General Pathology

1. Prof.Dr.
Khalil Hassan Zenad
Aljeboori
Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Lecture 22
DISEASES OF ALIMENTARY
SYSTEM

2. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Lesion of oral cavity
organ Congenital malformation inflammation Tumor (benign, malignant)
The lips Cleft lip, maro, micro cheilia Viral, bacterial, spirochetal,
protozoa, deficiency diseases
Papilloma, squamous cell
carcinoma,fibroma lipoma…..
The mouth cleft palate, atresia of soft palate,
marco and mirco stomia
Viral, bacterial, spirochetal,
mycotic protozoa ,leukoplakia
Squamous cell carcinoma, sarcoma, mixed
tumor angioma , papilloma, myoma
The tongue Microglossia macroglossia aglossia,
geographic tongue
Clossitis, syphilis, tuberculosis,
ulcer ,leukoplakia
Sqaumous cell carcinoma, angioma,
papilloma, myoma
The gum 1.melanotic pigmentation,
hematochromatosis
2.lead,bismuth, mercury
Addison’s disease
heavy metals.
Tumors and inflammation similar to other
part of mouth
The teeth and jaw Anamolies of number, size, shape,
eruption malocclusion…etc
Dental caries, apical abscess Ameloblastoma, dintigerous cyst,
adontoma
The salivary glands Absence, cyst Parotitis, ranula, sjogren
syndrome, sialolithiasis
Mixed tumor, squamous cell carcinoma,
adenoma, hemangio endothelioma
The pharynx Tonsillitis, pharyngitis (bacterial
diseases….)
Sqaumous cell carcinoma transitional cell
carcinoma lympho epithelioma,
nasopharyngeal fibroma

3. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Congenital anomalies:
1. Atresia with trachea-esophageal fistula.
2. Congenital shortening.
3. Heterotopic gastric mucosa.
4. Webs.
Esophagus:

4. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
 Inflammation and ulcerations:
Follow swallowing or corrosive chemicals, T.B, peptic ulcer and varices at lower end in obstruction of portal
circulation i.e. cirrhosis.
 Tumors:
Benign are rare, malignant tumors are squamous cell carcinoma, adeno-carcinoma are rare, carcinoma 3% in Iraq of
tumors.
 Obstruction:
1. Congenital
2. Post inflammatory fibrosis
3. Tumors
4. Cardio spasm or stricture of lower portion is due to spasm of cardiac sphincter.
5. Pressure from outside.
Diverticula:
May be of pulsion type due to pressure in esophagus forcing the wall outward at weak point, or due to
traction by inflammation, adhesion to surrounding structures.

5. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Stomach:
Congenital abnormalities:
Congenital pyloric stenosis, due to hypertrophy and spasm of muscle of pylorous with normal mucosa.
Inflammations:
Acute gastritis caused by various irritant food, alcoholic drinks, poisons.
Chronic gastritis:
1. Chronic hypertrophic gastritis: in which thickening of mucosa and submucosa together with
inflammatory cells infiltration.
2. Chronic atrophic gastritis: in which atrophy of mucosa and submucosa with inflammatory cells
infiltration. It occur in case of pernicious anemia and in case of vitamin B deficiency in aged persons,
achlorhydria and iron deficiency anemia are common features. It is precancerous condition.

6. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Ulcers of stomach:
1. Acute ulcers
2. Chronic peptic ulcer
3. Acute ulcers:
produced by a variety of injuries such as coarse and excessively hot foods, septicemia, extensive burn of skin, lobar
pneumonia, cerebral veinous accidents, ulcers are usually pin point size, superficial multiples are more frequent in
stomach than duodenum and often hemorrhage.
1. Chronic peptic ulcer:
It refers to ulceration in areas which may be acted upon by acid gastric juice i.e stomach and first portion of duodenum.
Etiology- two mechanisms:
A. Devitalization of localized area of mucous.
B. Constitutional predisposition.
When there is achlorhydria due to pernicious anemia, peptic ulcer does not occur, changes in vascular supply
(thrombosis and embolism), localized infection, influence of central nervous system. Recently autoimmunity has been
involved as a possible etiology. 95% of ulcer occur in the magenstrase this region comparable to other regions of
stomach is exposed to more trauma, lack protective mucin, and it subjected to greater muscle traction.

7. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Gross appearance: constant location (pyloric, post wall, lesser curvature first portion of duodenum).Usually
single size few mm to 3cm larger usually carcinomatous, peptic ulcer in duodenum is never a carcinoma indurated,
deep, punched out or funnel shape, steep on cardiac side and sloping on pyloric side, the base is covered by necrotic,
granulation tissue fibrosis around edge of ulcer which may lead to hourglass deformity of the stomach or pyloric
stenosis.
Microscopically: fibrosis, chronic inflammatory cells infiltration at the base and this is topped by a layer of
granulation tissue which become necrotic toward the surface, endarteritis obliterans at the base.
Clinical picture: pain after meal and relieve by taking alkalines.
Complications:
1. Hemorrhage
2. Perforation
3. cicatricle contraction (hour glass and pyloric stenosis)
4. malignant transformation

8. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
1.usually at pylorus may be:
a)congenital.
b)sac of healed ulcer.
c)carcinoma.
2.bezoar or concretion masses of (indigested material).
Obstruction of stomach:

9. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Comparison of benign and malignant gastric ulcer
Ulcerative carcinoma Chronic ulcer(Benign)
Duration History lesson than 2 years More than 2 years
Age Past forty Under forty
Size Over 2.5 cm Less than 2.5 cm
Position Very near pylorous 2-3 inches from pylorous
Edge Raised round Sharp, punched out
Acidity Often hypoacidity Hyperacidity
Blood group Carcinoma of stomach common in
group A
frequent in group O

10. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
 Benign tumors:
Adenoma, gastric polyp and benign myoma, benign tumor may arise from
all layers of stomach (adenoma from mucosa, myoma from muscularis,
fibroma from serosa).
 Malignant tumors:
Carcinoma: constitute 5% of all malignancies in Iraq, among people group
A between 50-60 years old.
Tumors:

11. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Grossly:
1. papillary, polypoid, cauliflower, fungated.
2. Scirrhous, infiltrating, diffuse fibrosis of the wall.
3. Ulcerative type.
Microscopically:
 adenocarcinoma, scirrhous or mucoid types, secondary carcinoma transcoelomic spread in the
ovaries, important site for metastasis tumor supraclavicular lymph node adjacent to thoracic duct.
 Hematemesis: vomiting of blood due to diseases of esophagus (varices and cancer) disease of
stomach ulcer, cancer, disease of duodenum (peptic ulcer) and blood diseases.
 Melena= stool stained with blood pigment or altered blood.
Main forms;

12. PRESENTATION
ENDS
Copyrights © 2017 l Aliraqia University l Dentistry l Pathology l Prof.Dr.
Khalil Hassan Zenad Aljeboori.
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