Gastric Pathology for Medical Students

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GASTRIC PATHOLOGY
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Achalasia

• Failure to relax the lower esophageal sphincter
  due to loss of mesenteric (Auerbachs) plexus
• Barium swallow show dilated esophagus with distal
  stenosis. (BIRD BEAK)
• Associated with an increase in esophageal
  carcinoma
• Also associated with 2 CHAGAS Disease

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Barrets Esophagus

• GLANDULAR METAPLASIA
• Replacement of the (Normal) Stratified Squamous
  Epithelium of the Esophagus with (Gastric)
  Columnar Epithelium in the Distal Esophagus
• Barrets becomes
• Adenocarcinoma
• Corrosive Esophagitis
• Results from Reflux

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ESOPHAGEAL CANCER

• Achalasia A
• Barretts Esophagus B
• Corrosive Esophagitis C
• Diverticuli D
• Esophageal Web E
• Familial F

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CHRONIC GASTRITIS

• Type A (FUNDAL)
• Autoimmune Disorder characterized by Antibodies
  to parietal cells
• Pernicious Anemia
• Achlorhydria
• Type B (ANTRAL)
• Caused by H.Pylori Infection
• BOTH CAN CAUSE GASTRIC CARCINOMA

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PEPTIC ULCER DISEASE

• GASTRIC
• DUODENAL

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Gastric Ulcer

• Pain Greater with Meals
• 70 H. Pylori
• NSAIDS
• Due to decrease
• mucosal protection
• WEIGHT LOSS

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Duodenal Ulcer

• Pain DECREASE with Meals
• 100 H. Pylori
• Increase ACID
• Due to decrease
• mucosal protection
• HYPERTROPHY OF BRUNNERS GLAND
• WEIGHT GAIN

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H.Pylori Treatment

• TRIPLE THERAPY
• Metrodiazanole
• Bismuth Salicylate
• Amoxicillin or Tetracyclin

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INFLAMMATORY BOWEL DISEASE

• Crohns
• Ulcerative Colitis

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CHROHNs

• Infectious (giant cell, Macrophages)
• May involve any part of GI Tract, usually
  terminal ileum, colon
• Rectal sparing
• Non-caseating granuloma
• Strictures, fistulas, malabsorbtion
• Migratory Polyathritis
• Erythema Nodosum

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Ulcerative Colitis

• Auto Immune
• COLON
• Mucosal Inflammation
• Pseudopolyps
• Crypt Abscesses and Ulcers
• Severe Stenosis
• Toxic megacolon
• COLERECTAL CARCINOMA
• Pyoderma Gangrenosum
• Sclerosing Cholangitis

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Diverticular Disease

• Diverticulum
• Diverticulosis
• Diverticulitis

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Diverticulum

• Blind Pouch off of
• Alimentary Canal
• Most in esophagus,stomach
• Duodenum, colon
• Most have attentuated Muscularis Propia

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Diverticulosis

• Many Diverticuli
• Associated with Low-Fiber Diets
• Population over 60 years approaches near 50

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Diverticulitis

• INFLAMMATION OF DIVERTICULI
• CLASSICAL LLQ PAIN
• Perforation
• Peritonitis
• Abscess formation
• Stenosis

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HIRSCHPRUNGS DISEASE

• Congenital Megacolon
• DILATED
• Absence of PARASYMAPATHETIC GANGLION
• Aurbachs or Meissners Plexus

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COLERECTAL CANCER RISK FACTORS

• Colerectal Villous Adenoma
• Chronic Inflammatory Bowel Disease
• Increasing Age
• Familial Adenomatous Polyps (FAP)
• Hereditary Nonpolyposis Colerectal Cancer (HNPCC)
• SCREEN PATIENTS OVER 50Years with Occult stool

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GASTRIC ULCER
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Acute Appendicitis
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Adenocarcinoma
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Demarcated Acute Gastritis
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Early Karposis in Aids
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Duodenal Lymphoma
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Gross Chrohns Disease
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Perforated Ulcer
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NECROTIZING ESOPHAGITIS
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SEVERAL DIVERTICULUM
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