Patologi Manusia Dasar

GANGGUAN SALURAN
CERNA BAGIAN ATAS
M. Hafidz MS, dr.

Saluran Cerna Bagian Atas

(Upper GI Tract)

Dari mulutorofaringlaringofaringesofagus-gasterduodenum
Batas Saluran
Cerna Atas-Bawah:
Lig. Treitz (pada
flexura
duodenojejunalis)

Oral Cavity

Caries
Gingivitis
Periodontitis
Aphthous ulcers
Oral herpes
Candidiasis
Leukoplakia
metaplasia
cells produce keratin
associated with tobacco

use

Squamous cell
carcinoma

Oral Inflammations and

Infections

Gingivitis
Oral candidiasis (thrush)
Herpes Simplex (cold sore)
Parotitis
Stomatitis (inflammation of the mouth)

Gingivitis
Etiology Neglected oral hygiene
Stress

Manifestations

Bleeding during tooth brushing

Pus
Loosening of teeth (peridonitis)
Treatment
Prevention, Dental care, dental rinses,
flossing

Oral Candidiasis (Thrush)

Etiology Candidiasis albicans

Immunosuppression

Manifestations
White patches in oral cavities
Treatment
Nystatin swish and swallow
Amphotericin B

Herpes Simplex (Cold Sore)

Etiology Herpes simplex I or II

Stress exacerbates

Manifestations
Vesicle formation
Treatment-antivirals
Zovirax

Parotitis

Etiology Staph, Strep,virus

Manifestations
Pain in gland/ear
Lack of saliva
Treatment
Antibiotics, analgetic
Mouthwashes

Stomatitis
(Inflammation of the Mouth)

Etiology-

Side effect of chemotherapy

Trauma
pathogens

Manifestations

Excessive salivation
Halitosis
Sore mouth
Treatment

Remove cause
Soothing mouth wash solutions
Blend diet

Oral Cancer

Common sites

Lower lip
Lateral border of tongue
Buccal mucosa
Etiology
Tobacco use
Chronic irritation
UV light-Cancer of the lip

Manifestations of Oral
Cancer

LeukoplakiaSmokers patch
Erythroplakia
Sore that does not heal
Late

Pain especially moving jaw

Dysphagia
Cancer of the lip-induration
Pain in tongue when eating

Disorders of the Esophagus

Food

Mout
h
Pharyn
x

Upper
esophageal
sphincter
relaxes

Stoma
ch

Food
moves
into
esophagu
s

Lower
esophageal
sphincter
(LES) relaxes

Normal
Esophagu
s

Diseases of the Esophagus

Can present
with
dysphagia
pain
bleeding

Achalasia
spasm of the

lower
esophageal
sphincter

Hiatal hernia
protrusion of

stomach through
esophageal
hiatus

Achalasia

Incomplete relaxation of LES (resting

pressure >30mm Hg)
etiology
idiopathic - most common
Chagas disease - Latin America
secondary to cancer (esophagus, stomach)

Hiatal Hernia

2007 Thomson - Wadsworth

Reflex Esophagitis & Barrett

Metaplasia

Reflex of gastric acid

In about 10% of patients, develops into Barrett metaplasia
squamous cells develop into acid-secreting gastric epithelium
increased risk for esophageal carcinoma

Barretts Esophagus

I.

Barretts esophagus ulceration of posterolateral wall

II.

Midesophageal stricture from healed Barretts ulcer

III.

Adenocarcinoma secondary to Barretts esophagus

Esophagitis
I.

Early Esophagitis

II.

Diffuse
nodularity of
mucosal surface
Mod. Esophagitis

III.

Thickened folds
and nodularity
in distal
esophagus
Severe Esophagitis

Diffuse
ulcerations and
stricture

Esophagitis

GERD (#1 cause)

Infectious esophagitis
Pill esophagitis
Caustic ingestion
Radiation
Sclerotherapy

Infectious esophagitis
clinical manifestations

+++ Odynophagia
Dysphagia
Solids & liquids

Fever (uncommon)
Bleeding (uncommon)

Esophagitis - diagnosis

Endoscopy
Infectious
Candida white plaques
Herpes vesicles
Definitive dx via biopsy

Candidal esophagitis
Common in
HIV
Antibiotics
Chemotherapy
+++dysphagia
Tx: fluconazole

HSV Esophagitis
Common in:
Chemotherapy
HIV
Tx: acyclovir

Reflux esophagitis stricture

pizza
Food impacted proximal
to stricture
Could attempt glucagon

Esophageal Strictures
I.

Caustic stricture

Narrowing of 2/3 of esophagus due to

caustic ingestion years ago

Accidental in children

Suicide

II.

Radiation stricture

Smooth midesophageal stricture

Esophageal obstruction
foreign body management

Sharp objects
Urgent intervention
Cause intestinal perforation in 15-35%

Batteries
button batteries urgent removal
Zn, Li, Hg leakage causes toxicity

Bell in esophagus

Mallory-Weiss Syndrome
Laceration
Usually caused by
severe vomiting
Could be lifethreatening
bleeding

Associated with cirrhosis

No symptoms until rupture

Esophageal Carcinoma

Arise from
squamous
carcinoma
Risk factors
are
tobacco use
alcohol abuse

Tends to
invade &
metastasize
early

Acute Hemorrhagic Gastritis

Uncommon
Caused by
aspirin &

NSAIDs
alcohol abuse
heavy smoking

Upper
abdominal
pain, nausea,
vomiting

Stress Ulcers

Superficial defects
Associated with
stressful
conditions
trauma
brain injury
alcohol abuse

Called erosions

Peptic Ulcer Disease

Erosion
superficial to muscularis mucosa
no scarring

Ulcer
penetrates muscularis mucosa
scarring

PUD - etiology
Duodenal

Gastric

H. pylori

90%

60%

NSAIDs

7%

35%

Stress-induced

<3%

<5%

Zollinger-Ellison

<1%

<1%

PUD & H. pylori

Gram negative rod

Lives in upper GI tract between epithelial
surface and mucus
fecal-oral transmission
Increases risk of gastric cancer
Almost all non-NSAID ulcers are due to
H.pylori (95% duodenal, 84% gastric as
per Rosen)
Dx: serology, biopsy, C14 breath test
Not practical for emergency medicine

PUD & NSAIDs

Direct effect
Diffuse into mucosal cells
Become trapped and directly damage cell
Inhibition of prostaglandin secretion
Reduced mucus production
Reduced cell turnover

Indirect effect
Systemic inhibition of COX decreases

production of protective prostaglandins

PUD Hx and Px

Abdominal pain (94%)

Generally epigastric
Usually worst 2-4 hours after meal
Often between 2-3AM (HCl secretion

highest)
Relieved with antacids

Duodenal ulcer
Pain worst before meal
Relieved by meal

Peptic Ulcers

Deep, solitary defects

Mostly caused by H.
pylori
About 80% occur in
duodenum & 20% in
stomach
Associated with chronic
gastritis, cigarette
smoking, & long-term
use of NSAIDs, alcohol
Can be affected by
stress
personality
family history

Usually asymptomatic except for pain

until hemorrhage or perforation develops

Duodenal Ulcer
Note fresh bleeding at
edge
>90% H.pylori
NSAIDS

Gastric Ulcer
Clean, well demarcated,
benign looking
All should be biopsied as
high risk of cancer

Stomach Ulcer
Upper GI with barium contrast
Arrow = ulceration

Zollinger-Ellison Syndrome

Pancreatic islet tumor which secretes

gastrin
This leads to recurrent ulcers

Gastric Carcinoma

95% are
adenocarcinomas
Worldwide as deadly
as lung cancer
Risk factors
H. pylori & chronic

atrophic gastritis
diet high in smoked,
pickled, or saltpreserved food
diet low in fresh fruit &
vegetables

Usually asymptomatic
until advanced

Congenital Anomalies
Gastroschisis

Omphalocel
e

Umbilical
Hernia

Vascular Diseases

Ischemia due to

atherosclerosis
embolism
vasculitis
volvulus
shock
CHF
MI

Diarrheal Diseases

May experience
dehydration
Irritable bowel
syndrome

functional
abdominal pain, bloating

Viral & bacterial

enterocolitis

either upset of normal

flora or introduction of
pathogen
rotavirus
Norwalk virus

Protozoal infections
amebic dysentery
giardiasis

Necrotizing Enterocolitis

>>> Unknown
cause
Early feeding
with non
breastmilk intake
Melenahematoschezia

Inflammatory Bowel
Disease
Episodic
bloody diarrhea
Autoimmune etiology
Genetic influence
Involvement of extraintestinal tissues

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