Pathology of the upper GIT Flashcards
What are the different pathologies of the upper GIT?
1) Congenital anomalies
2) Achalasia
3) Hiatal hernia
4) Diverticula
5) Laceration
6) Varices
7) Reflux
8) Barretts
9) Esophagitis
10) Neoplasms (Benign, squamous cell carcinoma, Adenocarcinoma)
What is meant by heart burn?
It is a burning sense of pain in the chest
What is meant by dysphagia?
It is a non-specific terms that denotes a Difficulty in swallowing
What is meant by hematemesis?
The vomiting of blood
What is meant by hemoptosis?
When there is blood in the sputum
What are the different types of obstructive esophageal diseases?
1) Mechanical Obstruction (closed route)
2) Functional Obstruction (problem in the peristalsis)
What are the different forms of mechanical obstruction of the esophagus?
1) Ectopic tissue (gastric, sebaceous, pancreatic)
2) Atresia/Fistula
3) Stenosis/Webs
4) Schiatzki “ring” in the lower esophagus
What is meant by atresia/fistula?
- It is when a thin, non-canalized cord replaces a segment of the esophagus
- It occurs most commonly at the level of the tracheal bifurcation, where a fistula connects the upper or lower esophageal pouches to the bronchus or the trachea
- It can result in aspiration pneumonia, severe suffocation, electrolyte & fluid imbalances
What is meant by stenosis?
It is the narrowing of the esophagus due to inflammation and scarring, which might be due to chronic gastroesophageal reflux, irradiation, or a caustic injury these all will lead to inflammation = healing = narrowing
What is meant by the esophageal rings and webs?
- They are folds that can partially or completely block the esophagus
1) Rings are bands of normal esophageal tissue that forms constrictions around the inside of the esophagus most commonly in the distal esophagus
2) Webs are thin layers of cells that grows across the inside of the esophagus most commonly in the upper esophagus
What are the possible causes of the rings and webs of the esophagus?
1) Iron deficiency anemia
2) Plummer vinson syndrome
What are the various functional obstruction of the esophagus
- Problem in the peristalsis (discoordinated contraction/spasm of the muscularis), like:
1) Achalasia
2) Hiatal Hernia
3) zenker “Diverticulum”
4) Esophagophrenic diverticulum
5) Mallory-Weiss tear
What is meant by achalasia?
- AKA Esophagospasm
- It is an esophageal motility disorder involving the smooth muscle layer of the esophagus (in the absence of other explanations like cancer or fibrosis)
- Achalasia is characterized by a difficulty in swallowing, regurgitation and in some cases chest pain
What is the triad of achalasia?
1) Esophageal aperistalsis (inability of the smooth muscle to move food down the esophagus)
2) Incomplete relaxation of the lower esophageal sphincter
3) Increased Lower esophageal sphincter tone
What are the types of achalsia?
1) Mostly Primary (idiopathic cause)
2) Secondary achalasia in (Chagas disease “kissing bug” bl bed, Diabetic autonomic neuropathy, infiltrative disorders like malignancy, amyloidosis or sarcoidosis)
What is meant by hiatal hernia?
It is the protrusion of the stomach into the thorax due to a defect in the diaphragmatic crura (either the esophageal hiatus is too big or the muscle is too weak)
What are the major types of hiatal hernia?
- In all cases the stomach is above the diaphragm
1) Sliding
- The gastroesophageal junction slides with the stomach above the diaphragm (it is the most common one
2) Paraesophageal
- Only the fundus of the stomach is above the diaphragm
3) Mixed
4) Short esophagus
What are the associated factors with hiatal hernia?
- It increases with age
- Associated with ulceration, bleeding, perforation, strangulation
What is meant by esophageal diverticulum?
- It is an outpouching of the mucosa through the muscular layer of the esophagus
What are the types of esophageal diverticulum?
1) True (the four layers)
2) False diverticulum (the mucosa and submucosa layers)
What are the different locations of esophageal diverticulum?
1) Zenker (high): Posterior outpocketing of the mucosa and submucosa (psudo-diverticulum) through the cricopharyngeal muscle (due to its relaxation and contraction), resulting in an incoordination between the pharyngeal propulsion and cricopharyngeal relaxation (associated with bad breath, and regurgitation of the food)
2) Traction (Mid): Traction (pushing and pulling part of the esophagus) from the mediastinal inflammation
3) Epiphrenic “as it is close to the diaphragm” (Low): due to motor dysfunction (like achalasia, diffuse esophageal spasm)
What is meant by laceration?
- Longitudinal mucosal tears in the lower esophagus
- It is associated with vomiting but not in a normal person as their gastroesophageal muscles relaxes but in alcoholic or prolonged vomiting this muscle relaxation mechanism fails to occur and thus laceration will happen Mallory-Weiss tears
- If the gastroesophageal muscles fails to relax the esophageal wall will tear and patients might present with hematemesis
What are the most vulnerable GIT site to develop varices?
In the junction between the systemic and portal circulation (esophageal, umbilical and hemorroids)
- Any increase in the portal pressure would lead to varices (liver cirrhosis, hepatitis C and B can all increase the portal pressure)
- Massive, sudden, fatal hemorrhage is the most feared consequence
- Varices can be detected using angiography (dilated veins lying within the submucosa of the distal esophagus and proximal stomach)
What is esophagitis?
Inflammation of the esophagus (made of stratified squamous mucosa)
