lecture 1 Flashcards
Overview of General Pathology and class
What do we need to know from the Pathology of esophagus and stomach lecture?
- Clinical features and complications of upper GI
- Diagnostic methods, pathogenisis and pathology teatement and prognosis
- integration of cell reaction, neoplasia and inflammation
What are the manifestation of Upper GI disease?
- Nausea and vomitting (N&A)
- Reflux and coughing
- dysphagia
- odynophagia which is pain swallowing
- Chest pain, heartburn and abdominal pain
What are the complications of upper GI disease?
- Bleeding
- Hematmesis (vomitting blood), Coffee ground emesis( vomitting looks like coffee grounds) and Melena (Shitting blood)
- Obstruction
- Obstruction leads to pain, nausea and vomitting
- Perforation which means a whole is made where things pass through
- This lead to peritonitis and fever and abdominal tenderness
What are the diagnositic methods of upper GI problems?
Endoscopy and Occult blood test
What does the normal esophegeal mucosa consist of?
Epithelium of non keratinized strartified squamous mucosa.
What causes the pathology of esophagus?
- Obstuction due to mechanica (atresia and stenosis) or functional such as dsymotility and achalasia (cant push food down to stomach)
- Vascular disease due to hypertension
- Varices is basically when the veins are enlarged around the esophagus due to hypertension
- Esophagitis:
- Chemical
- Infections due to Candida
- Candida
- CMV and HSV
- Reflux disease (Barret and GERD)
- Eosinophillic esophagitis
- Esophegeal tumors
- Adenocarcinoma
- squamous cell carcinmoma
What are the causes, clinical features and pathology of Chemical esophagitis? and how is it managed?
- Causes: alcohol, corrosive acides, hot fluids and smoking ans pills
- clinical features odynphagia, hemorrage and perforation
- pathology:
- ulceration and acute inflammation
- management
- self limited, endoscopy or surgry
- Infectious Esophagitis:
- What are the causes, Clinical features and Patholgoy
- Causes
- Herpes, CMV and fungal
- Clinical:
- Immunosuppressed
- Desquamative skin disease
- Bullous pemphigoid
- Odynophagia and dysphagia
What is reflux esophagitis?
Reflux of gastric content into the lower third of esophagus, most common gastric ailness. The causes is due to dysfunction of the lower esophgeal sphincter. cuases backflow of stomach juices . Most common in people over 40, could lead to tooth enamel loss and aspiration pneumonia.
TREATMENT IS PROTON PUMP inhibitor
What are the pathology of reflux esophagitis?
- Hyperemia that then turns into an ulcer.
- This is due to basal zone hyperplasa,2)% increase in total thickness.
- Elongation of papillae to upper third of epithelium and youll see increase of eosinophils, neutrophils and lymphocytes
- This is due to basal zone hyperplasa,2)% increase in total thickness.
What is Bareet Esophagus?
- Occur in 10% of individuals with sympotmatic GERD.
- Occurs in white males 40-60
- Barret disease could lead to dysplasia and Neoplasm. Adenocarcinoma
- If dysplasia occurs they have to be treated
The pathology: Characterised by Goblet cell metaplasia
BARRET IS an old dude (40-60) who likes to drink (Goblet Cells) and has to watch out for cancer
How can you identify Barret disease?
- Endosocpy;
- Pathces of red velvet mucosa extending upward from Gastropespjheal junction
- Intestinal mucosa metaplastic and squamous mucosa wand columnar.
- So the columnar goblet metaplastic combines with the squamous mucosa in the intestines
1.
- So the columnar goblet metaplastic combines with the squamous mucosa in the intestines
What is eosiphinillic esophagitis?
- Chronic immunologically (Eosinophils) mediated disorder
- Atopia (not in contact with allergen but causes hypersensitivity.
Leads to food impaction and gerd Like symptoms
Patients try proton inhibitors but usually refractory (symptoms unmanageable)
Signs: crcumferential rings and large number of eosinophills.
What are the two most common esophegeal tumors?
Adenocarinmoa and squamous cell carcinoma
What re risk factors and population of esoph. adenocarcinoma? What are the clinical features?
Whats the prognosis?
Increase incidence since the 70s, affects white males and more common in men than women (7x).
- Smoking and alcohol abuse, are risk factors, and barret or esophagitis and nitrites in diet.
Clinical features?
- Usually occurs in distal third of esophagus
- insidious onset
- Difficulty swallowing and vomitting, bleading and progressive weight loss
Prognosis:
5 years only 25% survives
Whats the pathology of eso. Adenocarcinoma? Gross and micro inspections
Gross inspection: Flat or raised patches: basically raised off surface and diffusley infiltrare and ulceration
- Micro:
- Back to back mucin producing glands with dysplastic features ( Cells surrounded by mucus in histo slides
Whats squamous cell adenocarcinoa of esophagus? Population? Risk factors?
- Usually in adults over 45 men are more likely and 6x more likely in african americans.
- Risk factors are alcohol and smoking, leads to achlasia (Difficultu to pass food down, plummer vinson syndrome, previous radiation exposure of mediastinum
What are the clinical featues of SCC of esophagus, Prognosis? Groos and microinspection?
- SCC occurs in mid third of Esophagus, bengin in the begining and present obstruction m weight loss and difficulty swallown godynphagia and dysphagia bleeding too
- Prognosis: 9% survive 5 years
- Gross:
- small grey or white plaque that grows then into turmos masses, ulcerated or diffuelsely inflitrative ( So rigidity and lumenal narrowing) 6awwywat
- Micro:
- Moderate to well differentiated and they have INTERCELLULAR bridges!
What is the histology of cardia and pylrous vs the body of the stomach?
Py.. and Cardia have longer ducts and shorrter glands but the opposite in the body
What are the 5 pathologies of stomach?
- Gastrophathy and acute gastritis
- Stress related mucosal disease
- Chronic gastritis
- Bacterial or autoimmune
- Peptic ulcers
- Gastric tumprs or neoplasm
- Whats the difference between gatropathy and acute gastritis?
- What causes gastropathy.
- Whats the pathogenisis?
- Gastropathy= no neutrophils but there is regeneration
- Causes:
- NSAIDs, alcohol , bile and stress
- Pathogenesis:
- increase in damage (peptic enymes and gastric acids)
- Or decrease in protection aka damage to mucin and bicrobinates
Whata are the pathology of gastritis and gastropathy?
- Melena, Epgastric pain, nausea and hemmorage
- If you see its bluer histologically then its gastropathy but if you see a lot of neutrophils then its gastritis
What is stress induced mucosal diseases? Population? Pathogenisis? Symptoms and patholgoy and how to manage it?
- Severe trauma patient, surgeries, extensive burns and serious medical disease or other physiolgic stress
- Also known as stress, cushing and curling ulcers
- Symptoms: nausea, vomitting hemmorage and melena, hematamesis
- Pathology is multiple acute ulcers
- Management is proton inhibitors and prophylaxors. Management of underlying conditon too
What are the cuses of chronic gastrits and how to differentiate between the two?
Chronic gastritis is usually caused by heliobacter pyloris, or autoimmune;.
- Heliocobacter usually happens in antrum, normal or markdly increase gastrin, youll see neutrophils and antibodies to the bacteria
- Autoimmune:Happens in the body
- Markdly increased gastrin
- decreased ascid production
- antobodie to parietel cells,
- Lymphocytes and macrophages
