MEDICAL TERMINOLOGY

1ère année Médecine / Pharmacie

Pr Achref Miry

2024 – 2025

Course 3

Digestive System
(part 2)

Pr Achref MIRY

[email protected]

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 Accessory organs

Salivary glands :

• The salivary glands secrete into the mouth.

• They are the first accessory organs to act on
food.
• They secrete salivary amylase, an enzyme that
begins starch digestion.

Amylase Maltose

Liver:

• The liver is a large gland with multiple

functions.
• A major role is processing blood, removing
toxins, and converting nutrients into new
compounds.
• The hepatic portal system carries blood from
other abdominal organs to the liver.
• In digestion, the liver secretes bile, which
emulsifies fats, breaking them into smaller
units.

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 Liver functions Hepatic portal system Fat emulsification (Bile)

The Gallbladder :

• The gallbladder stores bile until needed for

digestion.
• The common hepatic duct (from the liver) and
the cystic duct (from the gallbladder) merge to
form the common bile duct.
• The common bile duct empties bile into the
duodenum.

Extrahepatic biliary ducts

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The pancreas :

• The pancreas produces digestive enzymes

released into the duodenum via the pancreatic
duct.
• It also secretes bicarbonate, which neutralizes
strong stomach acid.

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 Clinical aspects of the digestive accessory organs

Hepatitis:

• In industrialized countries, hepatitis is most

commonly caused by viral infection.
• More than five types of hepatitis viruses have
been identified.
• Vaccines are available for hepatitis A (HAV)
and hepatitis B (HBV).

Types of Hepatitis:

• Hepatitis A (HAV):
o Most common type.
o Spread through fecal-oral contamination,
often via food handlers or unsanitary
conditions.
o Can be acquired by eating contaminated
food, especially seafood.

• Hepatitis B (HBV):
o Spread through blood and body fluids
(sexual contact, needle sharing, close
contact).
o Infected individuals may become carriers.
o Can be serious or fatal and may lead to
liver cancer.

• Hepatitis C (HCV):
o Transmitted through blood and blood
products or close contact.
o Drug treatment is available for a cure.

• Hepatitis D (HDV, Delta Virus):

o Highly pathogenic but only infects those
already infected with HBV.

• Hepatitis E (HEV):
o Similar to HAV, spread through
contaminated food and water.
o Has caused epidemics in Asia, Africa, and
Mexico.

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 Hepatitis D contamination Symptoms of hepatitis A

• Hepatitis means inflammation of the liver and

also causes necrosis (death) of liver cells.
• It can be caused by infections, drugs, or toxins.
• Liver function tests on blood serum help in
diagnosis.
• Jaundice (icterus) is a symptom of hepatitis and
other liver or biliary diseases.
• It appears as yellowing of the skin, eyes, and
mucous membranes due to bilirubin in the
blood.

Causes of hepatitis Jaundice Jaundice (skin ; neonate)

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Cirrhosis :

• Cirrhosis is a chronic liver disease marked by

hepatomegaly, edema, ascites, and jaundice.
• Progression leads to internal bleeding and
brain damage due to blood composition
changes.
• A major complication is portal hypertension
(increased pressure in the hepatic portal system).
• Portal hypertension causes splenomegaly and
varices (varicose veins) in the distal esophagus,
which may lead to hemorrhage.
• The main cause of cirrhosis is excessive alcohol
consumption.

Hepatomegaly Edema Ascites

Splenoomegaly Esophagus varices Hemorrhage ; esophageal varices

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Gallstones:

• Cholelithiasis refers to the presence of

gallstones in the gallbladder or bile ducts,
often associated with cholecystitis (gallbladder
inflammation).

• Symptoms include biliary colic (pain in the

right upper quadrant - RUQ), nausea, and
vomiting.
• Most gallstones are composed of cholesterol, a
component of bile.
• Women are more prone to gallstones due to
estrogen, which increases cholesterol levels in
bile.
• Risk factors include pregnancy, oral
contraceptives, obesity, and rapid weight loss
after stomach reduction surgery.

• Treatment options:
o Drugs may dissolve gallstones.
o Cholecystectomy (gallbladder removal)
is often performed, now mostly
laparoscopic.
o After removal, bile flows directly into
the duodenum via the common bile
duct.

• Diagnosis methods:
o Ultrasonography, radiography, MRI.
o ERCP (Endoscopic Retrograde
Cholangiopancreatography): A
technique to visualize and correct
biliary/pancreatic duct obstructions
using a contrast medium injected from the
duodenum before imaging.

Bile flow after cholecystectomy Gallstone ; Ultrasound ERCP

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Pancreatitis

• Pancreatitis is inflammation of the pancreas.

• Causes include alcohol abuse, drug toxicity,
bile obstruction, and infections.
• Acute pancreatitis is diagnosed by blood tests
showing increased amylase and lipase levels.
• Glucose and bilirubin levels may also be
elevated.
• The disease often resolves with symptomatic
treatment.

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Case study 1

• Family history: No known history of gallbladder disease

• Patient: 47-year-old female
• Symptoms: Sudden onset of severe right upper quadrant (RUQ) abdominal pain, nausea, vomiting, fever
• Onset: Symptoms started 24 hours ago after a fatty meal
• Additional signs: Positive Murphy’s sign, guarding, mild jaundice
• Ultrasound findings: Gallbladder wall thickening, presence of gallstones, pericholecystic fluid
• Laboratory results: Elevated white blood cell count (WBC), mildly elevated liver enzymes
• Diagnosis: Acute calculous cholecystitis
• Treatment plan: Intravenous fluids, antibiotics, pain management, laparoscopic cholecystectomy

Murphy’s sign Intravenous fluids Laparoscopic cholecystectomy

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Useful Expressions for Case Summary Writing

1. Introduction (Patient Presentation) :

• The patient is a [age]-year-old [male/female] presenting with...
• A [age]-year-old [male/female] was admitted with complaints of...
• The patient has a history of ...
• The chief complaint is ...
• The symptoms started [timeframe] ago and have been [progressing/worsening].

2. Symptoms Description :
• The patient reports [symptoms], accompanied by...
• The symptoms include [list of symptoms].
• The pain is localized/diffuse/sharp/dull/colicky.
• The symptoms were triggered by [event].
• There is a history of [symptom], which has worsened over time.

3. Physical Examination Findings :

• On examination, the patient had [finding].
• A positive Murphy’s sign was noted.
• The patient exhibited guarding/rebound tenderness/mild jaundice.
• There was palpable tenderness in the [location].

4. Diagnostic Findings :
• Laboratory tests revealed [abnormal findings].
• The white blood cell count was elevated/normal/low.
• Liver function tests showed mildly elevated liver enzymes.
• Ultrasound findings confirmed [condition], showing [specific abnormality].
• Imaging studies indicated the presence of [abnormality].

5. Diagnosis :
• The findings are consistent with [diagnosis].
• A diagnosis of [condition] was made based on [clinical/laboratory/imaging] findings.
• The most likely diagnosis is [condition], given the presence of [symptoms/findings].
• Differential diagnoses include [list possible conditions], but the findings favor [final diagnosis].

6. Treatment Plan :
• The patient was started on [medication/treatment] for symptom management.
• Supportive therapy, including [IV fluids/antibiotics/pain management], was initiated.
• Surgical intervention (e.g., laparoscopic cholecystectomy) was planned.
• The patient will undergo [procedure], followed by [postoperative care plan].
• Close monitoring is required to assess response to treatment.

The patient is a 47-year-old female with no known family history of gallbladder disease. She presents with
a sudden onset of severe right upper quadrant (RUQ) abdominal pain, accompanied by nausea,
vomiting, and fever. Symptoms started 24 hours ago, following the ingestion of a fatty meal.
On physical examination, Murphy’s sign is positive, and the patient exhibits guarding and mild jaundice.
Laboratory tests reveal an elevated white blood cell count (WBC) and mildly elevated liver enzymes. An
ultrasound shows gallbladder wall thickening, multiple gallstones, and pericholecystic fluid, confirming
the diagnosis of acute calculous cholecystitis.
The patient is started on intravenous fluids, antibiotics, and pain management. Due to the presence of
gallstones and ongoing inflammation, a laparoscopic cholecystectomy is planned to prevent complications
and recurrence. Postoperative follow-up will focus on monitoring recovery and dietary adjustments.

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Case study 2

• Family history: No known history of pancreatic disease

• Patient: 52-year-old male
• Symptoms: Severe epigastric pain radiating to the back, nausea, vomiting
• Onset: Symptoms started suddenly 12 hours ago after alcohol consumption
• Additional signs: Low-grade fever, tachycardia, abdominal tenderness, mild hypotension
• Laboratory results: Elevated serum amylase and lipase, mild leukocytosis, elevated liver enzymes
• Imaging findings: CT scan shows pancreatic edema and mild peripancreatic fluid collection
• Diagnosis: Acute pancreatitis (likely alcohol-induced)
• Treatment plan: Intravenous fluids, pain management, bowel rest, close monitoring for complications

Case study 3

• Family history: No known history of liver disease

• Patient: 38-year-old male
• Symptoms: Fatigue, nausea, loss of appetite, dark urine, jaundice
• Onset: Symptoms started one week ago, progressively worsening
• Additional signs: Mild right upper quadrant (RUQ) tenderness, low-grade fever
• Laboratory results: Elevated ALT and AST, increased total bilirubin, positive hepatitis B surface antigen
(HBsAg)
• Imaging findings: Liver ultrasound shows mild hepatomegaly without cirrhosis
• Diagnosis: Acute hepatitis B
• Treatment plan: Supportive care (hydration, rest, symptom management), liver function monitoring,
antiviral therapy if severe

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