Pathology - G.I.

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If there is a malfunction in the GI tract

you will get malnutrition

GI tract is (from out)

easy entry point for microbes, toxins

GI tract is (From withinin)

susceptible to ischemia, hemorrhage, and cancer

GERD definition

gastric esophageal reflux disease
acid from stomach because of faulty LES or hiatal hernia

GERD implications

patient uncomfortable supine
bad taste
erosion posterior teeth, and maxillary palatal

Esophageal Varices

portal hypertension leads to veins around esophagus buldging into lumen. Possible ulcer and bleeding. Bloody vomit (hematemesis)

Mallory-Weiss Syndrome

esophageal lacerations
longitudinal tears near junction of stomach
Hiatal hernia present in 75%
often from chronic alcoholics
Bloody vomit (hematemesis)

Squamous cell carcinoma

MOST esophageal cancers
M>F 3:1
age 50-60
associations: alcohol and tobacco

Adenocarcinoma

increasing in USA
M>F 8:1
Associations: barrett esophagus and GERD

Adenocarcinoma developes with GERD because

epithelium must protect itself from constant acid attacks. It increases mucous glands. Once changed, easier to mutate

most heartburn is due to

faulty lower esophageal sphincter not hiatal hernia

antrum

neutral mucin glands of the stomach

Hiatal hernia

portion of stomach protrudes above diaphragm
most hiatal hernias are sliding (95%)

Gastritis (inflammation of gastric mucousa)

symptoms: heartburn, abdominal pain, anemia
Causes:
Reactive (bile reflux, stress)
Infectious (H. pylori, CMV)
Immunologic (Autoimmune)
Granuloma (crohns, TB, sarcoid)
idiopathic

Acute Gastritis

breakdown of mucosal barrier allows acd to damage cells. Leads to erosions, ulcerations, hemorrhage with variable acute inflammation (the cause of pain)

Reactive Gastropathy

chemical type. Epithelial cells around stomach look different because of acids, drugs, etc.

chronic gastritis

morphological change increased lamina propria and chronic inflammation, due to bugs or (auto?)immune

Atrophic Gastritis

comes after chronic gastritis; stomach looses glands, mucousa layer thins, metaplasia of intestines

Helicobacter pylori prognosis

bug that lives in acidic environment. Has urease and phospholipase which breaks down mucous allowing epithelium to be damage. Leads to inflammation and more acid.

Helicobacter pylori clinical

peptic ulcer disease. Can affect anywhere in digestive tract that is exposed to acid.
Treatment: antibiotics

neuroendocrine tumors (in the GI)

carcinoid tumors are

Glandular epithelium

adenocarcinoma and signet ring cell carcinoma derive from

polyp

a type of neoplasm. any nodule or mass that projects above the level of the surrounding mucosa

hyperplastic polyps

most common GI neoplasm

adenocarcinoma associations

H. pylori, smoked and pickled foods, aflatoxin, nitrosamines, high salt, low antioxidants, atrophic gastritis (with intestinal metaplasia)

adenocarcinoma types

intestinal type with gland formation
diffuse type with signet cells

lymphoma

most common location for GI lymphomas is the stomach (but polyps in stomach are rare)

lymphoma types

association: H. pylori
MALT lymphoma H pylori related treat bug treat lymphoma
Large B cell lymphoma

Infectious small intestine path

cryptosporidiosis, giardiasis, mycobacterium avium-intracellulare, whipple disease

clinical features small intestine malabsorption and inflammation

diarrhea, steatorrhea, abdominal cramps/pain

Celiac disease

gluten sensitivity. 1/300 affected most subclinical anything that contains gliadin, will elicit an immune response

celiac disease clinical

watery diarrhea, anemia, weight loss, antibodies to gliadin. All the inflammation flattens out the vili leading to malabsorption

bowel perforation and acute peritonitis

a possibility when the intestines become ischemic for whatever reason. feces spills through necrotic hole into body cavities (bad news)

Meckel's diverticulum

a patient thinks its appendicitis with GI bleeding, but it may be a little bit of extra bowel near the appendix that is an embryological remnant. maybe lined with mucousa, or stomach, or pancreatic tissue

volvulus

twisting of the bowels, may lead to ischemia

intussuspection

bowel within a bowel

metastatic from somewhere else

usually if you've got cancer in the bowel its

a gastrinoma neoplasm

zollinger ellison syndrome

adenocarcinoa of the bowels

ampulla of vater
may arise in dysplasic polyps
clinically: biliary obstruction, pancreatis

mucousa of the stomach intestines and colon

s: glandular mucousa
i: tall villi
c: flat contains crypts

ulcerative colitis

inflammation of bowels
abdominal pain, bloody diarrhea
more lamina propria, mucosa ulcerations, atrophy, pseudopolyps
architectural distortion
NO granulomas or skip lesions

adenocarcinoma

most common malignancy of the colon

Crohn Disease

like ulcerative colitis but distinguished by
skipping of ulceration areas
granulomas
ulcers throughout entire GI tract including mouth

Crohn Disease Histo

transmural chronic inflammation
acute inflammation (cryptitis, crypt abscesses, aphthous ulcers
noncaseating (cheese) granulomas
fissuring ulcerations, fistulae
thickening of bowel wall, creeping fat strictures

Crohn Disease clinical

like ulcerative colitis:
abdominal pain, bloody diarrhea, inflammation with increased risk of adenocarcinoma
associations: primary sclerosing cholangitis

diverticulitis vs diverticulosis

one is out pocketing of the colon brought on by low fiber etc. and the other is inflammation and bleeding of these out pockets. Often in descending and sigmoid colon

adenoma to carcinoma

when all polyps are removed patients don't get cancer

adenomatous polyposis coli (APC) gene

tumor suppressor degrades a transcriptional activator of proliferation. degrades B-catenin

TP53

tumor suppressor gene

K-RAS

when mutated permenant upregulation of signals

deleted in colon cancer (DCC)

a gene that when deleted is associated with colon cancer

MLH1, MSH1

dna repair genes (mismatch repair)

Familial adenomatous polyposis

germline mutation: APC
100s of adenomas young
100% risk of colon cancer by middle age
Treatment: prophylactic colectomy

Hereditary NON-polyposis colon cancer (HNPCC)

germline mutation like FAP but different genes: MLH1, MSH1
dna replication errors aplenty
get cancer younger than normal

less effective

chemo and radiotherapy is___ effective in colon cancer

Hemorrhoids

varices (buldges) around perianal venous plexus
trying to hard to poo and stationary venous blood during pregnancy contribute
itching mucus discharge bleeding
treat with: preparation H, doughnut pillow

anal fissures

dry stool scratching up you rectum
painful, bloody
change your diet and habits

squamous cell carcinoma associated with

HPV-16
HPV-18

STDs associated with colon

condyloma, HPV-6, HPV-11
Herpes simplex 2

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