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Lecture 9

Non-neoplastic Gastrointestinal Tract

Most common variant of esophageal atresia The upper esophagus ends in a blind pouch. The lower esophageal pouch joins the trachea or the main bronchus, forming a fistula between the esophagus and the trachea.
A condition characterized as the abnormal innervation of the esophagus and lower esophageal sphincter. This results in the absence of peristalsis, incomplete relaxation of the lower esophageal sphinceter, and increased basal tone of the sphincter. Achalasia
Characteristics of an esophagus with achalasia Persistent achalasia results in (1) dilatation and lengthening of the esophagus above the lower sphincter (2) muscular hypertrophy (3) loss of myenteric ganglion cells in the esophageal wall.
A condition that mainly effects women over age of 40. A syndrome consisting of esophageal webs, iron deficiency anemia, and atrophic glossitis. Plummer-Vinson Syndrome
Acquired sac-like dilatation of the upper stomach that protrudes above the diaphram. Hiatal Hernia
What percentage of hiatal hernias are sliding? 90%
What percentage of hiatal hernias are paraesophageal? 10%
Mucosal ring found in the lower esophagus, arising near the squamocloumnar junction. It is sometimes associated with hiatal hernias. Schatzki's ring
Pouches of esophagus lined by mucosa and submucosa or all layers of the esophageal wall. Esophageal diverticula
Esophageal diverticula that occurs in the upper esophagus. Zenker's diversticula. 70% of esophageal diverticula are located in the pharyngo-esophageal area.
Bleeding caused by superficial lacerations or tears of esophageal mucosa caused by prolonged vomiting. Most often associated with alcoholism and hiatal hernias. Mallory-Weiss Syndrome
Perforation of the distal esophagus typically in middle-aged men who experience violent vomiting after heavy eating or alcohol intkae or both. Boerhaave's Syndrome
Dilated and tortuous esophageal submucosal veins that occur secondary to portal hypertension. Bleeding from these vessesl is typically massive and result in death. Esophageal varices
Cause of esophageal varices Portal Hypertension
Causes of esophagitis (1) gastric reflux (2) prolonged intubation (3) ingestion of irritants (4) uremia (5) viral infections (6) fungal infections (7) radiation (8) dermatologic conditions (9) graft vs. host disease
Most common cause of esophagitis Gastroesophageal Reflux
Complications of long-standing gastroesophageal reflux (1) Esophagitis (2) Esophageal ulceration (3) Esophageal laceration (4) Esophageal stricture (5) Barrett's esophagus
What is the prevalence of Barrett's esophagus? 10%
Type of esophagitis that typically occur in immunocomproimsed patients Viral and fungal esophageal infections: Candida, herpes virus, and CMV
A congenital condition characterized by hypertrophy of hte circular muscle of the muscularis propria. Most commonly occurs in males. Congential hypertrophic pyloric stenosis
Treatment of congenital hypertrophic pyloric stenosis Plyloromyotomy, which is the surgical divsion of the pyloric muscle to open up the narrowed gastric outlet.
Pathophysiology of acute gastritis (1) increased gastric acid production with back diffusion through the mucosa (2) decreased buffering by bicarbonate (3) decreased gastric blood flow
An autoimmune condition characterized by hypo- or achlorhydria and hypergastrinemia. Caused by antibodies aganist parietal cells and intrinsic factor. Some patients develop pernicious anemia due to loss of intrinsic factor. Type A chronic gastritis
Area of the stomach involved in Type A chronic gastritis Typically involves the body of the stomach, but spares the antrum
What autoimmune conditions are associated with Type A chronic gastritis? Hashimoto's thyroiditis and Addison's disease
(T or F) Patients with Type A chronic gastritis are at risk for development of dysplasia and gastric adenocarcinoma. True
A condition characterized by increased gastric acid secretion due to H. pylori infection, which is strongly associated with gastric and duodenal uclers. Type B chronic gastritis
Infectious cause of achalsia Traypanosoma cruzi infection in Chagas Disease
Pathogensis of H. pylori infection The bacteria produces urease, resulting in the formation of ammonia in the stomach, which buffers the pH.
How does chronic gastritis occur in the setting of partial gastrectomy? Chronic gastritis due to reflux of duodenal contents
Pathogenesis of stress ulcers Stress ulcers develop due to mucosal hypoxia, which occur in the setting of shock, burns, spesis, trauma, or intracranial abnormalities.
Common drugs associated with gastric and duodenal uclers (1) Aspirin (2) Steroids (3) NSAIDs
A condition characterized by multiple or recurrent peptic uclers or peptic ulcers in aberrant sites. Zollinger-Ellison Syndrome
Pathogenesis of Zollinger-Ellison Syndrome Increased acid production induced by hypergastrinemia (secreted by gastrinoma)
Most common location of gastric ulcers Lesser curve of the stomach near the junctin of hte body and the antrum
Most common loction of the duodenal ulcer First portion of the duodenum
Pathogenesis of gastric ucler Gastric ulcers arise due to a defect in mucosal resistance. Patients typically ahve low or normal amounts of gastric acid production.
Pathogenesis of duodenal ulcers. Duodenal ulcers arise due to hypersecretion of acid and pepsin, increased responsiveness to stimuli for acid secretion or rapid gastric emptying.
A concretion of accumulated swallowed material typically composed of vegetable residues or hair. Bezoar
Disease characterized by hyperplasia of teh mucosal epithelial cells, body glandular atrophy, and protein-losing entropathy. Menetrier's disease
Disease characterized by body glandular hyperplasia, recurrent peptic ulcer disease, and hypergastrinemia without hyperplasia of mucosal gastric epithelium. Zollinger-Ellison Syndrome
Created by: UVAPATH2