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Surgical Pathology & X-rays for
Medical Students2007
GIT-1Salivary Glands
Esophagus
Stomach & Duodenum
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Salivary Glands
Thyroglossal cyst
Branchial remnants Pharyngeal pouch
Esophagus
Congenital esophageal atreasia
Esophageal varices
Esophageal diverticulum
Barrett’s esophagus
Cancer esophagus
Cardiac achalasia
Stomach & Duodenum
Normal appearance
Hiatus hernia
Congenital diaphragmatic hernia
Index
Gastric & duodenal ulcers
Acute gastritis & acute peptic ulcers Chronic gastric ulcer
Complications of peptic ulcers
Hour-glass stomach
Congenital pyloric stenosis
Adult pyloric stenosis
Cancer stomach
Pseudo-pancreatic cyst
Volvulous of stomach
Duodenal atresia
Jejunal atresia
Duodenal ulcers
Duodenal diverticulum
To return to this index from any slide, click on “INDEX”
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Salivary Glands
INDEX
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Salivary Glands
INDEX
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Swellings of Salivary Glands
Neoplasms
Adenoma
Carcinoma
Nonepithelial
Inflammatory
Viral: Acute: Mumps
Chronic: ?HIV
Bacterial:
Chronic bacterial sialadenitis (usually submandibular complicating chronic obstruction
Acute ascending
sialadenitis (usually parotid in dehydrated postoperative patients with poor mouth hygiene)
Specific Infections:
Mumps
Bilateral parotid
swelling with HIV
INDEX
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Sialolithiasis - (Salivary stones)
Minor glandsSubmandibular
80%
Parotid
10%
Sublingual
7%
Incidence
Majority areradio-opaque
Majorityare
radiolucent
Large submandibular stone
Because secretions
are viscid rich in mucous & the gland
lies below the opening
of its duct
INDEX
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Plain X-ray showing submandibular stone
This is the occlusal view of the mandible that best demonstrates the stone
INDEX
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Stonesubmandibular
gland
INDEX
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Sialography: Stone submandibular gland
INDEX
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•The classic presentation of a
submandibular stone is pain
and swelling prior to or
during meal
•This requires almostcomplete obstruction of the
submandibular duct
•If partial obstruction occurs
swelling may be mild with
chronic painful enlargement
of the gland
•If diagnostic doubt then
stone can be demonstrated
by sialogram
Submandibular Sialogram
Showing a stone in the submandibular duct
The stone is NOT radiolucent, but it looks so because this is a subtracted image
INDEX
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1 2
1- Stone in the Rt submandibular duct
(anterior 2/3 of the duct is anterior to the lingual n.)
2- Surgical removal
(Linear incision along the duct -notice the stay suture)
INDEX
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?
Stone submandibular ductRanula
INDEX
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Ranula
A large mucous retention
cyst (mucocele) secondary to
obstruction of a minor
salivary gland or thesublingual gland.
They represent a unilocular
cyst in the sublingual space
INDEX
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Salivary Tumours
CarcinomasNonepithelial
tumoursAdenomas
Parotid pleomorphic adenoma
Usual locations
of benign
parotid tumours
Nodularity
& regional
lymphatic
metastasis
is highly
suspicious
of
malignancy
What are the otherclinical signs that
suggest malignancy?
INDEX
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Salivary Tumours
Nearly all salivary tumours are slowly growing (even malignant
tumour)
Is pain a reliable indication of malignancy?
Pain is not a reliable indication of malignancy except after
invasion of sensory nerves
Benign tumours may present with aching pain due to capsular
distension and outflow obstruction of saliva
The only reliable clinical indication of malignancy are:
Facial nerve palsy in parotid tumours
Indurations or ulceration of overlying skin or mucosa
Regional lymphatic metastasis
INDEX
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CT & MRI :
Confirm that the
mass is arising from
the salivary gland
Demonstrate thetumour borders (well
circumscribed in benign & diffuse invasive in
malignant)Show anatomical
relations to plan for
surgery
Invastigations of Salivary Tumours
MRI
Rt. parotid tumour extending into the
superficial & deep
lobes
Sq. cell ca
Rt.
CT
Well
circumscribed Lt.parotid tumour of
the superficial lobe
Pleomorphicadenoma
INDEX
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Invastigations of Salivary Tumours
Fine needle aspiration (FNA)
For histopathological diagnosis
Open surgical biopsy is absolutelycontraindicated in tumours of major
salivary glands
Why?
Pleomorphic adenomas are poorly
encapsulated and are very tens. Open
biopsy will seed the surrounding tissues
with tumour cells causing multiple localrecurrences over many years
Open biopsy is done if the tumour is clearly infiltrating or invading the skin
INDEX
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Thyroglossal cyst
Branchial remnants
Pharyngeal pouch
INDEX
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Thyroglossal cyst & fistula
INDEX
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The classical site for a
thyroglossal cyst
Thyroglossal cystsEmbryology
•The thyroglossal tract arises form foramen caecum at
junction of anterior 2/3 and posterior 1/3 of the tongue.
• Any part of the tract can persist causing a sinus, fistulae or
cyst.
•Most fistulae are acquired following rupture or incision of
infected thyroglossal cyst
INDEX
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C4
This is a CT scan at the level of C4 vertebrae. Try to identify the following structures :
Sternomastoid muscle
Hyoid bone
Air in laryngeal vestibule
Internal jugular vein
Internal carotid artery
External carotid artery
External jugular vein
What is this structure?
Thyroglossal cyst
INDEX
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•Usually found in subhyoid portion of tract
•75% present as midline swellings
•Remainder can be found as far lateral as lateral tip of hyoid bone
•The cyst elevates on protrusion of the tongue
•Can present as an infected cyst due lymphoid tissue in the cyst wall •If infected, aspirate cyst rather than incise prevents formation of thyroglossal fistula
TreatmentSistrunk Operation •Transverse skin crease incision
•Platysma flaps raised.
•Cyst dissected•Middle 1/3 of hyoid and any suprahyoid
tract extending into the tongue dissected
Clinical features of Thyroglossal cysts
INDEX
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Fistulography: “note the position of the fistula
anterior to the trachea (black air)”
The classical site for a
thyroglossal fistula
Thyroglossalfistula
INDEX
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•Branchial fistulae and cysts
usually arise from second
branchial sinus• Arise on anterior border of
sternomastoid
•Often bilateral and extend
deep into neck•Internal opening
occasionally found in
tonsillar fossa
•Treatment is by surgical
excision
Notice the opening lateral to the mid line
Branchial remnants
Branchialcyst
Branchial
fistulaINDEX
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Pharyngeal pouch•Is posteromedial pulsion diverticulum through Killian's
dehiscence
•Occurs between thyropharyngeus and cricopharyngeus muscles. Both form the inferior constrictor of the pharynx
•Male : female ratio is 5:1
•Usually only seen in the elderly
•Aetiology is unknown but upper oesophageal sphincter dysfunction may be important
INDEX
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Clinical features•Commonest symptoms are:
dysphagia, regurgitation and
cough
•Recurrent aspiration can resultin pulmonary complications
• A carcinoma can develop
within the pouch
•Clinical signs are often absent,however, a cervical lump may
be present that gurgles on
palpationBarium swallow show residual
pool of contrast within the pouch
Pharyngeal pouch
INDEX
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EsophagusNormal
anatomy
Cervical
Thoracic
Abdominal
INDEX
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The esophagus have asmooth outline. No
persistently narrowed
areas are seen.
Peristalsis can be
observed on screening
the patient.The whole examination
can be recorded on video
if necessary (video-swallow
examination).
Normal barium swallow
Lateral view: The course and diameter of the esophagus
are normal, the longitudinal mucosal folds are regular
INDEX
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NORMAL ANATOMY of Oesophagus-Double contrast study
•The mucosal surface of the esophagus is smooth
and featureless on double contrast examination.•When the esophagus is distended the mucosal
folds disappear.
•When the esophagus is partially collapsed , then
straight parallel longitudinal folds are easily seen.
•The Z-line demarcates the squamocolumnar
junction separating esophageal mucosa from
gastric folds.
• A number of mediastinal structures cause
extrinsic impressions upon the adjacentesophagus in the normal individual.•In the elderly individual, osteophytes projecting from the
anterior surface of the thoracic vertebrae, a tortuous aorta or
an enlarged left atrium may also cause impressions upon
the esophagus.INDEX
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Normal endoscopic pictureof the esophagus
INDEX
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Congenital EsophagealAtreasia
INDEX
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Congenital esophageal atreasia
The most common
type of trachio-
esophageal fistula
is a blind end
upper esophagus
and a lower remnant connected
to the trachea
INDEX
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Oesophageal atresia (diagnosis)
If suspected, a small
nasogastric tube willarrest at the blind pouch &
will not reach the stomach
INDEX
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Examination with contrast material: The white arrows point to the blind end of the
esophagus filled with contrast material. The middle lobe of the right lung is partially
atelectatic because of aspiration. Presence of a lower fistula is suggested by the
presence of gas in the distended stomach
Atresia of the esophagus
INDEX
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Oesophageal atresia
INDEX
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Esophageal varices
INDEX
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Esophageal varices
INDEX
With t l h t i ll t l l d l b t
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With portal hypertension, collateral vessels develop between
portal and systemic veins:
Around the lower end of the esophagus & fundus of stomach
(esophageal & fundal varices) [ splenic vein – short gastric veins – coronary vein – esophageal veins – azygos system ]
Around the rectum (Hemorrhoids) [ superior hemorrhoidal – middle &
inferior hemorrhoidal ]
Around the umbilicus (Caput medusa) [ paraumbilical veins – epigastric veins ]
Around the liver & diaphragm & retroperitoneal veins.
The normal portal pressure is less than 200 mm saline
Collateral circulation does not effectively decompress the portal system
The four major manifestations of portal hypertension are:
Esophageal varices, ascites, hypersplenism and encephalopathy.
INDEX
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Factors implicated in the formation of ascites :
Increased portal venous pressure
Reduced serum osmotic pressure due to hypoalbuminemia
Sodium & water retention (inc. adrenal cortical hormones & dec. anti-diuretic hormone)
Encephalopathy is related to high blood ammonia level
It can result from natural or surgically created porto-systemic shunts in
patients with marked hepatocellular dysfunction
Hypersplenism
Sequestration and destruction of any or all of the cellular elements of the blood
WBC > 4000 /ml
Platelets > 100,000 /ml
Are spontaneous ecchymosis and purpra common presentations of portal hypertension alone? NO
INDEX
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Esophageal varices
“Autopsy”
Upper GI endoscopy
INDEX
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Oesophageal varices
Barium swallow
Numerous rounded and
elongated smooth-
contoured filling defects
are present in the inferior two thirds of the
esophagus.
The contour of the
esophagus is irregular andspeculated.
INDEX
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Barium swallow:Oesophageal varices
INDEX
Management of acutely bleeding varices
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Sengstaken –Blakemore tube
g y g
In patients with hepatocellular
dysfunction, bleeding should be rapidly
controlled to avoid:
•The effect of shock on hepatic function.
•The toxic effect of digested blood
absorption.
Temponade & gastric wash
Main lines of treatment:
Heamodynamic stabilization with
blood transfusion
Reduce the portal blood pressure:
•Vasopressine causes constriction of the
splanchnic arteria circulation reducing the portal blood pressure 40%
•Propranolol
Sengstaken balloon temponade
Injection sclerothrapy INDEX
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Injection sclerotherapy of esophageal varices
INDEX
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Follow-up barium swallow
Note the staplersin the lower end
of oesophagus
(a treatment modality for esophageal varices)
INDEX
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Esophageal diverticulum
INDEX
B i ll
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Barium swallow
Esophageal diverticulum
INDEX
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Barium swallow - Lateral view
Esophageal diverticulum
Two sharp-contoured filling
excesses can be seen on the
ventral contour of the esophagus
below the tracheal bifurcation(arrows)
INDEX
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Barrett’s esophagus
INDEX
Gastro-esophageal reflux disease [GERD] is a common disorder
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Gastro esophageal reflux disease [GERD] is a common disorder
Gastro-esophageal reflux are prevented by:
•Lower esophageal sphincter
•Normal hiatus of the diaphragm
GERD may or may not be accompanied with sliding esophageal hernia
Clinical features:
Retrosternal burning pain(heart burn) provoked by fatty
food
Fatty dyspepsia is more common in GERD than
gallstone disease
Objective diagnosis: esophageal manometry
with 24h pH recording
Management of GERD
•Bed tilte
•H2 blockers
•Proton pump inhibitors
•Surgery (failed medical or complications)
Complications of GERD
Stricture
Shortening
Columnar metaplasia [Barrett’s] INDEX
Barrett’s esophagus
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Barrett s esophagus
Normal lower esophagus Barrett’s esophagus
Columnar metaplasia in the lining mucosa
of the lower esophagus in response to
chronic gastro-esophageal reflux.
What are the complications of Barrett’s esophagus?
Increased risk of
adenocarcinoma 25 times
Bands of metaplastic
epithelium extend proximally
Endoscope view
INDEX
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INDEX
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Gastroesophageal reflux with longitudinal ulcers
arising from the GE junction
INDEX
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Cancer esophagus
INDEX
N l f h h
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Neoplasms of the oesophagus
Benign Tumours
(RARE)
Malignant TumoursSarcoma
Malignant Melanoma
CARCINOMA
Squamous Cell CA
usually Upper 2/3 Adenocarcinoma
usually Lower 1/3
Oat cell CA
Clinical Features of CA OE
1. Dysphagia
2. Weight loss
3. Recurrent laryngeal n. palsy
4. Cervical Lymphadenopathy
ADVANCEDDESEASE
CA OE has poor prognosis because symptoms occur late
INDEX
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Upper 2/3 of the esophagusLower 1/3 of the esophagus
C. Oat cell carcinoma ( occasionally)
INDEX
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Remember the pathological types of
cancer oesophagus. INDEX
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Midesophagus SquamousCell Carcinoma
Squamous cell carcinomaarises most commonly
in the upper and middle
esophagus
INDEX
Pre-cancerous conditions:
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Pre-cancerous conditions:
•Smoking & alcohol
•Food contamination of fungi•Diet deficiency in beta carotin,
vitamin E & selinium
Clinical features:Dysphagia is a sign of advanced
disease
Early symptoms are nonspecific
During endoscopy, biopsy any lesion even if small (small
cancers are curable)
INDEX
Investigations for suspected CA esophagus
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Investigations for suspected CA esophagus
Upper GI endoscopy
with biopsy of any suspected lesion
Ba swallow
INDEX
Endoscopy of the esophagus
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Advancedsquamous cell CAof the oesophagus
Endoscopy of the esophagus
EarlyadenocarcinomacomplicatingBarrett’s
esophagus
INDEX
Barium swallow
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Irregularity looks like
an apple core lesion
in the esophagus.
This is typical in
carcinoma of the
esophagus
Barium swallow
INDEX
Barium swallow
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Barium swallow
CA esophagus – lateral view
INDEX
Barium swallow
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Barium swallow
CA oesophagus
INDEX
CA Oesophagus
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Presenting symptom: Dysphagia
CA Oesophagus
Irregular stricture with shouldered margins
INDEX
Barium swallow
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Barium swallow
CA oesophagus
INDEX
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barium swallow
demonstrates the typical
apple core lesion seen
with distal esophagealadenocarcinoma
associated with chronic
reflux disease.
Also seen is a typicalsliding hiatal hernia with
the gastric folds fixed
above the diaphragm.
INDEX
Barium swallow
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Barium swallow
This is not CA esophagus.
The esophagus is displacedby CA lung.
Note the smooth lining of the
displaced segment
INDEX
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Corrosive stricture
of the esophagus
INDEX
Ba swallow -
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Ba swallow -Corrosive stricture
AP view:
Narrowing with smooth
outlines at the level of the
middle third of the
esophagus with a dilatation
observed above it.
Distally the lumen of the
esophagus is of about the
normal diameter.
INDEX
Carcinoma of the esophagus has a poor survival rate
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Carcinoma of the esophagus has a poor survival rate
because of late discovery after spread
Spread
Local spread
•Through the
wall into adj.
structures
•Satellite
nodules in the
proximal
esophagus(submucosal lymphatics)
Lymphatic spread
Spread to the
celiac LNs is a
bad prognostic signand regarded as
distant metastasis
(M) in the TNM
classification
Systemic spread
•Liver
•Lungs•Brain
•bone
INDEX
Carcinoma
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of theesophagus
INDEX
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Postoperative barium
swallow demonstrating thegastric conduit in the
cervical position with the
silver clips marking the
anastomosis
INDEX
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Achalasia of the cardiac sphincter
INDEX
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© GIT176
Achalasia Inability to relax lower esophageal sphincter leads to massive
esophageal dilation and produces the characteristic "birds beak"
deformity in barium swallow
Ba swallow Autopsy
INDEX
Barium swallow examination: achalasia Early stage
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The esophagus
has smoothcontour and is
narrowed
conically at the
esophago-cardial junction
(arrow), above
this the distal
part of theesophagus is
dilated
Barium swallow examination: achalasia Early stage
INDEX
L t t
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Late stage:
The esophagus is
extremely dilated abovethe severely narrowed
cardia (arrow), with a
slightly tortuous course
and inhomogenous
contrast material filling
pattern because of the
residual food inside
INDEX
h l i (
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Achalasia (of the cardiac
sphincter)
Note the huge dilatationof the oesophagus
INDEX
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Achalasia with bird's beak deformity of the distal esophagus
INDEX
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Lateral view ofbarium swallow
in a patient with
achalasia.
Note grossly
dilated esophaguswith abrupt
tapering to “bird
beak-like” shape
of lower
esophagealsphincter
INDEX
A h l i
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Achalasia
The oesophagushugely dilated and
tortuous.
INDEX
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Please compare and contrast between cardiac achalasis & CA lower end esophgus
INDEX
Barium swallow: CA oesophagus v/s Achalasia
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The cardia is normally below the diaphragm
In X-ray 1, theoesophagus is
interrupted
above the
diaphragmIn X-ray 2, the
cardia belowthe diaphragm
is closed with“bird beak-like”
shape
1 2
This is CA lower end
esophagus
Achalasia of
cardia
INDEX
Treatment options for cardiac achalasia
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Pneumatic dilation
performed
endoscopically
Lower esophagealsphincter myotomy
incises enough muscle torelieve symptoms but not
enough to result in
gastroesophageal reflux
INDEX
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Normal anatomy
& di d i i t
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& corresponding endoscopic picture
INDEX
Normal loweroesophagus & stomach
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oesophagus & stomach
This is the normal appearance of the lower oesophagus & stomach, which
has been opened along the greater curvature.
INDEX
Normal upper GI
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o a uppe Gbarium study:
The stomach is of
normal size andshape, its mucosal
folds are regular.
The fornix is filled
with contrastmaterial because of
the supine position.
The duodenum is
normal.Jejunal loops filled
with contrast
material are visible
behind the stomach INDEX
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Hiatus Hernia
INDEX
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Siding hiatus
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Siding hiatushernia
Siding hiatus hernia( l)
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(retrosternal)
INDEX
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Postmortumspecimen
Diaphragmatichernia
INDEX
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Gastric & duodenal ulcers
INDEX
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Gastric Ulcer
INDEX
Mechanism of acid production in
the gastric parietal cell
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the gastric parietal cell
INDEX
Acute gastritis
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gwith diffuse
heamorrhage
INDEX
Etiology: Disruption of gastric mucosal
Acute Peptic Ulcers
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Etiology: Disruption of gastric mucosal
barrier appears as multiple erosions.
50% of patients give history of
NSAID/aspirin intake. Acute peptic ulcers cause short attacks of
dyspepsia & classically present with
hemorrhage.
Pathology: Frequently multiple.
Stomach - They can occur in any part.Duodenum - Almost always confined to first
part.
Shallow punched out and seldom invade
musclecoats unlikely to leave healing scars.
Acute duodenal ulcer in anterior wall
occasionally perforates.
These acute lesions can progress to chronic
ulcers.
INDEX
Chronic Gastric Ulcer
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INDEX
Chronic gastric ulcer
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The ulcer is deep, with sharp proximal edge & a sloping distal edge
The arrow points to an eroded gastric artery which has caused fatal hemorrhage
What are the complications of chronic gastric ulcer?
INDEX
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Malignant
gastric ulcer
Top view, the ulcer is
very suspicious
Longitudinal section:
The pylorus is to the left .Edges are everted.
Several prominent
nodes of the lesser
omentum contained
metastatic cancer.
The adenocarcinoma is
infiltrating between the
layers
INDEX
Chronic gastric ulcer
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Chronic gastric ulcer The edges of the ulcer
are heaped up due toepithelial regeneration.
The ulcer base is
smooth
and contains onlygranulation tissue
If the ulcer was discovered
on endoscopy, multiplebiopsies should be taken to
exclude malignancy –even if
the ulcer looks benign
INDEX
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Chronicgastric ulcer
INDEX
Barium meal
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Benign gastric ulcer on the
lesser curvature of the
stomach
INDEX
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Large ulcer is filledwith barium on the
lesser curvature of
the stomach with
star-shaped
mucosal folds
converging towards
the lesion
INDEX
Barium study
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Gastric ulcer
INDEX
Upper GI bariumstudy:
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study:
It shows a largegastric ulcer along
the lesser
curvature of the
stomach.
Surgery was
performed and the ulcer was benign
INDEX
Barium meal
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gastric ulcer
There is a largeulcer crater on the
greater curvature
aspect of the distal
stomach (arrow).There are multiple
folds radiating to
the edge of the
ulcer crater. All the
folds taper gradually to the
edge of the crater.
INDEX
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Carmens meniscus sign
Barium meal
Pre-pyloric gastric ulcer
INDEX
This gastric ulcer has
Chronic Gastric Ulcer
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This gastric ulcer has
been present for some
time as judged by the
amount of puckering of the surrounding mucosa
and by the depth of the
ulcer.
The gastric mucosa
around shows gastritis.
Frequently, vessels in the
base of the ulcers will
ulcerate and the patient
will bleed profusely, if notfatally
Does infection have arole in the developmentof peptic ulcer?
INDEX
Helicobacter pylori
It i i t t i th ti l f
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It is important in the etiology of :
•Chronic gastritis
•Peptic ulcer
•Gastric cancer
Helicobacter pylori Hydrolyze urea Amonia (strong alkali)
Antral „G‟ cells
Gastrin
Gastric acid
hypersecretion
Eradication therapy
is a main treatment in peptic ulcer
Metronidazole
Amoxycillin
Bismuth
A proton pump inhibitor is usually
added INDEX
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Helicobacter gastritis Helicobacter organisms may
be tested for urease activity.
Staining of the gastric biopsy
shows
the characteristic curved rods
embedded in the mucin layer
of the stomach
INDEX
Complications of peptic ulcers
Bleeding
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Bleeding
•Patient presented with hematemesis,
shock followed by melina
•Endoscopy showed acute gastric
bleeding
Perforation
•Patient presented
with acute
abdominal pain
•Plain X-ray chest
& abdomen
showed air under
the diaphragm
Penetration
Posterior wall ulcer penetrates to
pancreas (back pain)
INDEX
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"Hourglass" contraction of the stomach Due to chronic peptic ulceration there is fibrosis and contracture of
the stomach leading to an hourglass shape
Results in altered stomach mobility with delayed gastric emptyingINDEX
Upper GI endoscopy for diagnosis of peptic ulcer
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INDEX
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Congenital pyloric stenosis
INDEX
AbnormalStomach antrum& pyloric canal
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Antrum
Pyloric canal
Normal
INDEX
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Hypertophic pyloric stenosis. Note the prominent hypertrophied circular pyloric muscle
with elongation and narrowing of the pylorus
It is a cause for "projectile" vomiting in infants about 3 to 6 weeks of age. Males are affected
more than females(4:1)
It should be differentiated from other causes of vomiting in infancyINDEX
Symptoms include non-bilious vomiting often starting as simple
regurgitation progressing to projectile vomiting after most
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g g p g g p j g
feedings.Vometing contains milk but no bileLess frequent findings are constipation, progressive weight loss,
dehydration, hypochloremic alkalosis. Symptoms occur most commonly during the second to sixth weeks
with peak age at presentation being 3rd -4th weeks. HPS rarely
presents after 3 months of age.
Physical examination may
reveal visible gastric peristaltic
waves and a palpable pyloric
mass (olive).
INDEX
If the clinical and
physical findings
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U.S. Findings:
There is thickening and elongation of the pyloric muscle. diagnostic for HPS
are suggestive of
HPS then anultrasound exam
is the first study of
choice.
D.D. of Hypertophicpyloric stenosis of
infancy
•Gastro-esophageal reflux
•Raised intracranial pressure
•Duodenal atresia
•Intestinal obstructionINDEX
Gasrtographin meal
C it l l i t i
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Congenital pyloric stenosis
INDEX
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(Adult) Pyloric StenosisGastric outlet obstruction
INDEX
Barium meal
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Pyloric stenosis
Barium meal
INDEX
Barium meal
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Pyloricstenosis
Barium meal
INDEX
24 hours after
Ba meal – pyloric stenosis
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24 hours after
drinking contrast
material most of it isstill visible in the
stomach with residual
food above it.
The stomach isdilated, its lower pole
hangs below the iliac
crest.
Only minimalcontrast material
filling is observed in
the small intestines
INDEX
Barium meal
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Pyloric stenosis
Barium meal
INDEX
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Cancer Stomach
INDEX
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A large tumor of
the stomachseen as a filling
defect in the
body and antrum
of the stomachcausing irregular
contours on both
the lesser and
the greater curve.
INDEX
Gastric Carcinoma
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How would you
suspect that a patient
is having cancer
stomach?
INDEX
Barium meal
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CA pylorus
INDEX
Cancer stomach Cancer stomach Cancer stomach
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Cancer stomachMalignant ulcer
Cancer stomachMalignant infiltration
Cancer stomachCauliflower mass
INDEX
Large ulcerated gastric carcinoma arising in the body of the stomach
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INDEX
Ba –meal
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Ulcer niche of
a malignantgastric ulcer
INDEX
CA stomach
Linitis plastica
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Marked narrowing of almost the
complete stomach, due to diffuse
infiltration of the gastric wall by a
carcinoma (linitis plastica)
Linitis plastica
Diffusely infiltrating carcinoma,
note leather bottle appearance
INDEX
Barium meal - CA stomach: Linitis Plastica
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The distal two thirds of the
stomach is narrowed, rigidperistalsis is absent.
stomach diameter is
decreased. The stomach
lacks the normal rugal
pattern. The mucosal surface is
often smooth but intact, and
ulcers are not a dominant
feature.
"leather bottle" stomach
describes diffuse submucosal
infiltration of the stomach.
INDEX
Early (curable) gastric cancer has no specific features that
Clinical manifestations of gastric carcinoma
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Early (curable) gastric cancer has no specific features that
can differentiate it from benign dyspepsia
Liberal use of gastroscopy in patients over 40 years of age with a new or persistent dyspepsia. With biopsy from any suspicious lesion.
N.B. gastric antisecretory drugs will improve symptoms of gastric cancer
Late symptoms:
•Early satiety
•Bleeding – iron deficieny anemia
•Pyloric obstruction
•Thromboplebitis (Trousseau’s sign) & DVT INDEX
M lti l
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Multiple
polypoid
gastric
masses in
the cardia,
fundus, and
antrum
Metastatic
INDEX
Postoperative stomach
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The afferent jejunal loop
connected to the gastric
stump shows onlyminimal filling, the
majority of the contrast
material flows into the
efferent loop
Postoperative stomach – after Billroth II partial
gastrectomy
INDEX
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Pseudo-pancreatic cyst
INDEX
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Pseudo-pancreatic
cyst
Barium meal
INDEX
Volvulous of the Stomach
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The axis of rotation is along the
mesenteric attachment, much the same as is seen with sigmoid colon volvulus
The axis of rotation is the long
axis of the stomach
Organoaxial volvulus Mesenteroaxial volvulus
INDEX
Barium meal
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Barium meal
Organo-axial volvulous of thestomach
INDEX
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Duodenum
INDEX
Plain X-ray abdomen(erect position)
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Duodenal atresia
Dilated stomach (S)
and the part of the
duodenum above the
obstruction (D). Other parts of abdomen do
not contain gas
INDEX
Plain X-ray abdomen
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Plain X ray abdomen(erect position)
Duodenal atresia
INDEX
Pl i X f th
Duodenal atresia
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Plain X-ray of the
abdomen:The arrows point to
the dilated stomach
and that part of the
duodenum which isabove the obstruction.
Other parts of
abdomen do not
contain gas
Double bubble
INDEX
Duodenal atresia
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Gastrographin meal:
The distended
stomach and
duodenum above the
obstruction are visible
after swallowingcontrast material
(arrows).
INDEX
Plain radiograph ofthe abdomen:
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the abdomen:
The arrows point tocharacteristic triplegas bubbles in the
stomach, duodenumand jejunum.
Jejunal atresia
INDEX
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# Ulcer in the 1st part of duodenum (with clean floor & no everted edge)
INDEX
Duodenal ulcer (Endoscopy)
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A 35-year-old woman
presents with tarry stools anda hemoglobin level of 7.5 g.
Notice bleeding points
Duodenal ulcer (Endoscopy)
INDEX
Investigations for suspected peptic ulcer
Gastro-duodenoscopy is the most sensitive investigation
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Gastric ulcerDuodenal ulcer
Biopsy
INDEX
Ba meal – 2 duodenal kissing ulcers
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Two well-defined
filling excessesfacing each other
are visible on the
opposite contour
of the duodenal
bulb (arrows)
INDEX
Duodenal ulcer with
trifoliate deformity
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y
INDEX
Duodenal ulcer
Ulcer niche
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INDEX
Barium follow-through
Di i l f
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Diverticulum of
the duodenum(3 rd part)
INDEX
Barium follow-through
Diverticulum of the
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A saccular lesion is
filling from the
horizontal part of
the duodenum(arrow).
Course of the
jejunal loops isnormal
duodenum