Esophagus pathology

3,080 views

Published on

Basic pathology for medical student

Published in: Health & Medicine
0 Comments
15 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
3,080
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
15
Embeds 0
No embeds

No notes for slide
  • A: The embryonic foregut begins as a single tube from which the tracheobronchial diverticulum develops. B: The more proximal portion of the foregut divides into the posterior esophagus and the anterior tracheal tree. C: Septation results from ingrowth of epithelium and mesenchyme in the area of constriction. D: This ingrowth eventually forms a complete septum between the trachea and the esophagus.
  • http://www.naspghan.org/wmspage.cfm?parm1=220http://www.gastro.com/Gastro/photography/gastroesophageal_junction.aspx
  • http://www.trying-to-conceive.com/family/parenting/when-your-infant-keeps-vomiting/http://www.flickr.com/photos/8009253@N06/485647195/http://healthcareproductreviewsite.com/what-is-the-perfect-cure-for-acid-reflux/
  • http://www.nature.com/gimo/contents/pt1/fig_tab/gimo20_F4.html
  • http://www.nature.com/gimo/contents/pt1/fig_tab/gimo22_F4.html
  • http://www.mayoclinic.com/health/medical/IM04155
  • http://kulma.blogspot.com/2009_01_01_archive.htmlhttp://www.coughdoc.com/index.cfm?asset_id=1443
  • http://www.intechopen.com/books/therapeutic-gastrointestinal-endoscopy/transgastrostomal-observation-and-management-using-an-ultrathin-endoscope-after-percutaneous-endosco
  • http://www.umcutrecht.nl/subsite/radiotherapy-research/Research-projects/mri_guided_radiotherapy/esophageal-cancer.htm
  • http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=551CDCA7-A3C1-49E5-B6A0-C19DE1F94871&GDL_Disease_ID=E81B63D8-A04A-470B-A155-4AAC759EDB2D
  • http://www.websters-online-dictionary.net/images//photos/National%20Cancer%20Institute%20=%20done/3915-300dpi.jpg
  • Esophagus pathology

    1. 1. Manasanan Raveesunthornkiat, MD7/12/2012
    2. 2. OBJECTIVES• Recall – embryology, anatomy, physiology• Learn – What diseases? – What signs and symptoms? – How to diagnose? – How to treat?
    3. 3. UESUpper 1/3 SquamousMiddle 1/3Lower 1/3 LES Gastric
    4. 4. • Dysphagia• Heartburn (pyrosis)• Regurgitation• Hematemesis
    5. 5. Structure Function
    6. 6. • Congenital anomaliesClinical presentation – Drooling – Aspiration – Suffocation – Pneumonia
    7. 7. • “Failure to relax” • Uncertain etiology • Risk for squamous cell carcinoma Clinical presentation – Young adulthood – Progressive dysphagia – Nocturnal regurgitation – AspirationPathologyProgressive dilation above the LESThickened muscular wallNormal or ulcerated mucosaAbsent of myenteric ganglia at the body
    8. 8. Manometer • Aperitalsis • Partial or incomplete relaxation of the LES with swallowing • Increased resting tone of the LESManometry
    9. 9. Complication of portal hypertension
    10. 10. Pathology• Dilated submucosal veins• Distal esophagus, proximal stomachClinical features• Masssive hematemesis (when rupture)
    11. 11. • Endoscopic management• Surgical management• Supportive management – Temporary stop bleeding – Blood transfusion – Protect airway• Treated underlying diseases
    12. 12. Dysphagia Odynophagia Upper RetrosternalGI bleeding painFistula Perforation Sepsis
    13. 13. EsophagitisInfection Idiopathic Mechanical Virus Traumatic Radiation Chemical Bacteria Reflux Mycobacteria Medication Corrosive Fungus agents
    14. 14. • especially in immunocompromised persons• acute-onset nausea and vomiting• Odynophagia Herpes simplex (HSV)• Fever Cytomegalovirus (CMV)• retrosternal pain Epstein-Barr (EBV)• GI bleeding Human papilloma (HPV)• Spontaneous esophageal perforation.
    15. 15. PathologyPunched-out ulcersNuclear inclusions indegeneratingepithelial cells
    16. 16. Staphylococcus aureusStaphylococcus epidermidisStreptococcus strains
    17. 17. Esophageal tuberculosisAcid fast stain positive (acid fast bacili)
    18. 18. Most common  Candida speciesOthers:Histoplasma, Paracoccidioides, Trichosporon, Aspergillus, Cryptococcus, Coccidioides, Fusarium, Blastomyces, and Mucor Adherent gray-white pseudomembranes
    19. 19. Narrowing site• Doxycycline• Emepromium Bromide• KCL• Quinidine(forms mss-like lesion)• Iron sulphate• NSAIDs• Alendronate
    20. 20. strong corrosive chemical substances(alkalis or acids)Extent of the injury depends on- Type --alkali > acid- Amount- Concentration- Physical state- Exposure durationComplications• Stenosis• Perforation• Mediastinitis• Pneumonitis
    21. 21. Pathology: Coagulative necrosisThree grades (Gumaste and Dave)
    22. 22. • Symptomatic treatment – Improve patient status• Definitive treatment – Antibiotics, antiviral, antifungal drugs• Prevent complication – Stricture – Rupture• Prevent recurrence
    23. 23. Adults > 40 yrSymptoms Dysphagia Heart burn
    24. 24. A multifactorial disorderA lower mean LES resting pressure Increased gastric volume/ pressureMuscle weakness after mealsScleroderma-like diseases pyloric obstructionMyopathy gastric stasisPregnancy during acid hypersecretion statesSmoking ObesityMedications PregnancySurgical damage to the LES AscitesEsophagitis tight clothes Transient relaxation of LES Inadequate or slowed clearance of refluxed material Delayed gastric emptying Reflux of both acid and alkaline secretions
    25. 25. • GI tract consequences – Bleeding, ulceration – Stricture – Barrett esophagus Extra-esophageal manifestations
    26. 26. 24-hour pH study Endoscopy with Biopsy
    27. 27. Gross: HyperemiaMicroscopic• Basal zone hyperplasia• Elongation of lamina propria papillae• Inflammatory cells
    28. 28. Reflux Heal Stricture Barrett 5% UlcerationInjuryInflammationEpithelial proliferation Adenocarcinoma
    29. 29. Life style • Positioning modification • Diet Medication • Acid suppression therapy Prevent • Barette esophagus complication • Esophageal stricture Treatment of • Surgeryunderlying diseases
    30. 30. • Intestinal metaplasia• Complication of long- standing GERD• 10% of GERD patients• Most important risk factor for esophageal adenocarcinoma
    31. 31. Intestinal metaplasia (Barrett)  dysplasia  adenocarcinoma
    32. 32. ก. ?ข.ค.ง.
    33. 33. • Ulceration• Perforation• Stricture• Luminal mass• Invasion to adjacent organs
    34. 34. Squamous cell carcinomaAdenocarcinoma Upper-lower esophagusLower esophagus
    35. 35. • Smoking 5- to 10-fold. • Barette esophagus• Alcohol• Hot beverage• Plummer-Vinson syndrome, celiac sprue and achalasia• Chronic esophagitis• Chemical injury with esophageal stricture 20-40 yr• HPV infection• Webs, rings and diverticula
    36. 36. MRI
    37. 37. • 5-year survival 10%• Depend on staging
    38. 38. • Treatment modality – Surgery – Chemotherapy – Radiation• Curative care – Complete resection• Palliative care – Improve quality of life – End of life care
    39. 39. Benign smooth muscle tumorSubmucosal mass
    40. 40. Reference• Abbas K and Aster F, Robbin and Cotran pathologic basis of disease. 8th edition. Saunders Elsevier, Philadelphia, 2010• Rubin R and Strayer DS, Rubin’s pathology: clinicopathologic foundations of medicine .6th edition. Lippincott Company, China, 2012• Noffsinger AE, Stemmermann GN, Lantz PE and Isaacson PG. Gastrointestinal pathology an atlas and text. 3rd edition. Lippincott Company, Philadelphia, 2008

    ×