Gastrointestinal system ppt GERD Barrett's esophagus Carcinoma esophagus Peptic ulcer – Gross and microscopic features Carcinoma stomach – Gross and microscopic features Ulcerative lesions of intestine Carcinoma colon – Gross and microscopic features

GERD
Barrett's esophagus
Carcinoma esophagus
Peptic ulcer – Gross and microscopic features
Carcinoma stomach – Gross and microscopic features
Ulcerative lesions of intestine
Carcinoma colon – Gross and microscopic features

1. REVISION GASTROINTESTINAL TRACT

2. OBJECTIVES GERD Barrett's esophagus Carcinoma esophagus Peptic ulcer – Gross and microscopic features Carcinoma stomach – Gross and microscopic features Ulcerative lesions of intestine Carcinoma colon – Gross and microscopic features

3. ESOPHAGITIS Inflammation of the esophageal mucosa Etiological factors: Physical, Radiations chemical, biologic agents; e.g tuberculosis, candidiasis, herpes simplex, CMV others; crohn disease, graft verses host disease (GVHD)

4. REFLUX ESOPHAGITIS (GERD) Microscopy :Epithelial hyperplasia due to basal cell proliferation Intraepithelial eosinophils Lamina propria; neutrophils, eosinophils and lymphocytes Tips of elongated lamina propria papillae shows congested venules

5. REFLUX ESOPHAGITIS CLINICAL MANIFESTATIONS Heartburn, chest pain ,dysphagia Complications Superficial ulceration Bleeding Stricture formation Tendency to develop Barrett esophagus

6. BARRETT ESOPHAGUS A segment of distal esophagus above the level of LES shows metaplastic columnar epithelial lining with goblet cells. Complication of GERD( H.pylori is protective) Barrett’s oesophagus is a premalignant condition evolving sequentially from Barrett’s epithelium (columnar metaplasia) → dysplasia → carcinoma in situ → oesophageal adenocarcinoma.

7. PATHOGENESIS BARRETT ESOPHAGUS Ulceration and subsequent re-epithelization by columnar cells to cope with existing conditions Ulceration, induced by reflux and occurs in 10% of these patients Columnar cells could arise from migration of gastric mucosa or from stem cells of mucosa

8. BARRETT ESOPHAGUS Diagnosis Endoscopic examination and biopsy Main complications 1. Peptic ulcer 2. Stricture 3. Bleeding 4. Dysplasia and adenocarcinoma (Persons with Barrett esophagus have 30 to 100 fold greater risk of developing adenocarcinoma)

9. CARCINOMA ESOPHAGUS SQUAMOUS Heavy smoking Alcohol consumption Any part of esophagus; middle thirds 50%, lower thirds 30%, upper thirds 20% ADENOCARCINOMA Barrett's esophagus The common locations are lower and middle third of the oesophagus .

10. BENIGN ULCER V/S MALIGNANT ULCER Benign ulcer Malignant ulcer Features

11. PEPTIC ULCER

12. PEPTIC ULCER GROSS FEATURES Gastric ulcers are found predominantly along the lesser curvature in the region of pyloric antrum , more commonly on the posterior wall . Duodenal ulcers are commonly found in first part of the duodenum , more commonly on the anterior wall . Peptic ulcers of either gastric or duodenal mucosa are small (1-2.5 cm in diameter), round to oval and punched out . The mucosal folds converge towards the ulcer. Benign chronic gastric ulcer Partial gastrectomy specimen is identified by thick muscular wall and irregular mucosal folds . The luminal surface shows a punched out round to oval ulcer , about 1 cm in diameter (arrow) penetrating into muscularis layer.

13. PEPTIC ULCER MICROSCOPIC FEATURES 4 histologic zones 1. Necrotic zone lies in the floor of the ulcer The tissue elements show coagulative necrosis giving eosinophilic smudgy appearance with nuclear debris. 2 . Superficial exudative zone lies underneath the necrotic zone and is composed of fibrinous exudate containing necrotic debris and a few leucocytes, predominantly neutrophils . Chronic peptic ulcer Histologic zones of the ulcer are illustrated. The mucosal surface shows necrosis, ulceration, and inflammation.

14. PEPTIC ULCER MICROSCOPIC FEATURES 4 histologic zones 3. Granulation tissue zone is seen merging into the necrotic zone. Composed of nonspecific chronic inflammatory infiltrate and proliferating capillaries . Zone of cicatrisation is seen outer to the layer of granulation tissue Composed of dense fibrocollagenic scar tissue . Chronic peptic ulcer Histologic zones of the ulcer are illustrated. The mucosal surface shows necrosis, ulceration, and inflammation.

15. CARCINOMA STOMACH GROSS FEATURES Most common pattern is flat, infiltrating and ulcerative growth with irregular necrotic base and raised margin . Other gross patterns include fungating ( polypoid ) scirrhous ( linitis plastica ) colloid ( mucoid ) ulcer cancer. Ulcerative carcinoma stomach. The luminal surface of the stomach in the region of the pyloric canal shows an elevated irregular growth with ulcerated surface and raised margins

16. CARCINOMA STOMACH MICROSCOPIC FEATURES Tubular and acinar pattern of growth is seen infiltrating the stomach wall. The tumour invades into the wall of stomach for variable depth. The tumour cells show varying degree of anaplasia but is more often poorly-differentiated with high degree of anaplasia

17. ULCERATIVE LESIONS OF GIT

18. ULCERATIVE LESIONS OF GIT Cushing ulcer seen in esophagus, stomach or the duodenum. associated with intracranial disease or head injury. caused by gastric acid hypersecretion due to vagal nuclei stimulation. Curling ulcer seen in proximal duodenum. associated with burns or trauma. Caused due to reduced blood supply and systemic acidosis in burns or trauma.

19. ULCERS OF GIT TUBERCULOSIS ULCER Site IC Valve Transverse ulcers Granulomas with necrosis Stricture TYPHOID ULCER Peyers patches Longitudinal ulcers Lymphocytes and plasma cells Perforation Hemorrhage

20. CARCINOMA COLON GROSS FEATURES The right-sided growth, tends to be fungating , large, cauliflower-like, soft and friable mass projecting into the lumen. The left-sided growth has napkin-ring configuration  it encircles the bowel wall circumferentially with increased fibrous tissue forming annular ring with central mucosal ulceration.

21. CARCINOMA COLON MICROSCOPIC FEATURES The tumour has infiltrating glandular pattern in the colonic wall with varying grades of differentiation of tumour cells. About 10% cases show mucin -secreting colloid carcinoma with pools of mucin

22. STAIN

23. Most common complication of gastric ulcer Scirrhous carcinoma Perforation Massive hematemesis GIST

24. About Crohn's disease Loss of haustration Linear fissure Cobbelstone colon String sign of kantor Pseudopolyps

25. Most common site of ca esophagus Middle 1/3 Upper 1/3 Lower 1/3 Lower end of esophagus

26. Tumor mc associated with H.Pylori MALTOMA Adenocarcinoma Squamous cell carcinoma None

27. Most common site of benign gastric ulcer is Upper third of lesser curvature Greater curvature Pyloric antrum Lesser curvature near incisura angularis

28. True about Ulcerative colitis is all except Rectum involved Pseudopolyps Pancolitis Non caseating granulomas