ACG Institute. The primary mission of the ACG Institute for Clinical Research Education is to advance the field of clinical gastroenterology through education and. I/51xEt8zBVtL._SR600%2C315_PIWhiteStrip%2CBottomLeft%2C0%2C35_PIStarRatingFIVE%2CBottomLeft%2C360%2C-6_SR600%2C315_SCLZZZZZZZ_.jpg' alt='Gastroenterology Sleisenger Pdf' title='Gastroenterology Sleisenger Pdf' />Share this Read this article in PDF format. Gallstone disease is a disease of hepatobiliary system, caused by cholesterol andor bilirubin metabolic disorder, and. Organization of physicians, researchers and educators whose primary practice or research involves the functions and disorders of the digestive system. Provides. Primary sclerosing cholangitis PSC is a disease of the bile ducts that causes inflammation and obliterative fibrosis of bile ducts inside andor outside the liver. Crohn disease is an idiopathic, chronic inflammatory process that can affect any part of the gastrointestinal tract from the mouth to the anus see the. Diagnosis and Management of Spontaneous Bacterial Peritonitis This guidance is based on LTHT guidelines for the management of Spontaneous Bacterial Peritonitis. Vomiting WikipediaHeaving redirects here. For the sailing term, see Heaving to. For the sailing term heaving down, see Careening. Vomiting, also known as emesis and throwing up, among other terms, is the involuntary, forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. Vomiting can be caused by a wide variety of conditions it may present as a specific response to ailments like gastritis or poisoning, or as a non specific sequela of disorders ranging from brain tumors and elevated intracranial pressure to overexposure to ionizing radiation. The feeling that one is about to vomit is called nausea, which often precedes, but does not always lead to, vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting. In severe cases, where dehydration develops, intravenous fluid may be required. Self induced vomiting can be a component of an eating disorder, such as Bulimia Nervosa, and is itself now an eating disorder on its own, purging disorder. Vomiting is different from regurgitation, although the two terms are often used interchangeably. Regurgitation is the return of undigested food back up the esophagus to the mouth, without the force and displeasure associated with vomiting. The causes of vomiting and regurgitation are generally different. Complications. Aspiration of vomit. Vomiting can be dangerous if the gastric content enters the respiratory tract. Under normal circumstances the gag reflex and coughing prevent this from occurring however, these protective reflexes are compromised in persons under the influences of certain substances such as alcohol or anesthesia. The individual may choke and asphyxiate or suffer an aspiration pneumonia. Dehydration and electrolyte imbalance. Prolonged and excessive vomiting depletes the body of water dehydration, and may alter the electrolyte status. Gastric vomiting leads to the loss of acid protons and chloride directly. Combined with the resulting alkaline tide, this leads to hypochloremicmetabolic alkalosis low chloride levels together with high HCO3 and CO2 and increased blood p. H and often hypokalemia potassium depletion. The hypokalemia is an indirect result of the kidney compensating for the loss of acid. With the loss of intake of food the individual may eventually become cachectic. A less frequent occurrence results from a vomiting of intestinal contents, including bile acids and HCO3, which can cause metabolic acidosis. MalloryWeiss tear. Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa MalloryWeiss tear. This may become apparent if fresh red blood is mixed with vomit after several episodes. Dentistry. Recurrent vomiting, such as observed in bulimia nervosa, may lead to destruction of the tooth enamel due to the acidity of the vomit. Digestive enzymes can also have a negative effect on oral health, by degrading the tissue of the gums. Pathophysiology. Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. The area postrema is a circumventricular organ and as such lies outside the bloodbrain barrier it can therefore be stimulated by blood borne drugs that can stimulate vomiting or inhibit it. There are various sources of input to the vomiting center The chemoreceptor trigger zone at the base of the fourth ventricle has numerous dopamine D2 receptors, serotonin 5 HT3 receptors, opioid receptors, acetylcholine receptors, and receptors for substance P. Stimulation of different receptors are involved in different pathways leading to emesis, in the final common pathway substance P appears involved. Mtv Vma 2012 Full Show. The vestibular system, which sends information to the brain via cranial nerve VIII vestibulocochlear nerve, plays a major role in motion sickness, and is rich in muscarinic receptors and histamine H1 receptors. The cranial nerve X vagus nerve is activated when the pharynx is irritated, leading to a gag reflex. The vagal and enteric nervous system inputs transmit information regarding the state of the gastrointestinal system. Irritation of the GI mucosa by chemotherapy, radiation, distention, or acute infectious gastroenteritis activates the 5 HT3 receptors of these inputs. The CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centers. The vomiting act encompasses three types of outputs initiated by the chemoreceptor trigger zone Motor, parasympathetic nervous system PNS, and sympathetic nervous system SNS. They are as follows citation neededThe neurotransmitters that regulate vomiting are poorly understood, but inhibitors of dopamine, histamine, and serotonin are all used to suppress vomiting, suggesting that these play a role in the initiation or maintenance of a vomiting cycle. Vasopressin and neurokinin may also participate. Phases. The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent hiccups. In this retching phase, nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. The relief of pressure and the release of endorphins into the bloodstream after the expulsion causes the vomiter to feel better. Contents. Gastric secretions and likewise vomit are highly acidic. Recent food intake appears in the gastric vomit. Irrespective of the content, vomit tends to be malodorous. The content of the vomitus vomit may be of medical interest. Fresh blood in the vomit is termed hematemesis blood vomiting. Altered blood bears resemblance to coffee grounds as the iron in the blood is oxidized and, when this matter is identified, the term coffee ground vomiting is used. Bile can enter the vomit during subsequent heaves due to duodenal contraction if the vomiting is severe. Fecal vomiting is often a consequence of intestinal obstruction or a gastrocolic fistula and is treated as a warning sign of this potentially serious problem signum mali ominis. If the vomiting reflex continues for an extended period with no appreciable vomitus, the condition is known as non productive emesis or dry heaves, which can be painful and debilitating. Color of vomitcitation neededBright red in the vomit suggests bleeding from the esophagus. Dark red vomit with liver like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer. Coffee ground like vomit suggests less severe bleeding in the stomach, because the gastric acid has had time to change the composition of the blood.