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Gastrointestinal system (B)

Gastrointestinal system (B). Maram Abdaljaleel , MD Dermatopathologist & Neuropathologist Faculty of Medicine University of Jordan. management. Mostly periodic surveillance endoscopy with biopsy to screen for dysplasia .

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Gastrointestinal system (B)

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  1. Gastrointestinal system (B) MaramAbdaljaleel, MD Dermatopathologist & Neuropathologist Faculty of Medicine University of Jordan

  2. management • Mostly periodicsurveillance endoscopywith biopsy to screen for dysplasia. • high-grade dysplasia and carcinoma surgical resection (esophagectomy) • newer approaches: photodynamic therapy, radiofrequency ablation, and endoscopic mucosectomy.

  3. Esophageal carcinoma: • Two morphologic variants : adenocarcinoma and squamous cell carcinoma. • Worldwide, squamous cell carcinoma is more common but adenocarcinoma is on the rise. • Presents as: • dysphagia, odynophagia, obstruction, altering diet from solid to liquid foods, weight loss, debilitation, hemorrhage and sepsis

  4. Esophageal adenocarcinoma • typically arises in a background of Barrett esophagus and long-standing GERD. • Risk factors: • documented dysplasia • Tobacco use • Obesity • previous radiation therapy. • whites, men (7:1),western countries

  5. Adenocarcinoma usually occurs distally and involves gastric cardia

  6. Squamous Cell Carcinoma • adults males >45 years, African Americans • Risk factors: • alcohol & tobacco use • poverty, rural and underdeveloped areas • caustic esophageal injury, • frequent consumption of very hot beverages, • previous radiation therapy to the mediastinum.

  7. Squamous cell carcinoma most frequently is found in the mid-esophagus

  8. Diseases of the stomach

  9. Gastritis and gastropathy: • When neutrophils are present acute gastritis. • When cell injury and regeneration are present but inflammatory cells are absent gastropathy • Agents causing gastropathy include NSAIDs, alcohol, bile, and stress-induced injury.

  10. Pathogenesis: • The gastric lumen is strongly acidic pH close to 1 • Multiple mechanisms protecting the gastric mucosa: • Mucinsecreted by surface foveolar cells forms a thin layer of mucus that prevents food particles from touching the epithelium and promoting formation of layer of fluid with neutral pH • secretion of bicarbonate ions by surface epithelial cells. • Rich blood supply of the gastric mucosa buffering and removes protons Any disturbance of protective mechanisms can result in gastropathies, acute gastritis or chronic gastritis

  11. Stress-Related Mucosal Disease • Stress ulcers: critically ill patients with shock, sepsis, or severe trauma. • Curling ulcers: severe burns or trauma. • Cushing ulcers: intracranial disease

  12. Chronic Gastritis: • Symptoms include: persistent Nausea and upper-abdominal discomfort. • Causes: • The most common cause of chronic gastritis is infection with the bacillus Helicobacter pylori. • Autoimmune gastritis represents<10% of cases of chronic gastritis but is the most common cause in patients without H. pylori infection. • Chronic NSAID use is a third important cause • Less common causes include radiation injury and chronic bile reflux.

  13. Spiral-shaped H. pylori abundant within surface mucus Intraepithelial and lamina proprianeutrophils are prominent. Intestinal metaplasia: goblet cells admixed with gastric foveolar epithelium

  14. Treatment: • Combinations of antibiotics and proton pump inhibitors.

  15. Thank you

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