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Choose life, so that you and
   your children may live
                      Deuteronomy 30:19
Sherrie-Ann L. Vergara, MD
UP College of Medicine Class 2005
Course Requirement:
Basic understanding of your Basic Sciences
Topics:
• GI Tract Pathology
• Endocrine Glands Pathology
• Others : Low birth weight infants, Vitamins
Basis of Grades:
• Attendance/ Recitation
• Reports
• Quizzes
• Exams, etc.
TYPES OF METABOLISM

1. Anabolic
   - simple to complex

2. Catabolic
   - complex to simple
FUNCTIONS OF LIFE

3.   DIGESTION
4.   RESPIRATION
5.   GROWTH
6.   RESPONSIVENESS
7.   REPRODUCTION
8.   EXCRETION
9.   MOVEMENT
WHAT IS METABOLISM?

It pertains to all the chemical reactions
  that occur in a living system
  necessary for the performance of
  various functions of life.
   Each function involves several chemical
    reactions

   Each chemical reaction involves several
    steps

   Each of the different function is
    interrelated

   Each chemical reactions are interrelated
OVERVIEW OF DIGESTIVE DISORDERS

 1. CLASSIFICATIONS

 2. UPPER GIT

 3. LOWER GIT

 4. ACCESORY ORGANS
CLASSIFICATION DIGESTIVE
            DISORDERS

1. FUNCTIONAL
      a. Obstruction
      b. Absorption
      c. Hyperactivity

2. ANATOMICAL
      a. Upper GIT
      b. Lower GIT
METABOLIC IMPLICATION OF GIT
          DISORDERS:
MEANS OF MAINTAINING
            FUNCTION

ALTERNATIVE FEEDING PATTERNS
  a. IV Infusion
  b. Enteral Hyperalimentation
  c. Total Parenteral Nutrition
  d. Elemental Diets
  e. Fat Emulsion Feeding
UPPER GIT
 • dysphagia
 • Vomiting or Regurgitation
 • Flatulence
 • Pain
 • Hematemesis
 • Melena
LOWER GIT
 • Pain
 • Vomiting or Regurgitation
 • Flatulence
 • Abdominal Distention
 • Hematochezia
 • Diarrhea
 •Constipation
BW < 2500 grams
   Prematurity

   Small for Gestational Age (SGA)
•Genetic or Chromosomal
Abnormalities
• Acquired Congenital Diseases
• Placental Insufficiency
• Cord Coil
•Multiple gestation
• Maternal Illness
• Reproductive organ anomally
• Nutritional Status
• Smoking
• Alcoholism
PROBLEMS WITH LBW BABIES
  • Greater risk for respiratory problems


  • Higher risk for Intraventricular Hemorrhage


  • Associated cardiac problems with premature babies


  • Impaired thermoregulation


  • Slower growth
PREVENTION
 • Regular prenatal check up


 • Multivitamins


 • Avoidance of smoking and alcohol
PREVENTION


 • Adequate nutrition


 • Judicious use of medications
   Among the most common congenital anomalies

   Severity varies

   May present as a cleft lip, cleft palate or both

   Cause is Multifactorial
    - Genetic
    - Environmental
• Defective growth the medial
Failure of fusion of of palatal
shelves
nasal and maxillary process
during the 5th week of embyonic
• Failure of the shelves to attain
developmentposition
a horizontal

• Lack of contact between
shelves

• Rupture after fusion of
shelves
MAJOR MEDICAL CONCERN

  • Risk of aspiration because of communication
  between oral and nasal cavities

  • Airway obstruction

  • Difficulties with feeding of a child with a cleft and
  nasal regurgitation
Breastfeeding an infant with a cleft
  • Massaging the breast and applying hot packs on the breast 20
  minutes before nursing usually helps.

  • The mother should apply pressure to the areola with her fingers to
  help the engorged nipple protrude..

  • If the infant cannot hold onto the nipple any more, the mother can
  collect the remaining milk and can finish the feeding with collected
  milk in a bottle.

  • The mother should increase her fluid intake (drink lots of water).
Feeding milk with a bottle

  • A variety of nipples and bottles are made specifically for infants
  with clefts.

  • A soft nipple is generally better than a hard nipple

  • Use a crosscut nipple to prevent choking. The crosscut is on the
  tongue side.

  • The bottle should be squeezed and released, not continually
  squeezed.

  • The nipple is angled to a side of the mouth, away from the cleft.
Other recommendations
  • More upright or seated positions prevent the milk from
  leaking to the nose and causing the infant to choke.

  •Advise the mother to stop feeding and allow the infant to
  cough or sneeze for a few seconds when nasal regurgitation
  occurs.

  • Gaining weight and preventing aspiration and ear infections
  are the most important parts of caring for neonates with a
  cleft during their first days and weeks of life.
RECOMMENDED PROTOCOL

 • Diagnostic examination, general counseling of parents,
 feeding instructions

 • Age 3 months - Repair of CL and placement of ventilation
 tubes

 • Age 6 months - Presurgical orthodontics, if necessary; first
 speech evaluation

 • Age 9 months - Speech therapy begins
RECOMMENDED PROTOCOL
 • Age 9-12 months - Repair of CP (placement of ventilation
 tubes if not done at the time of CL repair)

 • Age 1-7 years - Orthodontic treatment

 • Age 7-8 years - Alveolar bone graft

 • Older than 8 years - Orthodontic treatment continues
   The most common cause of intestinal
    obstruction in infancy

   Also known as infantile hypertrophic
    pyloric stenosis (IHPS)

   Etiology is unknown and probably
    Multifactorial
GIT
             ENVIRONMENTAL        DEVELOPMENT             GENETICS


                                  HYPERTROPHY
                                 And HYPERPLASIA




                                  NARROWING OF THE
                                   GASTRIC ANTRUM




NONBILIOUS   DECREASED     EPIGASTRIC
                                           VISIBLE
 VOMITING    URINE AND     DISTENTION                                IMPAIRED
                                           GASTRIC     DEHYDRATION
(METABOLIC      STOLL    (OLIVE-SHAPED                               NUTRITION
                                         PERISTALSIS
ALKALOSIS)     OUTPUT         MASS)
OTHER COMMON FINDINGS:

   Hypochloremic, hypokalemic metabolic alkalosis

   Hypernatremia or hyponatremia

   Dilated stomach bubble ON X-ray

   String sign and shoulder sign on UGI
DIAGNOSTICS

   Plain x-rays

   Ultrasonography




                      Normal UGIS   Gastric Outlet Obstruction
DIAGNOSTICS


   Upper gastrointestinal imaging (UGI)


   Electrolytes, pH, BUN, and creatinine
MANAGEMENT:

   Immediate treatment requires correction of fluid
    loss, electrolytes, and acid-base imbalance

   Surgery is the curative treatment
MANAGEMENT:

   Endoscopic balloon dilatation has been used in
    certain selected patients with short-term
    symptomatic relief
Alteration In Metabolism
Alteration In Metabolism

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Alteration In Metabolism

  • 1. Choose life, so that you and your children may live Deuteronomy 30:19
  • 2. Sherrie-Ann L. Vergara, MD UP College of Medicine Class 2005
  • 3. Course Requirement: Basic understanding of your Basic Sciences Topics: • GI Tract Pathology • Endocrine Glands Pathology • Others : Low birth weight infants, Vitamins Basis of Grades: • Attendance/ Recitation • Reports • Quizzes • Exams, etc.
  • 4. TYPES OF METABOLISM 1. Anabolic - simple to complex 2. Catabolic - complex to simple
  • 5. FUNCTIONS OF LIFE 3. DIGESTION 4. RESPIRATION 5. GROWTH 6. RESPONSIVENESS 7. REPRODUCTION 8. EXCRETION 9. MOVEMENT
  • 6. WHAT IS METABOLISM? It pertains to all the chemical reactions that occur in a living system necessary for the performance of various functions of life.
  • 7. Each function involves several chemical reactions  Each chemical reaction involves several steps  Each of the different function is interrelated  Each chemical reactions are interrelated
  • 8.
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  • 12. OVERVIEW OF DIGESTIVE DISORDERS 1. CLASSIFICATIONS 2. UPPER GIT 3. LOWER GIT 4. ACCESORY ORGANS
  • 13. CLASSIFICATION DIGESTIVE DISORDERS 1. FUNCTIONAL a. Obstruction b. Absorption c. Hyperactivity 2. ANATOMICAL a. Upper GIT b. Lower GIT
  • 14. METABOLIC IMPLICATION OF GIT DISORDERS:
  • 15. MEANS OF MAINTAINING FUNCTION ALTERNATIVE FEEDING PATTERNS a. IV Infusion b. Enteral Hyperalimentation c. Total Parenteral Nutrition d. Elemental Diets e. Fat Emulsion Feeding
  • 16. UPPER GIT • dysphagia • Vomiting or Regurgitation • Flatulence • Pain • Hematemesis • Melena
  • 17. LOWER GIT • Pain • Vomiting or Regurgitation • Flatulence • Abdominal Distention • Hematochezia • Diarrhea •Constipation
  • 18. BW < 2500 grams
  • 19. Prematurity  Small for Gestational Age (SGA)
  • 20.
  • 21. •Genetic or Chromosomal Abnormalities • Acquired Congenital Diseases
  • 22. • Placental Insufficiency • Cord Coil •Multiple gestation
  • 23. • Maternal Illness • Reproductive organ anomally • Nutritional Status • Smoking • Alcoholism
  • 24. PROBLEMS WITH LBW BABIES • Greater risk for respiratory problems • Higher risk for Intraventricular Hemorrhage • Associated cardiac problems with premature babies • Impaired thermoregulation • Slower growth
  • 25. PREVENTION • Regular prenatal check up • Multivitamins • Avoidance of smoking and alcohol
  • 26. PREVENTION • Adequate nutrition • Judicious use of medications
  • 27.
  • 28.
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  • 30.
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  • 32.
  • 33. Among the most common congenital anomalies  Severity varies  May present as a cleft lip, cleft palate or both  Cause is Multifactorial - Genetic - Environmental
  • 34.
  • 35.
  • 36.
  • 37. • Defective growth the medial Failure of fusion of of palatal shelves nasal and maxillary process during the 5th week of embyonic • Failure of the shelves to attain developmentposition a horizontal • Lack of contact between shelves • Rupture after fusion of shelves
  • 38. MAJOR MEDICAL CONCERN • Risk of aspiration because of communication between oral and nasal cavities • Airway obstruction • Difficulties with feeding of a child with a cleft and nasal regurgitation
  • 39. Breastfeeding an infant with a cleft • Massaging the breast and applying hot packs on the breast 20 minutes before nursing usually helps. • The mother should apply pressure to the areola with her fingers to help the engorged nipple protrude.. • If the infant cannot hold onto the nipple any more, the mother can collect the remaining milk and can finish the feeding with collected milk in a bottle. • The mother should increase her fluid intake (drink lots of water).
  • 40. Feeding milk with a bottle • A variety of nipples and bottles are made specifically for infants with clefts. • A soft nipple is generally better than a hard nipple • Use a crosscut nipple to prevent choking. The crosscut is on the tongue side. • The bottle should be squeezed and released, not continually squeezed. • The nipple is angled to a side of the mouth, away from the cleft.
  • 41. Other recommendations • More upright or seated positions prevent the milk from leaking to the nose and causing the infant to choke. •Advise the mother to stop feeding and allow the infant to cough or sneeze for a few seconds when nasal regurgitation occurs. • Gaining weight and preventing aspiration and ear infections are the most important parts of caring for neonates with a cleft during their first days and weeks of life.
  • 42. RECOMMENDED PROTOCOL • Diagnostic examination, general counseling of parents, feeding instructions • Age 3 months - Repair of CL and placement of ventilation tubes • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation • Age 9 months - Speech therapy begins
  • 43. RECOMMENDED PROTOCOL • Age 9-12 months - Repair of CP (placement of ventilation tubes if not done at the time of CL repair) • Age 1-7 years - Orthodontic treatment • Age 7-8 years - Alveolar bone graft • Older than 8 years - Orthodontic treatment continues
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  • 45.
  • 46. The most common cause of intestinal obstruction in infancy  Also known as infantile hypertrophic pyloric stenosis (IHPS)  Etiology is unknown and probably Multifactorial
  • 47. GIT ENVIRONMENTAL DEVELOPMENT GENETICS HYPERTROPHY And HYPERPLASIA NARROWING OF THE GASTRIC ANTRUM NONBILIOUS DECREASED EPIGASTRIC VISIBLE VOMITING URINE AND DISTENTION IMPAIRED GASTRIC DEHYDRATION (METABOLIC STOLL (OLIVE-SHAPED NUTRITION PERISTALSIS ALKALOSIS) OUTPUT MASS)
  • 48.
  • 49. OTHER COMMON FINDINGS:  Hypochloremic, hypokalemic metabolic alkalosis  Hypernatremia or hyponatremia  Dilated stomach bubble ON X-ray  String sign and shoulder sign on UGI
  • 50. DIAGNOSTICS  Plain x-rays  Ultrasonography Normal UGIS Gastric Outlet Obstruction
  • 51. DIAGNOSTICS  Upper gastrointestinal imaging (UGI)  Electrolytes, pH, BUN, and creatinine
  • 52. MANAGEMENT:  Immediate treatment requires correction of fluid loss, electrolytes, and acid-base imbalance  Surgery is the curative treatment
  • 53. MANAGEMENT:  Endoscopic balloon dilatation has been used in certain selected patients with short-term symptomatic relief