proton Pump Inhibitors
–Histamine-2 Receptor Antagonists (H2RA)
• Surgery
–Repair
–Partial Gastrectomy
–Vagotomy
![Page 31: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/31.jpg)
Normal functions
• Secretion of acid, pepsin, IF
• Gastric mucus & mucosal barrier
• Storage of food & controlled release into duodenum
- peristalsis
- pyloric sphincter
relaxation
Disordered function
• Disorders of acid secretion
• Gastric ulcers
• Dumping
• Gastroparesis
• Pyloric stenosis & vomiting
STOMACH
Normal & Disordered GI Function
![Page 32: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/32.jpg)
Derangements in Gastric Secretion
1. Anacidity - Pernicious anemia
2. Hypoacidity- Gastric ulcer, Gastric CA
3. High acid output- Duodenal ulcer
4. Very high acid secretion - Gastrinoma
![Page 33: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/33.jpg)
SMALL INTESTINE
Normal functions
• Intestinal enzymes & secretions
• Absorption of nutrients, electrolytes & special nutrients
• Intestinal motility & transit
Disordered function
?
Normal & Disordered GI Function
![Page 34: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/34.jpg)
Sites for intestinal absorption
• Duodenum and proximal jejeunum
– Fats
– CHO
– amino acids
– minerals
– vitamins except B12
• Terminal ileum
Special receptors for B12, bile salts
![Page 35: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/35.jpg)
SMALL INTESTINE
Normal functions
• Intestinal enzymes & secretions
• Absorption of nutrients, electrolytes & special nutrients
• Intestinal motility & transit
Disordered function
• Maldigestion
• Malabsorption
• Abnormal transit -obstruction or too rapid
Normal & Disordered GI Function
![Page 36: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/36.jpg)
Case Scenario
A 24 year old woman presents to the clinic complaining of loss of weight of 10 kg and diarrhoea, over the past 3 months.
• What is the cause ?
• How would you find out ?
• How would you treat this ?
![Page 37: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/37.jpg)
Malabsorption
• Fat malabsorption
Steatorhea
Deficiency of vitamins A,D,E,K
• Protein malabsorption
Body wasting, hypoproteinemia, edema
• Carbohydrate malabsorption
![Page 38: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/38.jpg)
How Would You Detect
Malabsorption ?
• Faecal fat test 100 gram fat diet for 7 days
• Faeces collected last 3 days
• N< 6 grams fat / day excreted
▪ May be abnormal in pancreatic, biliary
or mucosal disease
![Page 39: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/39.jpg)
How Would You Test Intestinal Absorption ?
Xylose Absorption test
▪ 25 g oral dose
▪ Urine collected for 5 hours (N> 5 g xylose excreted)
▪ Measure Serum Sample at 90 mins (N> 2 mmol/L)
▪ Abnormal in jejeunal mucosal disease
![Page 40: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/40.jpg)
Mucosal Biopsy
![Page 41: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/41.jpg)
Causes of Malabsorption
Defects of luminal digestion
▪ Inadequate lipolysis
▪ Decreased conjugated bile salts
Defects of mucosal cell transport
▪ Non-specific (tropical sprue, celiac dis)
▪ Specific eg disaccharidase deficiency)
Defects of fat transport in intestinal lymphatics
![Page 42: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/42.jpg)
Normal functions
• Bile
• Bilirubin excretion
• Liver functions
Disordered functions
• Fat maldigestion
& malabsorption
• Jaundice
• Liver failure
Liver & Biliary system
Normal & Disordered GI Function
![Page 43: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/43.jpg)
![Page 44: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/44.jpg)
Case Scenario
A 62 year old man presents at the hospital clinic with jaundice which was noticed for one week. He also has tea-coloured urine.
•What is the cause ?• How would you confirm this ?
• How would you treat this ?
![Page 45: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/45.jpg)
![Page 46: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/46.jpg)
![Page 47: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/47.jpg)
Gallstones
10-20% of the population
Calcium bilirubinate stones
Deconjugation of conjugated bilirubin in bile -
>free bilirubin combines with calcium->
insoluble
Cholesterol stones
Altered proportions of cholesterol, lecithin
and bile salts
![Page 48: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/48.jpg)
Ampulla of Vater:
Major papilla
Cannulation of
Major papilla
Cholangiogram
![Page 49: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/49.jpg)
Normal functions
• Bile
• Bilirubin excretion
• Liver functions
Disordered functions
• Fat maldigestion
& malabsorption
• Jaundice
• Liver failure
Liver & Biliary system
Normal & Disordered GI Function
![Page 50: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/50.jpg)
Functions of the liver
▪ Formation of bile
▪ Carbohydrate metabolism
▪ Detoxification of drugs, toxins
▪ Urea & amino acid metabolism
▪ Production of plasma proteins
▪
▪ Deconjugating steroid hormones
▪ Jaundice
▪ Hypoglycaemia
▪ Hepatic encephalopathy
▪ Muscle wasting
▪ Hypoalbuminemia,
▪ Oedema, coagulopathy
▪ Gynecomastia
▪ Infections / sepsis
▪ renal failure
Liver Failure
![Page 51: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/51.jpg)
Case Scenario
A 56 year old female is seen in the
hospital clinic. She has jaundice,
bruises, and swelling of the abdomen
and legs. She complains of tiredness,
easy fatiguability and confusion.
• What is the cause ?
• How would you confirm this ?
![Page 52: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/52.jpg)
What is the disordered physiology here?
![Page 53: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/53.jpg)
![Page 54: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/54.jpg)
Functions of the liver
▪ Formation of bile
▪ Carbohydrate metabolism
▪ Detoxification of drugs, toxins
▪ Urea & amino acid metabolism
▪ Production of plasma proteins
▪ Deconjugating steroid hormones
▪ Jaundice
▪ Hypoglycaemia
▪ Hepatic encephalopathy
▪ Muscle wasting
▪ Hypoalbuminemia,
▪ Oedema, coagulopathy
▪ Gynecomastia
▪ Infections / sepsis
▪ renal failure
Liver Failure
![Page 55: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/55.jpg)
Liver Architecture
![Page 56: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/56.jpg)
Liver Cirrhosis
Liver cirrhosis is a diffuse process
involving loss of normal liver architecture
due to fibrosis and nodule formation, as a
result of hepatocellular necrosis. It implies
irreversible liver disease.
![Page 57: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/57.jpg)
Cirrhotic liver
![Page 58: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/58.jpg)
Causes of Cirrhosis
• Infections
–Hepatitis B
–Hepatitis C
• Toxins
–Alcohol
–Organic solvent, benzenes
• Metabolic Disorders
–Wilson’s Disease
– Fatty Liver (NASH)
• Autoimmune Conditions
–Primary Biliary Cirrhosis
–Autoimmune Hepatitis
![Page 59: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/59.jpg)
Spectrum of Liver Disease in Hepatitis B
▪ Acute Hepatitis
▪ Chronic Hepatitis
▪ Chronic liver disease ( Cirrhosis )
▪ Compensated liver cirrhosis
▪ Decompensated cirrhosis
▪ Liver failure
![Page 60: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/60.jpg)
COLON
Normal functions
• Absorption of water
• Colonic motility
• Colonic transit
Disordered function
• Diarrhoea
• Constipation
• Colonic obstruction & pseudo-obstruction
Normal & Disordered GI Function
![Page 61: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/61.jpg)
COLON
Functions
• Absorption of water and Na
• Secretion of K, bicarbonate and mucous
• Storage and propulsion of faeces
• Digestion
![Page 62: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/62.jpg)
Case Scenario
A 68 year old man complains of constipation for the past 3 months. He has difficulty moving his bowels and the stools are small and thin. Previously his usual pattern of bowel movements was once daily. He now presents with a severely distended abdomen and inability to pass motion.
What is the cause ?
How would you confirm this ?
How would you treat this ?
![Page 63: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/63.jpg)
Recognize the altered physiology
• difficulty moving his bowels and stools small and thin = slow transit ? obstruction
• Previously his usual pattern of bowel movements was once daily = a change
• severely distended abdomen and inability to pass motion = obstruction
![Page 64: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/64.jpg)
Colonoscopy
![Page 65: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/65.jpg)
X-Ray
![Page 66: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/66.jpg)
Intestinal obstructionFailure of transit
–Distension, pain, constipation, vomiting
Net secretion of fluid and electrolytes
–Dehydration and electrolyte imbalance
Bacterial translocation
– sepsis
![Page 67: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/67.jpg)
Intestinal Obstruction
Extrinsic
• Something from outside the intestine
Intrinsic
• Something inside the lumen
![Page 68: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/68.jpg)
Transit
mouth to caecum - 6 hours
transit through colon - 36 hours
liquid contents in right colon
solid stool in left colon
propulsion in sigmoid
storage and defaecation in rectum
![Page 69: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/69.jpg)
Too FAST = Diarrhoea
Key symptoms
• Loose or watery stools
• 3 or more bowel movements a day
• Stool weight > 200g/day
• ACUTE: 1.5% of adult hospitalisations
• CHRONIC: 5% of population
![Page 70: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/70.jpg)
Too SLOW = Constipation
Key symptoms
• Hard or lumpy stools
• <3 bowel movements a week
• Straining to defecate
• Sensation of anorectal obstruction
• Manual manuveurs to evacuate stool
![Page 71: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/71.jpg)
Stool form also affected by transit
![Page 72: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/72.jpg)
Obesity
• The new epidemic of plenty
• Energy Imbalance
• Different ways of measuring obesity:
–Weight
–Body Mass Index (Height –Weight)
–Waist circumference
–Waist Hip Ratio
![Page 73: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/73.jpg)
Energy Homeostasis
Vitamins
Minerals
Water
Digestion
Products
Chemical
breakdown
of ingested
foods to
smaller
molecules
Establish
optimal
chemical
conditions
in the
gut for
digestion
Liver
GlycogenPancreas Brain
Eating
portal
vein glucoseinsulin glucagon insulin
glucagon glucose
+
Fats (lymphatics)
AA
![Page 74: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/74.jpg)
Energy productionThe Energy Balance
![Page 75: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/75.jpg)
Lipid transport in the body
![Page 76: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/76.jpg)
The global effects of the energy imbalance
Blood Vessels
• Coronary blockage (AMI)
• Strokes
Fatty Liver
• Liver stores the fat
• Fat induces inflammation
• NASH / Cirrhosis
Peripheral FAT
deposition
• Obesity
• Insulin Resistance
![Page 77: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/77.jpg)
Common GI Disorders: Summary
▪ Understand common GI disorders
that arise from disturbance of physiology
▪ Dysphagia
▪ Gastric Ulcers and bleeding
▪ Derangements of gastric acid secretion
▪ Malabsorption
▪ Jaundice, gallstones
▪ Liver failure
▪ Constipation and colon obstruction
▪ Obesity
![Page 78: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/78.jpg)
Are there region-specific public health concerns that can be addressed by modifying the gut microbiota? Do you see a need for epidemiological studies to establish correlations and associations between gut microbial communities and health?
De Filippo et al. Effect of Diet on shaping microbiota, comparative study: PNAS 2010
![Page 79: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/79.jpg)
Taipei
Taichung
Beijing
Yogyakarta
Bali
Bangkok
Khon Kaen
Fukuoka
Lanzhou
Tokyo
Bacteroidaceae
Lachnospiraceae
Ruminococcaceae
Prevotellaceae
Bifidobacateriaceae
Stool bacteria composition of children living in 10 cities in Asia
J Nakayama, K Watanabe, JH Jiang, K Matsuda, SH Chao, P Haryono, O La-ongkham, MA Sarwoko, IN Sujaya, L Zhao, KT Chen, YP Chen, HH Chiu, T Hidaka, NX Huang, C Kiyohara, T Kurakawa, N Sakamoto, K Sonomoto, K Tashiro, H Tsuji, MJ Chen, V Leelavatcharamas, CC Liao, S Nitisinprasert, ES Rahayu, FZ Ren, YC Tsai, YK Lee (2015) Diversity in gut bacterial community of school-age children in Asia. Scientific Reports, 5:8397/DOI 10.1038/srep08397.
![Page 80: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/80.jpg)
![Page 81: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/81.jpg)
Brain-Gut Talk
![Page 82: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/82.jpg)
![Page 83: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/83.jpg)
Clostridia Difficile Colitis
Brody TJ, Khoruts A.FMT and emerging applications. Nat Rev Gastroenterol 2012.
![Page 84: Gastrointestinal Tract Dysfunction Obesity - … · Faeces collected last 3 days ... Formation of bile ... storage and defaecation in rectum. Too FAST = Diarrhoea Key symptoms](https://reader033.vdocuments.site/reader033/viewer/2022051801/5ad7ef2b7f8b9ab8378cbc1e/html5/thumbnails/84.jpg)
Ask yourself…..
• WHY …. Am I studying physiology?
• WHERE …. Can it be applied?
• WHAT …. Happens when physiology gets disordered?
• WHEN …. Will I get to apply what I’ve learnt? RIGHT NOW!