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DANYLO HALYTSKI LVIV NATIONAL MEDICAL UNIVERSITY
DEPARTMENT OF PATHOPHYSIOLOGY
Methodical guide
for English-speaking students 3 rd – year in studying
of General medicine in practical training
on the theme
“PATHOPHYSIOLOGY OF THE DIGESTIVE SYSTEM.
INSUFFICIENCY OF DIGESTION.”
On the subject Pathological Physiology
Lviv-2014
3
DANYLO HALYTSKYI NATIONAL MEDICAL UNIVERSITY OF LVIV
Department of pathological physiology
Methodical guide
for English-speaking students 3 rd – year in studying
of General medicine in practical training
on the theme
“PATHOPHYSIOLOGY OF THE DIGESTIVE SYSTEM.
INSUFFICIENCY OF DIGESTION. ”
On the subject Pathological Physiology
Subject
Pathological physiology
Module 2
Pathophysiology of organs and systems.
Year of study
3rd
Faculty
Medical
Lviv-2014
4
Methodical instructions for practical classes in pathological physiology - section
“Pathophysiology of the digestive system. Insufficiency of digestion. Pathophysiology of
organs and systems” intended for medical students have been prepared by: Prof.
M.S.Reheda MD, assist. prof. Sementsiv N.G., assist. prof. M.A. Kolishetska, assist.
prof. Baida M.L.
Methodical guide for practical training of medical students on the theme
˝Pathophysiology of the digestive system. Insufficiency of digestion.˝ is compiled in
accordance with the demands of typical curriculum program on pathophysiology syllabus
for the students of higher educational medical establishments of the ІІ-ІІІ levels of
accreditation, Kyiv 2006.
Reviewed by :
Associate professor
of the Department of Pathological Anatomy
with the course of Forensic Medicine
of Danylo Halytski Lviv National Medical University
Servetnyk M.I.
Associate professor
of the Department of Pharmacology
of Danylo Halytski Lviv National Medical University
Havryluk I.M.
Associate professor
head of the Department of Foreign languages
of Danylo Halytski Lviv National Medical University
Isayeva O.S.
Approved and recommended for publication at the sitling of the Cycle Methodical
Commission in Danylo Halytski Lviv National Medical University
PROCEEDINGS №1
2014
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PATHOPHYSIOLOGY OF THE DIGESTIVE SYSTEM.
INSUFFICIENCY OF DIGESTION.
I. SIGNIFICANCE OF THE THEME
The digestive system provides intake of food components that get into alimentary
chanel (proteins, fats, carbohydrates), absorption of formed nutrients and removing from
an organism of some end-products of metabolism. Numerous functions of digestive
system are regulated by central and vegetative nervous system, humoral and endocrine
influences. Disorders of regulation cause disturbance of normal course of the processes
in alimentary channel, leads to insufficiency of digestion and promote development of
many diseases.
The diseases of digestive organs take considerable place in general morbidity of the
population. Chronic gastritis and peptic ulcer meet in all age groups and have not
tendencies to decrease. The most of them course chronically and is characterized by bend
to relapses and acute. It leads to loss of working ability and disability. It should account,
that not only organic, but also the functional disorders of alimentary system seriously
influence on state of the whole organism, on its metabolism. The leading etiological
factors of disturbance of digestion are the errors in nutrition, infectious agents, toxic
substances and medicines drugs abusing by alcohol and nicotine, psychic, traumas,
negative emotions. Pathogenetical the grounded methods of prevention and treatments of
illnesses of gastrointestinal tract is based on knowledge of the nature of these pathogenic
factors and mechanisms of those disorders.
II. CONCRETE TEACHING GOALS
1.
2.
3.
4.
5.
6.
7.
Students have to:
Know the definition of the term “deficiency digestion”, its classification.
Know etiological factors of deficiency digestion and principles of indigestion
experimental modeling.
Be able to list syndromes that are shown in case of indigestion, to explain their
features.
Know an etiology and pathogenesis of indigestion in the mouth.
Know an etiology and pathogenesis of indigestion in the stomach.
Explain an etiology and pathogenesis of gastric ulcer.
Know an etiology and pathogenesis of indigestion in the guts.
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8. Know an etiology and pathogenesis of an acute pancreatitis and pathogenesis of
the pancreatic shock.
9. Explain the role of the secretory function of the pancreas violations when an
abdominal digestion and parietal digestion are disturbed.
10. Characterize intestinal dyskinesias.
11. Explain mechanisms of intestinal autointoxication creation and overgrowth
creation.
III. BASIC KNOWLEDGE, ABILITIES AND SKILLS NECESSARY TO COMPREHEND
THE THEME (interdisciplinary integration)
Names of previous subjects
Normal anatomy
Histology
Normal physiology
Obtained knowledge and skills
Anatomy of the digestive tract
Histological structure of the stomach
and intestines
research of the secretory stomach
function; defining of gastric acidity in
healthy animals
IV. ASSIGNMENTS FOR INDEPENDENT WORK TO BE DONE WHILE
PREPARING FOR THE PRACTICAL CLASS
1. Basic terms, parameters and characteristics necessary to learn while
preparing for the practical class
Term
Definition
Deficiency of digestion
The pathological process, when the
digestive system doesn’t metabolize
food.
Hyperrexia
An pathological increasing of appetite
Poliphagia
The increasing of eating
Bulimia
The extreme degree of appetite
increasing
Anorexia
An pathological depression of appetite
Aphagia
The stopping of eating
Flatulence
An excess of gases in the stomach.
Hyposalivation
The reducing of the saliva secretion
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Hypersalivation
The increasing of the saliva secretion
Xerostomia
The dryness of mucous in the mouth
Disgezіa
Tastes violations
Hypogezіa
The regression of the taste sensibility
Hypergezia
The increasing of the taste sensibility
Paragezia
When a taste is present but an
appropriate stimulus is absent
False paragezia
When the constant feeling of some taste
is present in the mouth in spite of eating
Dysphagіa
Disturbances of swallowing
Maldigestion syndrome
Violations of abdominal digestion
Malabsorption syndrome
Violations of parietal digestion
2. Theoretical questions for the practical class:
1.
2.
3.
4.
5.
Disorder of digestion in the mouth, its reasons.
Etiology of gastrointestinal tract diseases.
Determination of digestion violation and classification.
General signs of digestion violation and their pathogenesis.
Disturbances of the stomach digestion: violations of gastric secretion and motor
function.
6. An etiology and pathogenesis of gastric and duodenum ulcer.
7. Disorder of intestine digestion; the role of the pancreas and liver violations.
3. Practical work (assignments) to be done during the class:
Test 1. Acid estimation of digestive juices. (by the titration method).
Tasks
Instructions for the tasks
Pour 5 ml of digestive juice in the retort. It means finishing of neutralization
Add 1-2 drops of dimethyl-amido- free hydrochloric acid by caustic
nitrogen-benzol and titrate to appearing of soda.
pink color
Note a quantity of caustic soda that was It means neutralization of loosely
spent. Then titrate to appearing of (yellow)
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canary color
coupled acid.
Note a quantity of substance that was
spent. Add 1-2 drops of phenolphthalein
and titrate to appearing of red color
(neutralization of other acids). Note a
quantity of substance that was spent again.
The results are summarized in a table into
different units.
They are: free acid, loosely coupled
acid, other acids and total acidity.
Repeat check experiment for each of
samples.
Test 2. PH estimation of digestive juices. (by the Mihaelis- Davidson method).
Tasks
Instructions for the tasks
Pour 1ml of filtered digestive juice into For this experiment we need some
digestive juice, support, test-tubes,
each of 5 test-tubes. Add 1 drop of every
pipettes, medicine droppers.
indicators into each of them. Set of
indicators are
1-0.03% solution of methyl-violet;
2-0.25% solution of spirit thronealyn;
3-0.125% water solution of congo-rot;
4-0.25% water solution of methyl-orange;
5-0.25% water solution of neutral-rot.
Observe changing of colors and determine
acidity.
This table helps us to determine needed
acidity for colors, which were appeared
after addition an indication. One of these
color determines pH-level.
V. CONTENT OF THE THEME
Digestive system pathology includes disorders of gastrointestinal tract and
disorders of digestive glands – pancreas and liver.
In many ways, the digestive system can be thought of as a well-run factory in
which a large number of complex tasks are performed. The three fundamental processes
that take place are: 
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
Secretion: Delivery of enzymes, mucus, ions and the like into the lumen, and
hormones into blood. 

Absorption: Transport of water, ions and nutrients from the lumen, across the
epithelium and into blood. 

Motility: Contractions of smooth muscle in the wall of the tube that crush, mix and
propel its contents.
Each part of the digestive tube performs at least some of these tasks, and different
regions of the tube have unique and important specializations.
Insufficiency of digestion is a pathological condition at which the digestive system
does not provide assimilation of the nutrients that get inside the organism. As a result
starvation can develop.
Depending on ethiology there are hereditary caused (some kinds malabsorption)
and the acquired insufficiencies of digestion.
The reasons that cause the development of insufficiency of digestion may be:
1. Alimentary (food) factors - reception of bad and rough food, live on dry
rations, irregular reception of food, disbalanced meal (for example, reduction of the
maintenance of vitamins, proteins in a diet), overindulge in alcohol.
2. Physical factors. Among factors of this group the greatest role belongs to
radiation which effects epithelial cells of the alimentary channel which have high mitotic
activity.
3. Chemical agents are the reason of digestion disorders after poisonings with
inorganic and organic substances during manufacture and in life.
4. Biological factors - bacteria (for example, v.cholera, causative agents of
dysentery, typhoid fever, paratyphus), bacterial toxins (for example, at salmonellosis,
staphylococcal infection), viruses (for example, adenoviruses), helminths.
5. Organic effects - congenital anomalies of digestive system, postoperative
conditions, tumours of digestive system.
6. Disorders of nervous and humoral regulation - psychoemotional disorders
(neurotic and neurosis-like conditions), mental diseases (schizophrenia, a manic depressive syndrome), organic diseases of the central nervous system (encephalites),
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lesions of peripheral structures of vegetative nervous system, reflex disorders (various
viscero-visceral reflexes). Disorders of humoral regulation of digestion may be
connected to disorders of synthesis and secretion of gastrointestinal hormones (gastrine,
secretin, cholecystokinin-pancreazymin etc.).
Insufficiency of digestion may be shown by the following syndromes:
1) starvation;
2) dispeptic syndrome;
3) dehydratation;
4) disturbance of the acid-basic balance;
5) intestinal autointoxication;
6) the painful syndrome.
VI. MATERIALS FOR SELFCONTROL
A. Assignments for self-control
No
Assignments
1
List the manifestations of digestion
disorder in case of the gastric
hypersecretion
2
List the complications of gastric and
duodenum ulcer
3
Explain the development and
manifestations of dumping syndrome
Instructions for the assignments
Explain mechanisms of these
complications. List 3-4
manifestations.
B. Tasks for self-control:
TASK 1. A woman has distinct hypersalivation syndrome. Patient has to remove saliva
from her mouth with napkin because of hard pain when she is swallowing.
What kind of acid-base disorders may develop in this patient in some time and why?
TASK 2. Three years ago a man aged 45 was operated on for stomach resection. After
the operation the content of erythrocytes in the blood is 2.0x1012, Hb 85 g/l, color index1.27.
Describe possible changes in oral cavity in this case.
TASK 3. A patient, aged 50, complains of a bad appetite, loss of weight, weakness, pain
in the stomach area, and eructation. At laboratory examination of him: Hb-2x1012/L,
stomach secretion 0.4 l, pH of stomach juice-7. Pernicious anemia is diagnosed in this
patient.
What compound of gastric juice deficiency is the cause of the disease?
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TASK 4. A patient has increased gastric secretion in response to both mechanical and
chemical stimuli. He has high acidity of gastric juice with pH equals 2.0 on an empty
stomach. After the breakfast pH restores to normal in 12 minutes and is continuously
dropping during following 2 hours.
What type of stomach secretion is being observed in this patient?
TASK 5. A patient aged 42 was admitted to the hospital with gastric hemorrhage
(ulcerous disease was excluded by a patient). Ulcer and hyperplasia of gastric mucose
were revealed.
What investigation is it necessary to carry out to confirm the diagnosis of ZollingerEllison syndrome in this patient?
TASK 6. A patient aged 42 complains of pains in epigastric area, vomiting; vomitory
masses have color of “coffee grounds”, melena. In anamnesis there is ulcerous disease of
the stomach. On examination: skin is pale, heart rate-110 beats per minute; AP90/50mm.hg. Blood analyses: erythrocytes-2.8 x 1012/l; leucocytes-8x109/l; hemoglobin90gr/l.
What is the possible complication that developed in the patient?
TASK 7. Ulcerous disease of the stomach is revealed in a woman aged 52, who has been
ill with contact dermatitis. On examination it is determined that the patient had been
taking corticosteroid preparations for a long period of time.
What is the main mechanism of ulcer development in this case?
TASK 8. A patient age 37 was admitted into a surgical department with the signs of
acute pancreatitis; vomiting, diarrhea, bradycardia, hypotension, dehydration of the
organism.
Why are hypotension observed?
TASK 9. A 67-year-old woman, who has cholecystitis for a long time, suddenly
developed sharp pain in the upper part of abdomen, nausea, and vomiting after food
intake. Acute pancreatitis was diagnosed in this patient.
What preparation must be used first of all and why?
TASK 10. A patient with signs of encephalopathy was hospitalised in neurological inpatients department and co relation between increase of encephalopathy and substances
passing from intestine into systemic blood circulation was determined.
What compounds formed in the intestine may cause endotoximia?
B.
Tests for self-control:
1.
After taking a fatty food a patient feels nausea, flaccidity, later the sign of steathorrhea
has appeared, cholesterol in the blood 9,2ml/c. The cause of this state is the deficiency
of:
A. Chylomicrones.
B. Triglyceroides.
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C. Bile acids.
D. Fatty acids.
E. Phopholipids.
2. A patient aged 45 had the diagnosis ulcer of the stomach. On examination of secretory
function of the stomach it was determined that the amount of basal secretion was
100mole/hr, acidity of basal secretion -60mml/hr. What factors action contributes to the
hypersecretion in the stomach?
A. Gastrine.
B. Pancreatic polypeptide.
C. Somatostatin.
D. Glucagon.
E. Betaendorphin.
3. On laboratory examination increased amount of diastase in the urine and also a large
amount of undigested fat in stool were revealed in a patient female with complain of
circular character pain in epigastric area. What form of gastrointestinal tract pathology
are described signs typical for?
A. Inflammation of large intestine.
B. Acute appendicitis.
C. Infectious gastritis.
D. Ulcerous disease of the stomach.
E. Acute pancreatitis.
4. A part of patient pancreas was resected. What kinds of product must be limited in his
diet?
A. Sour milk product
B. Fruits.
C. Not fatty boiled meat.
D. Fatty and fried meal.
E. Vegetables.
5. What enzyme deficiency is the cause of maldigestion of fats in the gastrointestinal
tract and increase of neutral fats in the stool?
A. Gastric lipase
B. Intestinal lipase.
C. Hepatic lipase,
D. Enterokinase.
E. Pancreatic juice.
6. Decrease of synthesis and secretion of trypsin is observed in chronic pancreatitis. The
splitting of what substances is broken?
A. Proteins.
B. Nucleic acids
C. Polysaccharides.
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D. Lipids.
E. Liposoluble vitamins.
7. In coprologic investigation it is determined that stool is discoloured, there are drops of
neutral fat in it. The most possible cause of this is the impairment of?
A. Secretion of intestinal juice.
B. Process of absorption in the intestine.
C. Entering of bile into the intestine.
D. Acidity of gastric juice.
E. Secretion of pancreatic juice.
8. A patient had been taking antibiotics of a wide spectrum of action for a long period of
time that caused decrease of appetite, nausea, and diarrhea with saprogenic smell. What
is the side effect of treatment?
A. Hepatotoxic action.
B. Allergic reaction.
C. Dysbacteriosis.
D. Nephrotoxic action.
E. Direct irritative action
9. On examination of a patient suffering from acute pancreatitis increased amount of
chylomicrons was determined in the blood. What enzyme activity is sharply decreased in
this pathology?
A. Lipoprotienelipase.
B. Pancreatic lipase.
C. Pancreatic phospholipase.
D. Tissue triglyceride lipase.
E. Tissue diglyceride lipase.
10. The analysis of gastric juice of an elderly man who complained of unmotivated
weakness, sickness, absence of appetite showed achylia, achlorhydrea, and presence of
lactic acids and coagulated blood, decreased of pepsin secretion. What disease causes
such clinical-laboratory symptoms?
A. Cancer of the stomach.
B. Chronic gastritis.
C. Chronic pancreatitis.
D. Cavitary Maldigestion.
E. Acute gastritias.
11. A man with chronic hepatitis has dyspeptic disorders: decrease of appetite, nausea,
unstable stool, and steatorrhea. What is the mechanism of dyspeptic disorders in hepatic
pathology?
A. Intoxication
B. Hypoglycemia
C. Cholalemia
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D. Hypocholea
E. Hyperbilirubemia
12. Spasmodic pains in the abdomen and repeated diarrhoea with mucus appeared in a
healthy person 3-5 hours later after taking meals. This was preceded by nausea and
momentaneous vomiting, general weakness, loss of appetite. What is the most possible
cause of the desired symptoms?
A. Chronic pancreatitis
B. Food intoxication
C. Enterocolitis
D. Hyperacid state of the stomach
E. Chronic gastritis
13. A man who works at a storage battery plants complains of constant feeling of weight
and periodical spasmodic pains in the abdomen, constant retention of stool (not more
often than one time per three day). This is accompanied by frequent headaches,
flaccidity, absence of appetite, and bad taste in the mouth. What are the causes of these
disorders?
A. Hyper acid state of the stomach
B. Hypoacid state of the stomach
C. Spastic lead colie with constipation
D. Chronic pancreatitis
E. Parietal maldigestion
14. Due to chronic gastritis a man has the impaired structure of the mucous membrane,
decreased indices of acid formation function of the stomach. The most essential negative
result of this will be the impairment of:
A. Excretion of secretum
B. Pancreatic juice secretion
C. Secretory function of small intestine
D. Evacuation of chyme into duodenum
E. Protien digestion
15. On laboratory examination increased amount of diastase in the urine and also a large
amount of undigested fat in stool were revealed in a patient with complains of circular
character pains in epigastric area. What form of gastrointestinal tract pathology are the
described signs typical for?
A. Inflammation of the large intestine
B. Acute appendicitis
C. Infectious hepatitis
D. Ulcerous disease of the stomch
E. Acute pancreatitis
16. A patient aged 35 with ulcerous disease had a rejection of antral portion of the
stomch. What gastrointestinal hormone secretion will be impaired due to operation?
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A. Gastrin
B. Secritin
C. Neurotensin
D. Histamine
E. Cholecystokinin
17. A patient aged 57 was admitted to a gastrointestinal department with suspicious on
Zolliger-Ellison syndrome, which was proved by sharp increase of gastrin level in the
blood serum. What impairment of secretory gastric function is the most possible?
A. Hyperacid hyposecretion
B. Hyperacid hypersecretion
C. Hypoacid hypersecretion
D. Achylia
E. Hypoacid hyposecretion
18. A patient with signs of encephalopathy was hospitalised in neurological in- patients
department and co relation between increase of encephalopathy and substances passing
from intestine into systemic blood circulation was determined. What compounds formed
in the intestine may cause endotoximia?
A. Acetoacetat
B. Biotin
C. Indole
D. Ornitin
E. Buthirat
19. 150 ml of meat broth were introduced into the stomach cavity of experimental dog to
a probe the content of what substance will increase quickly in the animal’s blood?
A. Insulin
B. Vasointestinal peptide
C. Neurotensin
D. Somatostatin
E. Gastrin
20. A patient age 37 was admitted into a surgical department with the signs of acute
pancreatitis; vomiting, diarrhea, bradycardia, hypotension wearness, dehydration of the
organism. What preparation must be used first of all?
A. Ephedrine
B. No-spa
C. Pephenazine
D. Contrical
E. Platyphyllin
ANSWERS: 1.-C.2.-A.3.-E.4.-D.5.-E.6.-A.7.-C.8.-C.9.-A.10.-A.11.-D.12.-B.13.-C.14.-E.15.-E.16.-A.17.-B.18.-C.
19.-E.20.-D.
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