PHAR216 Gastrointestinal

Disorders
Instr. Övgü İşbilen
Cyprus International University
Faculty of Pharmacy
Disorders of the Esophagus
Congenital Abnormalities

Types
Stenosis
Atresia
Fistula
Newborn aspirates
while feeding.
Pneumonia: poor
airway control, and
fluid management
problems were
frequent
complications
Fistula is an abnormal connection between two
hollow spaces 
Stenosis is an abnormal narrowing in a blood vessel or
other tubular organ or structure.
Atresia: Absence of a normal opening, or failure of a
structure to be tubular. 
Not an easy repair
 Achalasia

Achalasia is a failure of smooth

muscle fibers to relax, which can
cause a sphincter to remain
closed and fail to open when
needed.  The default condition is
contraction
Inflammation leads to
 Scarring and
 Loss of ganglia cells
Decreased innervation means
no relaxation
Leads to retention of food,
inflammation and more scarring
Esophageal Scarring and Ring formation

Inflammation leads to
Scarring and
Loss of ganglia cells
Decreased innervation
means no relaxation
Leads to retention of
food, inflammation
and more scarring
Esophageal Diverticulae

Traction
Pulsion
Magicians
A Zenker's diverticulum, also
pharyngoesophagealdiverticulum, also pharyngeal
pouch, also hypopharyngealdiverticulum, is
a diverticulum of the mucosa of the pharynx, just above
the cricopharyngeal muscle
Epiphrenic diverticula are pulsion diverticula of
the distal oesophagus arising just above the lower
oesophageal sphincter, more frequently on the right
posterolateral wall. 
Hiatal Hernia

Incompetence of
diaphragmatic opening
Portion of stomach is in
thorax
‘Sliding’ type ->
Leads to
Regurgitation of food
Acid reflux
Ulceration
Hiatal Hernia

 In a hiatal hernia(also

called hiatus hernia)
the stomach bulges up
into the chest through that
opening.
“Rolling type
May lead to gastric
mucosal ischemia.
Ulceration
GI bleeding
Esophagitis

Inflammation of
mucosa
Lots of causes
Reflux of stomach
acid ->
Infectious agents
 Bacteria
 Viral (HIV)
 Fungal (HIV)

Cytotoxic agents
Autoimmune
Barrett’s Change

Metaplasia of
squamous epithelium
Columnar epi
Repeat injury
 Reflux
Indicates serious or
prolonged damage
Cancer risk?
Barrett's esophagus refers to an
abnormal change(metaplasia) in the cells of the lower
portion of the esophagus. ... The main cause
of Barrett'sesophagus is thought to be an adaptation
to chronic acid exposure from reflux esophagitis.
Barrett’s Change
 Esophageal Varices

Dilation of esophageal
veins, distal 1/3.
Increased venous portal
pressure.
Cirrhosis
Life threatening
hemorrhage
Esophageal Varices
Esophageal Varices
Esophageal Cancer

Squamous cell
Repeat irritation
Tobacco
Invasive
Barrett’s change
Adenocarcinoma
Esophageal Cancer
Disorders of the Stomach
Gastritis
Acute
 Polys
 ETOH
 H. pylori
 Pain
 Bleeding
Chronic
 Mucosal atrophy
 Mucin cell hyper
 Lymphocytes
 Autoimmune
 B-12 deficiency
Chronic Gastritis
Helicobacter pylori

Gram negative rod

Lives on the epithelial
surface.
Urease destroys mucus
Increases acid secretion
Reduces duodenal bicarb
Intensifies inflammatory
response
Immunogenic
 Peptic Ulcer

Action of digestion
Balance between good
and evil
H. pylori
NSAIDs
 Aspirin
Complications
 Bleeding
 Perforation
 Penetration
 Scarring
Zollinger-Ellison
 Gastrin secreting tumor
Zollinger-Ellison syndrome is a rare condition in
which one or more tumors form in your pancreas or
the upper part of your small intestine (duodenum).

These tumors, called gastrinomas, secrete large

amounts of the hormone gastrin, which causes your
stomach to produce too much acid. The excess acid
then leads to peptic ulcers, as well as to diarrhea and
other symptoms.
Good and Evil
Stress Ulcers

This means stress, not

surprise
Trauma
 Major
 Head injury
 Burns
Vascular mediated
 Rearranged blood flow
Multiple ‘erosions’
Confined to mucosa
Can bleed seriously
Gastric Cancer

Adenocarcinoma
Risk factors
Nitrites
Smoked foods
Chronic gastritis with
H. pylori
Linitis Plastica
LINITIS PLASTICA DENOTES A DIFFUSE type of
carcinoma which accounts for 3–19% of gastric
adenocarcinomas.

 It is characterized by a rigidity of a major portion, or

all of the stomach, with the absence of a filling defect
or extensive ulceration
Small Bowel Disease
Mechanical Problems
Intussesception
Intussusception also cuts off the blood supply to the
part of the intestine that's affected, which can lead to a
tear in the bowel (perforation), infection and death of
bowel tissue. 

Intussusceptionis the most common cause of

intestinal obstruction in children younger than 3.
Meckle’s Diverticulum
A Meckel diverticulum is a vestigial remnant of the omphalomesenteric
(vitellointestinal) duct.

As a congenital anomaly, it is a true diverticulum that includes all three coats
of the small intestine.

Generally, a Meckel diverticulum ranges from 1 to 12 cm in length and is found

45-90 cm proximal to the ileocecal valve. It frequently contains heterotopic
tissue.

Ileal (Meckel) diverticula and other remnants of yolk stalk. Section of ileum
and diverticulum with ulcer.
Meckle’s Diverticulum
Congenital diverticulum of the distal small bowel.
 2 kinds of mucosa
 2 feet from the ileocecal valve.
 2 inches in size.
 Twice as common in males
Problems with a Meckle’s
Vascular Related

Bowel infarction
Hemorrhagic
Venous
Arterial
Septic shock
Very painful
Bowel infarction
Infectious Enteritis
Many agents infect the small bowel.
Viral
Bacteria
 Salmonella
Parasites
 Unicellular
 Giardia

 Multicellular
 Worms
Non-infectious Inflammatory

Crohn’s disease
Granulmatous enteritis
Transmural inflammation
No known infectious agent
Granulomas in about 40%
Fistula formation
Relapsing
Small bowel or colon
Ethnicity
No significant increased risk of
cancer (minimal at best)
Crohn's disease is a chronic inflammatory disease of
the digestive tract.
Symptoms include abdominal pain and diarrhea,
sometimes bloody, and weight loss.

Crohn's treatment consists of lifestyle changes, such as

exercise and a healthy diet, as well as over-the-counter
antidiarrhetics and prescription anti-inflammatory
medication
Crohn’s Disease
Transmural inflammation
Scarring and stricture formation
Fistulae
Crohn’s Microscopic
Granulomas about 40% of the time.
Transmural all the time
Gluten Enteropathy
Colonic Disease
Hirschprung’s Disease

Aganglionic segment
Peristalsis stops
Dilation of colon back
stream of the defective
segment.
Remove distal portion
that looks healthy.
Look for ganglia.
Hirschsprung's (HIRSH-sproongz) disease is a
condition that affects the large intestine (colon) and
causes problems with passing stool.

 The condition is present at birth (congenital) as a

result of missing nerve cells in the muscles of the baby's
colon.
Ulcerative Colitis

Mucosal
Crypt abscesses
Autoimmune element?
Starts in rectum and
works its way back.
Pseudopolyps
Toxic megacolon
Increased cancer risk
Ulcerative Colitis
Diverticulosis
Diverticulosis is a condition that develops when
pouches (diverticula) form in the wall of
the colon (large intestine). These pouches are usually
very small (5 to 10 millimeters) in diameter but can be
larger.
Diverticulitis
Colonic Polyps
A colon polyp is a small clump of cells that forms on
the lining of the colon.
Most colon polyps are harmless.
But over time, some colon polyps can develop
into coloncancer, which is often fatal when found in
its later stages
Colonic Polyps
Familial Polyposis

Millions of
adenomatous polyps
Genetic predisposition
100% of chance of
cancer
Familial Polyposis
Colon Cancer

Right and left side

have different
presentations
Right = anemia
Left = bowel changes
Contributing factors
Genetics
Dietary fiber
Dietary fat
Spread
Liver
Lymph nodes
Genetics of Colon Cancer
Colon Cancer
Appendicitis
Appendicitis

Obstruction of mouth
of appendix
 Fecolith
 Enlarged lymph nodes
Bacteria proliferate
and invade wall.
Rupture
 Peritonitis
 Abscess
Inguinal Hernia
Direct Abdominal Hernia