2. بسم الله الرحمن الرحيم GIT Diseases By Dr. Ghada Ahmed Lecturer of Pathology Benha Faculty of Medicine

3. Objectives Discuss different diseases of the esophagus Hiatal hernia Esophgeal varices Esophagitis Barrett’s esophagus Tumors Causes of dysphagia Discuss different diseases of the stomach Pyloric stenosis Gastritis Gastric ulcers Tumors Causes of haematemesis

4. Diseases of the esophagus

5. I. Hiatal hernia Sliding HParaesophageal H

6. II. Esophageal varices Causes

7. III. Esophagitis Causes: Reflux Gastric intubation Ingestion of irritant substance Infection (viral, bact, fungal) Cytotoxic/ radiation ttt

8. Reflux esophagitis: Def Causes Morphology Complications: (PU - Perforation- Barrett’s- Precancerous)

9. IV. Barrett’s esophagus IV. Barrett’s esophagus

10. V. Esphageal tumors Esophageal tumors BenignEpithelialMesenchymalMalignantEpithelialMesenchymal

11. Carcinoma of the esophagus Squamous cell carcinoma (90%): PF Sites Morphology Adenocarcinoma PF Site Morphology

12. Carcinoma of the esophagus

13. Effects of esophageal carcinoma Dysphagia Cachexia Hematemesis Tracheo-esophageal fistula Spread:

14. VI. Dysphagia In the wall (stricture) In the lumen (obstruction) Pressure from outside

16. Diseases of the stomach

17. Gastric mucosal barrier

18. I. Pyloric stenosis Congenital Acquired

19. II. GastritisAcuteChronic Chronic superficial gastritis Chronic atrophic gastritis

20. Acute gastritis Causes:  NSAI  Alcohol  Smoking  Infection  Stress  Cancer chemottt  Suicide attempts

21. Acute gastritis

22. Chronic gastritis Def Causes (AI, H.pylori, smoking, alcohol) Types:

23. Chronic superficial gastritis

24. Chronic Atrophic gastritis Gross m/p Gastric atrophy Metaplasia

26. H. pylori Pathogenesis Effects

27. III. Gastric ulcer Acute gastric ulcer

28. Peptic ulcer (chronic gastric ulcer) Def Sites P F

29. Pathogenesis of peptic ulcer Damaging forces: e.g. H.pylori Genetic, hormonal Enviromental Stress Mucosal defenses: Mucin Bicarbonate sec Epithelial barrier

31. Peptic ulcer (morphology)

33. Complications Bleeding (hematemesis- melena) Perforation Fibrosis----- (stenosis) Malignant transformation

35. IV. Tumors of stomach Benign Epithelial : Adenoma Mesenchymal Leiomyma, fibroma, lipoma, GIST Malignant Epithelial: *Adenocarc. *Mucinous carcinoma, *Signet ring carcinoma, *Undifferentiated carcinoma Mesodermal Lymphosarc. Carcinoid Lymphoma GIST

36. Gastric adenoma (polyp)

37. Gastrointestinal stromal tumors (GIST) Definition: (interstitial cells of Cajal) Age> 40 ys Sites60% gastric Morphology Effects

38. Morphology of GIST

39. Gastric carcinoma Incidence old male gp A Aetiology:  PF : Diet as nitrates Dried salted fish& meat Decreased intake of fresh veg& fruits:  Precancerous lesions (gastritis- ulcer- polyp)

40. Gastric carcinoma (sites) 50% 25%

41. Gastric carcinoma/ Gross 1- polypoid2-ulcerative

42. 3- infiltrative (Linitis plastica/ leather bottle st)

43. Gastric carcinoma m/p 1-Adenocarc. 2-Mucinous carc. 3-Signet ring carc.

44. Spread & metastases Direct spread Lymphatic spread Blood spread Transcoelomic spread Effects & Complications (bleeding-obstruction- hypoHCL- cachexia)

45. V. Haematemeis Defintion Causes

46. Haematemesis Local causes 1- esophgeal2- gastric3- duodenal General causes Blood diseases & vitamin def.

47. Next Diseases of small intestine