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
DIGESTION
3.
RESPIRATION
4.
GROWTH
5.
RESPONSIVENESS
6.
REPRODUCTION
7.
EXCRETION
8.
MOVEMENT
9.

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


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)


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

33. Among the most common congenital anomalies

Severity varies

May present as a cleft lip, cleft palate or both

Cause is Multifactorial

- Genetic
- Environmental

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

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
GENETICS
DEVELOPMENT
ENVIRONMENTAL
HYPERTROPHY
And HYPERPLASIA
NARROWING OF THE
GASTRIC ANTRUM
NONBILIOUS DECREASED EPIGASTRIC
VISIBLE
IMPAIRED
VOMITING URINE AND DISTENTION
GASTRIC DEHYDRATION
(METABOLIC STOLL (OLIVE-SHAPED NUTRITION
PERISTALSIS
ALKALOSIS) OUTPUT MASS)

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