PATHOLOGY OF THE GIT (PLD 202)

###GIT Physiology

• GIT consists of Mouth, Esophagus, Stomach, Small intestine, and Large intestine (Cecum, Rectum, and Anus)*

###Inflammation of Lips (Chelitis)

• Types of Chelitis:
  • Infective: caused by Virus (Herpes simplex), Bacteria (Staph and Syphilis), and Fungus (Candidia or Monilia)
  • Non-infective: caused by Dribbling of saliva, Vitamin B and iron deficiency

###Stomatitis

• Definition: Inflammation of the mucous membrane of the mouth
• Types of Stomatitis:
  • 1. Aphthous ulcers (commonest)
    • Self-limiting
    • Rounded superficial erosions covered with a gray white exudate having an erythematous rim
    • Less than 1 cm on the floor of the mouth and lateral border of the tongue
    • Causes: stress, fever, certain foods, malnutrition, pregnancy, and Hormonal Imbalance
  • 2. Herpetic stomatitis
    • Caused by HSV1, person-to-person transmission (kissing)
    • Usually asymptomatic, but the virus will persist in ganglia (trigeminal ganglia) in a dormant state
    • Reactivated in case of sun exposure, Respiratory tract infection, etc.
    • Appearance of vesicles (5mm diameter) called cold sores or fever blister
  • 3. Candida albicans (Opportunistic infection)
    • Normal flora (30-40%) of the population
    • Oral candidiasis (thrush or moniliasis) common in Diabetes mellitus, anemia, antibiotic or cortisone, and immunodeficiency
    • Common in children due to immature immunity

###Inflammation of Tongue (Glossitis)

• Acute glossitis: characterized by swollen papillae, occurs in eruptions of measles
• Chronic glossitis: the tongue is red without swollen papillae, seen in malnutrition
• Chronic atrophic glossitis: characterized by a smooth tongue

###Disorders of the Esophagus

• Swallowing disorders:
  • 1. Dysphagia: difficult or painful swallowing, results from narrowing of the esophagus, lack of salivary secretion, and weakness of the muscular structures
  • 2. Achalasia: failure to relax, the lower esophageal sphincter (LES) does not effectively allow food to pass through, may cause dilation above the LES
  • 3. Gastro-esophageal reflux (GER): persistent reflux of gastric content into the esophagus, due to incompetent esophageal sphincter, increase in pressure in the stomach, and common in children due to small capacity of the stomach
• Symptoms: heartburn, and complications include narrowing of the esophagus, and Barrett esophagus

###Stomach Disorders

• 1. Acute gastritis: transient inflammation of the gastric mucosa, severe, nagging pain, and come in short bursts
• 2. Chronic gastritis: long duration, and lymphocytes, plasma cells, macrophages
• 3. Ulcerative disorders: peptic ulcer disease, and stress ulcers (physiologic stress like in illness)
• 4. Cancer of the stomach

###Gastritis Symptoms

• Nausea, vomiting, indigestion, and feeling bloated
• Black stool due to bleeding

###Healthy Gastric Mucosa

• Intact mucosa, mucus production, blood flow to mucosa, and prostaglandin (stimulate secretion of mucous and bicarbonate to protect the stomach from acidic environment)

###Gastritis Pathogenesis

• Increase in acid secretion, decrease in adherent mucous layer, decrease in PGs secretion from the mucosa, and decrease in blood flow

###Causes of Acute Gastritis

• Infective: Salmonellosis, Staphylococcus (food poisoning)
• Non-infective: drugs (NSAIDs, cortisone), decrease in PGs, alcohol, smoking, shock, chemical irritant, and mechanical trauma

###Chronic Gastritis

• Types:
  • Type A: Autoimmune gastritis, affect fundus, less than 10% of chronic gastritis
  • Type B: Helicobacter pylori gastritis, antral gastritis, 90% of patients due to H. pylori

###Peptic Ulcer Disease (PUD)

• Presence of open sores or perforation in the area of the upper GIT (stomach and duodenum) that are exposed to acid
• Causes: H. pylori, long-term use of NSAIDs or aspirin

###Inflammatory Bowel Disease (IBD)

• Definition: chronic inflammation of the intestine
• Includes two disorders:
  • Ulcerative bowel disease:
    • Proctitis (rectum only)
    • Left-side colitis
    • Pancolitis (whole colon)
  • Crohn's disease:
    • Regional, takes certain region in the intestine
    • Deep penetrating (serositis), and skip lesions

###Ulcerative Colitis (UC)

• Definition: chronic non-specific inflammation of the large intestine
• Causes: no specific cause, genetic predisposition, viral, and autoimmune
• Pathology: mucosa appears deeply congested associated with mucopurulent discharge and superficial irregular ulcers
• Symptoms: diarrhea, abdominal bleeding, and rectal bleeding

###Crohn's Disease

• Definition: regional enteritis, non-caseating granuloma of the alimentary tract
• Causes: no specific cause, genetic predisposition, virus or bacteria, and autoimmune
• Site: terminal ileum, right colon, but any part can be affected
• Have skip lesions, linear deep penetrating ulcers, and cobblestone appearance

###GIT Physiology

• GIT consists of Mouth, Esophagus, Stomach, Small intestine, and Large intestine (Cecum, Rectum, and Anus)*

###Inflammation of Lips (Chelitis)

• Types of Chelitis:
  • Infective: caused by Virus (Herpes simplex), Bacteria (Staph and Syphilis), and Fungus (Candidia or Monilia)
  • Non-infective: caused by Dribbling of saliva, Vitamin B and iron deficiency

###Stomatitis

• Definition: Inflammation of the mucous membrane of the mouth
• Types of Stomatitis:
  • 1. Aphthous ulcers (commonest)
    • Self-limiting
    • Rounded superficial erosions covered with a gray white exudate having an erythematous rim
    • Less than 1 cm on the floor of the mouth and lateral border of the tongue
    • Causes: stress, fever, certain foods, malnutrition, pregnancy, and Hormonal Imbalance
  • 2. Herpetic stomatitis
    • Caused by HSV1, person-to-person transmission (kissing)
    • Usually asymptomatic, but the virus will persist in ganglia (trigeminal ganglia) in a dormant state
    • Reactivated in case of sun exposure, Respiratory tract infection, etc.
    • Appearance of vesicles (5mm diameter) called cold sores or fever blister
  • 3. Candida albicans (Opportunistic infection)
    • Normal flora (30-40%) of the population
    • Oral candidiasis (thrush or moniliasis) common in Diabetes mellitus, anemia, antibiotic or cortisone, and immunodeficiency
    • Common in children due to immature immunity

###Inflammation of Tongue (Glossitis)

• Acute glossitis: characterized by swollen papillae, occurs in eruptions of measles
• Chronic glossitis: the tongue is red without swollen papillae, seen in malnutrition
• Chronic atrophic glossitis: characterized by a smooth tongue

###Disorders of the Esophagus

• Swallowing disorders:
  • 1. Dysphagia: difficult or painful swallowing, results from narrowing of the esophagus, lack of salivary secretion, and weakness of the muscular structures
  • 2. Achalasia: failure to relax, the lower esophageal sphincter (LES) does not effectively allow food to pass through, may cause dilation above the LES
  • 3. Gastro-esophageal reflux (GER): persistent reflux of gastric content into the esophagus, due to incompetent esophageal sphincter, increase in pressure in the stomach, and common in children due to small capacity of the stomach
• Symptoms: heartburn, and complications include narrowing of the esophagus, and Barrett esophagus

###Stomach Disorders

• 1. Acute gastritis: transient inflammation of the gastric mucosa, severe, nagging pain, and come in short bursts
• 2. Chronic gastritis: long duration, and lymphocytes, plasma cells, macrophages
• 3. Ulcerative disorders: peptic ulcer disease, and stress ulcers (physiologic stress like in illness)
• 4. Cancer of the stomach

###Gastritis Symptoms

• Nausea, vomiting, indigestion, and feeling bloated
• Black stool due to bleeding

###Healthy Gastric Mucosa

• Intact mucosa, mucus production, blood flow to mucosa, and prostaglandin (stimulate secretion of mucous and bicarbonate to protect the stomach from acidic environment)

###Gastritis Pathogenesis

• Increase in acid secretion, decrease in adherent mucous layer, decrease in PGs secretion from the mucosa, and decrease in blood flow

###Causes of Acute Gastritis

• Infective: Salmonellosis, Staphylococcus (food poisoning)
• Non-infective: drugs (NSAIDs, cortisone), decrease in PGs, alcohol, smoking, shock, chemical irritant, and mechanical trauma

###Chronic Gastritis

• Types:
  • Type A: Autoimmune gastritis, affect fundus, less than 10% of chronic gastritis
  • Type B: Helicobacter pylori gastritis, antral gastritis, 90% of patients due to H. pylori

###Peptic Ulcer Disease (PUD)

• Presence of open sores or perforation in the area of the upper GIT (stomach and duodenum) that are exposed to acid
• Causes: H. pylori, long-term use of NSAIDs or aspirin

###Inflammatory Bowel Disease (IBD)

• Definition: chronic inflammation of the intestine
• Includes two disorders:
  • Ulcerative bowel disease:
    • Proctitis (rectum only)
    • Left-side colitis
    • Pancolitis (whole colon)
  • Crohn's disease:
    • Regional, takes certain region in the intestine
    • Deep penetrating (serositis), and skip lesions

###Ulcerative Colitis (UC)

• Definition: chronic non-specific inflammation of the large intestine
• Causes: no specific cause, genetic predisposition, viral, and autoimmune
• Pathology: mucosa appears deeply congested associated with mucopurulent discharge and superficial irregular ulcers
• Symptoms: diarrhea, abdominal bleeding, and rectal bleeding

###Crohn's Disease

• Definition: regional enteritis, non-caseating granuloma of the alimentary tract
• Causes: no specific cause, genetic predisposition, virus or bacteria, and autoimmune
• Site: terminal ileum, right colon, but any part can be affected
• Have skip lesions, linear deep penetrating ulcers, and cobblestone appearance