Esophgas Flashcards
Medication that cause esophagitis ?
• bisphosphonates !!! - osteoporosis
- tetracyclines
- NSAID
- potasium chloride
What octreotide ?! أوكتر يووو تايد
Somatostatin analog Treatment :- - Acromegaly - carcinoid syndrome - VIPoma - variceal bleeding نزيف الأوعية الدمويه داخل الGI ( esophageal varices )
Esophageal squamous cell carcinoma Where most common? Risk factor ? Location ? Histolopathology ?
- the most common on worldwide.
- cigarette smoking // alcohol intake // food containing N-nitroso // age > 50.
- 2/3 upper esophagus - common in middle third.
Keratin pearls // intercellular bridges.
Gastrin // 3G
^ gastric motility ^ gastric H secretion ^ growth of gastric mucosa ————- يرتفع مع هذه الحالات 🫶🏼 ^ stomach distention. ^ alkalinization !!!!! ^ chronic PPI use. ^ chronic atrophic gastritis (H. Pylori) ^^ ZE syndrome ( gastroma)
⬇️⬇️ by PH < 1.5
Cholecystokinin • CCK
كولي سيستوكاينين
^ gallbladder contraction ^ sphincter of Oddi relaxation ^ bile secretion ^ pancreatic secretion ⬇️ gastric emptying —- ⬆️ by fatty acids // amino acids
In cholecystitis: (gallbladder inflammation)
fatty foods increase CCK production and pain occurs when an inflamed and/or
obstructed gallbladder contracts.
Secretin
2 S - secretin + somatostatin ⬇️ gastric acid
Stimulation by intraluminal acidity.
stimulates the release of bicarbonate-rich
secretions from the exocrine pancreas.
^ bile secretin.
A. Motilin ??
B. Erythromycin ??
A.
•Action:
Produces migrating motor complexes (MMCs).
Regulation: ^ in fasting state.
B.
- Stimulate intestinal perstalsis
- Cause hypertrophic pyloric stenosis at neonate.
Vasoactive intestinal polypeptide // VIP hormone ??
-
Source :
Parasympathetic ganglia in sphincters,
gallbladder, small intestine.
Action:
^ intestinal water and electrolyte secretion ❗️
^ relaxation❗️of intestinal smooth muscle and sphincters !!!
VIPoma ??
Pancreatic tumor secretes VIP hormone ! WDHA syndrome: - Watery Diarrhea. - hypokalemia. - Achlorhydria / NO product HCL.
Nitric oxide // NO
Action: ^ smooth muscle relaxation, including lower esophageal sphincter (LES).
# Loss of NO secretion is implicated in / ^ LES tone of achalasia.
Bicarbonate
Brunner glands
Action: Neutralizes acid.
Regulation: ^ by pancreatic and biliary secretion with secretin
Curling ulcer
Severe burn (Curling ulcer): Hypovolemia leads to decreased blood supply and cause acute gastritis.
Cushing ulcer ?
Increased intracranial pressure (Cushing ulcer):
Cushing ulcers are likely induced by direct
stimulation of the vagus nerve by increased intracranial pressure,
thereby resulting in hypersecretion of
gastric acid.
[ head trauma ]
Stress ulcer ?
Shock : seen in ICU patient !!
They need PPI !!
Gastric erosion ??
defined as mucosal defects that do not fully extend through the muscularis mucosa
(erosions are limited to the mucosal layer).
Occuer an Acute erosive gastropathy !
acute erosive gastropathy
- vary widely;
- patients may be/asymptomatig
- present with life-threatening upper gastrointestinal bleeding.
Gastric ulcer ?
penetrate through the mucosal layer and extend into the submucosal
layers.
Chronic antral inflammation leads to
decrease in the number of somatostatin-producing cells (delta cells).
- H.pylori common site on antrum.
And the most common cause gastritis.
H. Pylori increase risk to ?
• ulceration (peptic ulcer disease),
• gastric adenocarcinoma (intestinal type) • MALT lymphoma
(low-grade B-cell lymphoma).
Differential diagnosis of ulcer include carcinoma !!!!
Duodenal ulcers are almost never malignant (duodenal carcinoma is extremely rare)
Gastric ulcers can be caused by gastric carcinoma (intestinal subtype).
لذلك مهم أننا ناخذ عينه في حال وجود قرحة معويه !!
Benign peptic ulcers:
• are usually small (<3 cm)
• sharply demarcated (“punched-out”)
• surrounded by radiating folds of mucosa.
Malignant ulcers :
• are large and irregular with (heaped up)margins.
Biopsy is required for definitive diagnosis.
