Gastrointestinal Problems -Growth & Development

Intestinal adaptation
Regulation of intestinal epithelial cell production &
adaptation is importantWHY?
Small intestine is one of the most rapidly proliferating
tissues in the body.
New epithelial cell produced in intestinal crypts
divide frequently mature
Specialist function for digestion & absorption
including synthesis brush border enzymes & transport
carrier proteins
Exfoliated into int.lumen total life span: 5 days

Many diseases:
@ Alterations in nutrient requirements
@ change balance between production & exfoliation

Positive: intestinal cell hyperplasi,

Negative: villus atrophy

Four basic types of epithelial cells in the small int.mucosa:

1. polarized epithelial cells
2. mucus-producing goblet cells villus (throughout small int)
3. Paneth cells
4. Enterochromaffin cells
1-4 all are produced from the same crypt stem cells
Stemm cell devide asymetrically2 daughter cells:
1. Stemm cell mature enterocytesproducing 1cell type
2. Differentiates into one of the other type of epithelial cells
multiple cell liniages
Most digestive & absorbtive function results from the cells
located in the outer 1/2 to1/3 of villus

Maintenance of mucosal architecture & function is

heavily dependent upon intralumilal nutrient:
production orloss epit.cells hyperplasia
loss or cell renewal atrophy
Adaptation: process by which the small intestinal
(SI) able to functionally adapt to nutrient needs
Nutrient needs --WHY?: Response to physiologic &
pathologic stimuli. E.g.:
Loss abs.surface (resection)
Others (needs; in lactation DM) int.mass
Adaptation considered as a compensatory overexspression
process responsible for maintenance of normal
mucosal integraty & function, primarily in response
to normal enteric feeding

Factors-production rate of crypts cells:

Cell cycle time/cct: duration cell cycle-interval 2 successive
divisions of a proliferative crypt cells (human:48hrs)
Starvation: crypt cell proliveration regulated by cct
Cell growth fraction/cgf: portion cell population devoted to
proliferation-bottom 2/3crypts.--influence cell production
If:portion of crypts devoted to prolif.largercell prod.rate

Starvation:cgf ; inflammatory conditions: cgf

Crypt cell population size/ccps: Prolif.epith. Associated
with crypt size ccps. Starvation: hypoproliferative
statesccps
Ratio #crypts : #villy. Normal Crypts : Villi = 1: 6

GI CAUSES OF FAILURE TO THRIVE

Inadequate ingestion due to dysphagia
Neuromuscular incoordination
Prosperative repair of oesophageal atresia
Esophagitis stricture
Achalasia
Anorexia
Inflamatory lesions
Chrown disease
- Gastritis
Celiac disease
- Enteric infection
Gastric or int. motility dis.
Defective digestion or absorption
Pancreatic insuff.
Intestinal disorders
- Cystic fibrosis
Celiac disease (accompanied by anorexia)
- Shachman syndrome
CMSE (Cows milk sensitive enteropathy)

- Short-gut syndrome
- Abetalipoproteinemia
- Lymphangiectasia
- Bacterial overgrowth
- Cholestasis liver disease
Excessive loses
Gastroesophageal reflex
Pyloric stenosis
Incomplete, recurrent bowel obstruction
DEVELOPING COUNTRIES?
Malnutrition
Prolonged/persistent diarrhea

1. Lingkaran Setan kurang gizi &

2
penyakit infeksi
Makanan
kurang

KURANG

GIZI

Berat badan
Nafsu makan

Praktek2 pemberian
makanan salah

Dtahan

Daya
Da tahan

PENYAKIT2
INFEKSI
Imunisasi kurang

Kepadatan
Kebersihan
kurang

PATOGENESIS
Titik sentral patogenesis diare pesisten
adalah kerusakan mukosa usus
FAKTOR2 PENYEBAB KERUSAKAN :
Berlanjutnya paparan etiologi infeksi
Infeksi intestinal sekunder
Infeksi parenteral sbg komplikasi / sbg penyakit
penyerta.
Bakteri tumbuh lampau di usus halus.
Gangguan gizi yg terjadi sebelum sakit
Menurunnya imunitas
Malabsorbsi
Alergi

Common GI problems
Vomiting
Diarrhea
Abdominal pain
Worrying pointers:
Chronicity of symptoms
Associated with loss or poor growth
Poor sleeping/Nocturnal waking
Recurrent interruption of normal activities
A family history of GI illness with similar
symptoms

GANGGUAN TUMBUH KEMBANG &

PENYAKIT GIT
Tujuan:
Mengenal berbagai peny.GIT penyebab GTK umum-negara
berkembang- Indonesia
Mengenal pencegahan