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GI Tutorial

GI Tutorial. General Structure. Mucosa Epithelium Lamina Propria Muscularis Mucosa Submucosa Connective tissue, blood vessels, nerve plexus Muscularis propria Serosa & subserosa Fat, connective tissue, blood vessels Lined by peritoneum in areas. Structure and Function.

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GI Tutorial

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  1. GI Tutorial

  2. General Structure • Mucosa • Epithelium • Lamina Propria • Muscularis Mucosa • Submucosa • Connective tissue, blood vessels, nerve plexus • Muscularis propria • Serosa & subserosa • Fat, connective tissue, blood vessels • Lined by peritoneum in areas

  3. Structure and Function • Tubular structure • Complications: • Bleed – Haemorrhage • Burst – Perforation • Block – Obstruction • Fistula formation • Digestive and Absorptive function • Complications • Malabsorption • Total • Specific: Vit B12, fatty acids, proteins • Diarrhoea

  4. GI Tumours • Tumour structure • Exophytic = nodule / polyp • Diffuse infiltrative = spread thru wall +/- stricture • Endophytic = ulcer / excavation • Microscopy • Adenocarcinoma • Signet ring carcinoma (stomach), typical adenoca (all areas) • Squamous cell carcinoma • Oesophagus, Anus, Pharynx, Oral Cavity • Rarer tumours • Carcinoid (anywhere, commonly appendix) • Sarcoma (leiomyosarcoma / gastrointestinal stromal tumour) • Lymphoma • Melanoma (oesophagus)

  5. GI Tumours • Pathogenesis = enviromental & host factors • Enviromental factors • Drugs • Smoking • Alcohol • Diet • Nitrosamines, Vit deficiency (Oesophagus) • Preservatives, Lack of fresh fruit/veg (Stomach) • Excess intake/red meat/refined carbs, low fibre (Colon)

  6. GI Tumours • Pathogenesis = enviromental & host factors • Host factors • Predisposing inherited conditions • FAP, Gardner syndrome, HNPCC (Colon ca) • Predisposing inflammatory conditions • Barretts oesophagus (oesophagus) • Autoimmune / HLO gastritis (stomach) • Coeliac disease (SI) • Ulcerative colitis (colon) • Family history (especially colon ca)

  7. Approach to GI Tumour Questions • Epidemiology • Male / female, age, race, geographic distribution • Pathogenesis • enviromental: drugs, diet, other • host: inherited / inflammatory conditions, family hx • Sequence of events: • Inflammation  metaplasia  dysplasia  invasion • Sequence of mutations (adenoma carcinoma sequence in colon)

  8. Approach to GI Tumour Questions • Morphology • Gross: • Location • Upper/mid/distal oesophagus, pylorus/cardia/fundus, duodenum/ ampulla/jejunum/ileum, caecum/asc/trans/des/sigmoid/rectum • Appearance • Exophytic, infiltrative, endophytic • Microscopy • Adenocarcinoma (+/- signet ring), squamous, other • Spread • Local lymph nodes, liver, lungs, ovaries

  9. Approach to GI Tumour Questions • Clinical • Presentation • Weight loss, anorexia, altered bowel habit, pain • Obstruction • dysphagia, vomiting, abdo distension with constipation • GI haemorrhage – chronic : anaemia • acute: haemoptysis, meleana, collapse • Metastatic disease – hepatomegaly, ascites, lung lesions • Prognosis / Staging • Complications: • Haemorrhage, Perforation, Obstruction, Fistula formation • Local spread: compression/invasion of adjacent organs • Distant mets

  10. SI obstruction

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