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GIT sphinter disorders أبريل 2023 - Coggle Diagram
GIT sphinter disorders
أبريل 2023
Introduction
Def.
Dysfunctions of the muscular rings (sphincters) that regulate the movement of substances through various parts of the digestive system
Lower Esophageal Sphincter (LES) Disorders
GERD
Pathophysiology
LES fails to close properly, leading to the reflux of stomach acid into the esophagus
CP
Heartburn
Regurgitation
Dysphagia
Chest pain
Difficulty swallowing
Investigations
Upper endoscopy
Esophageal manometry to assess LES pressure
PH monitoring to evaluate acid reflux
Imaging studies like barium swallow
TTT
Lifestyle modifications
Medications
reduce acid reflux (e.g.,PPI)
Relax the sphincter muscles (e.g., ca. channel blockers)
Surgical Procedures
Complications
Esophagitis
Esophageal strictures
Barrett's esophagus (precancerous).
Achalasia
Pathophysiology
Impaired relaxation of the LES, causing difficulty in food passage into the stomach
CP
Dysphagia
Regurgitation
feeling of fullness after eating.
Chest pain
Weight loss
Investigations
Upper endoscopy
Esophageal manometry to assess LES pressure
PH monitoring to evaluate acid reflux
Imaging studies like barium swallow
TTT
Medications
Endoscopic therapies (e.g., balloon dilation)
Surgical interventions (e.g., Heller myotomy).
Biliary Sphincter Disorders
Investigations
Liver function tests
Abdominal US
MRCP
ERCP
CP
Recurrent episodes of abdominal pain, nausea, vomiting, and jaundice.
TTT
Medications to relieve symptoms
Endoscopic sphincterotomy to widen the sphincter opening
Stent placement to improve bile flow.
Pathophysiology
Sphincter of Oddi dysfunction refers to the abnormal narrowing or spasm of the sphincter, leading to impaired bile and pancreatic juice flow.
Anal Sphincter Disorders
pathophysiology
Anal fissures often result from trauma or injury to the anal canal.
Anal sphincter dysfunction and fecal incontinence can occur due to damage or weakening of the muscles that control bowel movements, ex. childbirth trauma, nerve damage, muscle weakness, or surgery in the anal area
Types
Anal fissure
Anal sphincter disorder
Fecal incontinence
CP
Anal fissures present with pain, bleeding, and discomfort during bowel movements.
Anal sphincter dysfunction and fecal incontinence may manifest as the inability to control bowel movements, involuntary leakage of stool, and decreased anal tone.
Investigations
Anoscopy
Imaging studies (e.g., endoanal US),
Tests to assess anal sphincter function (e.g., anorectal manometry)
TTT
Lifestyle modifications,, topical medications, dietary changes, stool softeners
Physical thrapy : as fecal incontinence, pelvic floor exercises and biofeedback techniques to strengthen the muscles and improve control.
Surgical interventions such as sphincteroplasty.
Rare types
Hypertensive Lower Esophageal Sphincter (HTN-LES)
Abnormally high resting pressure of the lower esophageal sphincter (LES).
Symptoms similar to GERD, but with normal acid exposure in the esophagus.
The exact cause is not fully understood.
Nutcracker Esophagus
Motility disorder characterized by high-amplitude contractions of the esophageal muscles during swallowing.
Cause chest pain, difficulty swallowing, and sometimes mimic symptoms of GERD.
The exact cause is not known, but related to nerves controlling esophageal muscle abnormalities.
Paradoxical Puborectalis Contraction (Anismus)
A condition in which the muscles of the pelvic floor, including the puborectalis muscle, don't relax properly during attempts to have a bowel movement.
This can lead to difficulty in passing stool and may contribute to chronic constipation.
Anismus is a rare disorder, and the precise cause is not well understood.
Oddi Dysfunction Type III
Subtype of sphincter of Oddi dysfunction (SOD) where there is dysfunction of both the sphincter of Oddi and the duodenal bulb.
It can result in symptoms similar to SOD, but with additional features related to the duodenal bulb dysfunction.