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5 views20 pages

Git Vi

Uploaded by

sharmashaurya1101
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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GIT VI

Dr Jasneet Kaur Sandhu


Miscellaneous topics
• Barrett’s esophagus
• Difference between acute and chronic gastritis
• Acute appendicitis
• Diaphragmatic hernia, Meckel's diverticulum, achalasia, nut cracker
esophagus, corkscrew esophagus, Mallory Weiss tear, Boerhaave
syndrome
• Diarrhea, Malabsorption, hemorrhoids
• volvulus, intussception, celiac sprue, gluten hypersensitivity
• IBS
Barrett esophagus
• Complication of chronic GERD characterized by intestinal metaplasia
within the esophageal squamous mucosa and is associated with
increased risk of adenocarcinoma
• Incidence:
• General population- 2%
• In symptomatic GERD – 10%
• Age: 40-60 years, white males
Pathogenesis of GERD:
• Transient lower esophageal sphincter relaxation
• Mediated via vagal pathways
• Triggered by gastric distension, abrupt increase in intra abdominal pressure
(coughing, straining, bending), alcohol, tobacco, obesity, CNS depressants,
pregnancy, hiatal hernia, delayed gastric emptying, increased gastric volume.
Tongues of red velvety mucosa extending upward from the GEJ
alternating with smooth pale squamous mucosa.
Classification:
1. Long segment – more than/equal to 3 cm
2. Short segment - < 3cm  lower risk, less GERD features

Diagnosis:
- Endoscopic evidence of metaplastic columnar
mucosa above GEJ
- microscopy: intestinal metaplasia with goblet cells
Dysplasia:
• Features: atypical mitosis, nuclear hyperchromasia, irregularly
clumped chromatin, increased N:C ratio, failure of epithelial cells to
mature as they migrate to the esophageal surface.
• Low grade
• High grade

Epithelial cells invade lamina propria

Intramucosal carcinoma
Acute appendicitis
• Def: Acute inflammation of the vermiform appendix not attributable to
distinct inflammatory disorders, such as idiopathic inflammatory
bowel disease
• Disease of the young; most typically presents in children and adolescents (10 -
19 years), although no age group is exempt
• Male > female
• Stages:
1. Early acute appendicitis
2. Acute suppurative appendicitis
3. Acute gangrenous appendicitis
Etiology

• Obstruction of the appendiceal lumen followed by bacterial infection


• Can be from an appendicolith or some other mechanical etiologies
• Appendiceal tumors (benign or malignant)
• Intestinal parasites
• Hypertrophied lymphatic tissue
• Diverticulosis
• Vascular compromise
• Primary infection
• Hypersensitivity reaction
• Trauma
Diaphragmatic hernia:
• incomplete formation of the diaphragm  allows abdominal viscera
to herniate into thoracic cavity (esp left side)
• Severe  fatal pulmonary hypoplasia
Meckel diverticulum:
• True diverticulum is a blind out-pouching of the alimentary tract that
communicates with the lumen and includes all three layers of the bowel wall.
• Ileum
• Failed involution of the vitelline duct which connects the lumen of the
developing midgut to yolk sac (N- 5th to 9th week of gestation)
• Extends from the antimesenteric side of the bowel
• Rule of 2
• Hirschsprung disease: mutation in receptor tyrosine kinase  failure of
ganglion cells to migrate to the wall of colon  functional obstruction of
colon
• 10% - Down syndrome
• Megacolon
• Achalasia: incomplete LES relaxation + increased LES tone + aperistalsis of
esophagus
• Primary –rare, secondary – Chagas disease (trypanosoma cruzi)
• Mallory Weiss tear: longitudinal mucosal tear near GEJ
• Boerhaave syndrome: transmural tear, rupture of distal esophagus
• Esophageal obstruction:
• Nutcracker esophagus: intense, high amplitude, uncoordinated contractions of
inner circular and outer longitudinal smooth muscle  functional obstruction
• Corkscrew esophagus: repetitive, normal amplitude, simultaneous contractions of
the distal esophageal smooth muscle
• Esophageal rings vs web:
• Esophageal web:
• >40 years of age, women
• a/w GERD, GvHD, blistering skin diseases.
• Upper esophagus web + IDA + glossitis and cheilosis  Plummer Vinson syndrome
• Semi-circumferential, composed of fibrovascular CT + lining epithelium
• Esophageal ring:
• Circumferential, thick, composed of mucosa, submucosa, muscularis propria.
• Type A, type B (on the basis of location)
Malabsorption and Diarrhea
• Malabsorption: defective absorption of fat, fat and water soluble
vitamins, proteins, carbohydrates, electrolytes, minerals and water.
• Hallmark: steatorrhea
• Important causes: pancreatic insufficiency, celiac disease, crohn
disease.
• Defect in (any one or more):
1. Intraluminal digestion: break up of proteins, carbohydrates, fats.
2. Terminal digestion: hydrolysis of carbohydrates and peptides in brush
border of SI mucosa.
3. Transepithelial transport: nutrients, fluid, electrolytes transported across
and processed within SI epithelium.
4. Lymphatic transport of absorbed lipids

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