GASTROINTESTINAL TRACT DIAGNOSTIC EVALUATION DISORDERS

pt. 1 Maxine

Motility

Hirschprung Disease is a disorder of?

Peristalsis

movement of the food items from the mouth and down to the rectum/anus

Sympathetic and Parasympathetic

what are the involuntary movement?

Sympathetic response

this is the contractility of the intestine/stomach

Parasympathetic response

this is the relaxation of the intestine/stomach

Hirschprung Disease

also known as the congenital aganglionic megacolon

Congenital Aganglionic Megacolon

also known as the Hirschprung Disease

Congenital Aganglionic Megacolon/Hirschprung Disease

this is the Absence of ganglion cells

Ganglion Cells

what is Responsible for the parasympathetic regulation of the GI tract

Ganglion Cells

Without this there is no parasympathetic response

Short segment

This is when the rectum/sigmoid color area has no ganglion cells

Long segment

This is when the whole descending color has no ganglion cells

Loss of recto-sphincteric reflex

when we have no ganglion cells this will leads to

Unopposed sympathetic stimulation of the intestine

Loss of recto-sphincteric reflex leads to

Increased pressure on the intestine

Unopposed sympathetic stimulation of the intestine leads to

Clinical Man: Congenital Aganglionic Megacolon/Hirschprung Disease

Failure of the meconium to pass for the first 24-48 hours

Clinical Man: Congenital Aganglionic Megacolon/Hirschprung Disease

ribbon-like stool

ribbon-like stool

what is the Most prominent sign of Congenital Aganglionic Megacolon/Hirschprung Disease

Physical examination, Barium enema, Anorectal manometry, and Rectal biopsy

diagnostic eval of Congenital Aganglionic Megacolon/Hirschprung Disease

Barium enema

This is to know how far the obstruction is

Anorectal manometry

The catheter is connected to a machine that measures the pressure inside the intestine

Rectal biopsy

Insertion of the scope to get a tissue sample of the intestine to check if there is presence or absence of ganglion cells

Rectal biopsy

Needed for basis of the doctor to know until where it needs to be cut and on how the anastomosis will be performed

Ostomy

creating an opening on the abdomen for waste to be expelled

Soave endorectal pull-through

this is the Complete corrective surgery of Congenital Aganglionic Megacolon/Hirschprung Disease

Ostomy and Soave endorectal pull-through

what are the therapeutic management for Congenital Aganglionic Megacolon/Hirschprung Disease

Acute Appendicitis

this is an inflammatory disease

Appendix

an accessory organ on the ascending colon, in the right lower quadrant of the abdomen

Acute Appendicitis

this is caused by a trapped feces, parasitic, bacterial or viral infection in the GI tract

obstruction

what cause the mucus secreted by the appendix to be trapped

pressure

what is increased in the appendix that leads to appendicitis

appendicitis

increased pressure in the appendix that leads to

Clinical Man: Acute Appendicitis

Inflammation of the peritoneum

abdominal discomfort/pain in the periumbilical area

what is the 1st manifestation of the Acute Appendicitis

Blumberg’s sign

this is the Pain felt when pressure is released from the abdomen

Rousing’s sign

Pain in the RLQ upon palpation of the other quadrants in the abdomen

Psoas sign

Detection of irritation of the psoas muscle (major hip flexor) by passively extending the leg

supine

Psoas sign is done in what position?

Obturator’s sign

Passively rotating the hip internally while the patient’s knee is flexed at a 90-degree angle

Blumberg’s sign

High indication of appendicitis for the patient if they’re positive on this sign

Appendectomy

therapeutic Management for Acute Appendicitis