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Upper Gastrointestinal Pathology

Upper Gastrointestinal Pathology. Kristine Krafts, M.D. GI Pathology Outline. Esophagus Stomach Intestine Liver Gallbladder Pancreas. GI Pathology Outline. Esophagus Hiatal hernia Mallory-Weiss syndrome Barrett esophagus Carcinoma. Normal esophageal-gastric junction. Hiatal Hernia.

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Upper Gastrointestinal Pathology

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  1. Upper Gastrointestinal Pathology Kristine Krafts, M.D.

  2. GI Pathology Outline • Esophagus • Stomach • Intestine • Liver • Gallbladder • Pancreas

  3. GI Pathology Outline • Esophagus • Hiatal hernia • Mallory-Weiss syndrome • Barrett esophagus • Carcinoma

  4. Normal esophageal-gastric junction

  5. Hiatal Hernia • Dilated portion of stomach protrudes above diaphragm • Common! Usually asymptomatic. • Heartburn, reflux esophagitis • Danger: ulceration, bleeding

  6. Sliding (L) and rolling (R) hiatal hernias

  7. Mallory-Weiss Syndrome • GE junction tears • Severe vomiting (chronic alcoholics) • Symptoms: bleeding, pain, infection • Treatment: cauterization • Prognosis: usually heals; sometimes fatal

  8. Mallory-Weiss tears

  9. Mallory-Weiss tears

  10. Barrett Esophagus • 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

  11. Normal esophagus (L) and Barrett esophagus (R)

  12. Barrett esophagus

  13. Barrett esophagus

  14. Esophageal Carcinoma 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

  15. Adenocarcinoma of esophagus

  16. Squamous cell carcinoma of esophagus

  17. GI Pathology Outline • Esophagus • Stomach • Gastritis • Ulcers • Carcinoma

  18. Gastritis • Mucosal inflammation • Asymptomatic, or epigastric pain • Causes: H. pylori, autoimmune, NSAIDs • Danger: intestinal metaplasia

  19. Gastritis

  20. Chronic gastritis

  21. Helicobacter pylori organisms

  22. Ulcer • Erosion of mucosa into submucosa • Causes: H. pylori, NSAIDs • Symptoms: epigastric pain • Danger: bleeding, perforation

  23. Ulcer

  24. Gastric Carcinoma 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

  25. Intestinal-type gastric carcinoma: glands

  26. Diffuse gastric carcinoma: signet ring cells

  27. Signet ring cell

  28. Gastric carcinoma presenting as mass

  29. Gastric carcinoma presenting as ulcer

  30. Gastric carcinoma presenting as linitis plastica

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