NURS201 PHYSIOPATHOLOGY

2023-2024 ACADEMIC YEAR, FALL TERM

ASST. PROF. DR. UFUK KAYA

GASTRIONTESTINAL SYSTEM AND
RELATED PROBLEMS
 INTRODUCTION-01

• The gastrointestinal system (GIS) is also known as the digestive

system.

• The basic structures of the digestive system are the mouth, pharynx,
esophagus, stomach, small intestine, large intestine, rectum, anal
canal and anus.

• These basic structures are supported by digestive organs such as

salivary glands, liver, pancreas, gallbladder and bile ducts.
 INTRODUCTION-02

• The main function of the gastrointestinal system is to break down

nutrients taken through nutrition.

• In addition to digesting the food taken with nutrition, it ensures the

absorption of nutrients during the digestive process and removes
unwanted substances from the body.

• The length of the digestive tract in the system is approximately 10

meters.
FUNCTIONS OF THE DIGESTIVE
SYSTEM
 FUNCTIONS OF THE DIGESTIVE SYSTEM-01

• The basic functions of the digestive system are chewing, swallowing,

digestion, absorption and excretion of food taken with nutrition.

• After the food taken into the mouth is broken into smaller pieces by
chewing and swallowing, it is moistened and transmitted from the
mouth to the esophagus (mechanic digestion).

• Food in the stomach is broken into small pieces and mixed with
gastric fluids.
 FUNCTIONS OF THE DIGESTIVE SYSTEM-01
• In the next stage, nutrients easily pass into the small intestines with
the help of fluids from the pancreas and liver, and digestion ends.

• With absorption, small food molecules pass from the small intestines
to the blood and lymph circulation.

• During the excretion phase, solid waste products passing into the
large intestine and undigested and unabsorbed substances pass
through the anus and are thrown out of the body.

• The function of the gastrointestinal system begins in the mouth and

ends in the anus.
DIGESTION TYPES
 DIGESTION TYPES-01

Chemical Digestion:

• It is the chemical breakdown of food.

• Thanks to enzymes, the downward passage of nutrients along the

length of the gastrointestinal tract is ensured.

• Enzymes help denature food and turn it into small nutritional

molecules.
 DIGESTION TYPES-02

Mechanical Digestion:

• It is the mechanical destruction of food.

• Food taken into the mouth is broken into smaller pieces by chewing
and swallowing, then moistened, mixed and transmitted from the
mouth to the esophagus.

• This activity begins with chewing in the oral cavity and continues
throughout the digestive tract.
 STRUCTURE OF THE
GASTROINTESTINAL SYSTEM
 ORAL CAVITY-01

• The mouth is the beginning of the gastrointestinal system.

• After food is taken into the mouth, mechanical digestion begins by

chewing and grinding the food. Chemical digestion also begins in
the mouth.

• Food mixes with salivary amylase in the saliva and the

carbohydrates in the food turn into small sugar molecules.
 ORAL CAVITY-02
• Food mixed with saliva becomes moist and moves from the oral
cavity to the esophagus.

• In the oral cavity, the gums, teeth, cheeks and palate assist in the
mechanical digestion process.
 LIPS
• The lips surround the mouth opening and take part in speech.

• The lips are fleshy folds that contain skeletal muscles and sensory
receptors.

• These structures help determine the temperature and quality of

food and send food into the oral cavity.
 CHEEKS
• Cheeks help chew food.
 PALATE
• Both the hard and soft palate aid in the mechanical digestion of
food.
 TONGUE

• The tongue is a thin muscular organ.

• It helps chew the food by holding it between the teeth and mixing
it thoroughly, while also moving it towards the throat for
swallowing.

• In addition to taste, the tongue has an important role in speaking,

chewing and swallowing.

• There are approximately 10,000 taste receptors on the side and tip
of the tongue.
 TEETH

• Teeth develop in two stages: primary teeth and permanent teeth.

• Primary teeth, which are approximately 20, begin to develop from

the 6th month. These teeth usually fall out between the ages of 6
and 12.

• There are usually 32 permanent teeth and they have the potential
to remain until the end of life.
 SALIVARY GLANDS-01

• Parotid, submandibular and sublingual salivary glands are located

bilaterally in the oral cavity.

• Salivary glands secrete approximately 1 L of saliva per day.

• The main function of saliva is to moisten food and prevent the

growth of bacteria in the oral cavity.
 SALIVARY GLANDS-02
• The oral cavity is permanently moist due to the constant secretion
of saliva. It also makes it easier to swallow saliva.

• The bactericidal activity of lysozyme in saliva prevents bacteria that

may be present in food from reaching the lower digestive tract.
 PHARYNX
• The pharynx consists of the nasopharynx, oropharynx and
laryngeal pharynx.

• The pharynx connects the upper part of the mouth with the lower
part of the esophagus and larynx.

• When food is swallowed, the soft vein closes the nasal passage and
the epiglottis moves over the glottis to close the larynx and trachea.

• It allows nutrients to move down the esophagus rather than into the
respiratory area.
 ESOPHAGUS
• It extends from the pharynx to the stomach. Food passes through
the esophagus and into the stomach.

• The main function of the esophagus is to drag food and liquids from
the mouth to the stomach by movements and fluctuations
(peristaltic movements).

• The sphincters located at both ends of the esophagus are normally

closed. During swallowing, the upper sphincter opens and the
swallowed food enters the esophagus. The lower sphincter, located
at the entrance to the stomach, opens only when the consumed
food passes through the esophagus.
 STOMACH-01

• The stomach is a J-shaped organ located on the left side of the

upper abdomen, under the diaphragm, between the esophagus and
duodenum.

• The entrance from the esophagus to the stomach is called the

cardia, the upward part is called the fundus, the part below the
cardia is called the corpus, the extreme part is the antrum, and the
passage between the stomach and duodenum is called the pyloric
canal.
 STOMACH-02
• The cells of the gastric mucosa secrete various enzymes and substances necessary
for digestion, known as gastric juice.

The substances contained in gastric fluid and their functions are as follows:
• Mucus: Makes food slippery.
• Hydrochloric acid: It breaks down bacteria taken into the stomach with food, and
the acid is also essential for the digestion of surrounding proteins.
• Intrinsic factor: Helps the absorption of vitamin B12 in the last part of the small
intestines.
• Pepsinogen: Necessary for the chemical digestion of proteins.

• The production of gastric juice depends on the secretion of the gastrin hormone.

• Gastrin is secreted when food enters the stomach, and its secretion stops when the
stomach pH drops below 1.5.
 STOMACH-03
• The basic function of the stomach is to break down food chemically and
mechanically.
• It is the temporary storage area for food until it passes into the duodenum.
• It enables the food to turn into a semisolid substance called chyme,
liquefied, broken down and mixed with hydrochloric acid.
• It initiates the chemical digestion of proteins. Proteins are converted into
smaller polypeptides by pepsin.
• The milk thickens and casein is secreted from the milk.
• Digestion of fats begins in the stomach.
• The production of intrinsic factor is essential for the absorption of vitamin
B12.
 SMALL INTESTINES-01

• The length of the small intestines, which connects the stomach to

the large intestine, is approximately 6 m and is the longest structure
among the parts of the digestive system.

• The upper part of the small intestine consists of the duodenum, the
middle part consists of the jejunum, and the lower part consists of
the ileum.

• Duodenum is approximately 20-30 cm long, jejunum is 240 cm long,

and ileum is 270 cm long.
 SMALL INTESTINES-02

• The main function of the small intestines is to chemically break

down food and ensure the absorption of digested food.

• Protrusions called villi, which expand the surface of the small

intestine, enable the absorption of nutrients.

• While nutrients and vitamins such as iron and folic acid are
absorbed from the upper small intestine, bile salts and vitamin B12
are absorbed from the ileum.
 SMALL INTESTINES-03
• Duodenum: Further digestion of food coming from the stomach
takes place in this section. Pancreatic juice and bile are released into
the duodenum from the pancreas and gallbladder, respectively.

• Jejunum: Its main function is to further digest the nutrients coming

from the duodenum.

• Ileum: Mainly absorption occurs in the ileum. Small structures

called villi are responsible for absorption. Peyer's patches located in
the ileum are an important defense mechanism against bacteria
entering the body.
 LARGE INTESTINES-01
• Its length is approximately 1.5-2 m.

• The appendix is located in the section where the small intestines

open into the large intestines.

• Structures called cecum, ascending colon, transfer colon,

descending colon, sigmoid colon, rectum and anus constitute the
sections of the large intestine.

• Internal and external sphincters located in the anus control the anal
outlet.
 LARGE INTESTINES-02

• The large intestine has no villi and only mucus is secreted.

• Mucus containing abundant bicarbonate is secreted from the

epithelial cells in the large intestine mucosa.

• This mucus, on the one hand, protects the large intestine from the
activation of bacteria, and on the other hand, provides the
adhesiveness that holds the fecal matter together.
 LARGE INTESTINES-03

• Its basic functions include the absorption of fluids and

electrolytes and the excretion of undigested and unabsorbed
nutrients and bile pigments from the body as feces.
• Ensuring the absorption of water, electrolytes and vitamins
• Secreting mucus to lubricate feces
• Storing hard-to-digest nutrients such as cellulose and
vegetable fibers
• Producing vitamin K and some B complexes
• Defecation
ORGANS AUXILIARY TO DIGESTION
 LIVER-01
• The liver, the largest organ of the body, weighs 1.5 kg and consists
of 4 lobes.

• Portal venous blood constitutes 70% of the blood circulation of the

liver.
 LIVER-02
• Ensuring carbohydrate, fat and protein metabolism
• Replacing waste products and toxic substances
• Producing and storing glycogen
• Maintaining blood glucose level
• Converting horse product ammonia into urea
• Creating red blood cells in fetal life
• Storing minerals such as iron and copper
• Storing fat-soluble vitamins A, D, E, K and water-soluble vitamin B12
• Produce heat
• Producing bile, which provides an emulsion for the absorption of dietary fats
• Ensure immunity
 GALL BLADDER-01
• It is located under the right lobe of the liver and is approximately 7-
9 cm in length.

• It controls the flow of bile fluid produced in the liver from the liver
to the duodenum.

• Bile is secreted from the gallbladder with the presence of the

hormone called cholecystokinin.

• This hormone is carried to the gallbladder by blood flow, and with

the stimulation of smooth muscles, the gallbladder contracts and
bile is emptied.
 GALL BLADDER-02
• Storage, acidification • Release of
and concentration of cholecystokinin upon
bile stimulation
• Balancing the • Absorption of organic
hydrostatic pressure of components of bile
the bile ducts
 PANCREAS-01
The pancreas has endocrine and exocrine functions.

• Exocrine Function: Exocrine pancreas is responsible for the

production of enzymes necessary for the digestion of consumed
foods. The pancreas produces pancreatic juice, which is secreted
directly from the pancreas into the duodenum via the pancreatic
duct.

• Endocrine Function: The pancreas produces hormones that are

released directly into the bloodstream. These include insulin,
glucagon and somatostatin.
 PANCREAS-02
• Glucagon increases blood glucose levels.

• Insulin lowers blood glucose levels.

• Somatostatin regulates both glucagon and insulin levels.

DIGESTIVE SYSTEM DISORDERS
 GINGIVITIS-01
• Most cases of gingivitis are associated with poor oral hygiene.

• After bacteria infect the gums, they cause inflammation with their
toxins.

• Plaque accumulation can also lead to gingivitis.

• Plaque forms on the teeth due to the effect of bacteria, food

particles, mucus and colloid materials found in saliva, which adhere
to the teeth.
 GINGIVITIS-02

• Some medications such as fentoin, birth control pills, and heavy

metals such as bismuth cause inflammation in the gums.

• Brushing teeth hard and using dental floss are also among the
causes of gingivitis.

• Some people with diabetes mellitus and some pregnant women

may develop gingivitis due to hormonal changes.
 LIVER CIRRHOSIS-01
• It is a potentially life-threatening chronic disease of the liver.

• The main causes are: chronic liver diseases due to hepatitis B and C
and alcohol use.
 LIVER CIRRHOSIS-02
Physiopathology:

• The normal parenchymal structure turns into a nodular structure

surrounded by fibrous septa.

• The lesions are not symmetrical and homogeneous.

• In the early period, the liver enlarges and may increase in weight
due to fatty deposits, inflammatory exudate and edema.

• In the late period, the acute inflammatory reaction disappears,

fibrous tissue increases, the liver shrinks and loses weight and size.
 PEPTIC ULCER-01

• It describes an ulcer that develops in the lower parts of the

esophagus, stomach and duodenum.

• Peptic ulcer disease is characterized by the formation of ulcers in

the esophagus, stomach or duodenum areas of the gastrointestinal
tract mucosa exposed to gastric acid and pepsin.

• Duodenal ulcer is more common than gastric ulcer.

 PEPTIC ULCER-02
• Gastric ulcer develops as a result of exposure of the gastrointestinal
epithelium to the acidic gastric secretion of the stomach.

• Peptic ulcer usually responds well to drug therapy, but if left

untreated, it leads to serious complications such as gastrointestinal
wall perforation, bleeding, and stomach cancer.

• Causes include infection caused by Helicobacter pylori, excessive

alcohol and cigarette consumption, stress, excessive use of non-
steroidal anti-inflammatory drugs and aspirin-derived drugs,
excessive caffeine consumption and a family history of peptic ulcers.
 PEPTIC ULCER-03
Physiopathology:

• Too little mucus is produced while overproduction of gastric acid

causes continued erosion and ulceration of the gastrointestinal
tract.
• Fistula occurs as a result of mucosal erosion.
• The fistula allows acidic gastric contents to escape into the
peritoneum, leading to peritonitis.
• Stress, caffeine intake, smoking and alcohol consumption increase
acid production.
• Non-steroidal anti-inflammatory drugs and drugs such as aspirin
inhibit prostaglandins that protect the mucosal line.
 ULCERATIVE COLITIS-01

• It is a group of chronic inflammatory bowel diseases that includes

irritable bowel disease and Crohn's disease.

• Ulcerative colitis is chronic inflammation of the mucous membrane

of the colon and rectum.

• Possible causes include poor nutrition, stress, intestinal infections,

genetic factors and autoimmune dysfunction.
 ULCERATIVE COLITIS-02

Physiopathology-01:

• The inflammatory process occurs in the mucosa and submucosa of

the rectum and spreads throughout the colon.

• Inflammation and mucosal injury initiate the disease process by

causing swelling, edema and bleeding, and ulceration develops.

• Mucosal damage causes the patient to go to the toilet 10 times a

day with the urge to defecate.
 ULCERATIVE COLITIS-03

Physiopathology-02:

• Ulceration spreads throughout the submucosa, causing necrosis

and crusting of the mucous membrane.

• In the later stages of the disease, the colon wall thickens and
becomes fibrous. This thickening causes obstruction in the
intestines.

• Loss of normal bowel function can result in complications such as

dehydration and electrolyte imbalance.
 PERITONITIS-01

• It is the inflammation of the peritoneum that surrounds the organs

in the abdomen.

• It may be caused by bacteria or may develop due to contamination

of acidic content as a result of perforation or rupture of any organ in
the abdomen, such as the appendix and bladder.

• It may also occur due to intestinal leakage in the postoperative

period.
 PERITONITIS-02

• Physiopathology:

• Initially, an inflammatory response develops.

• As fluid accumulates in the peritoneal cavity, the surrounding tissues
become edematous.
• Dehydration develops in patients as a result of fluid and electrolyte
loss in the circulation flowing into the peritoneal cavity.
• Patients experience severe pain due to inflammation and infection
of the peritoneum.
• As inflammation worsens, septicemia may develop and result in
multiple organ failure.
 GASTROESOPHAGEAL REFLUX DISEASE-01
• It is the most common chronic
digestive disease of the
esophagus.

• It is a pathology in which
stomach acid and mostly bile
leak back into the esophagus.

• It is especially common in
pregnant women and after the
age of 40.
 GASTROESOPHAGEAL REFLUX DISEASE-02
Physiopathology-01:

• The cardia is the part of the stomach that connects to the esophagus.

• In patients diagnosed with gastroesophageal reflux, physio pathological

effects and symptoms occur due to cardia failure.

• Additionally, almost half of the patients have H. pylori infection.

• Gastroesophageal reflux is a disease characterized by regurgitation of

duodenal bile, enzymes and stomach acid into the esophagus and
exposure of the esophageal mucosa to gastric acid and pepsin.
 GASTROESOPHAGEAL REFLUX DISEASE-03
Physiopathology-02:

• The main cause of this disease is thought to be insufficiency in the lower

esophageal sphincter.

• Normally, the lower esophageal sphincter is contracted and prevents the

reflux of gastric contents.

• Reflux occurs due to some foods (such as oils, chocolate), liquids (such as
alcohol, caffeinated drinks), medications (such as beta adrenergic,
calcium channel blockers, nitrates), gastric distension, smoking and
recumbent position.
 ACHALASIA-01
• The reason for its emergence is unknown.

• This disease, which is not very common, usually occurs between the ages
of 20 and 40.
 ACHALASIA-02

Physiopathology:

• It is an esophageal motility disorder characterized by esophageal

denervation (loss of nerve impulse transmission).

• Normal peristaltic movements of the esophagus are replaced by

abnormal contractions due to the insufficiency of the lower esophageal
sphincter, which is necessary for comfortable swallowing.
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