Esophagus

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Esophagus

• Tracheoesophageal fistula
• Newborn copious saliva
• choking, coughing
• cyanosis on food intake
• Most common form lower part of esophagus joins
  the trachea (near the bifurcation)

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Esophageal diverticula

• Outpocketing of the esophageal wall
• False( pulsion) type the mucosa herniates into
  the muscular layer
• True (traction) type outpocketing of all the
  layers
• 3 common locations
• 1. above UES (Zenker diverticulum)
• 2. midpoint of the esophagus
• 3. above LES (Epiphrenic diverticulum)

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Zenkers diverticulum
Epiphrenic diverticulum
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Gastroesophageal reflux

• Reflux of gastric contents into the esophagus
• Heartburn, substernal pain, burning sensation
• Predisposing factors alcohol, smoking, pregnancy
• May lead to esophagitis, strictures, Barrett
  esophagus

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Barrett esophagus

• Normal epithelium squamous type
• Barrett becomes columnar with many Goblet cells
• Precursor for adenocarcinoma of the esophagus

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Barrett esophagus
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Barrett esophagus
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Cancer of the esophagus

• Most frequent type squamous cell carcinoma
• Dysphagia, weight loss, anorexia
• Upper and middle thirds of the esophagus
• Adenocarcinoma type lower third of the esophagus

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Cancer of the esophagus
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Congenital pyloric stenosis

• Hypertrophy of the circular muscle layer of the
  pylorus
• Projectile vomiting in 1st 2 weeks of life
• Palpable mass

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Gastritis

• Acute gastritis
• Causes
• NSAIDS
• smoking
• alcholic drinks
• burns
• Curlings ulcer
• Cushings ulcer

• Chronic gastritis
• Chronic inflammation, atrophy of the mucosa
• Helicobacter pylori gastritis most common form
• Increases risk of gastric cancer

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Acute Gastritis
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Peptic ulcers

• Common locations
• lesser curvature
• antrum
• prepyloric areas
• Causes H.pylori infection
• bile-induced gastritis
• Not a precursor lesion of carcinoma of the stomach

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Benign Gastric Ulcers
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Cancer of the Stomach

• Common more than 50 years old, men, Blood group
  A
• Predisposing factors
• H. pylori infection
• Nitrosamines
• excessive salt intake
• low fresh fruits, vegetables diet
• achlorhydia
• chronic gastritis

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Cancer of the stomach

• Most common type adenocarcinoma
• Rare in the fundus
• Aggressive spread to adjacent organs
• Virchow node large supraclavicular node
• Krukenberg tumors bilateral, enlarged ovaries,
  signet ring cells
• Two types
• 1. intestinal type fungating mass ulcer with
  irregular necrotic base and firm, raised margins
• 2. infiltrating or diffuse type linitis plastica

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Cancer of the stomach
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Krukenberg tumors
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Signet ring cells
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Small Intestine
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Peptic ulcer of the Small intestine

• Always associated with increased secretion of
  gastric acid and pepsin
• High risk in H. pylori infection
• Other predisposing factors
• aspirin, NSAIDS
• smoking
• Zollinger-Ellison syndrome gastrin-secreting
  tumor of the pancreas
• primary hyperparathyroidism
• Not a precursor of malignancy

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Crohn disease

• Chronic inflammatory disease of ALL the layers of
  the intestinal wall with thickening narrow lumen
• 20 30 year old, Jewish descent
• Small intestine and colon
• May lead to carcinoma
• Skip lesions
• Cobblestone appearance
• Fistulas
• Noncaseating granulomas

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Crohns disease

• Presents as
• abdominal pain
• diarrhea
• fever
• malabsorption
• obstruction
• fistula to bladder, vagina, skin

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Crohns disease
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Meckels diverticulum

• Most common congenital abnormality of the small
  intestine
• Remnant of the vitelline duct in the distal small
  bowel
• Peptic ulceration, bleeding, perforation
• Intussusception
• volvulus

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Celiac disease

• Malabsorption disease
• Sensitivity to gluten products
• Blunting of the intestinal villi
• Diarrheabulky, frothy, foul-smelling
• Weight loss, failure to thrive, weakness
• Treatment gluten-free diet

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Cancer of the small intestine

• Mostly adenocarcinoma
• Appendix carcinoid type when it metastasizes to
  the liver ? carcinoid syndrome
• Flushed skin
• Watery diarrhea, abdominal cramps
• Bronchospasm
• Valvular lesions of the heart

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Colon
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Ulcerative colitis

• Ulcers in the large intestine or entire colon
• Pseudopolyps
• Crypt abscesses
• Chronic diarrhea
• Most frequent presentation rectal bleeding
• Complications
• Toxic megacolon
• Colon perforation
• Colon cancer

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Colon Polyps

• Elevation of he intestinal surface
• Peutz-Jeghers polyps polyps in the colon dark
  spots on lips, hands, genitalia
• Villous adenomas highest potential of the
  adenomatous polyps to become malignant
• Familial polyposis malignant changes in 100 of
  cases

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Adenocarcinoma of the colon

• 60 to 70 years old
• Cancer marker CEA
• Predisposing factors
• adenomatous polyps
• familial polypposis
• 4x higher in relatives with colon cancer
• low fiber, high animal fat diet
• Cancer of the rectosigmoid annular enlargement
  obstruction
• Cancer of the right colon late obstruction
  chronic blood loss iron deficiency anemia