Pathophysiology of GIT I

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Complications of Crohn’s disease 61 Ulcerative colitis • max. incidence between 20 – 40. years of age • typically Caucasian Caucasian race race, north south gradient • inflammation limited to mucosa • starts at the bottom of Lieberkuhn’s crypts (infiltration by immune cells) • mainly rectum and sigmoideum • hyperemia hyperemia, abscesses and ulcerations, bleeding, pseudopolyps, event. strictures • clinical course • periodical = exacerbations x remissions (diarrhea, bleeding, abdominal pain, fever) • extraintestinal t i t ti l manifestations if t ti (5 – 15%): polyarthritis, osteoporosis, uveitis, cholangitis • chronic anemia, , strictures, , hemorrhoids, carcinoma 63 Pathophysiology of large intestine 62 • functions • resorption of water (0.5- 1l/24h) • along the whole length • motoric • pathology • obstipation p • diverticulosis • event. divertikulitis • polyposis l i • carcinoma • hereditary • polyposis • non-polypose • non-hereditary (sporadic) Polyps of large intestine • polyp = any lesion/prominence into the lumen • types • solitary • multiple • familiar polyposis, p yp , FAP) ) • autosomal dominant • precancerosis, polyps in puberty, carcinoma after 30th year of age • polyps more common in rectum but also in ileum • mutation in APC gene (Wnt pathway) • Gardner’s syndrome • juvenile j ppolyposis yp • etiology • hyperplasia in the inflammatory terrain • neoplastic • benign • malign 64
Tumors of large intestine • benign • adenoma (adenomatous polyp) • fibroma • leiomyoma • hemangioma • malign • lymphoma • carcinoid 65 • carcinoma • hereditary • polypose • FAP (mutation in APC gene) • Gardner’s syndrome • non-polypose l • HNPCC or Lynch syndrome (mutation in mismatch repair genes) • Li-Fraumeni syndrome y (mutation ( in p53 p gene) g ) • non-hereditary (sporadic) – most common Colorectal carcinoma • • carcinogenesis in the intestine progresses slowly upon the exposure to dietary carcinogens and event. with contribution tibti of f genetic ti predisposition di iti of the subject risk factors • • age, genetics, polyps, bowel inflammation, obstipation, diet, smoking symptoms • bleeding, blood in stools • change of peristaltics • • • diarrhea obstipation tenesmus • intest intest. obstruction • pain • extraintestinal • liver metastases • • icterus, pain, cholestasis = acholic stools hematologic • • sideropenic anemia, thrombosis fatique • stadia • • fever anorexia, i weight i ht lloss • • • 0 I II in situ invasion into the wall • III presence in local lymph nodes 67 • IV distant metastases Colorectal carcinoma 66 68
Page 1 and 2: 1 Pathophysiology of GIT I Oral cav
Page 3 and 4: Disorders of oesoph. motility • a
Page 5 and 6: Pathophysiology of stomach 17 Gastr
Page 7 and 8: Interplay of paracrine GIT factors
Page 9 and 10: 33 Symptoms of gastric vs. duodenal
Page 11 and 12: Intestinal secretion and absorption
Page 13 and 14: Obstructive and paralytic ileus 49
Page 15: Lactose intolerance prevalence 57 C

Pathophysiology of GIT I

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