Upper Gastrointestinal Tract Flashcards
Most common tracheoesophageal fistula
Type C
bands of normal esophageal tissue that form constrictions around the inside of the lower esophagus
rings
arise in the upper esophagus as thin layers of cells that grow across the inside of the esophagus
webs
Symptoms associated with rings and webs congenital disorders
- generally asymptomatic
- dysphagia (difficult, painless swallowing of solid food)
- odynophagia (acid reflux)
- Esophageal webs
- Oropharyngeal mucosal lesions
- Severe iron-deficiency anemia
- Oropharyngeal cancer
Plummer-Vinson Syndrome
An outpouching of the wall that contains all layers of the esophagus
true diverticulum
When the sac lacks muscular layer, it is referred to as a
false diverticulum or pseudodiverticulum
- Occur close to upper and lower esophageal sphincters, and in midportion of esophagus
- Complications: regurgitation of undigested food, halitosis, cough, and even aspiration pneumonia
Esophageal Diverticula
- Rare disorder. Failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing. No peristalsis in the body of the esophagus
- Cause: associated with loss or absence of ganglion cells in the mesenteric plexus.
- Common in Chagas disease: parasitic infection with protozoa Trypanosoma cruzi; ganglion cells are affected.
- Food is retained within esophagus. Esophageal hypertrophy. Dysphagia; regurgitation.
Achalasia
a group of diseases that causes abnormal growth of connective tissue. Cause unknown. Mainly women.
scleroderma
Two main types of scleroderma
Localized scleroderma affects only the skin.
Systemic scleroderma affects blood vessels and internal organs, as well as skin.
Fibrotic smooth muscle mainly affecting lower esophageal sphincter. Impaired peristalsis. This occurs most often in the esophagus, but may also be seen elsewhere in the GI tract.
Complications: dysphagia; heartburn caused by peptic esophagitis due to acid reflux from the stomach.
Scleroderma - progressive systemic sclerosis
Portion of upper stomach bulges through an enlarged esophageal hiatus in the diaphragm
Hiatal Hernia
Two types of Hiatal Hernia
Sliding Hernia: Common, mostly asymptomatic. Cap of gastric mucosa moves upward above the diaphragm.
Paraesophageal Hernia: Uncommon. Herniation of part of gastric fundus alongside the esophagus.
Large ______ can allow food and acid to back up into esophagus (gastroesophageal reflux, regurgitation), leading to heartburn and chest pain. Dysphagia, odynophagia
hiatal hernia
Any inflammation, irritation, or swelling of the esophagus
Esophagitis
Most common type of esophagitis
Reflux Esophagitis
Main barrier to gastroesophageal reflux (GER) is the ______
lower esophageal sphincter (LES)
What causes decrease in pressure of LES
Alcohol, cigarette smoking, fatty foods, chocolate, pregnancy, estrogen tx, certain meds
Superficial mucosal erosions and ulcers. Vertical line streaks.
Reactive proliferation of the lamina propria papillae into basal squamous epithelium which is thickened
Hyperemia; dilated capillary vessels. Increased inflammatory cells in submucosa
Reflux Esophagitis
Chronic esophagitis may result in _____ where fibrosis can narrow lumen
esophageal stricture/stenosis
Metaplastic changes to “specialized epithelium” secondary to chronic gastroesophageal reflux:
Esophageal squamous epithelium is replaced by columnar epithelium
Commonly in lower third of esophagus
Alcohol and tobacco are primary causes
Barret Esophagus
Metaplastic epithelium of a Barrett esophagus carries a risk of malignant transformation to an _____
adenocarcinoma
Immunosuppressed subjects:
AIDS
Meds for organ transplantation
Diabetes
Cancer chemotherapy
Antibiotic therapy
Dysphagia/odynophagia
Candida Esophagus
Infection with HSV I
Associated with lymphomas and leukemias
It may occur in otherwise healthy subjects
Herpetic Esophagitis
Pathogenesis:
Cigarette smoking: association with esophageal dysplasia
Excessive alcohol consumption
Plummer-Vinson syndrome; achalasia
Chronic esophagitis
Webs, rings, and diverticula
Diets low in fruits, vegetables, animal protein, trace metals
Esophageal Carcinoma
Types of Esophageal Carcinoma
Ulcerating: possible bleeding
Polypoid: early obstruction of lumen
Infiltrating: gradually narrow lumen
Account for ~ 60% of the malignant esophageal tumors in USA
esophageal adenocarcinoma
All adenocarcinomas arise from ______
Barrett epithelium
Muscular, sac-like organ that
connects the esophagus and
small intestine
stomach
The most distal and narrow section of the stomach is termed the ______ - as food is liquefied in the stomach it passes
through the _____ into the small intestine
pylorus; pyloric canal
Gastric mucosa erosions that can lead to sharp punched-out ulcers and bleeding. Acute inflammatory response.
Widespread petechial hemorrhages in any part of stomach (1-25 mm).
Symptoms: vague abdominal discomfort to massive, life-threatening bleeding and mucosal perforation.
Acute Hemorrhagic Gastritis
associated with a severe, acute illness, or trauma. The following increase your risk of acute gastritis:
Nonsteroidal anti-inflammatory drug use (NSAIDs)
Heavy alcohol use
Major surgery
Severe stress: Curling ulcers (deep) in severely burned pts.
CNS trauma: Cushing ulcers (deep)
Common factor: breakdown of mucosal barrier, which permits acid-induced injury
Acute Hemorrhagic Gastritis
Most common type of chronic gastritis in the USA.
Strong association with peptic ulcer disease
Helicobacter pylori Gastritis
Prevalence of infection with H. pylori increases with ____
age
Focal, chronic ulcers that occur in any portion of the gastrointestinal tract exposed to the aggressive action of gastric secretions
Peptic Ulcer Disease
Where do peptic ulcers occurs in order from most frequent to least frequent
Proximal duodenum
Distal stomach
gastroesophageal junction
Diet: little evidence supports role of food, alcohol, coffee.
Cigarette smoking: a definite risk factor,
Drugs: aspirin, other NSAIDs, and analgesics
Peptic Ulcers
First-degree relatives of people with peptic ulcers: ______ risk
3X
Risk of duodenal ulcer is ______% higher in people with type O blood
30
High circulating levels of pepsinogen I: _____ risk for duodenal ulcer
5X
Formation and persistence of peptic ulcers in the stomach and duodenum require ______ secretion.
HCl
Most common serious complication in up to 20% of pts. May manifest as anemia or occult blood in stools.
hemorrhage
Occurs in ~5% pts. In one third there is no symptoms of peptic ulcer. Most common in duodenal ulcers. High mortality rate.
perforation
Association with severe diseases:
Cirrhosis: 10X risk than in normal subjects
Chronic Renal Failure
Hereditary Endocrine Syndromes (Multiple endocrine neoplasia syndrome, type I)
Chronic Pulmonary Disease
Peptic Ulcers
Derived from pacemaker cells of Cajal in muscular tissue of the GI tract. Overexpression of c-kit oncogene encodes a tyrosine kinase that promotes cell proliferation. Nonagressive.
Gastrointestinal stromal tumors (GIST)
Hyperplastic: most common gastric polyps. Seen in pts with chronic gastritis. No malignant potential.
Adenomatous: usually solitary. Glands lined with dysplastic epithelium. Potential for adenocarcinomas.
Fundic gland polyps: No malignant potential
Epithelial polyps
Depth of invasion: limited to mucosa or submucosa
May have a more benign course, better prognosis
Metastasis to regional lymph nodes
Distant metastasis: the most common is to a supraclavicular node called Virchow node
Early Gastric Cancer
3 types of advanced gastric cancer
Polypoid (fungating): 33% of adeno CA. Solid mass projects into lumen.
Ulcerating: 33% of adeno CA. Shallow ulcers with irregular, raised, firm margins and ragged base (in contrast to benign peptic ulcer).
Diffuse infiltrating: 10% of adeno CA. No true tumor mass is seen. Wall of stomach is thickened and firm (“leather-bottle-like” lesion). When all stomach is compromised is called linitis plastica
