3. Diseases of Esophagus:
1- Esophageal Diverticula:
• A diverticulum of the esophagus is an outpouching of the esophageal wall
caused by a weakness of the muscularis layer or motility problems
• Treatment: Surgery is the optimal for persons with severe symptoms or
pulmonary complications.
2- Esophageal lacerations:
• Longitudinal tears at the gastroesophageal junction
• Clinical setting: chronic alcoholics after a severe vomiting
• Tear may be superficial or deep affecting all layers
• Clinical picture: Pain, bleeding, superimposed infection.
4. 3-Achalasia (failure to relax)
Def: Achalasia is an incomplete relaxation of the lower esophageal sphincter
during swallowing.
Clinical picture
1-Dysphagia
2-Regurgitation
3-Chest pain
4-Heart burn / Cough/Recurrent Chest Infection/ Weight loss.
4-Esophagitis:
Esophagitis is inflammation that may damage tissues of the esophagus
Esophagitis can cause painful, difficult swallowing and chest pain. Causes
of esophagitis include stomach acids backing up into the esophagus,
infection, oral medications and allergies.
5. 5- Barrett esophagus:
• A complication of long standing reflux esophagitis
• Replacement of squamous epithelium by columnar epithelium with goblet cells
• 30- to 40-fold greater risk to develop adenocarcinoma
6-Esophageal varices:
• Etiology: portal hypertension secondary to liver cirrhosis
• Asymptomatic until they rupture leading to massive hemorrhage
• 50% subsides spontaneously
• 20-30% die during the first attack
• Rebleeding occurs in 70% of cases within one year
6. 7- Cancer of the Esophagus:
Cancer of the esophagus is a relatively uncommon form of cancer that is
commonly linked to gastroesophageal reflux and Barrett esophagus
(adenocarcinoma) or alcohol and tobacco use (squamous cell carcinoma).
Squamous cell carcinoma
◦ More prevalent worldwide
◦ Risk factors: long-standing
esophagitis, achalasia,
smoking, alcohol, genetics
◦ 50% in middle 1/3
Adenocarcinoma
More common
Occurs on top of Barrett
esophagus
More in distal 1/3
7. Stomach
It secret acid ( to breakdown of food) , intrinsic factors (binds
vitamin B12) , release food to duodenum.
Pathological conditions
1) Obstruction
2) Gastritis
3) Ulcer
4) Gastroparesis
5) Tumors
6) Pernicious anemia
8. 1-OBSTRUCTION
It may be due to obstruction of pyloric , from inside by:
1-presence of foreign body.
2-Gastric polyp.
Or from outside by: 1-pressure from pancreatic tumor.
Symptoms
-Vomiting is the chief complaint with abdominal distension.
2-GASTRITIS:
• Def:Inflammation of the gastric mucosa. Classified into
• Acute gastritis: It may be infectious (viral, fungal or bacterial infection ) or chemical,
irritant food, or alcohol.
• CHRONIC GASTRITIS:
It characterized by infiltration of gastric mucosa with chronic inflammatory cells mostly
lymphocytes associated with mucosal atrophy
There are two main types of chronic gastritis:
Type A , with an autoimmune etiology.
Type B , caused by Helicobacter pylori infection.
Pyloric stenosis
9. 3-PEPTIC ULCER DISEASE:
Def. It is a defect in the mucosal surface of the stomach or duodenum.
Peptic ulcers can occurs in the stomach “ gastric ulcer” or in the duodenum “ duodenal
ulcer”
Causes
I. Decreased mucosal protection
II. Increased acid production
Symptoms of peptic ulcer:
Pain.
Vomiting of blood.
Nausea.
Tarry stools “ melena” i.e. blood in the stool which becomes black in color.
Peptic ulcer.
10. 4-GASTROPARESIS:
• Def. It is paralysis of stomach usually due to nerve damage or dysfunction.
• Some drugs as acetylcholine blocker cause decrease in gastric motility which may
result in gatroparesis.
5-GASTRIC CANCER:
• Helicobacter pylori infection is most common predisposing factor for gastric cancer.
• Adenocarcinoma is the common type of gastric cancer.
• Carcinoma of the stomach may appears as fungating tumor has a cauliflower-like
appearance , or ulcerated tumor which appears as irregularly shaped ulcerated area
“ similar to gastric ulcer”
• Symptoms: Nausea & GIT bleeding
• 6- PERNICIOUS ANEMIA:
• The cells of stomach produce intrinsic factors which binds Vitamin B12 facilitating its
absorption.
• Therefore absence of intrinsic factors interfere with vitamin B12 absorption which
leads to pernicious anemia
11. Its functions are related to digestion & absorption
Pathological conditions
1) Obstruction
2) Mal-absorption
3) Tumors
1-OBSTRUCTION:
It is blockage of the intestinal tract . As other parts of GIT, intestinal obstruction may be
due to pressure from tumor, gall stones, inflammatory changes causing adhesions such
as occur after surgery. Other causes of mechanical obstruction include e.g Volvulus,
which is twisting of the bowel on itself
12. 2-MALABSORPTION SYNDROMES:
Malabsorption is due to failed absorption of nutrients by the small intestines.
Defective intraluminal digestion:
1-pancreatic insufficiency
2-Defective bile secretion
3-Failure of stomach acid secretion.
Clinical features of malabsorption syndromes
Hematopoietic system:
Anemia: iron, folate and B12 deficiency
Bleeding: vitamin K deficiency
Musculoskeletal system:
Osteopenia: calcium and vitamin D deficiency
Skin:
Purpura: vitamin K deficiency
Dermatitis: vitamin A deficiency
Nervous system:
Peripheral neuropathy: folate and B12 deficiency.
13. 3-SMALL BOWEL TUMOR
• Benign neoplasms include adenoma, lipoma , leiomyoma
• Malignant neoplasms include adenocarcinoma , lymphomas and
sarcomas.
• Small bowel tumors may cause obstruction and /or bleeding.
• Symptoms
• Vomiting
• Abdominal pain
• Weight loss
• GI bleeding
14. It reabsorbs water and passage of undigested foods as stool
Pathological conditions:
1) Diverticula
2) Colitis
3) Tumors
4) Inflammatory Bowel Disease (IBD)
15. 1-DIVERTICULA
• Def. Diverticula are outpouchings of the intestinal mucosa through weakened
muscularis propria
• Low fiber diet leads to formation of hard stools which create extra squeezing
work for large intestine, with time, the wall becomes week and leads to
diverticula.
Symptoms
• Abdominal pain
• Lower GI bleeding
2-COLITIS
• Inflammation of colon.
• It may be due to infection or drugs e.g. antibiotics .
Symptoms:
• Abdominal pain
• Lower GI bleeding
Diverticula of intestine
16. 3-COLON CANCER
• Adenocarcinoma is one of the most common cancer.
Symptoms:
• Intestinal obstruction
• Abdominal pain
• Lower GI bleeding
• Weight loss
4-INFLAMMATORY BOWEL DISEASE (IBD)
• It includes two closely related conditions “Ulcerative colitis and Crohn’s disease”.
• Ulcerative colitis a disease of the large intestine, that includes characteristic ulcers in
the colon.
• The main symptom is usually constant diarrhea mixed with blood
• Crohn’s disease nearly similar to ulcerative colitis but it can affect any portion of
gastrointestinal tract
17. Hepatic diseases:
They include:
1- Hepatic abscesses
2- Hepatic steatosis i.e. Fatty change of liver
3- Hemochromatosis
4- Viral hepatitis
5- hepatic neoplasm
• Any liver diseases can lead to cirrhosis which increase risk of hepatic
cancer
18. LIVER PATHOLOGY:
JAUNDICE:
Bile produced in the liver and then drains through intrahepatic biliary system into
extrahepatic biliary system.
Jaundice occurs due to increase in either unconjugated or conjugated bilirubin in
the circulation
Types of Jaundice:
1- Pre-hepatic jaundice
The pathology is occurring prior to the liver e.g. excessive hemolysis of RBCs as in
Hemolytic diseases
2- Hepatic jaundice
The pathology is located within the liver due to Hepatocellular damage e.g. acute
hepatitis.
3- Post-hepatic jaundice
The pathology is located after the conjugation of bilirubin in liver as in obstruction of
flow of bile e.g. stones in bile duct
19. 1- BACTERIAL HEPATIC ABSCESS
The main pathogenic bacteria are E. coli and Staphylococcus aureus
Clinical manifestations
• High fever
• Pain in hepatic area
• Hepatomegaly
• Jaundice
• Elevation of WBC counts
2- HEPATIC STEATOSIS (FATTY LIVER)
• It occurs secondary to alcohol abuse ( alcoholic liver disease)
• It cause mild elevation in AST and ALT levels
• It may associated with obesity, diabetes and malnutrition
• The severely affected liver become enlarged and yellowish in colour.
20. 3- VIRAL HEPATITIS
HEPATITIS A
• Transmission:
• Contaminated food (fecal oral transmission)
• Spreads rapidly → Acute viral hepatitis → Jaundice
• Painful enlarged liver
• Never become chronic
HEPATITIS B
• Transmission:
• Sexual transmission & Blood transfusion & Across placenta
• Lead to
• 1-Acute hepatitis (90%) with rapid destruction of liver
• 2- Chronic hepatitis (10% ) usually asymptomatic
• Complication
• Cirrhosis & Primary hepatocellular carcinoma
21. HEPATITIS C:
• Transmission
• Sexual & Blood transfusion &Across placenta
• Lead to:
• 1-Acute hepatitis
• 2-Most cases (50%) go to chronic hepatitis, asymptomatic and 20% develop to cirrhosis
• Complication
• Increased risk of hepatocellular carcinoma
HEPATITIS D:
• Transmission
• Sexual & Blood transfusion & Across placenta
• Complication
• Cirrhosis
HEPATITIS E:
• Transmission
• Similar to hepatitis A & Spreads rapidly Contaminated food
Lead to →Acute viral hepatitis → Jaundice
22. 4- HEMOCHROMATOSIS
Abnormal high amount of iron in the blood leads to accumulation of iron in
parenchymal cells resulting in side effects, including heart failure, diabetes mellitus
and hepatic pigmented cirrhosis.
• Hemochromatosis can be acquired or hereditary.
5- HEPATIC NEOPLASM
• It may be benign or malignant. Malignant ones may be primary or secondary
• Benign hepatoma
• It is more common in female and often secondary to oral contraceptives uses
• Hepatocellular carcinoma
Etiology : 1- Viral hepatitis 2- Liver cirrhosis 3- Aflatoxin produced by
fungus aspergillus 4- Other chemical carcinogens e.g. nitrosamine
Diagnostic methods
AFP (-fetoprotein ) & ultrasound, CT, MRI
23. GALL STONE
The two main components necessary for bile synthesis are
i. Pigment from bilirubin
ii. Cholesterol
Causes
1-Excess of these component can lead to gall stones
formation(excess pigments may occurs due to excessive
haemolysis of RBCs).
2-Stasis in the gall bladder is predisposing for gall stones
formation.
3-Chronic cholecystitis (inflammation of the gallbladder ) can
increase the risk of gall stones.
24. Clinical manifestation
• It may be without symptom which is called asymptomatic gallstones
• It may cause biliary colic(upper abdominal discomfort after meals,
especially fatty meals).
• Clinical findings:
• High WBC count.
• Elevation of alkaline phosphate and bilirubin
Complications:
1-The stone can pass into common bile duct and obstruct it lead to
jaundice
2-The stones may pass into duodenum cause obstruction of
pancreatic duct leads to pancreatitis
25. PANCREAS
Function of pancreas
• The pancreas has 2 main function
• Endocrine:
Regulates blood glucose
Via Insulin, glucagon.
• Exocrine (acini & duct)
Production and release of digestive Enzymes (acini) chymotrypsin,
trypsin, lipase , amylase
Bicarbonate (ducts)
Secretions to duodenum via duct.
26. ACUTE PANCREATITIS
• Acute inflammation of the pancreas
Causes :
• Gallstones:60%
• Alcohol:4%
• Drugs
• Infectious agents
Clinical findings
Elevation of serum amylase and lipase levels
CHRONIC PANCREATITIS
• chronic inflammation of pancreas characterized by repeated inflammation
and replacement of pancreatic acinar tissue by fibrous tissue
Causes
• Alcohol
• Obstructive pancreatitis
27. TUMORS OF PANCREAS :
• Pancreatic carcinoma
• Arise from acinar or duct cells
• Main symptom
• Obstructive jaundice
• Distended gallbladder
• Abdominal pain
• Diabetes
INSULINOMA:
• Pancreatic endocrine neoplasm arise from B cell
• Symptoms:
• Spontaneous hypoglycemia
• Relief of symptoms by oral or intravenous administration of glucose
