G.I. Clinical Correlation

History and Clinical

Approach to Upper

Gastrointestinal Disease

Edward Magid MD FACG

Associate Professor Of Medicine

Department of Medicine

The Chicago Medical school

Rosalind Franklin University of

Medicine and Science

Clinical Correlation Of

Gastric Physiology with

Pathophysiology

Our Motto: “Don’t Mess with

Mother Nature…..If You Can Help

It”

“Go With The Flow” Know The

Normal To Understand The

Abnormal

Dr. William Beaumont

The Early Years

Wm Beaumont was the 2 nd of 9

siblings

Born in Connecticut Nov 21, 1785

1807 became Schoolmaster in

Champlain and

Secretary of local debating

society

Became interested in the healing

arts

1809 began reading under Dr

Benjamin Moore

1811 began apprenticeship in St

Albans Vermont

Pathway To Modern Medicine

Contributors and Contributions

• 1600 Robert Hook: Developed the Microscope

• 1673 Antonie Leeuwenhoek: Father of Microbiology

• 1822 William Beaumont: Began GI Studies

• 1842 Crawford Long: Gas Anesthesia, Ether

• 1847 Ignaz Semmelweis: Puerperal Fever

• 1851 Claude Bernard: Physiological Homeostasis

• 1862 Louis Pasteur: Germ Theory, Vaccination

• 1867 Joseph Lister: Antiseptic Surgery, Carbolic Acid

• 1880 Ferdinand Cohn: Life Cycle Bacillus, Spores

• 1881 Theodore Billroth: First Successful Gastrectomy

• 1882 Robert Koch: Found cause TB, 4 Postulates

• 1895 Wilhelm Roentgen: Discovered X-ray

• 1966 Many: The Ultrasound, Human Application

• 1967 Godfrey Hornsfield: Invented CT Scanner

• 1972 Allen McLoed: CT Human Diagnostic Application

• 1973 Paul Lauterbur: Invented the MRI

PARIETAL SIMULATION

VAGUS NERVE (ACETYLCHOLINE)

GASTRIN

SECRETIN (MINIMALLY)

CHOLECYSTOKININ (PANCREOZYMIN)

GIP (GASTRIC INHIBITORY PEPTIDE)

SECRETAGOGUES

MEAT (BEEF, POULTRY, FISH)

CAFFIENE

SUGARS

CHOCOLATE

ALCOHOL

NICOTINE

Bariatric Surgery

Roux-n-Y Gastric Bypass

Bariatric Surgery

Vertical-Banded Gastroplasty

DUMPING SYNDROME

EARLY POSTPRANDIAL

LATE POSTPRANDIAL

BLIND LOOP SYNDROME

DIARRHEA

DUMPING SYNDROME

LOSS OF PYLORUS

LOSS OF STORAGE FUNCTION OF THE

STOMACH

HYPERTONIC CHYME OF STOMACH

CHANGED TO ISOTONIC SOLUTION IN

LOSS OF OSMOTIC REGULATION OF

CHYME ENTERING DUODENUM AND

THROUGH DUODENUM AND JEJUNUM:

COMMON DUCT SECRETIONS ARE NOT

IN SYNCHRONY WITH PASSING

STOMACH CONTENT

DUODENUM RESULTING FROM

PYLORIC CONTROL OF TRANSIT TIME.

JEJUNUM:

LOSS OF CONTROL OF TRANSIT TIME

DUMPING SYNDROME

EARLY POSTPRANDIAL

INTESTINAL CONTENTS BASICALLY

ISOTONIC. GASTRIC HYPERTONIC

MOVEMENT OF HYPERTONIC CHYME INTO

INTESTINE CAUSES FLUID SHIFT WITH

DISTENSION

TACHYCARDIA, FLUSHING, HYPOTENSION,

SYNCOPE, WEAKNESS LASTING UP TO AN

HOUR. ONSET OF SYMPTOMS 30 TO 45

MINUTES.

NUTRITIONAL DEFICIENCIES,

OSTEOPOROSIS, ELECTROLYTE

IMBALANCE, ARRHYTHMIAS, ANEMIA,

WEIGHT LOSS, WEAKNESS

RX: EAT SLOWLY, SEMI-SUPINE, NO LIQUIDS

WITH MEALS, SMALL MEALS,

ANTICHOLINERGICS.

DUMPING SYNDROME

LATE POSTPRANDIAL

LAG TIME OF HYPERGLYCEMIA WITH

INSULIN OUTPUT RESULTING IN

HYPOGLYCEMIA.

Sx: OCCURS 2 TO 3 HRS AFTER A

MEAL.

BLOOD GLUCOSE CAN FALL AS LOW

AS 20MG TO 30MG%.

TACHYCARDIA, PALENESS

DIAPHORESIS, HEADACHE, SEVERE

WEAKNESS, SYNCOPE.

RX: EAT SLOWLY, SEMISUPINE,

SEVERAL DRY SMALL MEALS A DAY.

PEPTIC ULCER THERAPY (OLD)

DUODENAL ULCER: NO ACID NO

ULCER

GASTRIC ULCER: LITTLE OR NO

ACID THERAPY

DIET: REMOVE SECRETAGOGUES

SEDATION

NEUTRALIZE ACID: ALKALIES;

CALCIUM CARBONATES, ALUMINUM

ANTICHOLINERGICS:

SURGERY: REMOVE GASTRIN

(ANTRECTOMY), Ach (VAGOTOMY)

ACID, R/O MALIGNANCY

LAKES

PEPTIC ULCER ETIOLOGY

HYPERCHLORHYDRIA (DUODENUM)

HELICOBACTER PYLORI

NSAID

STRESS ULCERS

STEROID MEDICATION

UNKNOWN FACTORS EFFECTING

THE PROTECTIVE MECHANISMS OF

THE STOMACH AND DUODENUM

PRESENT MEDICAL PEPTIC ULCER

DISEASE THERAPY

ANTACIDS

H2 BLOCKERS

PROTON PUMP INHIBITORS

ABOVE COMBINATIONS WITH

ANTIBIOTIC THERAPY (H-

PYLORI)