upper gastrointestinal pathology
TRANSCRIPT
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Upper Gastrointestinal PathologyKristine Krafts, M.D.
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GI Pathology Outline
• Esophagus• Stomach• Intestine• Liver• Gallbladder• Pancreas
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GI Pathology Outline
• Esophagus• Hiatal hernia• Mallory-Weiss syndrome• Barrett esophagus• Carcinoma
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Normal esophageal-gastric junction
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• Dilated portion of stomach protrudes above diaphragm
• Common! Usually asymptomatic.
• Heartburn, reflux esophagitis
• Danger: ulceration, bleeding
Hiatal Hernia
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Sliding (L) and rolling (R) hiatal hernias
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• GE junction tears
• Severe vomiting (chronic alcoholics)
• Symptoms: bleeding, pain, infection
• Treatment: cauterization
• Prognosis: usually heals; sometimes fatal
Mallory-Weiss Syndrome
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Mallory-Weiss tears
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Mallory-Weiss tears
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• Replacement of squamous epithelium by columnar epithelium with goblet cells
• Complication of long-standing reflux esophagitis
• Danger: 30-100x risk of adenocarcinoma
• Treatment: screen for high-grade dysplasia
Barrett Esophagus
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Normal esophagus (L) and Barrett esophagus (R)
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Barrett esophagus
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Barrett esophagus
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Adenocarcinoma• Commonest type in US
• Risk factor: Barrett esophagus
• Distal 1/3 of esophagus
• Symptoms: insidious onset; late obstruction
Squamous cell carcinoma• Commonest type worldwide
• Risk factors: esophagitis, smoking, alcohol, genetics
• Middle 1/3 of esophagus
• Symptoms: insidious onset; late obstruction
Esophageal Carcinoma
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Adenocarcinoma of esophagus
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Squamous cell carcinoma of esophagus
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GI Pathology Outline
• Esophagus• Stomach• Gastritis• Ulcers• Carcinoma
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• Mucosal inflammation
• Asymptomatic, or epigastric pain
• Causes: H. pylori, autoimmune, NSAIDs
• Danger: intestinal metaplasia
Gastritis
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Gastritis
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Chronic gastritis
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Helicobacter pylori organisms
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• Erosion of mucosa into submucosa
• Causes: H. pylori, NSAIDs
• Symptoms: epigastric pain
• Danger: bleeding, perforation
Ulcer
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Ulcer
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Intestinal type• Arises in intestinal
metaplasia
• Risk factors: chronic gastritis, bad diet
• Glandular morphology
• Generally asymptomatic
Diffuse type• Arises from gastric glands
• Risk factors undefined
• Signet ring morphology
• Generally asymptomatic
Gastric Carcinoma
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Intestinal-type gastric carcinoma: glands
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Diffuse gastric carcinoma: signet ring cells
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Signet ring cell
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Gastric carcinoma presenting as mass
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Gastric carcinoma presenting as ulcer
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Gastric carcinoma presenting as linitis plastica