GI 2 Upper GI Pathology PDF

GENERAL PATHOLOGY Upper GI pathology Dr. Antonio Barrasa  Intended learning objectives To introduce to the clinical presentation of the patient with diseases of the upper gastrointestinal system – Characterization of the upper GI system – Generalities of t...

GENERAL PATHOLOGY Upper GI pathology Dr. Antonio Barrasa  Intended learning objectives To introduce to the clinical presentation of the patient with diseases of the upper gastrointestinal system – Characterization of the upper GI system – Generalities of the mouth pathology – Introduction to diseases of the esophagus – Introduction to gastric diseases – Introduction to duodenal disturbances Dr. Antonio Barrasa  Upper GI system Duodenoyeyunal flexure (Ángulo de Treitz) – Suspensory muscle of the duodenum (Treitz ligament) duodenum blocked by sup mesenteric artery Dr. Antonio Barrasa  Upper GI system Clinical manifestations – Bleeding – Obstruction: Vomits without distention – Acid and bile Diagnostic implications – Within reach of upper GI endoscopy Along with ERCP and ultrasonography Dr. Antonio Barrasa  Mouth Inflammations – Gingivitis and dental caries, glossitis, tonsilitis, pharyngitis, parotiditis, – Infections, radiations, autoimmune diseases Motor impairment – Chewing impairment, dysphagia – Neuropathies, myopathies, collagenopathies Salivation disturbances – Inflammations, obstructions, tumors Neoplasms – Epidermoid carcinoma, lymphoma, Kaposi’s AIDS Dr. Antonio Barrasa  Esophagous Inflammations (esophagitis) – Infections, radiations, autoimmune diseases Motor impairment – Neuropathies, myopathies, collagenopathies Neoplasms – Epidermoid carcinoma, adenocarcinoma, lymphoma Anatomical alterations – Tumors - Fistula - Perforation – Cysts - Atresia UPPER AND LOWER PART DOESN't connect Dr. Antonio Barrasa  Dysphagia Oropharyngeal tube narrow – Movement dyscoordination – Difficult initiation of swallowing – Choking and aspiration Esophageal – Esophageal stenosis – Initially for solids progresses to affect intake of fluids – Food sticking and regurgitation Dr. Antonio Barrasa Esophago-gastric junction Achalasia GERD Hiatal Hernia not reflux ! Cancer Dr. Antonio Barrasa  Achalasia Reduction of ganglionic cell in LES – Hypertonic LES – Progressive dysphagia – Esophageal dilatation – Diagnosis Manometry Biopsy – Treatment Dilatation Esphincterotomy Dr. Antonio Barrasa  GERD Return of gastric contents to esophagus – Hypotonic LES – Causes heartburn, regurgitation & unspecific symptoms – Esophagitis & Barrett’s esophagus – Diagnosis phmetry Endoscopy – Treatment PPI, diet Fundoplication Dr. Antonio Barrasa  Hiatal hernia Passage of abdominal contents through the esophageal hiatus of the diaphragm – May cause GERD – Sliding, paraesophagic & mixed – Diagnosis GI transit Endoscopy – Treatment PPI, diet Fundoplication Dr. Antonio Barrasa  Cancer Neoplasms may arise in the esophagus or stomach – Epidermoid carcinoma & adenocarcinoma – Obstruction symptoms – Weight loss and distant disease – Diagnosis Endoscopy – Treatment Surgery, ChT, RT Paliation Dr. Antonio Barrasa  Stomach Inflammations (gastritis) – Chronic, acute or specific Motor impairment – Gastroparesis Neoplasms – Adenocarcinoma, GIST, MALT Anatomical alterations – Ulcers – Pyloric obstruction Dr. Antonio Barrasa  Gastroparesis Defective gastric emptying without physical obstruction – Vomiting, early satiation and distention – Primary: Gastric pacemaker dysfunction – Secondary Autonomic nerves dysfunction – Diabetic neuropathy Muscular GI disorders – Amyloidosis, dystrophies, sclerosis Medications – Opiates, calcium antagonists, anticholinergics Dr. Antonio Barrasa  Gastritis prostaglandin : increase inflammation cause mucous production in stomach contraction of uterus and opening of the cervix = causes abortion Acute – NSAIDs corticoids and NSAIDS inhibit mRNA production of CO (no more prostaglandin) / SAID = inhibit CO paracetamol SAIDS but weaker – H. pylori – Alcoholic, infections, drugs (iron), bile, stress Chronic – Autoimmune chronic gastritis Pernicious anemia – Menetrier’s disease inflammatory folding large and huge ac production Specific – Systemic diseases megaloblastic annemia lack of vit B12 like chrohn disease microcytic anemia Dr. Antonio Barrasa  H. pylori Gram negative spiral flagellated bacteria – Adhesion: BabA, SabA – Urease – Toxins: GagA, VacA encorine antigfens = encore to the mucosa production of the mucous by stomach that protect the acidic environment of the stomach Consequences – Acute & chronic gastritis – Hyperchlorhydria/atrophy – Peptic ulcer – Neoplasms Adenocarcinoma, MALT only canceer that can be cured with antibiotics lympoid tissue of mucosa Dr. Antonio Barrasa  Peptic ulcer Ø Duodenal ulcer Ø 6-15% western population Ø More frequent in males Ø 90% located in 1st portion of duodenum Ø Almost ever benign Ø Gastric ulcer Ø Occur later in life (6th decade) Ø More tendency to be asymptomatic Ø Incidence similar to duodenal ulcer Dr. Antonio Barrasa  Peptic ulcer Ø Duodenal ulcer Ø 6-15% western population Ø More frequent in males Ø 90% located in 1st portion of duodenum Ø Almost ever benign Ø Gastric ulcer Ø Occur later in life (6th decade) Ø More tendency to be asymptomatic Ø Incidence similar to duodenal ulcer Dr. Antonio Barrasa  Clinical manifestations Ø Epigastric pain or discomfort Ø May awake the patient Ø Relieved with antacids or food Ø Many asymptomatic (specially NSAID induced) Ø Typical association with spring and autumn Ø Symptoms less defined in gastric ulcers Ø Nausea Ø Weight loss Diagnosis: Endoscopy Dr. Antonio Barrasa  Complications Ø Perforation anterior face of GI Ø 6-7% patients Ø Equally more frequent in NSAID consumers chemical inflammation Ø Leads to peritonitis Ø Penetrations to adjacent organs and fistulas possible Ø Outlet obstruction portal blood = contaminated Ø 1-2% patients due to peripyloric ulcers Ø Initially reversible Ø Vomits and weight loss Ø Bleeding Ø 15% ulcer patients Ø 20% of them ever had symptoms Ø More frequent in NSAID consumers Ø Hematemesis, melena and cardiovascular instability Dr. Antonio Barrasa  Upper GI bleeding Ø The most common GI emergency Ø 50-170 Admissions/100.000 inhabitants/year Ø 10% mortality Ø Sources: Ø Esophagus: Varices due to liver disease Ø Peptic ulcer Ø Hiatal hernia Ø Gastric cancer Ø Vascular malformations Ø Mallory Weis Ø Aorto-duodenal fistula Dr. Antonio Barrasa Upper GI bleeding Ø Hematemesis Ø Melena Ø Hematochezia Ø Cardiovascular compromise Ø Management: Ø Endoscopy Ø Resuscitation Ø Surgery Ø Sengstaken, portal vein hypotensive drugs, TYPS and liver transplantation Dr. Antonio Barrasa Many thanks [email protected] Dr. Antonio Barrasa