DIGESTIVE SYSTEM
that are more easily digested.
Digestive System
- -is made up of the gastrointestinal tract-also
called the GI tract or digestive tract- and the
liver, pancreas, and gallbladder.
- The Gl tract is a series of hollow organs joined in
a long, twisting tube from the mouth to the
anus.
The gastrointestinal tract
- is the tract from the mouth to the anus which
includes all the organs of the digestive system in
humans and other animals.
Food taken in through the mouth is digested to extract
nutrients and absorb energy → and the waste expelled
as feces
What organs make up the digestive system?
- Our digestive system is uniquely constructed to
do its job of turning your food into the nutrients
and energy you need to survive.
And when it's done with that, it handily packages your
solid waste, or stool, for disposal when you have a
bowel movement.
The main organs that make up the digestive system (in
order of their function) are:
- mouth
- Esophagus
- Stomach
- small intestine
- large intestine
- Rectum
- anus.
Helping them along the way are the pancreas,
gallbladder and liver.
Mouth
- is the beginning of the digestive tract.
In fact, digestion starts before you even take a bite.
Your salivary glands get active as you see and smell that
pasta dish or warm bread.
After you start eating, you chew your food into pieces
Your saliva mixes with the food to begin to break it
down into a form your body can absorb and use.
When you swallow, your tongue passes the food into
your throat and into your esophagus.
Esophagus
- Located in your throat near your trachea
(windpipe)
- receives food from your mouth when you
swallow.
-
The epiglottis is a small flap that folds over your
windpipe as you swallow to prevent you from choking
(when food goes into your windpipe).
A Series of muscular contractions within the esophagus
called peristalsis delivers food to your stomach.
But the firstaring-like muscle at the bottom of your
esophagus, called the lower esophageal sphincter →
has to relax to let the food in.
The sphincter then contracts and prevents the contents
of the stomach from flowing back into the esophagus.
(When it doesn't and these contents flow back into the
esophagus, you may experience acid reflux or
heartburn.)
Stomach
- is a hollow organ, or "container," that holds
food while it is being mixed with stomach
enzymes.
These enzymes continue the process of breaking down
food into usable form.
Cells in the lining of the stomach secrete strong acid and
powerful enzymes that are responsible for the
breakdown process.
When the contents of the stomach are processed
enough → they're released into the small intestine.
Small intestine
Made up of three segments: duodenum, jejunum, and
ileum
- Is a 22-foot long muscular tube that breaks
down food using enzymes released by the
pancreas and bile from the liver.
Peristalsis also works in this organ, moving food through
and mixing it with digestive juices from the pancreas
and liver.
Duodenum
- is the first segment of the small intestine.
It's largely responsible for the continuous
breaking-down process.
Jejunum and ileum
- lower in the intestine are mainly responsible for
absorption of nutrients into the bloodstream.
Contents of the small intestine start out semi-solid, and
end in liquid form after passing through the organ.
Water, bile, enzymes and mucus contribute to the
change in consistency.
Once the nutrients have been absorbed and the
leftover-food residue liquid has passed through the
small intestine → it then moves on to the large
intestine, or colon.
Pancreas
- secretes digestive enzymes into the duodenum
that break down protein, fats and
carbohydrates.
- also makes insulin, passing it directly into the
bloodstream.
Insulin is the chief hormone in your body for
metabolizing sugar.
Liver
- has many functions, but its main job within the
digestive system is to process the nutrients
absorbed from the small intestine.
Bile from the liver secreted into the small intestine also
plays an important role in digesting fat and some
vitamins.
The liver is the body's chemical "factory."
It takes the raw materials absorbed by the intestine and
makes all the various chemicals the body needs to
function.
- also detoxifies potentially harmful chemicals.
- It breaks down and secretes many drugs that
can be toxic to the body.
Gallbladder
- stores and concentrates bile from the liver, and
then releases it into the duodenum in the small
intestine to help absorb and digest fats.
Colon (large intestine)
- is responsible for processing waste so that
emptying the bowels is easy and convenient.
It's a 6-foot long muscular tube that connects the small
intestine to the rectum.
- is made up of the cecum, the ascending (right)
colon, the transverse (across) colon, the
descending (left) colon, and the sigmoid colon,
which connects to the rectum.
Stool, or waste left over from the digestive process →
passed through the colon by means of peristalsis, first in
liquid state and ultimately in solid form.
As stool passes through the colon → water is removed.
Stool is stored in the sigmoid (S-shaped) colon until a
"mass movement" empties it into the rectum once or
twice a day.
It normally takes about 36 hours for stool to get through
the colon. The stool itself is mostly food debris and
bacteria.
These "good" bacteria perform several useful functions
such as:
- synthesizing various vitamins
- processing waste products and food particles
and protecting against harmful bacteria.
When the descending colon becomes full of stool, or
feces → it empties its contents into the rectum to begin
the process of elimination (a bowel movement).
Rectum
- is a straight, 8-inch chamber that connects the
colon to the anus.
- job is to receive stool from the colon, let you
know that there is stool to be evacuated
(pooped out) and to hold the stool until
evacuation happens.
When anything (gas or stool) comes into the rectum →
sensors send a message to the brain.
The brain then decides if the rectal contents can be
released or not.
If they can → the sphincters relax and the rectum
contracts → disposing its contents.
If the contents cannot be disposed → the sphincter
contracts and the rectum accommodates so that the
sensation temporarily goes away.
Anus
- is the last part of the digestive tract.
It is a 2-inch long canal consisting of the pelvic floor
muscles and the two anal sphincters (internal and
external).
The lining of the upper anus is able to detect rectal
contents.
It lets you know whether the contents are liquid, gas or
solid.
The anus is surrounded by sphincter muscles that are
important in allowing control of stool.
The pelvic floor muscle creates an angle between the
rectum and the anus that stops stool from coming out
when it's not supposed to.
The internal sphincter is always tight, except when stool
enters the rectum.

This keeps us continents (prevents us from pooping

involuntarily) when we are asleep or otherwise unaware
of the presence of stool.
When we get an urge to go to the bathroom, we rely on
our external sphincter to hold the stool until reaching
the toilet, where it then relaxes to release the contents.

ABDOMEN

Components Of Digestive System

Human Digestive System

 - consists of the gastrointestinal tract plus the
accessory organs of digestion.
Digestion involves the breakdown of food into smaller
and smaller components, until they can be absorbed
and assimilated into the body.
Digestive Processes.
The processes of digestion include six activities:
- Ingestion
- Propulsion
- mechanical or physical digestion
- chemical digestion
- Absorption
- defecation.
The first of these processes, ingestion → refers to the
entry of food into the alimentary canal through the
mouth
Four stages of food processing in your body:
- ingestion
- digestion
- absorption
- elimination
Why is Digestion important?
- for breaking down food into nutrients, which
the body uses for energy, growth, and cell
repair.
Food and drink must be changed into smaller molecules
of nutrients before the blood absorbs them and carries
them to cells throughout the body.
What is Pepsin?
- is an endopeptidase → breaks down proteins
into smaller peptides (that is,a protease).
It is produced in the stomach and is one of the main
digestive enzymes in the digestive systems of humans
and many other animals, where it helps digest the
proteins in food.
- powerful enzyme in gastric juice that digests
proteins such as those in meat, eggs, seeds, or
dairy products.
- is the active protein-digesting enzyme of the
stomach
- acts on protein molecules by breaking the
peptide bonds that hold the molecules together.
Digestion of protein is completed in the small intestine
by the pancreatic enzymes:
- trypsin
- chymotrypsin
- carboxypeptidase
A protease (also called peptidase or proteinase)
- is an enzyme that catalyzes (increases the rate
of) proteolysis → the breakdown of proteins
into smaller polypeptides or single amino acids.
They do this by cleaving the peptide bonds within
proteins by hydrolysis → a reaction where water breaks
bonds.
How does the Digestive system work?
- works by moving food through the Gl tract.
- begins in the mouth with chewing and ends in
the small intestine.
As food passes through the GI tract, it mixes with
digestive juices → causing large molecules of food to
break down into smaller molecules.
Salivary amylase
Carbohydrate digestion also initiates in the mouth.
Amylase, produced by the salivary glands → breaks
complex carbohydrates to smaller chains, or even
simple sugars.
It is sometimes referred to as ptyalin.
What Digestion occurs in the mouth?
Mechanical digestion begins in the mouth as the food is
chewed.
Chemical digestion involves breaking down the food into
simpler nutrients that can be used by the cells.
- begins in the mouth when food mixes with
saliva.
Saliva contains an enzyme (amylase) that begins the
breakdown of carbohydrates.
Absorption
Digested food molecules are absorbed in the small
intestine.
This means that they pass through the wall of the small
intestine and into our bloodstream, then digested food
molecules are carried around the body to where they
are needed.

Nutrients In, Waste Out: How the Human Body Absorbs
Nutrients and Eliminates Waste Ingested food is
chewed, swallowed, and passes through the esophagus
into the stomach where it is broken down into a liquid
called chyme.
Chyme passes from the stomach into the duodenum →
mixes with bile and pancreatic juices that further break
down nutrients.
Finger-like projections called villi line the interior wall of
the small intestine and absorb most of the nutrients.
The remaining chyme and water pass to the large
intestine, which completes absorption and eliminates
waste.
Small intestine
- is the part of the intestines where 90% of the
digestion and absorption of food occurs, the
other 10% taking place in the stomach and large
intestine.
The main function of the small intestine is absorption of
nutrients and minerals from food.
How does the small intestine digest food?
The small intestine has millions of tiny finger-like
projections called villi.
These villi increase the surface area for more efficient
food absorption.
Within these villi, many blood vessels are present that
absorb the digested food and carry it to the
bloodstream.
1. Villi That Line the Walls of the Small Intestine
Absorb Nutrients
Villi that line the walls of the small intestine absorb
nutrients into capillaries of the circulatory system and
lacteals of the lymphatic system.
Villi contain capillary beds, as well as lymphatic vessels
called lacteals.
Fatty acids absorbed from broken-down chyme pass into
the lacteals.
Lacteals
- lymphatic vessels of the small intestine which
absorb digested fats
Other absorbed nutrients enter the bloodstream
through the capillary beds → are taken directly to the
liver, via the hepatic vein, for processing.
Capillaries are microscopic blood vessels that connect
the arterioles with the venules, and a network of
capillaries is known as capillary bed.
The fluid that leaks out of the capillaries is known as
interstitial fluid.
It's this leaked interstitial fluid that bathes your body
cells in nutrients
Large intestine
- compacts liquid waste into solid waste.
2. The Large Intestine Completes Absorption and
Compacts Waste
Chyme passes from the small intestine through the
ileocecal valve and into the cecum of the large intestine.
Any remaining nutrients and some water are absorbed
as peristaltic waves move the chyme into the ascending
and transverse colons.
This dehydration, combined with peristaltic waves, helps
compact the chyme.
- the pulpy acidic fluid which passes from the
stomach to the small intestine, consisting of
gastric juices and partly digested food.
The solid waste formed is called feces.
It continues to move through the descending and
sigmoid colons.
The large intestine temporarily stores the feces prior to
elimination
3. Defecation Eliminates Waste From the Body
The body expels waste products from digestion through
the rectum and anus.
This process, called defecation involves:
- contraction of rectal muscles
- relaxation of the internal anal sphincter
- initial contraction of the skeletal muscle of the
external anal sphincter.
The defecation reflex is mostly involuntary, under the
command of the autonomic nervous system. But the
somatic nervous system also play a role to control the
timing of elimination
Anatomy of the Large Intestine
What are the four parts of the large intestine?
The colon consists of four parts:
- ascending colon
- transverse colon
- descending colon
- sigmoid colon.
While the small intestine plays a major role in absorbing
nutrients from food, the large intestine plays a much
smaller role.
The 4 major functions of the large intestine are:
- recovery of water and electrolytes
- formation and storage of feces
- fermentation of some of the indigestible food
matter by bacteria.
- (ileocaecal valve) controls the entry of material
from the last part of the small intestine called
the ileum
Large intestine → is the final part of your digestive
tract.
Undigested food enters your large intestine from your
small intestine.
It then reabsorbs water that is used in digestion and
eliminates undigested food and fibre.
This causes food waste products to harden and form
feces, which are then excreted.
Defecation
- also called bowel movement, the act of
eliminating solid or semisolid waste materials
(feces) from the digestive tract.
Muscular contractions (peristaltic waves) in the walls of
the colon move fecal material through the digestive
tract to the rectum.
- is the final act of digestion, by which organisms
eliminate solid, semisolid, or liquid waste
material from the digestive tract via the anus.
Humans expel feces with a frequency varying from a few
times daily toafew times weekly.
Liver
- is an organ only found in vertebrates
- detoxifies various metabolites
- synthesizes proteins and produces biochemicals
necessary for digestion and growth.
In humans, it is located in the right upper quadrant of
the abdomen, below the diaphragm.
Liver Metabolism
- liver plays a central role in all metabolic
processes in the body.
In fat metabolism the liver cells break down fats and
produce energy.
They also produce about 800 to 1,000 ml of bile per day.
If someone's blood sugar levels are too low, the liver
breaks down glycogen and releases sugar into the
blood.
How does the liver work?
- liver's main job is to filter the blood coming
from the digestive tract, before passing it to the
rest of the body.
 - secretes bile that ends up back in the intestines.
- makes proteins important for blood clotting and
other functions
Drug Metabolism
Drugs are most often eliminated by biotransformation
and/or excretion into the urine or bile.
- The process of metabolism transforms lipophilic
drugs into more polar readily excretable
products. The liver is the major site for drug
metabolism, but specific drugs may undergo
biotransformation in other tissues, such as the
kidney and the intestines.
[Note: Some agents are initially administered as inactive
compounds (pro-drugs) and must be metabolized to
their active forms.]
Metabolism
- is the process by which drugs are chemically
changed from lipid-soluble form suitable for
absorption and distribution toamore
water-soluble form that is suitable for excretion.
The process effectively eliminates the parent drug.
How does the liver metabolize drugs?
Most drugs must pass through the liver, which is the
primary site for drug metabolism.
Once in the liver → enzymes convert prodrugs to active
metabolites or convert active drugs to inactive forms.
The liver's primary mechanism for metabolizing drugs is
via a specific group of cytochrome P-450 enzymes.
Cytochromes P450 (CYPS)
- are a superfamily of enzymes containing heme
as a cofactor that function as monooxygenases.
In mammals, these proteins oxidize steroids, fatty acids,
and xenobiotics, and are important for the clearance of
various compounds, as well as for hormone synthesis
and breakdown.
Xenobiotic
- is a chemical substance found within an
organism that is not naturally produced or
expected to be present within the organism.
It can also cover substances that are present in much
higher concentrations than are usual.
Examples of commonly used anesthetic drugs
metabolized by cytochrome P450:
● CYP2 B6&CYP2C9 = propofol, ketamine.
● CYP2E1 = sevoflurane, isoflurane, halothane.
● CYP3A4 = midazolam, fentanyl, alfentanil,
lidocaine, ketamine.
What are the four stages of drug metabolization?
The four stages are:
- absorption
- distribution
- metabolism
- excretion.
The entire process is sometimes abbreviated ADME.
Are all drugs metabolized in the liver?
- liver is the principal site of drug metabolism.
Although metabolism typically inactivates drugs, some
drug metabolites are pharmacologically active →
sometimes even more so than the parent compound.
The enzymes involved in metabolism are present in
many tissues but generally are more concentrated in the
liver
What is the biotransformation process?
-is the process by which a substance changes from one
chemical to another (transformed) by a chemical
reaction within the body.
Metabolism or metabolic transformations are terms
frequently used for the biotransformation process.
Biotransformation
- is the process by which lipophilic therapeutic
agents are rendered more hydrophilic by the
liver → resulting in drug excretion in urine or
bile.
Hydrophilic is an antonym of lipophilic.
hydrophilic is having an affinity for water; able to
absorb, or be wetted by water while lipophilic is having
the quality of dissolving in lipids. Tending to combine
with or dissolve in lipids or fats.
What are the phases of metabolism?
Phase I reactions of drug metabolism involve:
- oxidation
- reduction
- hydrolysis of the parent drug
Resulting in its conversion to more polar molecules.
Phase II reactions involve:
- conjugation by coupling the drug or its
metabolites to another molecule, such as:
- Glucuronidation
- Acylation
- Sulfate
- Glicine
There are three phases of a drug's action in the body.
Pharmaceutical Phase.
First is the pharmaceutical phase → where the
medication is ingested, and dissolves in the stomach so
that it can be absorbed....
Pharmacokinetic Phase.
Pharmacodynamics.
Pharmacodynamics (PD)
- is the study of the biochemical and physiologic
effects of drugs (especially pharmaceutical
drugs).
In particular, pharmacodynamics is the study of how a
drug affects an organism, whereas pharmacokinetics is
the study of how the organism affects the drug.
An example of pharmacodynamics is someone studying
how methadone affects a person getting over heroin
addiction.
What are the 4 phases of pharmacokinetics?
The four processes involved when a drug is taken are
absorption, distribution, metabolism and elimination
or excretion (ADME).
Pharmacokinetics
-is the way the body acts on the drug once it is
administered.
It is the measure of the rate (kinetics) of absorption,
distribution, metabolism and excretion (ADME).
Do all drugs enter the bloodstream?
Metabolism.
After a medicine has been distributed throughout the
body and has done its job, the drug is broken down, or
metabolized, the M in ADME.
Everything that enters the bloodstream – whether
swallowed, injected, inhaled or absorbed through the
skin - is carried to the body's chemical processing plant,
the liver.
PEPTIC ULCER
A peptic ulcer is a sore on the lining of your stomach,
small intestine or esophagus.
A peptic ulcer in the stomach is called a gastric ulcer.
A duodenal ulcer is a peptic ulcer that develops in the
first part of the small intestine (duodenum).
An esophageal ulcer occurs in the lower part of your
esophagus.
Peptic Ulcer Disease
- can involve the stomach or duodenum.
Gastric and duodenal ulcers usually cannot be
differentiated based on history alone, although some
findings may be suggestive.
Epigastric pain
- is the most common symptom of both gastric
and duodenal ulcers, characterized by a
gnawing or burning sensation and that occurs
after meals - classically, shortly after meals with
gastric ulcers and 2-3 hours afterward with
duodenal ulcers.
In uncomplicated peptic ulcer disease, the clinical
findings are few and nonspecific. "Alarm features" that
warrant prompt gastroenterology referral include:
- bleeding
- anemia
- early satiety
- unexplained weight loss
- progressive dysphagia or odynophagia
- recurrent vomiting
- family history of gastrointestinal (GI) cancer
Peptic ulcers are defects in the gastric or duodenal
mucosa that extend through the muscularis mucosa.
The epithelial cells of the stomach and duodenum
secrete mucus in response to irritation of
the epithelial lining and asaresult of cholinergic
stimulation
What is the cause of peptic ulcer disease
- peptic ulcer refers to a lesion located in either
the stomach (gastric) or small intestine
(duodenal)
Primary cause of PUD
- infection by the gram-negative bacterium
Helicobacter pylori.
Secondary factors include:
- secretion of excess gastric acid
- hyposecretion of adequate mucous protection
Duodenal ulcers tend to cause abdominal pain that
comes on several hours after eating (often during the
night) → this is due to the presence of acid in the
digestive tract without a food "buffer."
Eating or taking an acid-reducing medication may
relieve symptoms.
Ulcers can often be diagnosed through upper
endoscopy.

What are the complications of peptic ulcer?
Complications of peptic ulcer disease (PUD) include:
- bleeding
- perforation
- penetration
- gastric outlet obstruction
Peptic ulcer → condition in which there is discontinuity
in the entire thickness of the gastric or duodenal
mucosa that persists as a result of acid and pepsin in the
gastric juice.
Esophageal ulceration due to acid reflux is generally
classified under GERD.
Peptic ulcer disease often presents to clinicians as
dyspepsia.
However, not all patients with dyspepsia have peptic
ulcer disease
Dyspepsia is defined as persistent or recurrent pain or
discomfort centered in the upper abdomen.
The most common causes of dyspepsia are non-ulcer or
functional dyspepsia,GERD and peptic ulcer.
Epidemiology:
- incidence of duodenal ulcer is now declining,
which follows the decline in H. pylori infection.
- Hospital admission rates for gastro-intestinal
bleeding associated with gastric and duodenal
ulcers are rising, especially in older patients.
This is probably a consequence of increased
prescriptions for low-dose aspirin, NSAIDS, antiplatelets,
anticoagulants and selective serotonin reuptake
inhibitors (SSRI).
Infection by H. pylori, a spiral bacterium of the stomach,
remains an important epidemiological factor in causing
peptic ulcer
Most H. pylori infections are acquired by oral-oral and
oral-fecal transmission.
Most important risk factors for H. pylori infection are:
- low social class, overcrowding and home
environment during childhood, for example, bed
sharing.
Subjects who become infected with H. pylori when
young are more likely to develop chronic or atrophic
gastritis with reduced acid secretion that may protect
them from developing duodenal ulcer.
However, it may promote development of gastric ulcer
as well as gastric cancer.
Duodenal ulcer seems to develop in those who are
infected with H. pylori at the end of childhood or later.
Pathogenesis:
There are two common forms of peptic ulcer disease:
- Those associated with the organism H. pylori
and those associated with the use of aspirin and
NSAIDS.
- Less common is ulcer disease associated with
massive hypersecretion of acid which occurs in
the rare gastrinoma (Zollinger-Ellison Syndrome)
Helicobacter pylori
- Gram-negative microaerophilic bacterium found
primarily in the gastric antrum of the human
stomach.
- 95% or more of duodenal ulcers and 80-85% of
gastric ulcers are associated with H. pylori.
The contribution of H. pylori infection to the risk of
ulcers in NSAID users is not clear but there appears to
be an additive effect.
The underlying pathophysiology associated with H.
pylori infection
- involves the production of cytotoxin-associated
geneA(CagA) proteins and vacuolating
cytotoxins, such as vac A → which activate the
inflammatory cascade.
CagA status and one genotype of the vacAgene are also
predictors of ulcerogenic capacity of a strain.
In addition, a number of enzymes produced by H. pylori
may be involved in causing tissue damage and include:
- urease
- hemolysins
- neuraminidase
- fucosidase.
Gastrin
- is the main hormone involved in stimulating
gastric acid secretion, and gastrin homeostasis is
also altered in H. pylori infection.
The hyperacidity in duodenal ulcer may result from H.
pylori-induced hypergastrinemia.
The elevation of gastrin may be consequence of
bacterially mediated decrease of antralD cells that
secrete somatostatin, thus losing the inhibitory
modulation of somatostatin on gastrin or direct
stimulation of gastrin cells by cytokines liberated during
the inflammatory process.
Long-standing hypergastrinemia → leads to an
increased parietal cell mass.
High acid content in the proximal duodenum → leads to
metaplastic gastric-type mucosa, which provides a niche
for H. pylori infection followed by inflammation and
ulcer formation.
Non-steroidal anti-inflammatory drugs:
Three patterns of mucosal damage are caused by
NSAIDS these include:
- superficial erosions and hemorrhages
- silent ulcers detected at endoscopy
- ulcers causing clinical symptoms and
complications.
Weak acid NSAIDS, such as acetylsalicylic acid
- are concentrated from the acidic gastric juice
into mucosal cells that may produce acute
superficial erosions via inhibition of COX and by
mediating the adherence of leukocytes to
mucosal endothelial cells.
Enteric coating may prevent this superficial damage but
does not demonstrate any clinical benefit in terms of
reduction of gastro-intestinal bleeding or ulceration
(Bhatt et al., 2008).
The major systemic action of NSAIDS that contributes to
the formation of ulcers is the reduction of mucosal
prostaglandin production.
All NSAIDS share the ability to inhibit CO
The presence of NSAID-induced ulcers does not
correlate with abdominal pain and NSAIDS themselves
often mask ulcer pain.
Patients taking NSAIDS have a four-fold increase in risk
of ulcer complications compared with non-users.
Risk factors for NSAID ulcers
- Age greater than 65 years
- Previous peptic ulceration/bleeding
- High dose of NSAID or more than one NSAID
(including aspirin)
- Short-term history of NSAID use (<1 month)
- Concomitant corticosteroid or anticoagulant use
- Cardiovascular disease
The most important risk factors are a history of ulcer
complications and advancing age, particularly over 75
years.
Ulcers have been found to be more common in patients
who have taken NSAIDS for less than 3months, with the
highest risk observed during the first month of
treatment
The risk increases with higher doses of NSAID but
mucosal damage occurs with even very low doses of
NSAIDS, particularly aspirin.
Corticosteroids alone are an insignificant ulcer risk, but
potentiate the ulcer risk when added to NSAIDS,
particularly in daily doses of at least 10 mg prednisolone
(Lanza et al., 2009).
Low-dose aspirin (75 mg/day) alone increases the risk of
ulcer bleeding and this effect may be due to the
antiplatelet action, independent of other risk factors.
Concomitant use of aspirin with NSAIDS further
increases the risk.
There is no evidence that anticoagulants increase the
risk of NSAID ulcers but they are associated with an
increase in the risk of.
There is no evidence that anticoagulants increase the
risk of NSAID ulcers but they are associated with an
increase in the risk of hemorrhage.
Selective cyclo-oxygenase-2 inhibitors:
- The gastro-intestinal side effects of conventional
NSAIDS are mediated through the inhibition of
COX-1
- COX-1 stimulates synthesis of homeostatic
prostaglandins while CoX-2 is predominantly
induced in response to inflammation.
Selective COX-2 inhibitors tend not to reduce the
mucosal production of protective prostaglandins to the
same extent as NSAIDS.
COX-2 inhibitors are, therefore, considered to be safer
than non-selective NSAIDS in patients at high risk of
developing gastro-intestinal mucosal damage
CoX-2 inhibitors contraindications:
- increase in cardiovascular risk, including heart
attack and stroke, has resulted in the
withdrawal of some COX-2 inhibitors from the
market.
New contraindications is the recommendation that they
should not be taken by patients with established heart
or cerebrovascular disease, or taken in combination
with low dose aspirin as this negates any beneficial
gastro-intestinal Protective effects.
Candidates for Cox-2 inhibitors are patients at high risk
of NSAID-related gastro-intestinal events but who do
not require low-dose aspirin therapy.
Clinical manifestations:
- Upper abdominal pain occurring 1-3hafter
 meals and relieved by food or antacids is the
classic symptom of peptic ulcer disease.
- The relationship to meals is more marked in
duodenal ulcer than in gastric ulcer.
Anorexia, weight loss, nausea and vomiting, heartburn
and eructation can all occur with peptic ulcer disease.
Complications of peptic ulcer disease:
- hemorrhage, chronic iron-deficiency anemia,
pyloric stenosis and perforation.
In the elderly:
- presentation is more likely to be silent and
gastro-intestinal bleeding may be the first
clinical sign of disease
Peptic ulcer bleeding is the most frequent and severe
complication of peptic ulcer disease.
Patient assessment:
- Presenting symptoms of dyspepsia require
careful assessment to judge the risk of serious
disease or to provide appropriate symptomatic
treatment.
Drugs causing dyspepsia
- Antibiotics
- Bisphosphonates
- Calcium channel blockers
- Corticosteroids
- Drugs with antimuscarinic effects, for example,
tricyclic antidepressants
- Iron
- Nitrates
- NSAIDS including aspirin
- Potassium chloride
- Theophylline
Investigations:
- Endoscopy is generally the investigation of
choice for diagnosing peptic ulcer, and the
procedure is sensitive, specific and safe.
- Endoscopic investigation should be undertaken
in patients with alarm features and in those
patients over 55 years who present with
unexplained or persistent symptoms of
dyspepsia.
Alarm features:
- Dysphagia
- Pain on swallowing
- Unintentional weight loss
- Gastro-intestinal bleeding or anemia
- Persistent vomiting
- On NSAIDS or warfarin
Radiology:
- Double-contrast barium radiography should
detect 80% of peptic ulcers. However,
endoscopy is more accurate and almost always
preferred.
A Gastrografin® meal is used to diagnose peptic
perforation in patients presenting with an acute
abdomen, if a plain abdominal X-ray is not diagnostic.
H. pylori detection:
-There are several methods of detecting H. pylori
infection.
They include non-invasive tests such as:
- serological tests to detect antibodies
- [13C] urea breath tests
- stool antigen tests.
Urea breath tests have a sensitivity and specificity over
90% and are accurate for both initial diagnosis and
confirmation of eradication.
The breath test is based on the principle that urease
activity in the stomach of infected individuals hydrolyses
urea to form ammonia and carbon dioxide.
The test contains carbon-labeled urea which, when
hydrolysed → results in production of labeled carbon
dioxide which appears in the patient's breath.
The stool antigen test uses an enzyme immunoassay to
detect H. pylori antigen in stool.
This test also has a sensitivity and specificity over 90%
and can be used in the initial diagnosis and also to
confirm eradication.
Serological tests are based on the detection of anti-H.
pylori IgG antibodies but are not able to distinguish
between active or previous exposure to infection
Treatment:
Triple therapy consists of:
- OCA: omeprazole 20 mg, clarithromycin 500 mg
and amoxicillin 1 g or
- OCM: omeprazole 20 mg, clarithromycin 250 mg
and metronidazole 400 mg.
Complications of peptic ulcer disease
Bleeding peptic ulcer:
 - Peptic ulcer is the most common cause of
non-variceal upper gastro-intestinal bleeding.
- Most patients with bleeding peptic ulcer are
clinically stable and stop bleeding without any
intervention.
Endoscopy allows identification of the severity of
disease as well as endoscopic haemostatic therapy
which is successful in reducing mortality.
Endoscopic therapy is necessary only in patients who
exhibit high-risk stigmata (active bleeding, non-bleeding
visible vessel, adherent clot) on endoscopy.
A number of pharmacological agents have been used for
endoscopic injection therapy such as 1:10,000
adrenaline (epinephrine), human thrombin and fibrin
glue.
Patients with uncontrolled bleeding should receive
repeat endoscopic treatment, arterial embolisation or
surgery. The risk of recurrent bleeding following
endoscopic therapy is reduced by increasing intragastric
pH during the first 3 days after the initial bleed and
eradication of H. pylori.
Acid suppression reduces the re-bleeding rate and
should be given to those patients at high risk of
re-bleeding following endoscopic haemostatic therapy.
Rationale=based on the fact that gastric acid inhibits
clot formation and if intragastric pH is maintained above
6 during the first 3 days after the initial bleed, there is
opportunity for clot stabilization and haemostasis.
PPIS significantly reduce re-bleeding rates compared
with H2-receptor antagonists and are the preferred
choice of treatment (Leontiadis et al., 2006).
Pyloric stenosis is an uncommon condition in infants
that blocks food from entering the small intestine.
Normally, a muscular valve (pylorus) between the
stomach and small intestine holds food in the stomach
until it is ready for the next stage in the digestive
process
Pyloric stenosis:
- Malignancy is the most common cause of
gastric outlet obstruction.
- Peptic ulcer disease is the underlying cause in
about 10% of cases.
- TX: If medical therapy fails to relieve the
obstruction, Endoscopic balloon dilation or
Surgery may be required
Zollinger-Ellison syndrome:
- This rare syndrome consists of triad of non-ß
islet cell tumors of the pancreas that contain
and release gastrin, Gastric acid hypersecretion
and severe ulcer disease.
- Extrapancreatic gastrinomas are also common
and may be found frequently in the duodenal
wall.
- Is a disease in which tumors cause the stomach
to produce too much acid, resulting in peptic
ulcers.
- Symptoms include abdominal pain and diarrhea.
The syndrome is caused by gastrinoma, a
neuroendocrine tumor that secretes hormone
called gastrin.
A proportion of these patients have tumors of the
pituitary gland and parathyroid gland (multiple
endocrine neoplasia type I).
Mgnt: Surgical resection of the gastrinoma may be
curative.
- Medical management consists of greater than
standard doses of PPIS.
Stress ulcers:
- Severe physiological stress such as head injury,
spinal cord injury, burns, multiple trauma or
sepsis may induce superficial mucosal erosions
or gastroduodenal ulcerations → may lead to
hemorrhage or perforation.
- Diminished blood flow to the gastric mucosa,
decreased cell renewal, diminished
prostaglandin production and, occasionally, acid
hypersecretion are involved in causing stress
ulceration.
- TX: Intravenous acid-suppression therapy,
histamine H2-receptor antagonists and PPIS,
and nasogastric tube administration of
sucralfate (4-6 g daily in divided doses) have
been used to prevent stress ulceration in the
intensive care unit until the patient tolerates
enteral feeding.
- The most commonly used regimen is
intravenous ranitidine 50 mg every 8hr reducing
to 25 mg in severe renal impairment
Ulcer-healing drugs
Proton pump inhibitors:
- The PPIS are all benzimidazole derivatives that
control gastric acid secretion by inhibition of
gastric H+, K+-ATPase, the enzyme responsible
for the final step in gastric acid secretion from
the parietal cell
The PPIS are inactive prodrugs that are carried in the
bloodstream to the parietal cells in the gastric mucosa. - glycopeptide
Under these acidic conditions the prodrugs are - monobactam antibiotics
converted to their active form, which irreversibly binds
the proton pump, inhibiting acid secretion. Treatment on digestive system disorders depend on:
- Manifestations present
PPIS require an enteric coating to protect them from - Organisms/pathogens involved
degradation in the acidic environment of the stomach - Severity of condition
apparent half-life is approximately 48 h.
This prolonged duration of action allows once-daily
dosing of PPIS, although twice-daily dosing is GASTROENTERITIS
recommended in some cases of erosive oesophagitis or
Barrett's esophagus when a sustained gastric pH of
Gastroenteritis
greater than 4.0 is required.
-is an inflammation of the lining of the intestines caused
by:
All PPIS are most effective if taken about 30 min before
-Virus
meal as they inhibit only actively secreting proton
- Bacteria
pumps.
- Parasites
Meals are the main stimulus to proton pump activity.
The optimal dosing time is 30-60 min before the first
Viral gastroenteritis
meal of the day.
- is the second most common illness in the U.S
- cause is often norovirus infection
Proton-pump inhibitors areagroup of medications
- spreads through contaminated food or water or
whose main action isapronounced and long-lasting
by contact with an infected person.
reduction of stomach acid production.

Available proton pump inhibitors include:

- omeprazole (Prilosec, Prilosec OTC)
- lansoprazole (Prevacid, Prevacid IV, Prevacid
24-Hour)
- dexlansoprazole (Dexilent, Dexilent Solutab)
- rabeprazole (Aciphex, Aciphex Sprinkle)
- pantoprazole (Protonix)

Gastrointestinal Medications
1. Antacids=Aluminum hydroxide, magnesium
hydroxide (Mylanta, Maalox) Calcium carbonate
(Tums, Rolaids, Chooz)...
2. Proton Pump InhibitorsOmeprazole (Prilosec)
Lansoprazole (Prevacid)...
3. Histamine2 Blockers=DCimetidine (Tagamet)
Ranitidine hydrochloride (Zantac)...
4. Promotility Agents=Metoclopramide (Reglan)
5. Dicyclomine belongs to class of drugs known as
anticholinergics/antispasmodics
Treatment for gastrointestinal infection includes taking
antibiotics and staying hydrated.
Common antibiotics used to treat gastrointestinal
infection are:
- penicillin
- cephalosporin
- antifolate/sulfa combinations
- nitroimidazole
- penem
Viral gastroenteritis
- is an intestinal infection marked by watery
diarrhea, abdominal cramps, nausea or
vomiting, and sometimes fever.
The most common way to develop viral
gastroenteritis–often called stomach flu
- is through contact with an infected person or by
ingesting contaminated food or water.
If you're otherwise healthy, you'll| likely recover without
complications.
But for infants, older adults and people with
compromised immune systems, viral gastroenteritis can
be deadly.
There's no effective treatment for viral gastroenteritis,
so prevention is key.
In addition to avoiding food and water that may be
contaminated, thorough and frequent hand-washing is
your best defense.
Symptoms
Although it's commonly called stomach flu,
gastroenteritis isn't the same as influenza. Real flu
(influenza) affects only your respiratory system–your
nose, throat and lungs.
Gastroenteritis, on the other hand, attacks your
intestines, causing signs and symptoms, such as:
- Watery, usually nonbloody diarrhea - bloody
diarrhea usually means you have different,
more severe infection
- Abdominal cramps and pain
- Nausea, vomiting or both
- Occasional muscle aches or headache
- Low-grade fever
Depending on the cause, viral gastroenteritis symptoms
may appear within one to three days after you're
infected and can range from mild to severe.
Symptoms usually last just a day or two, but occasionally
they may persist as long as 10 days.
Because the symptoms are similar, it's easy to confuse
viral diarrhea with diarrhea caused by bacteria, such as
Clostridium difficile, salmonella and E. coli, or parasites,
such as giardia.
When to see a doctor
If an adult, call doctor if:
- not able to keep liquids down for 24 hours
- been vomiting for more than two days
- vomiting blood
- dehydrated–signs of dehydration include
excessive thirst, dry mouth, deep yellow urine
or little or no urine, and severe weakness,
dizziness or lightheadedness
- notice blood in your bowel movements
- Have fever above 104F(40 C)
For infants and children
- See doctor right away if child:
- Has a fever of 102F(38.9 C) or higher
- Seems lethargic or very irritable
- Is in a lot of discomfort or pain
- Has bloody diarrhea
- Seems dehydrated-watch for signs of
dehydration in sick infants and children by
comparing how much they drink and urinate
with how much is normal for them
If you have an infant, remember that while spitting up
may be an everyday occurrence for your baby, vomiting
is not. Babies vomit for a variety of reasons, many of
which may require medical attention.
Call baby's doctor right away if baby:
- Has vomiting that lasts more than several hours
- Hasn't had a wet diaper in six hours
- Has bloody stools or severe diarrhea
- Has a sunken soft spot (fontanel)on the top of
his or her head
- Has a dry mouth or cries without tears
- Is unusually sleepy, drowsy or unresponsive
Causes
You're most likely to contract viral gastroenteritis when
you eat or drink contaminated food or water, or if you
share utensils, towels or food with someone who's
infected.
A number of viruses can cause gastroenteritis,
including:
Noroviruses.
- Both children and adults are affected by
noroviruses
- the most common cause of foodborne illness
worldwide.
- infection can sweep through families and
communities.
- It's especially likely to spread among people in
confined spaces.
- In most cases, you pick up the virus from
contaminated food or water, although
person-to-person transmission also is possible.
Rotavirus.
- Worldwide, this is the most common cause of
viral gastroenteritis in children, who are usually
infected when they put their fingers or other
objects contaminated with the virus into their
mouths.
- infection is most severe in infants and young
children.
- Adults infected with rotavirus may not have
symptoms, but can still spread the illness-of
particular concern in institutional settings
because infected adults unknowingly can pass
the virus to others.
- A vaccine against viral gastroenteritis is available
in some countries, including the United States,
and appears to be effective in preventing the
infection.
- Some shellfish, especially raw or undercooked
oysters, also can make you sick.
- Although contaminated drinking water is a
cause of viral diarrhea, in many cases the virus
is passed through the fecal-oral route
- someone with a virus handles food you eat
without washing his or her hands after using the
toilet.
Risk factors
Gastroenteritis occurs all over the world, affecting
people of every age, race and background.
People who may be more susceptible to gastroenteritis
include:
1. Young children. Children in child care centers or
elementary schools may be especially
vulnerable because it takes time for child's
immune system to mature.
2. Older adults. Adult immune systems tend to
become less efficient later in life. Older adults in
nursing homes, in particular, are vulnerable
because their immune systems weaken and
they live in close contact with others who may
pass along germs.
3. Schoolchildren, churchgoers or dormitory
residents. Anywhere that groups of people
come together in close quarters can be an
environment for an intestinal infection to get
passed.
Anyone with a weakened immune system.
If your resistance to infection is low- for instance, if your
immune system is compromised by HIV/AIDS,
chemotherapy or another medical condition-you may be
especially at risk.
Complications
The main complication of viral gastroenteritis is
dehydration
- a severe loss of water and essential salts and
minerals.
- If you're healthy and drink enough to replace
fluids you lose from vomiting and diarrhea,
dehydration shouldn't be a problem.
Infants, older adults and people with suppressed
immune systems may become severely dehydrated
when they lose more fluids than they can replace.
Hospitalization might be needed so that lost fluids can
be replaced intravenously. Dehydration can be fatal, but
rarely.
Prevention
The best way to prevent the spread of intestinal
infections is to follow these precautions:
Get your child vaccinated.
A vaccine against gastroenteritis caused by the rotavirus
is available in some countries, including the United
States.
Given to children in the first year of life, the vaccine
appears to be effective in preventing severe symptoms
of this illness.
Wash your hands thoroughly.
And make sure your children do, too.
If your children are older, teach them to wash their
hands, especially after using the toilet.
- It's best to use warm water and soap and to rub
hands vigorously for at least 20 seconds,
remembering to wash around cuticles, beneath
fingernails and in the creases of the hands.
- Then rinse thoroughly.
- Carry sanitizing wipes and hand sanitizer for
times when soap and water aren't available.
Use separate personal items around your home.
Avoid sharing eating utensils, drinking glasses and
plates. Use separate towels in the bathroom.
Keep your distance.
Avoid close contact with anyone who has the virus, if
possible.
Disinfect hard surfaces.
If someone in your home has viral gastroenteritis,
disinfect hard surfaces, such as counters, faucets and
doorknobs, with a mixture of 2cups (0.47 liters) of
bleach to 1gallon (3.8 liters) of water.
Check out your child care center.
Make sure the center has separate rooms for changing
diapers and preparing or serving food.
The room with the diaper-changing table should have a
sink as well as sanitary way to dispose of diapers.
Diagnosis
Your doctor will likely diagnose gastroenteritis based on
symptoms, a physical exam and sometimes on the
presence of similar cases in your community.
- A rapid stool test can detect rotavirus or
norovirus, but there are no quick tests for other
viruses that cause gastroenteritis.
In some cases, your doctor may have you submit a stool
sample to rule out a possible bacterial or parasitic
infection.
Treatment
There's often no specific medical treatment for viral
gastroenteritis.
Antibiotics aren't effective against viruses, and
overusing them can contribute to the development of
antibiotic-resistant strains of bacteria.
Treatment initially consists of self-care measures.
How is viral gastroenteritis treated?
Specific treatment is usually not needed.
In most cases, you simply need to drink plenty of fluids
and rest at home until the virus leaves your system. In
rare cases, you may need treatment for severe
dehydration, with IV (intravenous) fluids.
Over-the-counter oral rehydration solutions (ORS), such
as Pedialyte, can be helpful in mild cases.
Lifestyle and home remedies
If your family includes young children, it's a good idea to
have commercially prepared oral rehydration solutions
on hand.
Adults can drink sports drinks, broths or oral
rehydration solutions.
Drinking liquids that contain a lot of sugar, such as soft
drinks and fruit juices, can worsen diarrhea.
Smaller meals and a bland diet might help limit
vomiting. Some foods to consider:
- Soup
- Starches and cereals, such as potatoes, noodles,
rice or crackers
- Bananas
- Yogurt
- Broiled vegetables
Bacterial gastroenteritis → occurs when bacteria cause
an infection of the stomach or intestines.
People often refer to bacterial gastroenteritis as → food
poisoning.
- commonly results from the consumption of
food or water that has become contaminated
with bacteria or their toxins.
- can cause a range of symptoms, including
diarrhea, abdominal cramping, nausea, and
vomiting.
- essential for people with bacterial
gastroenteritis to rest and drink plenty of fluids.
Causes
Many types of bacteria can cause bacterial
gastroenteritis, including:
- Escherichia coli, which can occur in
undercooked beef and unwashed fruits and
vegetables.
- Shigella, which can be present in raw food and
contaminated water, including swimming pools.
- Staphylococcus and Salmonella, which may be
in raw or undercooked meats, eggs, and dairy
products.
- Yersinia enterocolitica, which raw or
undercooked pork can contain.
- Campylobacter, which might occur in milk and
raw or undercooked poultry.
- A person can get bacterial gastroenteritis after
eating contaminated food or drinking or
swallowing contaminated water.
- Food can become contaminated without proper
storage, handling, and cooking.
- Outbreaks of bacterial gastroenteritis can occur
if many people consume the same
contaminated food, possibly from a restaurant,
supermarket, or grocery store.
Bacterial gastroenteritis
- spreads quickly from person to person.
People can get the bacteria on their hands by handling
contaminated food or water. Harmful bacteria are also
present in the stools of people with bacterial
gastroenteritis.
People who get these bacteria on their hands can
spread them when they touch surfaces, objects, or
other people.
Anyone with these bacteria on their hands risks
becoming ill if they transfer them to their mouth, eyes,
or other openings on the body.
As a result, it is essential that people wash their hands
thoroughly after handling food or using the bathroom,
especially if they have bacterial gastroenteritis or any
other infection.
Symptoms
The symptoms of bacterial gastroenteritis can vary
between people and may depend on the bacteria
causing the illness.
In some cases, symptoms may not appear for up to 4
days after a person becomes infected.
Symptoms can include:
- vomiting and nausea
- diarrhea
- abdominal pain or cramping
- loss of appetite
- fever or chills
- bloody stools
Diagnosis
Adults with bacterial gastroenteritis should see a doctor
if their symptoms do not clear up within 5 days.
People should take children to see a doctor if their
symptoms do not clear up within 2 days.
A doctor will ask the individual about their symptoms.
If the doctor suspects bacterial gastroenteritis, they may
request a stool sample to identify the type of bacteria
causing the infection.
Treatment
- Bacterial gastroenteritis will often clear up on its
own without any treatment.
- However, vomiting and diarrhea can cause
 dehydration, so it is important to stay hydrated.
- This is usually possible to achieve at home by
drinking plenty of fluids, especially water.
Vomiting and diarrhea can also cause the body to lose
essential minerals such as sodium, potassium, and
calcium.
Eating soups or broths can replace both fluid and
minerals.
Fluid and mineral replacement solutions are also
available at drug stores.
If a person cannot keep fluids down or becomes too
dehydrated, they may need to go to the hospital → a
doctor will give them intravenous fluids and
electrolytes.
home from work or school
2. washing the hands frequently
3. avoiding cooking or handling foods that other
people may eat
4. cleaning door handles and other shared objects
after touching them
Complications
For most people, bacterial gastroenteritis will resolve
within a week or so.
The most common complication is dehydration, which
occurs when people lose fluids from vomiting and
diarrhea and do not replace them.
If a person becomes too dehydrated, they may need to
go to the hospital.

In severe cases of bacterial gastroenteritis, a doctor may

prescribe antibiotics.
Generally, people can treat the symptoms of bacterial Children and older adults have a higher risk of
gastroenteritis at home by: developing complications, so any caregivers should
- getting plenty of rest monitor them closely.
- drinking enough fluids to stay hydrated - high fever
- eating small amounts of mineral-rich food at - muscle aches
regular intervals - loss of bowel control
- avoiding dairy products, foods high in fiber, and - bleeding in the intestinal tract, which can lead
fruit to bloody stools
- avoiding sports or soft drinks, or other drinks - anemia
that are high in sugar - kidney failure
In very rare cases, untreated bacterial gastroenteritis
Prevention can result in brain damage or death.
A person can use the following hygiene practices to try Anyone who experiences severe or persistent symptoms
to prevent bacterial gastroenteritis: should seek medical attention as soon as possible.
1. washing the hands thoroughly before handling
foods and after using the bathroom Ecoli enteric infections
2. washing the hands thoroughly after touching - require fluid replacement with solutions
animals, especially farm animals containing appropriate electrolytes.
3. using a separate cutting board for raw meat Antimicrobials known to be useful in cases of traveler's
4. washing vegetables, fruits, and salads diarrhea include:
thoroughly before eating them - doxycycline
5. avoiding close contact with people who have - trimethoprim/sulfamethoxazole (TMP/SMZ)
gastroenteritis - fluoroquinolones
6. drinking bottled water when traveling, - rifaximin
especially in developing countries - rifamycin
7. avoiding eating raw meat and fish
8. avoiding drinking unpasteurized milk The following antibiotics are used to treat Shigella
9. storing food appropriately and discarding any dysentery:
items that expire or spoil Beta-lactams:
10. keeping the kitchen and bathroom clean - Ampicillin,
- amoxicillin,
The following precautions can help someone with - third-generation cephalosporins (cefixime,
bacterial gastroenteritis to avoid spreading the infection ceftriaxone),
to other people: - pivmecillinam
1. avoiding close contact with others and staying Quinolones:
 - Nalidixic acid,
- ciprofloxacin,
- norfloxacin,
- ofloxacin.
Macrolides:
- Azithromycin.

Some of the antibiotics that have been used to treat

staph infections are:
- cefazolin
- cefuroxime
- cephalexin The urinary system
- nafcillin (Nallpen) also known as the renal system or urinary tract, consists
- oxacillin (Bactocill) of:kidneys, ureters, bladder, and the urethra.
- dicloxacillin The purpose of the urinary system is to:
- vancomycin - eliminate waste from the body
- clindamycin (Cleocin) - regulate blood volume and blood pressure
- rifampin - control levels of electrolytes and metabolites
- telavancin (Vibativ). - regulate blood pH.
Combinations of antibiotics and other antibiotics can
also be used. Kidneys
Which antibiotics treat salmonella? - job is to filter your blood.
The first-line treatment for salmonella infections are: - They remove wastes, control the body's fluid
- Fluoroquinolones, such as: ciprofloxacin, and balance, and keep the right levels of
azithromycin. electrolytes.
Third-generation cephalosporins are also effective, and - All of the blood in your body passes through
often they are the first antibiotic given if a salmonella them several times a day.
infection is suspected but not confirmed. - Blood comes into the kidney, waste gets
removed, and salt, water, and minerals are
However, in more severe or complicated infections, adjusted, if needed
antibiotics may be useful.
Yersinia enterocolitica is usually susceptible in vitro to:
- aminoglycosides
- chloramphenicol
- tetracycline
- trimethoprim-sulfamethoxazole (TMP-SMZ)
- piperacillin
- ciprofloxacin
- third-generation cephalosporins

Azithromycin therapy would be a primary antibiotic

choice for Campylobacter infections,
when indicated with a typical regimen of 500 mg/d for 3
Ureter
days.
- Is a tube that carries urine from the kidney to
If the patient is bacteremic, treatment can be extended
the urinary bladder.
to two weeks.
- There are two ureters, one attached to each
However, Erythromycin is the classic antibiotic of
kidney.
choice.
- The upper half of the ureter is located in the
abdomen and the lower half is located in the
URINARY SYSTEM pelvic area
-

Urethra
- is the tube that carries urine from the bladder
to outside of the body.
- In males, it has the additional function of
ejaculating semen when the man reaches
orgasm.
- When the penis is erect during sex, the flow of
urine is blocked from the urethra → allowing
only semen to be ejaculated at orgasm.
The female urethra is a relatively simple tubular
structure that has the sole purpose of conducting urine
from the bladder to the outside of the body.
It is a short structure without complex investing
structures; thus, it is less prone to intrinsic pathology
than the male urethra
Urinary bladder
- Is a muscular sac in the pelvis, just above and
behind the pubic bone.
- When empty, the bladder is about the size and
shape of a pear.
- Urine is made in the kidneys and travels down
two tubes called ureters to the bladder.
- The bladder stores urine, allowing urination to
be infrequent and controlled
Urine formation
For the production of urine, the kidneys do not simply
pick waste products out of the bloodstream and send
them along for final disposal.
The kidneys' 2million or more nephrons (about a million
in each kidney) form urine by three precisely regulated
processes.
1. FILTRATION
2. REABSORPTION
3. SECRETION
What is the functional unit of the kidney?
Nephron → the functional unit of the kidney, is
responsible for removing waste from the body.
Each kidney is composed of over one million nephrons
that dot the renal cortex, giving it a granular appearance
when sectioned sagittally (from front to rear).
These processes ensure that only waste and excess
water are removed from the body.
Urine is formed in the kidneys through a filtration of
blood.
The urine is then passed through the ureters to the
bladder, where it is stored.
During urination, the urine is passed from the bladder
through the urethra to the outside of the body.
What are the three stages of urine formation and
where do they occur?
It is primarily composed of water and urea.
Urea is a special nitrogenous waste compound that the
body must routinely remove.
Urine formation occurs in the kidney in three stages:
- filtration
- reabsorption
- secretion
What are the components of urine?
Urine is an aqueous solution of greater than 95% water.
Other constituents include:
-urea, chloride, sodium, potassium, creatinine and other
dissolved ions, and inorganic and organic compounds.
What are the abnormal components of urine?
Abnormal constituents most commonly found in urine
are:
- protein (proteinuria)
- glucose (glycosuria)
- acetone (ketonuria)
=all may have a significance that must not be ignored.
What is the 1st step of urine formation?
Glomerular filtration is the first step in urine formation
and constitutes the basic physiologic function of the
kidneys.
- It describes the process of blood filtration in the
kidney, in which fluid, ions, glucose, and waste
products are removed from the glomerular
capillaries.
Filtration
- is the mass movement of water and solutes
from plasma to the renal tubule that occurs in
the renal corpuscle.
About 20% of the plasma volume passing through the
glomerulus at any given time is filtered.
This means that about 180 liters of fluid are filtered by
the kidneys every day.
Normal Chemical Composition of Urine
Urea 9.3 g/L.
Chloride 1.87 g/L.
Sodium 1.17 g/L.
Potassium 0.750 g/L.
Creatinine 0.670 g/L.
Other dissolved ions, inorganic and organic compounds
(proteins, hormones, metabolites).
What is the pH of urine?
According to the American Association for Clinical
Chemistry, the average value for urine pH is 6.0, but it
can range from 4.5 to 8.0.
Urine under 5.0 is acidic, and urine higher than 8.0 is
alkaline, or basic.
Different laboratories may have different ranges for
"normal" pH levels.
Acid-Base balance
The kidneys help maintain the acid-base balance by
excreting hydrogen ions into the urine and reabsorbing
bicarbonate from the urine.
What is the acid base mechanism?
Acid-base balance:
- refers to the mechanisms the body uses to keep
its fluids close to neutral pH (that is, neither
basic nor acidic) so that the body can function
normally.
How acid base balance is maintained in the body?
The kidneys help control acid-base balance by excreting
hydrogen ions and generating bicarbonate that helps
maintain blood plasma pH within a normal range.
Protein buffer systems work predominantly inside cells.
Buffer Systems in the Body
The buffer systems functioning in blood plasma include:
- plasma proteins
- phosphate
- bicarbonate
- carbonic acid buffers.
Acute kidney failure
- occurs when your kidneys suddenly become
unable to filter waste products from your blood.
When your kidneys lose their filtering ability →
dangerous levels of wastes may accumulate, and your
blood's chemical makeup may get out of balance.
Acute kidney failure–also called acute renal failure or
acute kidney injury
- develops rapidly, usually in less than a few days.
- is most common in people who are already
hospitalized, particularly in critically ill people
who need intensive care.
- can be fatal and requires intensive treatment.
However, acute kidney failure may be reversible.
If you're otherwise in good health, you may recover
normal or nearly normal kidney function.
Signs and symptoms of acute kidney failure may
include:
- Decreased urine output, although occasionally
urine output remains normal
- Fluid retention, causing swelling in your legs,
ankles or feet
- Shortness of breath
- Fatigue
- Confusion
- Nausea
- Weakness
- Irregular heartbeat
- Chest pain or pressure
- Seizures or coma in severe cases
Sometimes acute kidney failure causes no signs or
symptoms and is detected through lab tests done for
another reason.
Causes:
Acute kidney failure can occur when:
- have a condition that slows blood flow to your
kidneys
- experience direct damage to your kidneys
- kidneys' urine drainage tubes (ureters) become
 blocked and wastes can't leave your body acute kidney injury include:
through your urine - Bladder cancer
- Blood clots in the urinary tract
Impaired blood flow to the kidneys - Cervical cancer
Diseases and conditions that may slow blood flow to - Colon cancer
the kidneys and lead to kidney injury include: - Enlarged prostate
- Blood or fluid loss - Kidney stones
- Blood pressure medications - Nerve damage involving the nerves that control
- Heart attack the bladder
- Heart disease - Prostate cancer
- Infection
- Liver failure Risk factors:
- Use of aspirin, ibuprofen (Advil, Motrin IB, Acute kidney failure almost always occurs in connection
others), naproxen sodium (Aleve, others) or with another medical condition or event.
related drugs Conditions that can increase your risk of acute kidney
- Severe allergic reaction (anaphylaxis) failure include:
- Severe burns - Being hospitalized, especially for a serious
- Severe dehydration condition that requires intensive care
- Advanced age
Damage to the kidneys - Blockages in the blood vessels in your arms or
These diseases, conditions and agents may damage the legs - (peripheral artery disease)
kidneys and lead to acute kidney failure: - Diabetes
1. Blood clots in the veins and arteries in and - High blood pressure
around the kidneys - Heart failure
2. Cholesterol deposits → that block blood flow in - Kidney diseases
the kidneys - Liver diseases
3. Glomerulonephritis → inflammation of the tiny - Certain cancers and their treatments
filters in the kidneys (glomeruli)
4. Hemolytic uremic syndrome → condition that Complications:
results from premature destruction of red blood Potential complications of acute kidney failure include:
cells Fluid buildup.
5. Infection such as with the virus → causes - Acute kidney failure may lead to a buildup of
coronavirus disease 2019 (COVID-19) fluid in your lungs, which can cause shortness of
6. Lupus an immune system disorder → causing breath.
glomerulonephritis Chest pain.
7. Medications, such as certain chemotherapy - If the lining that covers your heart (pericardium)
drugs, antibiotics and dyes used during imaging becomes inflamed, you may experience chest
tests pain.
8. Scleroderma, a group of rare diseases affecting Muscle weakness.
the skin and connective tissues - When your body's fluids and electrolytes( your
9. Thrombotic thrombocytopenic purpura,a rare body's blood chemistry)- are out of balance →
blood disorder muscle weakness can result.
10. Toxins, such as alcohol, heavy metals and
cocaine
11. Muscle tissue breakdown (rhabdomyolysis) Permanent kidney damage.
that leads to kidney damage caused by toxins - Occasionally, acute kidney failure causes
from muscle tissue destruction permanent loss of kidney function, or end-stage
12. Breakdown of tumor cells (tumor lysis renal disease.
syndrome), which leads to the release of toxins - People with end-stage renal disease require
that can cause kidney injury either permanent dialysis - a mechanical
filtration process used to remove toxins and
Urine blockage in the kidneys wastes from the body- or a kidney transplant to
Diseases and conditions that block the passage of urine survive.
out of the body (urinary obstructions) and can lead to Death.
 - Acute kidney failure can lead to loss of kidney
function and, ultimately, death.
Prevention
Acute kidney failure is often difficult to predict or
prevent. But you may reduce your risk by taking care of
your kidneys. Try to:
Pay attention to labels when taking
over-the-counter (OTC) pain medications.
Follow the instructions for OTC pain medications, such
as aspirin, acetaminophen (Tylenol, others), ibuprofen
(Advil, Motrin IB, others) and naproxen sodium (Aleve,
others).
Taking too much of these medications may increase
your risk of kidney injury.
This is especially true if you have pre-existing kidney
disease, diabetes or high blood pressure.
Work with your doctor to manage kidney and other
chronic conditions.
If you have kidney disease or another condition that
increases your risk of acute kidney failure, such as
diabetes or high blood pressure, stay on track with
treatment goals and follow your doctor's
recommendations to manage your condition.
Make a healthy lifestyle a priority.
Be active; eat a sensible, balanced diet; and drink
alcohol only in moderation–if at all.
Diagnosis
If your signs and symptoms suggest that you have acute
kidney failure, your doctor may recommend certain
tests and procedures to verify your diagnosis.
These may include:
Urine output measurements.
- Measuring how much you urinate in 24 hours
may help your doctor determine the cause of
your kidney failure.
Urine tests.
- Analyzing a sample of your urine (urinalysis)
may reveal abnormalities that suggest kidney
failure.
Blood tests.
- A sample of your blood may reveal rapidly rising
levels of urea and creatinine–two substances
used to measure kidney function.
Imaging tests.
- Imaging tests such as ultrasound and
computerized tomography may be used to help
your doctor see your kidneys.
Removing a sample of kidney tissue for testing.
In some situations, your doctor may recommend a
kidney biopsy to remove a small sample of kidney tissue
for lab testing.
Doctor inserts a needle through your skin and into your
kidney to remove the sample.
Kidney biopsy
- During a kidney biopsy, doctor uses a needle to
remove a small sample of kidney tissue for lab
testing.
- The biopsy needle is inserted through your skin
and is often directed using the guidance of an
imaging device, such as ultrasound.
Treatment
For acute kidney failure typically requires a hospital stay.
Most people with acute kidney failure are already
hospitalized.
How long patient stay in the hospital depends on the
reason for acute kidney failure and how quickly patient
kidneys recover.
In some cases, patient may be able to recover at home.
Treating the underlying cause of kidney injury
For acute kidney failure involves identifying the illness
or injury that originally damaged kidneys.
Treatment options depend on what's causing kidney
failure.
Treating complications until kidneys recover
Doctor will also work to prevent complications and
allow patient kidneys time to heal.
Treatments that help prevent complications include:
Treatments to balance the amount of fluids in your
blood.
If patient acute kidney failure is caused by a lack of
fluids in blood, doctor may recommend intravenous (IV)
fluids.
In other cases, acute kidney failure may cause patient to
have too much fluid, leading to swelling in arms and
legs.
In these cases,doctor may recommend medications
(diuretics) to cause body to expel extra fluids.
Medications to control blood potassium.
If kidneys aren't properly filtering potassium from
blood, doctor may prescribe calcium, glucose or sodium
polystyrene sulfonate(Kionex)to prevent the
accumulation of high levels of potassium in your blood.
Too much potassium in the blood → can cause
dangerous irregular heartbeats (arrhythmias) and
muscle weakness.
Medications to restore blood calcium levels.
If the levels of calcium in blood drop too low,doctor may
recommend an infusion of calcium.
Dialysis to remove toxins from your blood.
If toxins build up in blood, patient may need temporary
hemodialysis–often referred to simply as dialysis → to
help remove toxins and excess fluids from your body
while your kidneys heal.
Dialysis may also help remove excess potassium from
the body.
During dialysis,a machine pumps blood out of the
patient body through an artificial kidney (dialyzer) that
filters out waste → blood is then returned to your body.
Chronic kidney disease also called chronic kidney
failure
- describes the gradual loss of kidney function.
Kidneys filter wastes and excess fluids from your blood,
which are then excreted in your urine.
When chronic kidney disease reaches an advanced stage
→ dangerous levels of fluid, electrolytes and wastes can
build up in patient body.
In the early stages of chronic kidney disease, patient
may have few signs or symptoms.
Chronic kidney disease may not become apparent until
kidney function is significantly impaired.
Treatment for chronic kidney disease focuses on slowing
the progression of the kidney damage, usually by
controlling the underlying cause.
Chronic kidney disease can progress to end-stage kidney
failure, which is fatal without artificial filtering (dialysis)
or a kidney transplant.
Signs and symptoms of chronic kidney disease develop
over time if kidney damage progresses slowly.
Signs and symptoms of kidney disease may include:
- Nausea
- Vomiting
- Loss of appetite
- Fatigue and weakness
- Changes in how much you urinate
- Decreased mental sharpness
- Chest pain, if fluid builds up around the lining of
the heart
- Shortness of breath, if fluid builds up in the
lungs
- High blood pressure (hypertension) that's
difficult to control
- Muscle twitches and cramps
- Persistent itching
- Sleep problems
- Swelling of feet and ankles
Signs and symptoms of kidney disease are often
nonspecific → meaning they can also be caused by
other illnesses.
Because kidneys are highly adaptable and able to
compensate for lost function, signs and symptoms may
not appear until irreversible damage has occurred.
Diseases and conditions that cause chronic kidney
disease include:
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis → an inflammation of the
kidney's filtering units (glomeruli)
- Interstitial nephritis → an inflammation of the
kidney's tubules and surrounding structures
Polycystic kidney disease
- Prolonged obstruction of the urinary tract, from
conditions such as: enlarged prostate, kidney
stones and some cancers
Vesicoureteral → a condition that causes urine to back
up into your kidneys
Recurrent kidney infection, also called pyelonephritis
Kidney infection (pyelonephritis) is a type of urinary
tract infection (UTI) that generally begins in your urethra
or bladder and travels to one or both of your kidneys.
A kidney infection requires prompt medical attention
Symptoms: Vomiting; Hematuria; Nausea
Normal kidney vs. diseased kidney
A normal kidney has about 1 million filtering units.
Each unit, called a glomerulus, connects to a tubule,
which collects urine.
Conditions such as high blood pressure and diabetes
take a toll on kidney function by damaging these
filtering units and collecting tubules and causing
scarring.
Polycystic kidney
A healthy kidney (left) eliminates waste from the blood
and maintains the body's normal chemical balance.
With polycystic kidney disease (right), fluid-filled sacs
called cysts develop in the kidneys, causing them to
grow larger and gradually lose their ability to function
normally.
 dialysis or a kidney transplant for survival

Prevention
To reduce your risk of developing kidney disease:

Follow instructions on over-the-counter medications.

- When using non prescription pain relievers,
such as aspirin, ibuprofen (Advil, Motrin IB,
others) and acetaminophen (Tylenol, others),
follow the instructions on the package. Taking
too many pain relievers could lead to kidney
damage and generally should be avoided if you
Risk factors have kidney disease. Ask doctor whether these
Factors that may increase your risk of chronic kidney drugs are safe.
disease include: Maintain a healthy weight.
- Diabetes - If at a healthy weight, work to maintain it by
- High blood pressure being physically active most days of the week.
- Heart and blood vessel (cardiovascular) disease - If you need to lose weight, talk with a doctor
- Smoking about strategies for healthy weight loss.
- Obesity - Often this involves increasing daily physical
- Being African-American, Native American or activity and reducing calories.
Asian-American Don't smoke.
- Family history of kidney disease - Cigarette smoking can damage your kidneys and
- Abnormal kidney structure make existing kidney damage worse.
- Older age - If a smoker, talk to a doctor about strategies for
quitting smoking.
Complications - Support groups, counseling and medications can
Chronic kidney disease can affect almost every part of all help you to stop.
your body. Manage medical conditions with doctor's help.
Potential complications may include: - If patients have diseases or conditions that
- Fluid retention → which could lead to swelling increase risk of kidney disease, work with a
in your arms and legs, high blood pressure, or doctor to control them.
fluid in your lungs (pulmonary edema) - Ask the doctor about tests to look for signs of
- A sudden rise in potassium levels in your blood kidney damage.
(hyperkalemia) → which could impair your
heart's ability to function and may be
life-threatening
- Heart and blood vessel (cardiovascular) disease
- Weak bones and an increased risk of bone
fractures
- Decreased sex drive, erectile dysfunction or
reduced fertility
- Damage to your central nervous system →
which can cause difficulty concentrating,
personality changes or seizures
- Decreased immune response → which makes
you more vulnerable to infection
- Pericarditis → an inflammation of the saclike
membrane that envelops your heart
(pericardium)
- Pregnancy complications → that carry risks for
the mother and the developing fetus
- Irreversible damage to your kidneys (end-stage
kidney disease) → eventually requiring either