Health of the gastrointestinal tract: maintaining normal work

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I. Anatomy and physiology of the gastrointestinal tract: health foundation

A. Overview of the structure of the gastrointestinal tract:

  1. Rot cavity: The primary stage of food processing. Mechanical grinding with teeth, moisturizing saliva, the beginning of digestion of carbohydrates with amylase. Language: taste perception, the formation of a food lump (Bolus). Salivary glands: production production (mumps, submandibular, sub -language).
  2. Sip and esophagus: The sip is a transitional stage common to the respiratory and digestive systems. The esophagus is a muscle tube that delivers food to the stomach through peristaltic contractions. The upper and lower esophageal sphincters regulate the passage of food.
  3. Stomach: Food tank, mechanical mixing, chemical digestion of proteins. The mucous membrane of the stomach: parietal cells (hydrochloric acid production), main cells (pepsinogen production), additional cells (mucus production). Solic acid activates pepsinogen into pepsin, denatures proteins, destroys bacteria. Pepsin breaks the proteins into peptides. The regulation of acidity and secretion of gastrin (hormone that stimulates the production of hydrochloric acid).
  4. Small intestine: The main place of digestion and absorption of nutrients.
    • Duodenum: He receives a chimus from the stomach, bile from the gallbladder (emulsification of fats), enzymes from the pancreas (trippsin, chiripripsin, amylase, lipase). Neutralization of sour chimus bicarbonate from the pancreas.
    • Jejunum: Continues digestion and absorption. The high density of villi and microse -increases the surface area for absorption.
    • Ileum: The absorption of nutrients, the absorption of vitamin B12 and bile acids completes. Contains Payerovs of plaques (lymphoid formations), playing a role in immune defense.
  5. Bulshose intestines: The absorption of water and electrolytes, the formation and storage of feces. Contains a huge amount of bacteria (microbiota) involved in the fermentation of undigested food residues, the synthesis of vitamins (K, B).
    • Caecum: The initial section of the large intestine contains appendix (lymphoid organ).
    • The colon (ascending, transverse, descending, sigmoid): Water absorption, formation of feces.
    • Rectum: Storage of feces.
    • Anus: The removal of feces. Internal and external sphincters regulate defecation.
  6. Liver: The key organ of metabolism, detoxification, synthesis of bile. Bile emulsifies fats, facilitating their digestion and absorption. The liver also plays a role in regulating the level of glucose in the blood, the synthesis of blood proteins, storage of glycogen, vitamins and minerals.
  7. Gall bladder: Storage and concentration of bile. He throws bile into the duodenum in response to the intake of fatty foods.
  8. Pancreas: Exocrine function: the development of enzymes for digestion of proteins, fats and carbohydrates. Endocrine function: the production of insulin and glucagon that regulates the level of glucose in the blood.

B. Physiological processes of gastrointestinal tract:

  1. Digering: The decomposition of complex food molecules for simple ones, which can be absorbed. Mechanical digestion (grinding of food) and chemical digestion (effect of enzymes).
  2. Suction: Transfer of nutrients from the gastrointestinal tract to the blood or lymph. It occurs mainly in the small intestine. Sucking mechanisms: active transport, passive transport, lightweight diffusion, endocytosis.
  3. Motorika: The movement of food along the gastrointestinal tract through peristaltic contractions. It is regulated by nervous and hormonal systems. The peristalsis provides mixing of food with enzymes and its advancement to the lower gastrointestinal tract departments.
  4. Secretion: The development of enzymes, hormones, mucus and other substances necessary for digestion and absorption of food. Secretation is regulated by nervous and hormonal systems.
  5. Excretion: The removal of undigested residues of food and metabolism products from the body in the form of feces.
  6. Microbiota: Community of microorganisms inhabiting gastrointestinal tract. Plays an important role in digestion, immune protection, synthesis of vitamins. Microbiotic imbalance (dysbiosis) can lead to various diseases of the gastrointestinal tract.
  7. Nervous regulation: The Entral nervous system (“intestinal brain”) controls motor skills, secretion and absorption in the gastrointestinal tract. Communication with the central nervous system through the vagus nerve and spinal cord.
  8. Hormonal regulation: Hormones produced by the gastrointestinal tract (gastrin, secretin, cholecystokinin) regulate secretion, motor skills and absorption.

II. Common gastrointestinal diseases: causes, symptoms and diagnosis

A. Esophagus diseases:

  1. Gastroesophageal reflux disease (GERB): The reverse casting of the gastric contents into the esophagus, causing heartburn, regurgitation, chest pain. Reasons: insufficiency of the lower esophageal sphincter, increased intra -abdominal pressure, hernia of the esophagus of the diaphragm. Diagnostics: esophagogastroduodenoscopy (EGDS), pH meter of the esophagus.
  2. Etofaghit: Inflammation of the mucous membrane of the esophagus. Causes: GERB, infections (candidiasis, herpes), medication (non -steroidal anti -inflammatory drugs – NSAIDs), radiation therapy. Symptoms: pain during swallowing, dysphagia (difficulty swallowing). Diagnostics: EGDS.
  3. The hernia of the esophageal opening of the diaphragm: The protrusion of part of the stomach through the esophageal hole of the diaphragm. Could be the cause of the GERB. Diagnostics: radiography of the stomach with barium, EGDS.
  4. Ahalasia of Cardia: Violation of the motor skills of the esophagus, characterized by the lack of relaxation of the lower esophageal sphincter. Symptoms: dysphagia, regurgitation, weight loss. Diagnostics: Manometry of the esophagus.
  5. Barrett’s esophagus: Metaplasia of the epithelium of the esophagus (replacing a normal flat epithelium with cylindrical, as in the intestines). A precancerous state associated with GERB. Diagnostics: EGDS with biopsy.
  6. Esophageal cancer: The malignant neoplasm of the esophagus. Risk factors: smoking, alcohol, Barrett’s esophagus. Symptoms: dysphagia, weight loss, chest pain. Diagnostics: EGDS with biopsy.

B. Diseases of the stomach and duodenum:

  1. Gastritis: Inflammation of the mucous membrane of the stomach.
    • Acute gastritis: Sudden inflammation caused by infection, drugs, alcohol, stress. Symptoms: abdominal pain, nausea, vomiting.
    • Chronic gastritis: Prolonged inflammation caused by infection Helicobacter pyloriautoimmune processes, chemical factors.
      • Gastritis type A (autoimmune): Antibodies to the parietal cells of the stomach, leading to a deficiency of vitamin B12.
      • Gastritis type B (bacterial): Infection Helicobacter pylori.
      • Gastritis type C (chemical): It is caused by the reception of NSAIDs, alcohol, bile reflux. Diagnostics: EGDS with biopsy, test for Helicobacter pylori (breathing test, fecal analysis, biopsy).
  2. Parlias of the stomach and duodenum: The formation of ulcers in the mucous membrane of the stomach or duodenum. Reasons: infection Helicobacter pylorireception of NSAIDs. Symptoms: abdominal pain (on an empty stomach is enhanced by a duodenal ulcer, after eating with a stomach ulcer), nausea, vomiting, bleeding (Melena – black stool, hematemesis – blood vomiting). Diagnostics: EGDS with biopsy, test for Helicobacter pylori.
  3. Dyspepsia: Digestion, manifested by pain or discomfort in the upper abdomen, nausea, vomiting, bloating. It can be functional (without organic cause) or organic (associated with the disease of the gastrointestinal tract). Diagnostics: exclusion of organic diseases (EGDS, ultrasound of the abdominal organs).
  4. Stomach cancer: Malignant neoplasm of the stomach. Risk factors: infection Helicobacter pylorismoking, a high content of salt and smoked food. Symptoms: weight loss, abdominal pain, dyspepsia, nausea, vomiting. Diagnostics: EGDS with biopsy.
  5. Gastroparesis: Slow emptying the stomach. Reasons: diabetes, surgical interventions, drugs, idiopathic gastroparesis. Symptoms: nausea, vomiting, bloating, feeling of quick saturation. Diagnostics: Scytraph of the stomach (assessment of the speed of emptying the stomach).

C. Diseases of the small intestine:

  1. Celiacia: Autoimmune disease caused by gluten intolerance (protein contained in wheat, rye, barley). Leads to damage to the mucous membrane of the small intestine and impaired suction of nutrients. Symptoms: diarrhea, abdominal pain, weight loss, anemia, fatigue. Diagnostics: serological tests (antibodies to tissue transglutaminase, antibodies to endomisia), EGDS with a biopsy of the small intestine.
  2. Crohn’s disease: Chronic inflammatory bowel disease that affects any gastrointestinal tract, but more often the iliac and colon. Symptoms: diarrhea, abdominal pain, weight loss, fever, rectal bleeding. Diagnosis: colonoscopy with biopsy, ileoscopy, MRI of the small intestine.
  3. Irritable intestine syndrome (SRK): The functional disorder of the gastrointestinal tract, characterized by abdominal pain associated with defecation, and changes in the frequency and consistency of the stool. There is no organic reason. Symptoms: abdominal pain, diarrhea, constipation, bloating. Diagnosis: Exclusion of organic diseases (colonoscopy, blood tests).
  4. Malibsorption: Violation of the absorption of nutrients in the small intestine. Reasons: celiac disease, Crohn’s disease, pancreatic deficiency, surgical interventions. Symptoms: diarrhea, weight loss, anemia, deficiency of vitamins. Diagnosis: blood tests (assessment of the level of vitamins, minerals), fecal analysis for fat.
  5. Lactase deficiency: Lack of lactase enzyme necessary for digestion of lactose (milk sugar). Symptoms: diarrhea, bloating, abdominal pain after drinking dairy products. Diagnosis: hydrogen respiratory test with lactose.
  6. Excessive bacterial growth syndrome (SIBR): Excessive amount of bacteria in the small intestine. Reasons: intestinal motility, anatomical anomalies, a decrease in the acidity of gastric juice. Symptoms: bloating, diarrhea, malabsorption. Diagnostics: hydrogen respiratory test with glucose or lactulose.

D. Diseases of the large intestine:

  1. Ulcerative colitis: Chronic inflammatory disease of the large intestine that affects only the colon and rectum. Symptoms: diarrhea with blood and mucus, abdominal pain, tenesma (false urges for defecation), fever. Diagnostics: Colonoscopy with biopsy.
  2. Diverticulis and diverticulitis: Diverticulas are small protruding in the wall of the large intestine. Saboteur – the presence of sabotage without inflammation. Diverticulite – inflammation of sabotage. Symptoms of diverticulitis: abdominal pain (usually in the lower left), fever, constipation or diarrhea. Diagnostics: colonoscopy, CT abdominal cavity.
  3. Polyps of the large intestine: Benign formations growing on the mucous membrane of the large intestine. Some polyps can degenerate into cancer. Diagnostics: Colonoscopy with polyps removal (polypectomy).
  4. Tm of intestines (colorectal cancer): The malignant neoplasm of the large intestine or rectum. Risk Factors: Age, Family Anamnesis, Polypes of the large intestine, inflammatory intestinal diseases, diet with a high fat content and low fiber content. Symptoms: a change in the frequency and consistency of the stool, rectal bleeding, abdominal pain, weight loss. Diagnostics: colonoscopy with biopsy, fecal analysis for hidden blood.
  5. Constipation: Rare or difficult defecation. Reasons: insufficient consumption of fiber and liquid, a sedentary lifestyle, taking medications, gastrointestinal disease. Diagnosis: Exclusion of organic diseases (colonoscopy, blood tests).
  6. Hemorrhoids: The expansion of veins in the area of ​​the anus and rectum. Symptoms: rectal bleeding, itching, pain in the anus. Diagnostics: inspection of the anus, rectoronoscopy.
  7. Anal cracks: Small ruptures of the mucous membrane of the anus. Symptoms: pain in defecation, rectal bleeding. Diagnostics: inspection of the anus.

E. Diseases of the liver, gall bladder and pancreas:

  1. Hepatitis: Inflammation of the liver. Reasons: viral infections (hepatitis a, b, c, d, e), alcohol, drugs, autoimmune diseases. Symptoms: jaundice (yellowing of the skin and sclera), fatigue, nausea, vomiting, abdominal pain. Diagnostics: blood tests (assessment of the level of hepatic enzymes, antibodies to hepatitis viruses), ultrasound of the liver, liver biopsy.
  2. Cirrhosis: Substitution of the normal fabric of the liver with a scar fabric. Reasons: chronic hepatitis, alcoholism, non -alcoholic fatty liver (NAZBP). Symptoms: fatigue, weakness, jaundice, ascite (fluid accumulation in the abdominal cavity), varicose veins of the esophagus. Diagnosis: blood tests (assessment of the level of liver enzymes, albumin, bilirubin), ultrasound of the liver, liver biopsy.
  3. Gallstone disease: The formation of stones in the gall bladder. Symptoms: pain in the right hypochondrium (bile colic), nausea, vomiting. Diagnostics: Ultrasound of the gallbladder.
  4. Cholecystitis: Inflammation of the gallbladder. Reasons: gallstone disease. Symptoms: pain in the right hypochondrium, fever, nausea, vomiting. Diagnosis: ultrasound of the gallbladder, blood tests (estimation of leukocytes).
  5. Pancreatitis: Inflammation of the pancreas.
    • Acute pancreatitis: Sudden inflammation of the pancreas. Reasons: gallstone disease, alcohol. Symptoms: severe abdominal pain (usually encircling), nausea, vomiting, fever. Diagnosis: blood tests (estimate of the level of amylase and lipase), CT abdominal cavity.
    • Chronic pancreatitis: Long -term inflammation of the pancreas. Reasons: alcoholism, cystic fibrosis. Symptoms: abdominal pain, malabsorption, diabetes. Diagnostics: CT abdominal cavity, endoscopic ultrasonography (EUS).
  6. Pancreatic cancer: The malignant neoplasm of the pancreas. Risk factors: smoking, diabetes, chronic pancreatitis, family history. Symptoms: abdominal pain, weight loss, jaundice, diabetes. Diagnostics: CT abdominal cavity, endoscopic ultrasonography (EUS).
  7. Non -alcoholic fatty liver disease (NAZBP): The accumulation of fat in the liver of people who do not abuse alcohol. Associated with obesity, diabetes, dyslipidemia. It can progress in non -alcoholic steatogepatitis (NAG), cirrhosis of the liver and liver cancer. Diagnostics: Ultrasound of the liver, liver biopsy.

III. Diagnostic methods in gastroenterology: tools for identifying pathologies

A. Endoscopic methods:

  1. Esophagogastroduodenoscopy (EGDS): Visual examination of the esophagus, stomach and duodenum with an endoscope (flexible tube with a camera). Allows you to identify inflammation, ulcers, tumors, polyps. A biopsy can be performed (taking a tissue sample for microscopic research).
  2. Colonoscopy: Visual examination of the large intestine using a colonoscope. Allows you to identify polyps, tumors, inflammation, ulcers. Polypectomy (removal of polyps) and biopsy can be performed. Screening for colorectal cancer.
  3. Rexoroscopy: Visual inspection of the rectum and sigmoid intestine with the help of a spectoroscope. Used to diagnose hemorrhoids, anal cracks, polyps, tumors.
  4. Endoscopic ultrasonography (EUS): Combination of endoscopy and ultrasound. Allows you to visualize the gastrointestinal wall and the surrounding organs (pancreas, bile ducts). Used to diagnose diseases of the pancreas, bile ducts, gastrointestinal cancer. A biopsy can be performed under ultrasound control.
  5. Capsule endoscopy: Swallowing a capsule with a camera that transfers images of the small intestine. It is used to diagnose bleeding from the small intestine, Crohn’s disease.

B. X -ray methods:

  1. X -ray of the stomach and duodenum with barium: A study using a contrast medium (barium), which allows you to visualize the contours of the stomach and duodenum. Used to diagnose peptic ulcer, tumors, hernia of the esophagus.
  2. Irrigoscopy: The radiography of the large intestine using barium. It is used to diagnose polyps, tumors, diverticulosis, inflammatory intestinal diseases.
  3. Computer tomography (CT) of the abdominal cavity: Obtaining post -layer images of the abdominal organs. It is used to diagnose diseases of the liver, gall bladder, pancreas, intestines, tumors, abscesses.
  4. Magnetic resonance imaging (MRI) of the abdominal cavity: Obtaining detailed images of the abdominal organs. It is used to diagnose diseases of the liver, gall bladder, pancreas, intestines, tumors, inflammatory intestinal diseases. MRI ENTEROGRAPHING for visualization of the small intestine.

C. Functional methods:

  1. PH metrics of the esophagus: Acidity measurement in the esophagus for 24 hours. Used to diagnose GERB.
  2. Manometry of the esophagus: Measurement of pressure in the esophagus. It is used to diagnose violations of the esophagus motor skills (Ahalasia of the Cardia).
  3. SCIINTIGHING of the stomach: Assessment of the speed of emptying the stomach. Used to diagnose gastroparesis.
  4. Hydrogen respiratory test: Assessment of the presence of excessive bacterial growth in the small intestine (SIBR) and lactase deficiency.

D. Laboratory methods:

  1. General blood test: Assessment of the level of hemoglobin, leukocytes, platelets. Can identify anemia, inflammation.
  2. Biochemical blood test: Assessment of the level of liver enzymes (ALT, AST, alkaline phosphatase, GGTP), bilirubin, albumin, glucose, lipids. Allows you to evaluate the function of the liver, pancreas, to identify metabolic disorders.
  3. Hidden blood analysis: Identification of hidden bleeding from the digestive tract. Used for screening for colorectal cancer.
  4. Analysis of feces for parasites and worm eggs: Identification of parasitic infections.
  5. Fecal analysis for fecal calprotectin: Assessment of inflammation in the intestines. Used to diagnose inflammatory diseases of the intestine (Crohn’s disease, ulcerative colitis).
  6. Tests on Helicobacter pylori: Respiratory test, fecal analysis, biopsy. Identification of infection Helicobacter pylori.
  7. Serological tests for celiac disease: Determination of antibodies to tissue transglutaminase, antibodies to endomy.

IV. Methods of treatment of gastrointestinal diseases: from medication to surgery

A. Drug therapy:

  1. Proton pump inhibitors (IPP): Block the production of hydrochloric acid in the stomach. Used to treat gerb, peptic ulcer, gastritis. Examples: omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole.
  2. H2 blockers: Histamine receptors that stimulate the production of hydrochloric acid are blocked. Used to treat GERB, peptic ulcer. Examples: Ranitidine, Famotidine, Nizatidine.
  3. Antacids: Neutralize hydrochloric acid in the stomach. Used to relieve symptoms of heartburn, dyspepsia. Examples: aluminum hydroxide, magnesium hydroxide, calcium carbonate.
  4. Prokinetics: Strengthen the motor skills of the gastrointestinal tract. Used for the treatment of gastroparesis, GERB. Examples: metoclopramide, domperidone.
  5. Antibiotics: Used for eradication Helicobacter pylori. They are usually used in combination with IPP and other antibiotics (clarithromycin, amoxicillin, metronidazole).
  6. Anti -inflammatory drugs:
    • Aminosalicylate (TEC 5): Used to treat inflammatory intestinal diseases (ulcerative colitis, Crohn’s disease). Examples: Mesalazine, sulfasalazine.
    • Corticosteroids: Used to treat inflammatory intestinal diseases. Examples: Prednisolone, Budesonide.
    • Immunosuppressors: Used to treat inflammatory intestinal diseases (Crohn’s disease, ulcerative colitis), autoimmune hepatitis. Examples: Azatioprine, Mercaptopurin, Metorsat.
    • Biological drugs: Used to treat inflammatory intestinal diseases (Crohn’s disease, ulcerative colitis). Examples: Infliximab, Adalimumab, Vedilizumab, Ustekinumab.
  7. Laxatives: Used to treat constipation.
    • Voluminous laxatives: Increase the volume of feces and stimulate peristalsis. Examples: psillium, methyl cellulose.
    • Osmotic laxatives: They attract water into the intestines and soften feces. Examples: lactulose, macrogol.
    • Stimulating laxatives: Stimulate intestinal motility. Examples: Bisacodil, Senna.
    • Softening laxatives: Lubricate feces and facilitate their passage through the intestines. Examples: Sodium Dokuzat.
  8. Enzyme drugs: They are used for enzyme failure (pancreatic insufficiency, lactase deficiency). Examples: pancreatin, lactase.
  9. Probiotics: Contain live microorganisms that can improve the composition of intestinal microbiots. Used to treat dysbiosis, irritable bowel syndrome.
  10. Antidiarious drugs: Used to treat diarrhea. Examples: lopeamid, sscitte dioctaedric.
  11. Preparations for the treatment of irritable bowel syndrome (SRK): Antispasmodics (drotaverin, furnitureurin), antidepressants (amitriptylin, cerrilin), agonists of guanilatziclase C (linaclotide, plenatide).
  12. Choleretic drugs: They are used for diseases of the gallbladder and biliary tract. Examples: ursodexicoic acid (UDC).

B. Surgical treatment:

  1. Cholecystectomy: Removing the gallbladder. Performed with gallstone disease, cholecystitis. It can be performed by laparoscopic or open.
  2. Appendectomy: Removing the appendix. Performed with appendicitis.
  3. Intestinal resection: Removing part of the intestine. It is performed with Crohn’s disease, ulcerative colitis, intestinal tumors, diverticulitis.
  4. Gastroctomy: Removing the stomach. It is performed with cancer of the stomach, peptic ulcer, complicated by bleeding or perforation.
  5. Coloctomy: Removing the colon. It is performed with ulcerative colitis, cancer of the large intestine, diverticulitis.
  6. Hemiccoctomy: Removing part of the colon.
  7. Esefaghactomy: Removing the esophagus. It is performed with cancer of the esophagus, Ahalasia of the Cardia.
  8. Operations for the hernia of the esophageal opening of the diaphragm: Fundipophytic (creating a cuff from the stomach around the esophagus).
  9. Hemorrhoid operations: Hemorrhoidctomy (removal of hemorrhoidal nodes), sclerotherapy, ligation of latex rings.
  10. Transplantation Baked: It is performed with cirrhosis of the liver, liver failure.

C. Endoscopic treatment methods:

  1. Polypectomy: Removing the polyps of the large intestine during colonoscopy.
  2. Endoscopic dilatation of the esophagus: Expansion of narrowed esophagus using a cylinder. It is performed with strictures of the esophagus, Ahalasia of the Cardia.
  3. Endoscopic stenting: Installation of stent (metal or plastic tube) in the narrowed area of ​​the esophagus, stomach, duodenum or large intestine.
  4. Argonoplasmen coagulation: Cauterization of bleeding vessels or removal of small tumors using argon plasma coagulator.
  5. Endoscopic retrograde cholangiopancreatography (ERCP): The method of treating diseases of the bile ducts and pancreas. Allows you to remove stones from the bile ducts, set the stent in bile ducts or pancreas.

D. Diet therapy:

  1. GERB: The exclusion of fatty, spicy, acidic food, coffee, alcohol, chocolate. Regular nutrition in small portions. Do not go to bed after eating.
  2. Peptic ulcer: The exception of acute, acidic, salty food, alcohol. Regular nutrition in small portions.
  3. Inflammatory intestinal diseases: Individual diet that eliminates products that cause exacerbation of symptoms. The exclusion of lactose, gluten, fodmap (enzymatic oligo, di-, monosaccharides and polyola) may be required.
  4. Irritable intestine syndrome: Low content of FODMAP. Exclusion of products that cause aggravation of symptoms.
  5. Celiacia: Strict exclusion of gluten from the diet.
  6. Lactase deficiency: Limiting the consumption of dairy products. Using products without lactose or low lactose.
  7. Constipation: Increase in fiber consumption (vegetables, fruits, whole grain products), liquids.
  8. Gallstone disease: Restriction of fatty food consumption.
  9. Pancreatitis: Limiting the consumption of fatty foods, alcohol.

V. Prevention of gastrointestinal diseases: care for the health of the digestive system

A. Healthy nutrition:

  1. Balanced diet: The inclusion in the diet of all necessary nutrients (proteins, fats, carbohydrates, vitamins, minerals).
  2. High fiber content: The use of vegetables, fruits, whole grain products. Fiber contributes to the normalization of the stool, maintaining the health of the intestinal microbiots.
  3. Limiting consumption of fatty, fried, spicy food: These products can cause heartburn, dyspepsia, exacerbation of inflammatory intestinal diseases.
  4. Limiting sugar consumption and processed products: These products can contribute to the development of dysbiosis, inflammatory intestinal diseases.
  5. Sufficient fluid consumption: Use of at least 1.5-2 liters of water per day. Water is necessary for the normal operation of the gastrointestinal tract, preventing constipation.
  6. Regular nutrition: Power supply in small portions 5-6 times a day. From

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