BỘ MÁY TIÊU HÓA (DIGESTIVE SYSTEM)

(tham khảo trong chapter 4 sách Clinical Pathophysiology của Aaron Berkowitz)

Ống Tiêu Hóa (the Gastrointestinal tube/system):

Thực Quản, Dạ Dày, Tiểu Trường, Đại Trường

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(đọc kỹ phần trên và nhớ là đã tóm tắt được ý chính rồi)

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 A- Diseases of the esophagus
Thực quản esophagus chỉ có chức vụ chuyển đồ ăn từ pharynx xuống stomach do
muscular contraction chứ không có chức vụ Tiêu (digestion) Hóa (absorption).
Các bệnh gây ra do:
- Obstruction: @ Etiology: bên ngoài đè vào (tumor của các cơ quan chung
quanh như khí quản, phổi, hạch lao, hạch ung thư di căn (metastasis), bên trong
bít ống (foreign bodies, tumors).
@ Symptoms & Signs: nuốt khó (dysphagia), pain nhầm với angina, ợ đồ ăn chưa
tiêu (regurgitation of undigested foods). Nếu mới đầu khó nốt đồ cứng rồi sau dần
không nuốt được đồ lỏng phải nghi bị malignant tumor (đã là cancer thì phải lớn
lên dần growth nếu không evolution là bướu lành).
- Muscle (cơ): cơ co & thắt (contract & relax)--> nhu động peristalsis chuyển
đồ ăn xuống và mở lower esophageal sphinter cho đồ ăn xuống dạ dầy, stimulated
by parasympathetic system (rest & didgest) nên nguyên nhân của bệnh là do chính
cơ hay do parasympathetis system.
* Failure to Contract --> esophageal dilation do cơ cấu của cơ trong
bệnh scleroderma và Chagas.

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 * Failure to Relax --> esophageal spasm when swallowing thỉnh thoảng hay
luôn luôn-- đau mimics angina.
* Failure to Contract & Relax: achalasia (mất peristalsis, lower esophageal
sphincter không mở được--> đồ ăn ứ đọng làm căng phồng esophagus ra như cái
diều chim (bird's beak), do tổn thương postganglionic parasympathetic neurons.

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 - Diverticula như diverticula trong colon, có thể gây ra do các lymphe node
(thường là hạch lao) bên ngoài kéo esophagus--> ói ợ lên đồ ăn chưa tiêu tích tụ
trong diverticulum. Bệnh này thường do bẩm sinh (congenital disease as Zenker's
diverticulum).

- Reflux (Gastroesophageal reflux disease GERD): do lower esophageal

sphincter yếu hay hiatal hernia (diaphragm hở nên stomach chui qua diaphragm
lên ngực) hay impaired emptying of the stomach (obstruction, gastroparesis:poor
gastric motility do CN X tổn thương)--> heartburn, ợ chua nhất là khi ngồi cúi
đầu hay nằm, lâu ngày sinh esophagitis, Barett's esophagus (premalignant
condition) dẫn đến ung thư esophageal adenocarcinoma.

Source
(A digestive disease in which stomach acid or bile irritates the food pipe lining.
This is a chronic disease that occurs when stomach acid or bile flows into the food pipe and
irritates the lining. Acid reflux and heartburn more than twice a week may indicate GERD.
Symptoms include burning pain in the chest that usually occurs after eating and worsens
when lying down. Relief from lifestyle changes and over-the-counter medications is usually
temporary. Stronger medication may be needed.)

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- Other esophagitis:caused by medications, chemotherapy, radiation, infection
and immunocompromised patients (HIV).
- Cancer: ngoài adenocarcinoma do Barett's esophagus, rượu và thuốc lá-->
squamous cell carcinoma. Both--> dysphagia + SOB (do tumor đè vào trachea).
Chữa trị bằng surgery, chemotheraty , radiation.
- Esophageal Varices là dilation of esophageal veins do cirrhosis/portal
hypertesion--> rupture (vì thành tĩnh mạch mỏng chịu áp lực lớn)--> esophageal
bleeding ( máu đỏ tươi khác với máu do gastric bleeding đen như bã cà phê coffee
ground)

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Cirrhosis theo lý thuyết tiết ra một chất làm dãn các tĩnh mạch, thực tế tĩnh mạch
bị nghẽn đường về tim dãn to ra như caput medusae, swollen legs và gây portal
hypertension, dilated splenic vein, esophageal varices.

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(The main symptom of caput medusae is a network of large, visible veins around
the abdomen. From a distance, it might look like a black or blue bruise)

Diagnosis (almost no symptoms):

 Endoscopic exam.

 Imaging tests. Both abdominal CT scans and Doppler ultrasounds of the

splenic and portal veins can suggest the presence of esophageal varices.
An ultrasound test called transient elastography that measures scarring in
the liver can help your doctor determine if you have portal hypertension,
which may lead to esophageal varices.
 Capsule endoscopy. In this test, you swallow a vitamin-sized capsule
containing a tiny camera, which takes pictures of the esophagus as it goes
through your digestive tract.

Treatment to prevent bleeding

Treatments to lower blood pressure in the portal vein may reduce the risk of
bleeding esophageal varices. Treatments may include:

 Medications to reduce pressure in the portal vein include propranolol

and nadolol (Corgard).
 Using elastic bands to tie off bleeding veins called endoscopic band
ligation.

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 Using an endoscope, the doctor uses suction to pull the varices into a
chamber at the end of the scope and wraps them with an elastic band,
which essentially "strangles" the veins so they can't bleed.
Treatment if you're bleeding

Bleeding esophageal varices are life-threatening, and immediate treatment is

essential. Treatments used to stop bleeding and reverse the effects of blood loss
include:

 Using elastic bands to tie off bleeding veins. Your doctor may wrap
elastic bands around the esophageal varices during an endoscopy.
 Medications to slow blood flow into the portal vein. Drugs such as
octreotide (Sandostatin) and vasopressin (Vasostrict) slow the flow of
blood to the portal vein. The drug is usually continued for up to five days
after a bleeding episode.
 Diverting blood flow away from the portal vein. If medication and
endoscopy treatments don't stop the bleeding, your doctor might
recommend a procedure called transjugular intrahepatic portosystemic
shunt (TIPS).
The shunt is an opening that is created between the portal vein and the
hepatic vein, which carries blood from your liver to your heart. The shunt
reduces pressure in the portal vein and often stops bleeding from
esophageal varices.
But TIPS can cause serious complications, including liver failure and
mental confusion, which can develop when toxins that the liver normally
would filter are passed through the shunt directly into the bloodstream.
TIPS is mainly used when all other treatments have failed or as a
temporary measure in people awaiting a liver transplant.
 Placing pressure on varices to stop bleeding. If medication and
endoscopy treatments don't work, doctors may try to stop bleeding by
applying pressure to the esophageal varices. One way to temporarily stop
bleeding is by inflating a balloon to put pressure on the varices for up to
24 hours, a procedure called balloon tamponade. Balloon tamponade is a
temporary measure before other treatments can be performed, such as
TIPS.

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 This procedure carries a high risk of bleeding recurrence after the balloon
is deflated. Balloon tamponade may also cause serious complications,
including a rupture in the esophagus, which can lead to death.

 Restoring blood volume. You might be given a transfusion to replace lost

blood and a clotting factor to stop bleeding.
 Preventing infection. There is an increased risk of infection with bleeding,
so you'll likely be given an antibiotic to prevent infection.
 Replacing the diseased liver with a healthy one. Liver transplant is an
option for people with severe liver disease or those who experience
recurrent bleeding of esophageal varices. Although liver transplantation is
often successful, the number of people awaiting transplants far outnumbers
the available organs.

B- Diseases of the Stomach

(tiếp trong phần 2)

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