Digestive System Can you enjoy your life without your digestive system? Characteristics of Digestive System Taking in energy sources 		Digestion  energy 					 tissue 		absorption	 waste Numerous organs Indiretly contact with outside environment  		Food→		Pathogenic factors→	 (physical, chemical, microbial) Common Lesions 			inflammation 			Ulcer 			bleeding 			perforation 			neoplasm 			functional disturbances  inflammation erosion ulcer  bleeding perforation  tumor Characteristics of Digestive System Not only a digestive organ but also endocrine organ 		 pancreas	  gastrin 				  glucagon 				  somatostatin 				  VIP 				  insulin Characteristics of Digestive System  Immune organ 			mucosa. submucosa 			lymhatic system 			Liver Unique neurologic system 			vagus 			sympathetic 			mesenteric plexus Relation with other systems 			 	 Diseases		 Symptom Esophagus inflammation	 dysphagia, heartburn 		  cancer 		  achalasia  GERD Stomach inflammation		 upper abdominal discomfort 		 ulcer	  	 pain, anorexia, acid reflux 		 cancer		 nausea, vomitting, hematemesis 		 functional dyspepsia	 melena Small intestine	  inflammation pericembilical pain  (bacterial, virus T.B)	 distention diarrhea 		bleeding, necrosis	 malabsorption 		ulcer. (Crohn’s) 		cancer(rare) Colon	inflammation 		 abdominal pain (lateral) 		(dysentry, non specific)	 constipation diarrhea 		ulcer			 hematochezia 		cancer 		Disease			Symptom Liver 	inflammation 	  hepatic area discomfort 		(hepatitis abcess)	  pain. hepatomegaly 		cirrhosis		  tenderness, jaundice 		cancer			  portal hypertension Biliary tract 	  		  colicky 		 inflammation  jaundice 		 stone, parasite, tumor 		 Disease			 Symptom pancreas inflammation	 upper abdominal pain 		 cancer			jaundice 						malabsorption Peritoneal mesenteric		abdominal pain 		 inflammation		tenderness 		 (T.B)			ascites 		 cancer(metastatic) Diagnosis & differential Diagnosis History 	main symptoms:pain (example) 		site, time and mode of onset 		frequency and duration. character 		severity, radiation, aggravating factors 		relieving factors Diagnosis & differential Diagnosis Signs: 	inspection→auscultation→percussion→palpation organ? Mass? 	 	abdominal wall? In abdomen? 		you palpate liver? 			or 		Liver palpate you?  digital rectal examination Other Exaninations blood: liver test. (TB.CB. ALT.AST. A.G. ALP. PT) 		 liver function test. 		 virus markers (hepatitis . ABCDE. etc) 		 tumor markers (CEA, CA19-9, CA125…) 	feces: routine, occult blood. parasites 	X Ray: plain film 		  barium meal examination 		  barium enema 		  PTCD 		  ERCP 		radio-Angiogram, DSA Biopsy: mucosa. Liver, pancreas CT Endoscopy (Diagnosis & treatment) 	Can reach almost all lumene of digestive tract, capsule endoscope Ultrasonography: endoscopic ultrasonography Isotope examination  biliary excretion 					gastric emptying 					13c. 14c-UBT MRI: MRCP PET Progress in the diagnosis and treatment of digestive disease Medical treatment of peptic ulcer (H2 RA PPI) Bleeding of gastrointestinal tract endoscopy Pathogenesis and treatment of gastrointestinal motility disorder (FD, IBS…) Experimental and clinical study in hepatic fibrosis The treatment of portal hypertension (medical, endoscopy) Artificial liver support system  MARS Liver transplantation Diagnosis and treatment of malignancy  Have had progress but no breakthrough Reasonable application of examination Indication The strength and weakness of every examination Not the more up-to-the-minute the better * * * * *