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Esophagus Tracheoesophageal fistula Newborn: copious saliva choking, coughing cyanosis on food intake Most common form: lower part of esophagus joins the.

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Presentation on theme: "Esophagus Tracheoesophageal fistula Newborn: copious saliva choking, coughing cyanosis on food intake Most common form: lower part of esophagus joins the."— Presentation transcript:

1 Esophagus Tracheoesophageal fistula Newborn: copious saliva choking, coughing cyanosis on food intake Most common form: lower part of esophagus joins the trachea (near the bifurcation)

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3 Esophageal diverticula Outpocketing of the esophageal wall False( pulsion) type: the mucosa herniates into the muscular layer True (traction) type: outpocketing of all the layers 3 common locations: 1. above UES (Zenker diverticulum) 2. midpoint of the esophagus 3. above LES (Epiphrenic diverticulum)

4 Zenker’s diverticulum Epiphrenic diverticulum

5 Gastroesophageal reflux Reflux of gastric contents into the esophagus Heartburn, substernal pain, burning sensation Predisposing factors: alcohol, smoking, pregnancy May lead to: esophagitis, strictures, Barrett esophagus

6 Barrett esophagus Normal epithelium: squamous type Barrett: becomes columnar with many Goblet cells Precursor for adenocarcinoma of the esophagus

7 Barrett esophagus

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9 Cancer of the esophagus Most frequent type: squamous cell carcinoma Dysphagia, weight loss, anorexia Upper and middle thirds of the esophagus Adenocarcinoma type : lower third of the esophagus

10 Cancer of the esophagus

11 Congenital pyloric stenosis Hypertrophy of the circular muscle layer of the pylorus Projectile vomiting in 1 st 2 weeks of life Palpable mass

12 Gastritis Acute gastritis Causes: NSAIDS smoking alcholic drinks burns : Curlings ulcer Cushings ulcer Chronic gastritis Chronic inflammation, atrophy of the mucosa Helicobacter pylori gastritis: most common form Increases risk of gastric cancer

13 Acute Gastritis

14 Peptic ulcers Common locations: lesser curvature antrum prepyloric areas Causes: H.pylori infection bile-induced gastritis Not a precursor lesion of carcinoma of the stomach

15 Benign Gastric Ulcers

16 Cancer of the Stomach Common: more than 50 years old, men, Blood group A Predisposing factors: H. pylori infection Nitrosamines excessive salt intake low fresh fruits, vegetables diet achlorhydia chronic gastritis

17 Cancer of the stomach Most common type: adenocarcinoma Rare in the fundus Aggressive spread to adjacent organs Virchow node: large supraclavicular node Krukenberg tumors: bilateral, enlarged ovaries, “signet ring” cells Two types: 1. intestinal type: fungating mass; ulcer with irregular necrotic base and firm, raised margins 2. infiltrating or diffuse type: linitis plastica

18 Cancer of the stomach

19 Krukenberg tumors

20 Signet ring cells

21 Small Intestine

22 Peptic ulcer of the Small intestine Always associated with increased secretion of gastric acid and pepsin High risk in H. pylori infection Other predisposing factors: aspirin, NSAIDS smoking Zollinger-Ellison syndrome: gastrin-secreting tumor of the pancreas primary hyperparathyroidism Not a precursor of malignancy

23 Crohn disease Chronic inflammatory disease of ALL the layers of the intestinal wall with thickening; narrow lumen 20 – 30 year old, Jewish descent Small intestine and colon May lead to carcinoma Skip lesions Cobblestone appearance Fistulas Noncaseating granulomas

24 Crohn’s disease Presents as: abdominal pain diarrhea fever malabsorption obstruction fistula to bladder, vagina, skin

25 Crohn’s disease

26 Meckel’s diverticulum Most common congenital abnormality of the small intestine Remnant of the vitelline duct in the distal small bowel Peptic ulceration, bleeding, perforation Intussusception volvulus

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28 Celiac disease Malabsorption disease Sensitivity to gluten products Blunting of the intestinal villi Diarrhea:bulky, frothy, foul-smelling Weight loss, failure to thrive, weakness Treatment: gluten-free diet

29 Cancer of the small intestine Mostly adenocarcinoma Appendix: carcinoid type; when it metastasizes to the liver  carcinoid syndrome: Flushed skin Watery diarrhea, abdominal cramps Bronchospasm Valvular lesions of the heart

30 Colon

31 Ulcerative colitis Ulcers in the large intestine or entire colon Pseudopolyps Crypt abscesses Chronic diarrhea Most frequent presentation: rectal bleeding Complications: Toxic megacolon Colon perforation Colon cancer

32 Colon Polyps Elevation of he intestinal surface Peutz-Jeghers polyps: polyps in the colon + dark spots on lips, hands, genitalia Villous adenomas: highest potential of the adenomatous polyps to become malignant Familial polyposis: malignant changes in 100% of cases

33 Adenocarcinoma of the colon 60 to 70 years old Cancer marker: CEA Predisposing factors: adenomatous polyps familial polypposis 4x higher in relatives with colon cancer low fiber, high animal fat diet Cancer of the rectosigmoid: annular enlargement; obstruction Cancer of the right colon: late obstruction; chronic blood loss; iron deficiency anemia


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