HMM 4401 Gastrointestinal disease

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1 HMM 4401 Gastrointestinal disease Ett sykehus - nær deg og dine

2 Admissions to inpatient hospital, > 70 yrs Main diagnoses Blefjell hospital, all dep Patient admissions Cancer and cancer related 500 Cardiovascular 1500 Lung, COPD 600 Digestion, hepatology 500 Gynecology, urology 300 Trauma 800 Cerebrovascular disease 460

3 Main gastrointestinal diseases? What diseases have you heard of? Know someone with? Worry about?

4 Main gastrointestinal diseases Swallowing problems, dry mouth, loss of appetite Heart burn, esophagitis, reflux Stomach ache, gastritis, dyspepsia, ulcer Digestion, malabsorbtion, sprue Liver diseases, gall bladder diseases, jaundice Pancreas diseases, pancreatitis Inflammatory bowel disease, Crohn, ulcerative colitis Diverticulitis Cancer

5 The digestive system Mouth Esophagus Stomach Intestine Liver/gall bladder Pancreas Large intestine

6 Function of the gastrointestinal system What is a metaphor for the gastrointestinal system? Mouth Esophagus Stomach Small intestine Liver Pancreas Large intestine

7 Function of the gastrointestinal system What is a metaphor for the gastrointestinal system? Mouth Esophagus Stomach Small intestine Liver Pancreas Large intestine Grinder, mechanical kneading, portioning into dudoenum Absorption of nutrients, excretion of toxins, adjusting blood sugar Absorbing water, keeping it until toilet is available,

8 Function of the upper GI Mouth Chewing, saliva Esophagus Tube with muscles Peristalsis, gravity Stomach Gastric acid HCl Gastrin Other enzymes

9 Function of middle GI Duodenum Small intestine Jejunum Ileum Liver Gall bladder Pancreas

10 Function of lower GI Large intestine Rectum Anus

11 Upper GI diseases Swallowing problems, dry mouth, loss of appetite Heart burn, esophagitis, reflux Stomach ache, gastritis, dyspepsia, ulcer

12 Esophagus, esophagitis Heart burn, esophagitis, reflux

13 Upper GI diseases Stomach ache, gastritis, dyspepsia, ulcer

14 Upper GI diseases Why do peple get ulcer? Nerves? Psychosomatic Coffee? Wine? Tobacco? Bad habits Nerves Blood type Genetic

15 Helicobacter pylori! bacteria

16 Ulcer disease Helicobacter pylori Nobel price % of duodenal ulcers Antibiotic treatment No ulcer without acid Anticids help, but antibiotic cures

17 Ulcer disease Do you know any antacids?

18 Ulcer can perforate stomach - emergency

19 pause

20 Clinical services Internal medicine in general hospital common diseases General medical and surgical wards Organ block or close relation surgeon/physician Diagnostics often outpatient service Cancer is a possibility in many cases Endoscopy universal test supplemented by X-ray etc. Hepatology very difficult very internal medicine Endoscopy is practical more like surgery

21 Stethoscopy and clinical examination Listen to two different stomachs, what do you hear? Where is the appendix? Where is the liver? Where is the spleen? Where is the stomach? Where is the gall bladder? Where are the kidneys? Percussion palpation - auscultation

22 The digestive system Stomach Intestine Liver/gall bladder Pancreas Appendix Large intestine

23 Endoscopy

24 Endoscopy what do you see?

25 Endoscopy what do you see?

26 Endoscopy Try the endoscope pretend to be a gastroenterologist

27 Diagnostic and therapeutic tool See upper and lower GI with own eyes Video and photographs Biopsies Removing small tumors Stopping bleeding Banding varices

28 Ulcerative colitis and Crohns disease See upper and lower GI with own eyes Video and photographs Biopsies Removing small tumors Stopping bleeding Banding varices

29 Ulcerative colitis and Crohns disease Inflammatory bowel diseases Often life long, start young Medication helps, but no cure Diarrhea, blood, pain End up with emergency surgery Cancer risk with UC Remicade and other expensive medication

30

31 Pancreas, liver, gall bladder Pancreas Liver gall bladder

32 Function of the pancreas sugar and fat

33 Pancratitis - causes

34 Pancratitis - causes

35 Function of the gall bladder Liver makes cholesterol soap and other things in bile Bile is stored in gall bladder and released after meals Red blood cells are destroyed and liver takes care of bilirubin Is also part of bile Bilirubin makes feces brown and urine yellow If blocked gall duct or liver failure you get yellow jaundice Cholecystitis acute abdomen! Gall bladder can be removed you still live

36 Gall bladder stones!?????

37 Function of liver detoxify us Alcohol Methanol Mushroom Pills Drugs Red blood cells M.m.

38 Too much toxins liver failure Liver cirrhosis Fat liver Ascites Flappy hands Mental confusion Acute and chronic

39 Hepatitis B world wide disease

40 Hepatitis A, food etc, not dangerous

41 Hepatitis B, killer and chronic

42 Hepatitis C, chronic, may give cancer

43 Acute abdomen surgical emergency Reflux, heart burn may feel like heart attack Ulcer may bleed a lot, may feel like heart attack Pancreatitis very painful, shock, Hepatitis virus, toxins Cholecystitis fat female at forty and everybody else Appendicitis all ages Diverticulitis Crohn and ulcerative colitis Ischemia and trauma of all organs

44 Future advances Even more specific and costly intervention Genetic therapy Infection/Antibiotic theories Immunology tailor made medication More technology Better decentralized care and diagnostics MRI, PET scan, etc.

45 Summary Stomach pain, indigestion, constipation etc normal Cancer in GI may give such symptoms Ulcer and dyspepsia have good treatments Hepatitis world wide killer and problem vaccine Liver disease and alcohol Pancreas, diabetes, obesity, life style

46 Main gastrointestinal diseases Swallowing problems, dry mouth, loss of appetite Heart burn, esophagitis, reflux Stomach ache, gastritis, dyspepsia, ulcer Digestion, malabsorbtion, celiac disease Liver diseases, gall bladder diseases, jaundice Pancreas diseases, pancreatitis Inflammatory bowel disease, Crohn, ulcerative colitis Diverticulitis Cancer

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