Gastrointestinal- Phatology Flashcards
Sialolithiasis
Can occur in 3 major salivary glands. Single stone more common in submandibular gland (Wharton duct).
Presents as recurrent pre-/periprandial pain and
swelling in affected gland. Caused by dehydration or trauma.
Treat conservatively with NSAIDs, gland massage, warm compresses, sour candies
Sialadenitis
inflammation of salivary gland due
to obstruction, infection, or immune-mediated
mechanisms.
Salivary gland tumors
Most commonly benign and in parotid gland. Tumors in smaller glands more likely malignant.
Typically present as painless mass/swelling. Facial pain or paralysis suggests malignan involvement of CN VII.
Salivary gland tumors
- Pleomorphic adenoma (benign mixed tumor)
Most common salivary gland tumor.
Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively.
May undergo malignant transformation.
Salivary gland tumors
- Mucoepidermoid carcinoma
most common malignant tumor, has mucinous and squamous components.
Salivary gland tumors
- Warthin tumor (papillary cystadenoma lymphomatosum)
benign cystic tumor with germinal centers. Typically found in smokers. Bilateral in 10%; multifocal in 10%.
Achalasia
- Etiology
- Manometry findings
Failure of LES to relax due to loss of myenteric (Auerbach) plexus due to loss of postganglionic inhibitory neurons (which contain NO and VIP).
uncoordinated or absent peristalsis with high LES resting pressure progressive dysphagia to solids and
liquids. Barium swallow shows dilated esophagus with an area of distal stenosis (“bird’s beak”).
Secondary Achalasia
(pseudoachalasia) may arise from Chagas disease (T cruzi infection) or extraesophageal malignancies (mass effect or paraneoplastic).
Esophageal pathologies
- Boerhaave syndrome
Transmural, usually distal esophageal rupture with pneumomediastinum due to violent retching.
Subcutaneous emphysema may be due to dissecting air (crepitus may be felt in the neck region or chest wall). Surgical emergency.
Esophageal pathologies
- Eosinophilic esophagitis
Infiltration of eosinophils in the esophagus often in atopic patients. Food allergens dysphagia, food impaction.
Esophageal rings and linear furrows often seen on endoscopy. Typically unresponsive to GERD therapy.
Esophageal pathologies
- Esophageal strictures
Associated with caustic ingestion and acid reflux.
Esophageal pathologies
- Esophagitis
Associated with
- reflux,
- infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched-out ulcers; CMV: linear ulcers),
- caustic ingestion,
- pill esophagitis (eg, bisphosphonates, tetracycline, NSAIDs, iron, and potassium chloride).
Esophageal pathologies
- Gastroesophageal reflux disease
Commonly presents as heartburn, regurgitation, dysphagia. May also present as chronic cough,
hoarseness.
Associated with asthma. Transient decreases in LES tone.
Esophageal pathologies
- Mallory-Weiss syndrome
Partial-thickness mucosal lacerations at gastro esophageal junction due to severe vomiting.
Often presents with hematemesis. Usually found in alcoholics and bulimics.
Esophageal pathologies
- Plummer-Vinson syndrome
Triad of Dysphagia, Iron deficiency anemia, and Esophageal webs.
May be associated with glossitis. Increased risk of esophageal squamous cell carcinoma (“Plumbers DIE”)
Esophageal pathologies
- Sclerodermal esophageal dysmotility
Esophageal smooth muscle atrophy decrease LES pressure and dysmotility acid reflux and dysphagia
stricture, Barrett esophagus, and aspiration.
Part of CREST syndrome.
Barrett esophagus
Replacement of nonkeratinized stratified squamous
epithelium with intestinal epithelium.
Due to chronic gastroesophageal reflux disease (GERD). Associated with risk of esophageal adenocarcinoma.
Esophageal cancer
- clinical presentation
Typically presents with progressive dysphagia (first solids, then liquids) and weight loss; poor prognosis.
Esophageal cancer
- Squamous cell carcinoma
- Adenocarcinoma
Upper 2/3. Alcohol, hot liquids, caustic strictures, smoking, achalasia. More common worldwide
Lower 1/3. Chronic GERD, Barrett esophagus, obesity, smoking, achalasia. More common in America
Acute gastritis
- Etiology
NSAIDs, Burns (Curling ulcer), Burns (Curling ulcer).
Especially common among alcoholics and patients taking daily NSAIDs