PEMICU 1

GASTROINTENSTIN
AL

Anatomy of
Upper GI Tract

Anatomy of Upper GI
Tract

Cavitas Oris

Biochemistry of Upper GI Tract

Human Physiology - From Cells to Systems 7th ed - L. Sherwood (Cengage, 2010) BBS

Swallowing Physiology

Human Physiology - From Cells to Systems 7th ed - L. Sherwood (Cengage, 2010) BBS

Human Physiology - From Cells to Systems 7th ed - L. Sherwood (Cengage, 2010) BBS

Human Physiology - From Cells to Systems 7th ed - L. Sherwood (Cengage, 2010) BBS

Disfagia

Disfagia means difficulty of Swallowing.

Etiology:
Prematurity
Airway & Upper GI Tract anomaly
Congenital larynx, Trachea and esophagus

defect
Anatomy Defect
Neurology Defect

Diagnose

Aloananesis
Physical Examination
Videofluoroskopi
Radiology

Therapy

Feeding Tube
Structure Anatomy function Therapy
Nonnutritive Sucking Stimulation
Surgery
Pharmacology

GERD

Risk Factor

Long LES
Anti Colinergik consumption
Hormone
Hiatus hernia

Sign & Simptom

Heartburn sensation
Disfagia
Regugitation
NCCP
Astma
Laryngitis

Diagnose

Endoscopic
Esophagographic with barium
pH Monitoring
Berstein test
Manometry
Sintigraphy
Proton pump inhibitor Acid
supression test

Treatment
No Smoking and
alcoholic
Reduce lipid
Antasid
consumption
Reduce body mass
Antagonis H2 Receptor
Do not wear tight shirt
Prokinetik
Avoid acid secretion food Sukralfat
Avoid weaken LES drugs PPI
Non Pharmacology
Pharmacology

Antasid

Safe and Effective for sign of GERD But

not for lession
Buffer & Develop LES Pressure
Effect:
Uncomfortable
Diarhea/ Constipation
Toxic for kidney

Dosage: 4 tabblespoon / day

Antagonis H2 Receptor

Supress Acid supression

Dosage:
Simetidine: 2x 800mg / 4 x 400mg
Ranitidine: 4 x 150mg
Famotidine 2x50mg
Nizatidin: 2x 150 mg

Prokinetic

Metoclopramide
Antagonis dopamine receptor
Effect: Drowzinnes, confusion, tremor
Dosage 3x10mg

Domperidone
Effect below metoclopramide
Dosage: 3x10-20mg/day

Cisapride
Antagonis receptor 5 HT4
Dosage: 3x10 mg

PPI

Drug of choice of GERD

Work by affect H, K, ATP-ase
Dosage:
Omeprazole: 2x20mg
Lansoprazole: 2x30 mg
Pantoprazole: 2x40mg
Rabeprazole: 2x 10 MG
Esomeprazole: 2x 40 mg

Complication

Striktur Esophagus
Esophagus Barret

Achalasia

Incomplete relaxation of the lower esophageal sphincter

in response to swallowing functional obstruction of the
esophagus dilation of the more proximal esophagus

Three major abnormalities:

Aperistalsis
Partial or incomplete relaxation of the lower esophageal

sphincter with swallowing

Increased resting tone of the lower esophageal sphincter

Pathognomonic
Inflammation in the myenteric plexus

Achalasia

Achalasia
Progressive dysphagia
Inability to completely

Dysphagia (most
common)
Regurgitation
Chest pain
Heartburn
Weight loss
Signs & Symptoms

convey food to the stomach.

Nocturnal regurgitation
aspiration of undigested
food
Developing esophageal

squamous cell carcinoma

Clinical Characteristic

Epidemiology (Frequency)

United States
The incidence of achalasia is approximately 1

per 100,000 people per year.

International
Chagas disease may cause a similar disorder.

Sex
The male-to-female ratio of achalasia is 1:1.

Age
Achalasia typically occurs in adults aged 25-60

years. Fewer than 5% of cases occur in children.

Medical Care
Goal: relieves symptoms by eliminating the outflow resistance
caused by the hypertensive and nonrelaxing LES

Mouth Ulcer
Primary Acute Herpetic Gingivostomatitis (HSV-1, 2)

Mouth Ulcer
Herpes Zoster (Reactivation of VZV)

Mouth Ulcer
Aphthous Ulcers