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GI Pathology Outline
Esophagus Stomach Intestine Liver Gallbladder
Pancreas
GI Pathology Outline
Esophagus Hiatal hernia Mallory-Weiss syndrome Barrett esophagus Carcinoma
Hiatal Hernia
above diaphragm
Common! Usually asymptomatic.
Heartburn, reflux esophagitis Danger: ulceration, bleeding
Mallory-Weiss Syndrome
GE junction tears Severe vomiting (chronic alcoholics)
Mallory-Weiss tears
Mallory-Weiss tears
Barrett Esophagus
Barrett esophagus
Barrett esophagus
Esophageal Carcinoma
Adenocarcinoma
Commonest type in US Risk factor: Barrett
esophagus
Distal 1/3 of esophagus Symptoms: insidious onset;
late obstruction
late obstruction
Adenocarcinoma of esophagus
GI Pathology Outline
Esophagus Stomach Gastritis Ulcers Carcinoma
Gastritis
Chronic mucosal inflammation Symptoms: asymptomatic, or discomfort Cause: Helicobacter pylori, autoimmune gastritis Danger: intestinal metaplasia
Chronic gastritis
Chronic gastritis
Asymptomatic gastritis
Carcinoma Lymphoma
Gastritis
Acute mucosal inflammation (usually transitory)
Causes include: NSAIDS, alcohol, smoking Superficial or full-thickness Can lead to erosions Asymptomatic or pain, vomiting, hematemesis
Ulcer
Erosion of mucosa into submucosa Causes: H. pylori, NSAIDs Symptoms: epigastric pain Danger: bleeding, perforation
Inflammatory cells
release toxins but cant kill bugs easily
Ulcer
Gastric Carcinoma
Intestinal type
Arises in intestinal
metaplasia
Diffuse type
Arises from gastric glands Risk factors undefined
Glandular morphology
Generally asymptomatic
GI Pathology Outline
Esophagus Stomach Intestine Diverticulosis Inflammatory bowel disease Carcinoma
Diverticulosis
Mucosa/submucosa herniates through
muscle wall
Older patients, low fiber diet Sigmoid colon Asymptomatic unless infected
(diverticulitis)
Diverticulosis
Diverticulosis
Ulcerative Colitis
Colon only Continuous Superficial Good response to surgery
Crohn disease
Ulcerative colitis
Adenoma
Colon Carcinoma
Almost always arises in adenomatous polyp
Diet: low fiber, high fat, lots of refined carbs Symptoms: silent for years fatigue, weakness, iron-deficiency anemia
Colon carcinoma
Colon carcinoma
GI Pathology Outline
Esophagus Stomach Intestine
Liver
Hepatitis Alcoholic liver disease
Hemochromatosis
Wilson disease Carcinoma
Viral Hepatitis
Caused by Hepatitis A, B, or C viruses Some cases asymptomatic Some cases symptomatic: Acute (jaundice) Chronic (may lead to cirrhosis and liver failure)
A - picornavirus
B - hepadnavirus C - flavivirus D - defective virus E - calcivirus
Physically
Handicapped Fellow Died Cycling
Hepatitis A Transmission Chronic Hepatitis Fulminant hepatitis Carcinoma Other stuff Bottom line Fecal-oral None
Hepatitis B Parenteral 5%
0.1%
No 50% of people > 50 are + Benign, selflimited disease
0.1-1.0%
Yes
Rare
Yes
Most common Vaccine reason for liver effective transplant Most recover; Nasty! Almost small % die 10% die
Hepatitis B outcomes
Hepatitis C outcomes
Jaundice
Yellow skin, eyes due to elevated bilirubin Conjugated hyperbilirubinemia liver excretion (hepatitis) bile flow (tumor blocking bile duct)
Unconjugated hyperbilirubinemia
production (hemolytic anemia) uptake (hepatitis)
Jaundice
Laboratory Tests
Serum aspartate aminotransferase (AST)
Hepatocyte integrity
Serum alanine aminotransferase (ALT) Serum bilirubin (total and direct)
Biliary function
Serum alkaline phosphatase Serum albumin
Hepatocyte function
Prothrombin time
Cirrhosis
Fibrotic, nodular liver Causes: alcoholism, hepatitis Leads to portal hypertension and liver failure Increased risk of liver carcinoma
Cirrhosis
Cirrhosis
Portal Hypertension
Decreased blood flow through liver Biggest cause: cirrhosis Symptoms ascites
Esophageal varices
Caput medusae
Liver Failure
End point of severe liver disease
drug overdose
Symptoms: jaundice, edema, bleeding,
hyperammonemia
Multiple organ-system failure Hepatic encephalopathy Hepatorenal syndrome
Hematomas, gingival bleeding Jaundiced mucosa Glossitis (in alcoholic hepatitis) Reduced healing after surgery
Alcoholic steatosis
Alcoholic cirrhosis
Liver failure
Massive GI bleed Infection
Hepatorenal syndrome
Hepatocellular carcinoma
Hereditary hemochromatosis
Autosomal recessive disease: body iron Cause: mutations in hemochromatosis gene
Wilson Disease
Autosomal recessive disease: body copper
Cause: mutation in gene regulating copper
excretion
Symptoms: acute and chronic liver disease,
Kayser-Fleischer Rings
Hepatocellular Carcinoma
Strongly associated with hepatitis B and C,
Hepatocellular carcinoma
Hepatocellular carcinoma
Metastatic Carcinoma
Most common malignancy in the liver Usually multiple lesions Most common primaries: colon, lung,
Metastatic carcinoma
GI Pathology Outline
Esophagus Stomach Intestine
Liver
Gallbladder Cholelithiasis
Cholecystitis
Cholelithiasis
Common! (10% of adults in US)
Cholesterol stones: Female, Fat, Fertile, Forty Pigment (bilirubin) stones: Asian countries,
Cholesterol gallstones
Pigmented gallstones
GI Pathology Outline
Esophagus Stomach Intestine
Liver
Gallbladder Pancreas
Pancreatitis
Carcinoma
Normal Pancreas
Exocrine pancreas Makes enzymes for digestion Diseases: Pancreatitis, cystic fibrosis, tumors Endocrine pancreas Makes insulin, glucagon, other hormones Diseases: Diabetes, tumors
Acute Pancreatitis
Acute inflammation and reversible destruction
of pancreas
Symptoms: abdominal pain radiating to back Main causes: alcoholism, gallstones
Obstruction (gallstones)
Chronic Pancreatitis
Longstanding, irreversible pancreatic destruction Most are alcohol related, some idiopathic Symptoms: silent, or bouts of jaundice and pain Prognosis: poor (50% mortality over 20 years)
Pancreatic Carcinoma
Highly invasive
Silent until late; then pain, jaundice Very high mortality: 5ys <5%
Pancreatic carcinoma
Pancreatic carcinoma