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Diseases of git
- 4. Inf. Thyroid Arts. R. Bronch. Art. Thoracic. Aor. Left Gastric Art. Variations: Inf, Phrenic Celiac Splenic Short Gast. www.freelivedoctor.com
- 24. REFLUX/GERD
- 31. ESOPHAGITIS
- 32. ESOPHAGITIS
- 40. ADENOCARCINOMA
- 42. STOMACH NORMAL: Anat., Histo, Physio. PATHOLOGY CONGENITAL GASTRITIS PEPTIC ULCER “ HYPERTROPHIC” GASTRITIS VARICES TUMORS BENIGN ADENOCARCINOMA OTHERS
- 43. ANATOMY Cardia (esoph), Fundus (diaph), Body (acid), Antrum, Pylorus Greater/Lesser Curvatures 1500-3000 ml Rugae INNERVATION: VAGUS, Sympathetic VEINS: Portal Blood Supply: RG, LG, RGE(O), LGE(O), SG, ALL 3 branches of the celiac
- 49. CELLS MUCOUS: MUCUS, PEPSINOGEN II CHIEF: PEPSINOGEN I, II PARIETAL: ACID ENTEROENDOCRINE: HISTAMINE, SOMATOSTATIN, ENDOTHELIN
- 50. PHYSIOLOGY PHASES (HCl Secretion) CEPHALIC (VAGAL) GASTRIC (STRETCH) INTESTINAL (DUOD)
- 51. ACID PROTECTION MUCUS HCO3- EPITHELIAL BARRIERS BLOOD FLOW PROSTAGLANDIN E, I
- 77. BEBNIBGNB .BENIGN TUMORS .MUCOSA (POLYPS) --- HYPERPLASTIC ---Fundic ---Peutz-Jaeger ---Juvenile ---ADENOMATOUS MUSCLE FAT
- 83. PAPILLARY
- 84. TUBULAR
- 85. MUCINOUS
- 86. SIGNET RING
- 87. ADENOSQUAMOUS
- 117. GIARDIA LAMBLIA
- 124. CELIAC DISEASE
- 127. WHIPPLE’s DISEASE
- 133. CROHN vs. UC
- 134. UC or CD?
- 143. DIVERTICULOSIS
- 144. DIVERTICULITIS
- 145. DIVERTICULITIS
- 147. OBSTRUCTION
- 152. POLYPS
- 153. PEDUNCULATED vs VILLOUS vs SESSILE
- 155. HPERPLASTIC POLYP
- 164. PAPILLARY
- 165. TUBULAR
- 166. MUCINOUS
- 167. SIGNET RING
- 168. ADENOSQUAMOUS
- 169. Tumor Stage Histologic Features of the Neoplasm Tis Carcinoma in situ (high-grade dysplasia) or intramucosal carcinoma (lamina propria invasion) T1 Tumor invades submucosa T2 Extending into the muscularis propria but not penetrating through it T3 Penetrating through the muscularis propria into subserosa T4 Tumor directly invades other organs or structures Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in 1 to 3 lymph nodes N2 Metastasis in 4 or more lymph nodes Mx Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis
- 172. A P P E N D I X
- 175. ACUTE APPENDICITIS
Notas do Editor
- Generally synonymous with the word “esophagospasm”
- Hiatal hernia with SHATZKI ring.
- “ TRUE” diverticula usually have all 4 layers in its wall: Muc/Submuc/Musc/Adventitia. Which one of these might result in dysphagia? Ans: Zenkers
- Note that the image on the right is the NON-microscopic demonstration of a squamo-columnar junction.
- Endoscopist’s point of view (left), and one of the treatment options (right). “Banding”, i.e., putting rubber bands on the varices, is also common.
- GERD is as MASSIVELY common as heartburn itself, because it IS heartburn!!!
- You can think of Barrett’s as REVERSE squamous metaplasia.
- Barrett’s on top, goblet cell on right, normal esophagus on bottom.
- Glandular “dysplasia”
- Candida, candida esophagitis in a HIV positive patient often is indicative of “full blown” AIDS.
- Herpes, from the points of view of the endoscopist and the pathologist. Might these large nucleolated cells be exfoliated as “Tzanck” cells?
- The very BEST way to classify ALL tumors of a major organ is to remember its basic HISTOLOGY
- Would you call this squamous “dysplasia”? Answer: YES Would your fear it would develop into squamous cell carcinoma? Answer: YES Does it always? Answer: NO Does it usually? Answer: With time, YES
- ALL 3 classic branches of the celiac axis supply the stomach: Common hepatic, left gastric, and splenic
- GE Junction is a squamo-columnar junction
- Body
- Pyloric sphincter
- Somatostatin (also known as growth hormone-inhibiting hormone ( GHIH ) or somatotropin release-inhibiting factor ( SRIF )) is a polypeptide that regulates the endocrine system and affects neurotransmission and cell proliferation via interaction with G-protein coupled somatostatin receptors and inhibition of the release of numerous secondary hormones. Endothelins are proteins that constrict blood vessels and raise blood pressure
- • The cephalic phase, initiated by the sight, taste, smell, chewing, and swallowing of palatable food, is mediated by vagal activity. • The gastric phase involves stimulation of stretch receptors by gastric distention and is mediated by vagal impulses; it also involves gastrin release from endocrine cells, the G cells, in the antral glands. Gastrin release is promoted by luminal amino acids and peptides and possibly by vagal stimulation. • The intestinal phase, initiated when food containing digested protein enters the proximal small intestine, involves a number of polypeptides besides gastrin.
- Prostaglandin E both DECREASES acid and INCREASES mucous.
- The acute/chronic patterns of gastritis generally conform to the poly/mono principles we so often have referred to. The “other” category of gastritis are also histologically based.
- Helicobacter pylori, gastric biopsy, silver stain on left, giemsa stain on right.
- Would an autoimmune gastritis be associated with megaloblastic anemia? Why? Answer: DECREASED intrinsic factor
- Eosinophilic gastritis
- Would this slide be seen in a REAL classroom to those sitting in the back row?
- A large obstructive bezoar usually takes on the shape and contour of the stomach
- Note that the “hypertrophy” is really various types of “hyperplasia”.
- Note prominence or “cerebrated” appearance of rugae.
- HYPERPLASTIC POLYPS are considered to be NON-neoplastic, and therefore NEVER turn into cancers. ADENOMATOUS polyps are true benign neoplasms and MAY turn into carcinomas, particularly if the exhibit DYSPLASIA on biopsy.
- I hope these are logical anatomic or “geometric” descriptions
- The LINITIS PLASTICA is the most SPECTACULAR, and most FEARED, of all gastric adenocarcinomas. It grows DIFFUSELY through all layers of the stomach, greatly thickening its wall, and giving the stomach a classic LEATHER BOTTLE appearance. It has a horrible prognosis.
- If you thought this yucky whitish stuff was mucin, what stain would you order to prove it? Answer: Mucicarmine stain. Is a positive muci-CARMINE stain RED (i.e., “carmine” colored)? Answer: YES
- Signet ring cells are POORLY differentiated adenocarcinoma cells, and are OFTEN seen with linitis plastica. Could those large “holes” in the cytoplasm possibly be mucicarmine positive” Answer: YES
- For as notoriously complex as all this sounds, they look like boring leiomyomas, and in the days PRE-immunochemistry, they probably WERE called smooth muscle tumors.
- Gastroschisis is also called paraomphalocele , laparoschisis , or abdominoschisis
- If the purpose of a bowel mucosal epithelial cell is to absorb fluid, it dpes NOT absorb fluid when it is damaged.
- Increased damage to an intestinal mucosal epithelial cell can result in EXUDATE from the mucosa TO the lumen
- Mucosal (villous) flattening and chronic mucosal inflammation
- Idiopathic Inflammatory Bowel Disease
- Idiopathic Inflammatory Bowel Disease
- Idiopathic Inflammatory Bowel Disease
- Granulomas are NOT found in UC, distinct mucosal pseudopolyps are not found in CD
- Pseudopolyp or fissure?
- * NOT “dysplastic” in the classic sense of the word
- Infarcted bowel is usually purple and paper thin
- Ileus is a disruption of the normal propulsive gastrointestinal motor activity from NON-mechanical mechanisms. Motility disorders that result from structural abnormalities are termed mechanical bowel obstruction.
- NOTE the various types of epithelial cells….this is the reason it is benign, i.e., NON monoclonal.
- TUBULAR adenoma, note how all the epithelial (glandular) cells look the same.
- Villous adenomas behave more aggressively than tubular adenomas
- Signet ring cells are POORLY differentiated adenocarcinoma cells, and are OFTEN seen with linitis plastica
- The presence of neutrophils invading the muscularis is the diagnostic criteria needed to diagnosis or confirm, acute appendicitis!
- A RUPTURED MUCINOUS CYSTADENOCARCINOMA can look exactly like benign pseudomyxoma peritoneii, but with tumor cells present