Pathology Of Eso And Stomach

Front 1

Esophageal diverticula

Back 1

upper eso

defect of cricopharyngeal muscles

leads to pulsion diverticulum secondary to pressure within eso

enlarge and can cause regurg

Front 2

Candida esophagitis

Back 2

pseudomembrane seen in early disease = acute esophagitis

may become severe

Front 3

GERD

Back 3

associated foods

causes relaxation of lower esophogeal sphincter LES

or increased intra abdominal pressure

occurs in 20-25% of adults

heartburn due to reflux of gastric contents

worse after eating when acid increases

Front 4

GERD pathology

Back 4

squamous hyperplasia

vasuclar dilation

eosinophils very prominent

Front 5

GERD complications

Back 5

aspiration pneumonia

esophagitis

barrett's esophagus = alteration, metaplastic lesion of squamous mucosa

Front 6

Barrett's eso

Back 6

metaplasia squamous mucosa, differentiated cell becomes more glandular in order to produce more mucus and more stomach like

can result in an increased risk of carcinoma = becoming more dysplastic and lead to cancer

appearance is roughened and glandular and somewhat erythmatous

Front 7

Barrett's Dx

Back 7

in situ hybridization used to see increased expression of villin protein which is evidence of metaplasia

goblet cells and small bowel like vili

Front 8

Esophogeal carcinoma

Back 8

patients over 50

more common in males

incidence of adenocarcinomas growing faster than any other cancer in the US

smoking and alcohol, 28% reductionf o cancer in statin users

Front 9

Eso cancer path

Back 9

polypoid or fungating = most common may produce obstruction most common, diffusely infiltrating flat lesions, or ulcerating

mostly lower third of eso and are adenocarcinomas

squamous is 40% and adenocarcinoma from Barrett's leison lower third of esophagus, necrosis in the biopsy and increased microvascularity

Front 10

Eso CA prognosis

Back 10

spread goes to regional lymph nodes, 75% has nodal metastases at surgery

prognosis overall 5% five year survival, 75% die within one year

need to dx early

new treatments; pt gets photosensitizing drug that is activated endoscopiccally as it absorbs light; cytotoxic high energy 02 molecules are create which kill tumor

Front 11

Stress ulcer

Back 11

imbalance between mucosal defense and damage from acid; uses mucous bicarbonate and increased blood flow to regenerate

Front 12

Acute gastric ulceration

Back 12

predisposing are common ICU

may also occur with NSAIDs or corticosteroids and decreased prostaglandins

may occur as stress ulcers due to ischemia, hypotension

patients present with GI bleed

Front 13

GIST

Back 13

Gi stromal tumors

mesenchymal tumors of the wall usually benign

looks like a leiommyoma derived from the intersitial cells of cajal (arising from the wall not the musosa)

spindle cell tumors microscopically; mutaitons in c-KIT which is a tyrosine kinase

Front 14

GIST prognosis

Back 14

most are 90% are benign

malignant criteria are size and the number of mitoses and deletions in the KIT gene

Rx of malignant lesions are surgical removal and imatinib

Front 15

Gastric carcinoma

Back 15

diet related and more common in higher incidence countries of Orient and Russia

high ages

more common in males

declining in US

Front 16

Gastric GA causes

Back 16

genetic

dietary

tobacco use

EBV with lymphoepithelila type

chronic gastritis

Front 17

Gastric Ca path

Back 17

usually in pylorus and antrum

usually over 2 cm

ulcerating with irregular, indurated, raised border, diffusely infiltrting without luminal growth; polypoid or fungating lesions are uncommon

affiliated with gland formation, signet ring cell type with cheers of clear cells

Front 18

Signet ring cell vs adenocarcinoma

Back 18

adeno are more common to cause ulcers

often are asymp untill dx weight loss nausea and anorexia

signet cells are filled with mucus and dont form glands and is more diffuse

Front 19

Gastric Ca Rx

Back 19

depends on early treatment, which is not often effective

prognosis epends on early detection, prognosis worse with HER2

10% 5 year survival overall

90% 5 year survival with early detection

Front 20

Pepsinogen in Gas Cancer

Back 20

both decrease in gastric juice in cancer, more reliable then serum,

PG1 much lower then controls

may become a new screening test

Front 21

HER2 mut

Back 21

human endothelial growth factor receptor

detected by immunostaining

has a worse prognosis

seen in intestinal/glandular type

NOT a signet ring type

use of herceptin under dstudy