Marshell Tendean, MD, DPCP

Understand gastrointestinal anatomy and

physiology.
To know common gastrointestinal hepatology
diseases.
Recognize common gastrointestinal- hepatology
symptoms.
Know approach to gastrointestinal-hepatology
disease.
Ancilary procedures related to gastrointestinal-
hepatology dicipline.
Dyspepsia.
Anatomy : Is an organ complex with distinc
function comprising from mouth to anus.
Function :
Assimilating nutrient
Eliminating waste


Mouth : mechanically processed, mixed with
salivary.
Esophagus : propels the bolus into stomach.
Stomach :
Mechanical digestion : mixing process
Ezymatic digestion : pepsin, acid intrinsic factor.
Small intestine : absorption of nutrient
(macro/micronutrient, vitamins, fat)
Colon : water absorption and preparation of
waste
Impaired digestion and absorption
Altered secretion
Altered gut transit
Immune dysregulation
Impaired gut blood flow
Neoplastic degeneration

Abdominal pain
Heart burn
Nausea and vomiting
Altered bowel habit
Gi bleeding
Obstructive jaundice

Including GI disease and extraintestinal
conditions the genitourinary tract,
abdominal wall, thorax, or (spine).
Most common cause functional dyspepsia.
Pain source :
Visceral pain generally is midline in location and
vague in character.
While parietal pain is localized and precisely
described.
Causes :
Common inflammatory diseases with pain.
Other intraabdominal causes of pain include
gallstone disease and pancreatitis.
Noninflammatory visceral sources include
mesenteric ischemia, neoplasia and constipation.
Heartburn, a burning substernal sensation.
Classically, heartburn is felt to result from
excess gastroesophageal reflux of acid.
Some cases exhibit normal esophageal acid
exposure and may result from reflux of
nonacidic material or heightened
sensitivity of esophageal mucosal nerves
Nausea and vomiting are caused by GI diseases,
medications, toxins, acute and chronic infection,
endocrine disorders, labyrinthine conditions, and
central nervous system disease.
The best-characterized GI etiologies relate to
mechanical obstruction of the upper gut; however,
disorders of propulsion including gastroparesis and
intestinal pseudoobstruction also elicit prominent
symptoms.
Nausea and vomiting also are commonly reported
by patients with irritable bowel syndrome and
functional disorders of the upper gut.
Constipation is reported as infrequent defecation, straining with
defecation, passage of hard stools, or a sense of incomplete fecal
evacuation.
Causes of constipation include obstruction, motor disorders of the
colon, medications, and endocrine diseases such as
hypothyroidism and hyperparathyroidism.
Diarrhea is reported as frequent defecation, passage of loose or
watery stools, fecal urgency, or a similar sense of incomplete
evacuation.
The differential diagnosis of diarrhea is broad and includes infections,
inflammatory causes, malabsorption, and medications.
Irritable bowel syndrome produces constipation, diarrhea, or an
alternating bowel pattern.
Fecal mucus is common in irritable bowel syndrome, while pus
characterizes inflammatory disease.
Steatorrhea develops with malabsorption.
Most commonly, upper GI bleeding presents with
melena or hematemesis, whereas lower GI bleeding
produces passage of bright red or maroon stools.
Chronic slow GI bleeding may present with iron
deficiency anemia. The most common upper GI causes
of bleeding are ulcer disease, gastroduodenitis, and
esophagitis.
The most prevalent lower GI sources of hemorrhage
include :
Hemorrhoids, anal fissures, diverticula, ischemic colitis, and
arteriovenous malformations.
Other causes include neoplasm, inflammatory bowel
disease, infectious colitis, drug-induced colitis, and other
vascular lesions.
Appear if bilirubin level >3 mg/l.
Jaundice results from prehepatic,
intrahepatic, or posthepatic disease.
Posthepatic causes of jaundice include biliary
diseases such as choledocholithiasis, acute
cholangitis, primary sclerosing cholangitis,
other strictures, and neoplasm and
pancreatic disorders, such as acute and
chronic pancreatitis, stricture, and
malignancy.
Abdominal pain :
Organic
Non Organic
Tumor of the GI tract
IBD
Diarrhoea
Absorbtion disorder
GI Bleeding (upper lower).
Hepatitis (acute or Chronic)
Liver abcess
Liver malignancy
Gall stones.
Billiary malignancy
Pancreatitis (acute or chronic)
Pancreatic malignancy
Liver cirrhosis
Good history
Accurate physical examination
Proper diagnostics:
Invasive.
Non invasive.
IAPP
Invasive :
Biopsy (ultrasound, CT-scan guided).
Endoscopy.
ERCP.
EUS.
Cholangiography.
Angiography

Non invasive :
Laboratory examination :
Imaging procedure :
Conventional
USG
CT scan
MRI
Nuclear
Group of disease hallmarked as pain or upset
upper in the epigastrium.
Organic (Known pathology)
Ulcer disease
Polyp
Gastritis
Malignancy
Functional (no known pathology)

Recognized as the presence of alarm symptoms.
Age > 45 yo
Hematemesis melena
Weight loss
Early satiety
Vomiting
Anemia.
Ulcer disease :
Duodenal (Hpylori related)
Gastric (malignancy or drug related)
Functional dyspepsia :
Ulcer type
Dysmotility type
Mixed type
Defined as the Rome III criteria.
Entertained if there were no anatomic
lession.
Diagnostics :
USG
Barrium meal
Endoscopy of the Upper Abdomen (Esophago-
gastro- duedunoscopy)
Treatment :
Antacid
Sukralfat
Anti spasmodic
H2R blocker
PPI