Diseases an syndromes of the

digestive system.
system.
Alcoholism..
Alcoholism
Endoinfectious processes of the
digestive system
Are disorders with inflammatory
manifestation
The cause of these diseases is biological
disbalance between human organism and
microorganisms located in digestive system
system..
– A large proportion of the faecal mass consists of bacteria (around
60% of faecal solids)
– The intestinal habitat of an individual contains 300–
300–500 and more
different species of bacteria
– The number of microbial cells within the gut lumen is about 10 times
larger than the number of eukaryotic cells in the human body
(Guarner F, Malagelada JR (February 2003). "Gut flora in health and disease". Lancet 361 (9356):
512–
512 –9.)
9.)
 Pathogenesis of digestive
system endoinfections
Congenital anomalies that weakens
immune system and worsens resistance to
microorganisms
– Enterocytic outer membrane dysfunction
– Cellular and/
and/or humoral immunity failure
– Digestive tract dysplasias
Megacolon,, dolichosigma
Megacolon dolichosigma,, diverticulum
Congenital small intestinal atresia with
enlargement,, purulent inflammation and
enlargement
necrosis
12 days of age newborn
newborn:: large
intestine removed due to
necrotizing colitis
Meckel Diverticulum
Diverticulum in large intestine
 Terminology
According to lesion site
– Tonsillitis,
Tonsillitis, enteritis
enteritis,, colitis
colitis,, appendicitis,
appendicitis,
cholecystitis
According to microorganisms
– Staphylococcal infection
infection,, candidosis etc.
 Tonsillitis
Inflammation in tonsils and pharynx
Bacterial infections may be superimposed
on the usual viral upper respiratory
infections or may be primary invaders
invaders.. The
most common offenders are Streptococci,
Streptococci,
Staphylococci or other pathogens
Predisposing factors can be common cold cold,,
immune system failure,
failure, vitamin deficiency,
deficiency,
other diseases
 Tonsillitis
According to course
– Acute or chronic
According to exudate
– serous,
serous, fibrinous,
fibrinous, purulent,
purulent, necrotizing
 Tonsillitis complications
Peritonsillar abscess
Retropharyngeal abscess
Purulent middle ear inflammation
Phlegmona
Trombophlebitis
Sepsis
Scarring
 Enteritis
Disruption of the absorption-
absorption-deteriorat
deteriorates
es
nourishment
Diarrhea become a cause of water and
salts loss
According to localisation
– Duodenitis,
Duodenitis, jejunitis
jejunitis,, ileitis
According to course
– Acute or chronic
According to etiology:
etiology: infectious
infectious,, toxic
toxic,,
immune and nutritional
 Enteritis morphology
Acute
– Catarrhal
– Fibrinous
– Purulent
– Ulcerous
Ulcerous--necrotizing
Chronic
– Depletion of epithelium brush border,
border, cell
vacualation and death
death,, lamina propria
infiltration with lymphocytes
lymphocytes,, plasma cells and
eosinophillic granulocytes
 Enteritis complications
Bleeding, perforation
Bleeding,
Dehidration
Chronic enteritis leads to exhaustion,
exhaustion,
hypoproteinemia,, anemia and avitaminosis
hypoproteinemia
Colitis
 Colitis
Typhlitis, also called caecitis or is a necrotising
Typhlitis,
inflammatory condition which typically involves the
caecum.. It can sometimes extend into the ascending
caecum
colon or terminal ileum.
Transversitis--colon transversum
Transversitis
Sigmoiditis--sigmoid intestine
Sigmoiditis
Proctitis--?
Proctitis
Proctosigmoiditis--?
Proctosigmoiditis
Pancolitis--?
Pancolitis
Enterocolitis--?
Enterocolitis
Gastroenterocolitis--?
Gastroenterocolitis
Colitis etiology
etiology,, pathogenesis
pathogenesis,,
morphology,, complications
morphology
similar as in enteritis
 Ulcerative colitis (UC)
Chronic inflammatory bowel disease (IBD)
is idiopathic disorder and usually begins
from rectum and progress proximally
Undulating course (relapsing disorder
disorder))
Inflammation usually limited to mucosa
and submucosa
Inflammation usually diffuse
 Ulcerative colitis

Normal segment
Cobblestone
 Ulcerative colitis histology
normal
 Ulcerative colitis triggers:
triggers:
Commensal bacteria normally present in
the intestinal lumen are probably involved
in IBD pathogenesis
Dietary and environmental factors
Primary immunological defects
Mucus secretion disorders
Genetic defects
Psychologic stress
Mixture of these factors
Pseudomembranous colitis
Pseudomembranous colitis
 Colitis complications
Exhaustion (innanitio
innanitio))
Anaemia
Sepsis
Amyloidosis
Toxic megacolon
Pseudopolyps
Intraepithelial neoplasia→carcinoma
 Appendicitis
Microorganisms triggers inflammation after
epithelium damage by:
by:
– luminal obstruction,
obstruction, dyskinesia and coprostasis
coprostasis,,
coprolith (a mass of hard fecal matter in the
intestine)) and
intestine and//or helmints
– Intravascular stasis and thrombosis
Small coprolith in appendix
without appendicitis
Coprolith and appendicitis
Enterobiosis in appendix
Roundworm in appendix
 Appendicitis forms
Superfitial (catarrhal
catarrhal))
Destructive
– Ulcerative
– Ulcerative
Ulcerative--phlegmonous (suppurative
suppurative))
– Abscedent
– Gangrenous
Superfitial (catarrhal
catarrhal))
Phlegmonous (suppurative
suppurative))
appendicitis macroscopically
Phlegmonous (suppurative
suppurative))
appendicitis microscopically
Gangrenous appendicitis
macroscopically
 Gangrenous appendicitis
microscopically:: necrotic tissue +
microscopically
exudation + bacterial colonisation
 Appendicitis complications
Microperforation
Macroperforation
Periappendicitis and localised fibrino-
fibrino-
purulent peritonitis
Diffuse purulent peritonitis
Intestinal adhesions→obstruction
Purulent thrombophlebitis→portal vein
branches inflammation→liver
abscesses→sepsis
Appendix perforation
 Appendicitis complication –
periappendicitis and localised
fibrino--purulent peritonitis
fibrino
Appendicitis complication –
diffuse purulent peritonitis
Late appendicitis complications
- adhesions
Appendicitis complication -
sepsis
Appendix with obliterated lumen
 Appendix empyema
empyema,, hydrops
appendicis,, appendicomucocele
appendicis

Lip mucocele
 Candidiasis
Common endoinfection damaging
newborns or cachectic people mouth,
mouth,
esophageal mucosa
Etiology – Candida albicans
albicans,, residing
normally in the skin
skin,, mouth
mouth,,
gastrointestinal tract and vagina as benign
commensals an seldom produce disease
in healthy people
Normal bacterial flora and good immune
condition protects from candida flush
 Candidiasis
Most commonly takes the form of a
superfitial infection on mucosal surfaces of
the oral cavity (thrush
thrush))
 Candidiasis complications
Inflammation→ulceration→perforation
Scarring an strictures after inflammation
subsides
Generalisation
Digestive tract endoinfections
Endoinfections and ulceration predispose
various matherial accumulations –
bezoars
They can be classified into four main types
according to constituents:
constituents:
– phytobezoars,
phytobezoars,
– trichobezoars,
trichobezoars,
– lactobezoars,
lactobezoars,
– pharmacobezoars
Phytobezoar from stomach
12 years of age boy
Trichobezoar removed from the stomach of
a 7 yr. old child
 Trichobezoar
19 years of age girl

Mansour-Ghanaei F, Herfatkar M, Sedigh-Rahimabadi M, Lebani-Motlagh M, Joukar F.

Huge simultaneous trichobezoars causing gastric and small-bowel obstruction. J Res
Med Sci. 2011 Mar;16 Suppl 1:S447-52.
 Trichobezoar
19 years of age girl

Mansour-Ghanaei F, Herfatkar M, Sedigh-Rahimabadi M, Lebani-Motlagh M, Joukar F.

Huge simultaneous trichobezoars causing gastric and small-bowel obstruction. J Res
Med Sci. 2011 Mar;16 Suppl 1:S447-52.
 Ulcer disease (morbus
ulcerosus),
ulcerosus ), gastric ulcer (ulcus
ventriculi),
ventriculi),
duodenal ulcer (ulcus duodeni
duodeni))
Gastric and duodenal mucosal defects
more than half of mucosa thickness
Mucosal defects less than half of mucosa
thickness - erosions
 Ulcer disease pathogenesis
Normally presenting damaging forces
– Gastric acidity
– Peptic enzymes
Normal defensive forces
– Surface mucus secretion
– Bicarbonate secretion into mucus
– Mucosal blood flow
– Apical surface membrane transport
– Epithelial regenerative capacity
– Elaboration of prostaglandins
 Ulcer disease pathogenesis
Increased damage and/
and/or impaired
defenses leads to disease
– H. pylori infection
– NSAID, aspirin
– Cigarettes
– Alcohol
– Gastric hyperacidity
– Duodenal-
Duodenal-gastric reflux
– Ischemia,
Ischemia, shock
shock,, delayed gastric emptying
emptying,,
host factors
Helicobacter pylori infection
 Ulcer disease morphology
Commonly found in gastric pylorus an
proximal duodenum
80 % of cases solitary ulcers
Roun or oval
oval,, 0,5-
0,5-3 cm in diameter
Various depth,
depth, can reach pancreas,
pancreas, liver
Gastric ulcer in histology
specimen
Ulcer morphology
Necrotic debris
Nonspecific
acute and
chronic infiltration
Granulation
tissue
Fibrosis
Ulcer disease complications and
causes of death
Tissue destruction:
destruction: bleeding,
bleeding, perforation,
perforation,
penetration to other organs
Infectious
Scarring leads to lumen stenosis
Neoplastic
 Precancerous conditions
Are associated with increased risk of
cancer
If left untreated, these conditions may lead
to cancer
 Examples of precancerous
conditions
Chronic inflammation with ulceration
Leukoplakia
Polyps
Atrophic gastritis
Barrett’s esophagus
Intraepithelial dysplasia or neoplasia
(carcinoma in situ
situ))

Stedman’s Medical Dictionary. 26th ed. 1995;1182,1405, 279.

Chronic inflammation with
ulceration
Polyps
 Cancer,, neoplasm
Cancer neoplasm,, tumor
Abnormally large
Partly autonomous
mass
With genetic changes
Continues to grow even
after cancerogen
influence cessation
Consumes organism
resources - parasitize
Cancer gracilis
Gastrointestinal
tract we can
investigate using
endoscopic
devices
 Clinical stage (group) I II III IV nenurod
atv. 120 594 538 180
Prostata
% 7,9 39,2 35,5 11,9
atv. 104 169 465 441 139
Lungs
% 7,9 12,8 35,3 33,5 10,5
atv. 530 122 14 1
Skin
% 78,2 18,0 2,1 0,1
atv. 82 79 115 247
Stomach
% 14,0 13,5 19,6 42,2 10,8
atv. 117 70 60 74
Kidney
% 33,0 19,7 16,9 20,8
atv. 46 96 103 81
Rectum
% 13,0 27,1 29,1 22,9
atv. 102 140 43 34
Urinary bladder
% 26,2 35,9 11,0 8,7 18,2
atv. 22 93 98 102
Colon
% 6,4 27,2 28,7 29,8

atv. 8 41 86 111
Oral cavity
% 3,0 15,6 32,7 42,2
atv. 9 18 41 118
Pancreas
% 4,1 8,2 18,7 53,9 15,1
LVI – lymph-vascular invasion
present/identified
M – distant metastasis (liver)
M – distant metastasis (heart)
M – distant metastasis (heart)
Gastrointestinal tract complications
and causes of death
Lumen obstruction
Bleeding
Perforation
Inflammation
Cachexia,, anemia and other organs
Cachexia
insufficiency due to metastasis
Alcohol drinking is bad habit
or disease
disease? ?
 Ethanol and humans
Alcohol consumption variants
– Acute intoxication after consumption of large
amount of alcohol
– Episodical,
Episodical, occasional drinking
– Domestic dr
drinking
inking very often
– Alcoholism when drinking constantly
First phase – drink if I want and not drink if I
don’t want
Second phase – I drink because I want
Third phase – I can’t stop drinking
 Ethanol = poison
poison,, toxic
toxic,, venom,
but it drinks
~50 % of adults
~5--10 % have chronic alcoholism
~5
Only 2% Lithuanian inhabitants says that in friends
and relatives meetings they does not drink alcohol
60% Lithuanian inhabitants says that in friends and
relatives meetings they drink alcohol if celebrate
something..
something
 Ethanol
20 % absorbs in the stomach
stomach,, other in the
intestines
Soluble in water so easy goes through
membranes an reaches all organs and cells
Most of ethanol in the blood is biotransformed
to acetaldehyde in the liver by three enzyme
systems consisting of alcohol dehydrogenase
(ADH), the microsomal ethanol-
ethanol-oxidizing
system (MEOS) and catalase
 Alcoholism
Alcoholism, also known as alcohol use
Alcoholism,
disorder (AUD
AUD)) and alcohol dependence
syndrome,, is a broad term for any
syndrome
drinking of alcohol that results
dependance and mental with somatic
complications
Alcohol use affects
affects all parts of the body
 Alcohol affects liver
Liver cell steatosis
Liver cell death
Liver cirrhosis
 Alcohol affects pancreas
Acute and chronic pancreatitis
(macroscopically
macroscopically))
Pancreatic necrosis
Pancreatic fibrosis

Normal pancreas
Alcohol affects gastrointestinal tract
Causes mucosal atrophy
Oral and esophageal mucosa hyperkeratosis
and dyskeratosis
Epitelial metaplasia
Erosions→ulcers→malignant transformation
Atrophic gastric mucosa
http://www.cancer.org/cancer/cancercauses/othercarcinogens/generalinformationaboutcarcinogen
probable-human-carcinogens
Gastric carcinoma
Ethanol affects cardiovascular
system
Alcohol cardiomyopathy
Hypertension
Heart Disease of Chronic Beer
Drinkers
 Ethanol affects hemopoesis
Granulocytes maturation
Decreases immunoglobulins production
Lowered resistance to infections
Due to thrombocytopenia worsens blood
clotting
and as a consequence - lobar
pneumonia
 Alcohol beverages affects
nervous tissue
As a consequence of B group vitamin
deficiency and direct toxic influence on
tissue
Alcohol encephalopathy couses increased
amounts of neuroglia→worsens memory,
memory,
mental degradation
Central and peripheral nervous systems
demyelinization,, polyneuropathys,
demyelinization polyneuropathys, pareses
Alcohol causes psychological
problems

https://www.youtube.com/watch?v=lwv7Utcf-gM
 Alcohol affects genital system
Weakens chromosome function
Pathological forms of spermatozoides
Gonads atrophy
atrophy,, disbalans of sex
hormones
– Lower testosterone in males and feminisation
 Alcohol affects genital system
For males spermatozoides renews 3 months
after alcohol consumption
For females ovules does not renews – only
decreases
 Alcohol affects fetus
Toxic influence on
impregnated ovum
Frequent spontaneous
abortions
Newborns with various
congenital dysplasias

Fetal Alcohol Spectrum Disorder (FASD)

https://www.youtube.com/watch?v=m7zfJCW9Yco
 Fetal Alcohol Spectrum
Disorder (FASD)
Microcephaly
Slow growth
Mental retardation
Face appearance
Alcohol couses skeletal-
skeletal-muscle
system damage
Fragmentation, lysis and diffuse fibrosis
Fragmentation,
Pain and weakness clinically
Myoglobinuria with renal insufficiency
Complications and causes of
death
Predominant complications and
causes of death
– Bleeding to death from esophageal varices
– Acute and chronic liver insufficiency
– Pancreatitis complications
– Diabetes complications
– Hearth insufficiency
– Endoinfectios
– Neoplasms
– Traumas and injury at home
home,, work
work,, road or
vacation...
vacation ...