GASTRO- INTESTINAL PATHOLOGY

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GASTRO-INTESTINAL PATHOLOGY
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ESOPHAGUS

• Location posterior mediastinum
• Distensible muscular tube
• 23-25 cm in length
• Upper esophageal sphincter lower esophageal
  sphincter
• Mucosa, submucosa, muscularis propria
• Transports food liquids from pharynx to stomach

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ESOPHAGUS CONGENITAL ANOMALIES
CONSTRICTIONS

• Atresia noncanalized segment of esophagus

• Fistula connection between esophagus trachea

• Hazards
• aspiration, pneumonia suffocation

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ESOPHAGUS CONGENITAL ANOMALIES
CONSTRICTIONS

• Webs Rings Main Sx dysphagia
• Uncommon, mid age women of unknown etiology
• Ledge- like mucosal protrusions

• Schatzkis rings
• Lower gastro-esophageal junction narrowings

• Webs
• Upper esophageal mucosal narrowings
• Plummer-Vinson/ Paterson- Brown-Kelly synd
  Perimenopausal female anemia glossitis? ?
  risk esophageal ca

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MC acquired (MCC GE reflux, chemical injury,
scleroderma, radiation injury)
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ACHALASIA

• Aperistalsis, failure of relaxation of LES inc
  resting tone of LES ? dysphagia, regurgitation,
  esophageal dilatation
• Predisposes to
• Aspiration pneumonia
• Candida esophagitis
• Diverticula
• Ca ( 5)
• MC is primary (neuronal degeneration) in young
  adults, remains for life

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ACHALASIA

• 2o achalasia
• Chagas dse (T. cruzi)
• Lesions of vagal motor nuclei
• Diabetic autonomic neuropathy
• Infiltrative disorders
• Morphology progressive esophageal dilatation
  above LES, diminished myenteric ganglia

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HIATAL HERNIA

• Upward protrusion of part of stomach through
  diaphragmatic (esophageal) hiatus
• Clinically
• Affects up to 20 of adults
• lt10 symptomatic

• Complications
• Reflux esophagitis
• Ulceration
• Bleeding
• Perforation

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HIATAL HERNIA patterns

• Sliding hiatal (gt90) px stomach slides through a
  widened hiatus

• Rolling/ paraesophageal (lt10) part of stomach
  (fundus) herniates alongside esophagus into
  thorax, vulnerable to strangulation, may be
  caused by previous sx

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MALLORY-WEISS SYNDROME

• Lacerations at GE junction
• 2o episode of excessive vomiting spasm of LES
• MC in alcoholics
• Clinical 5-10 of UGI bleeding
• Mallory-Weiss tears? hematemesis
• Morphology irregular longitudinal tear in EG
  junction. May involve only mucosa, or may rarely
  penetrate wall
• Tear penetrates all layers (Boerhaaves synd)?
  mediastinitis or peritonitis

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ESOPHAGEAL VARICES

• Collateral bypass channels in lower part of
  esophagus between branches of left gastric vein
  azygos veins
• Seen in long-standing portal HPN (alcoholic
  cirrhosis- 90)
• Morphology Tortuous, dilated veins w/in
  submucosa of lower esophagus, raising the mucosa
  tend to rupture

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ESOPHAGEAL VARICES

• Clinically
• Asymptomatic until rupture ? catastrophic
  bleeding (hematemesis melena)
• Rarely subsides spontaneously
• 40-50 fatality rate for each episode of bleeding
• 90 chance of recurrence in survivors

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ESOPHAGITIS

• Incidence 5 adults (US), 80 (Iran)
• Predisposing Factors
• Reflux of gastric contents (reflux esophagitis)
• Infections (immunosuppressed patients)
• Ingestion of irritants alcohol, hot tea, smoking
• Uremia
• Ca chemotx, Radiotx
• Prolonged gastric intubation
• Systemic desquamative disorders pemphigoid
• GVH dse

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REFLUX ESOPHAGITIS

• Clinical Features
• 24 hr pH studies
• pH lt4 gt 4.5 of the time
• Predisposing factors
• ?LES tone, hiatal hernia
• Heartburn regurgitation
• Hematemesis or melena
• Strictures ? dysphagia
• Barretts esophagus

• Morphology
• Hyperplasia
• Elongation of papillae
• Intraepithelial eos
• Ulceration hge in severe cases

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BARRETTS ESOPHAGUS

• Squamous ep replaced by columnar ep w/ intestinal
  metaplasia (goblet cells)
• Long- segment Barretts esophagus gt2cm segment?
  30- 40 fold inc risk of adenoca
• Short- segment Barretts esophagus lt2cm segment
  ? some inc risk of adenoca
• Columnar ep w/o goblet cells columnar lined
  esophagus w/o intestinal metaplasia ?
  significance ?

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BARRETTS ESOPHAGUS

• Pathogenesis
• Long-standing GERD ? damage to the squamous ep ?
  repair ? proliferation of pleuripotent basal
  cells ? differentiate into gastric type ep
  (mucus-secreting cells) ? mutations ? intestinal
  metaplasia

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ESOPHAGEAL ADENOCARCINOMA

• 50 of esophageal Ca (USA)
• Clinically
• arise in Barretts patients w/ long standing GE
  reflux dse (GERD)
• dysphagia, wt loss, bleeding
• overall 5-year survival is 15
• Mostly in distal 1/3 of esophagus
• Gross polypoid, ulcerative or infiltrative
• Histologic types tubular (intestinal), signet
  ring cell

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SQUAMOUS CELL CARCINOMA

• MgtF, gt50 y/o, highest incidence in Asia, 90 of
  esoph Ca worlwide
• Related to
• cigarette smoking
• Alcohol
• Nitrosamines
• fungus contaminated foods
• nutritional deficiencies
• HPV

• Upper 1/3- 20
• Middle 1/3- 50
• Lower 1/3- 30

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SQUAMOUS CELL CARCINOMA

• Mode of Spread
• Local- into mediastinal structures
• Submucosal lymphatics to nearby LN
• Insidious onset
• Dysphagia
• weight loss
• Hemorrhage
• TE fistula
• Overall 5-yr survival 5
• Pathologic staging - best indicator of prognosis
  for esophageal ca

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