بسم الله الرحمن الرحيم GIT Diseases By Dr. Ghada Ahmed Lecturer of Pathology Benha Faculty of Medicine

Objectives Discuss different diseases of the esophagus Hiatal hernia Esophgeal varices Esophagitis Barrett’s esophagus Tumors Causes of dysphagia Discuss different diseases of the stomach Pyloric stenosis Gastritis Gastric ulcers Tumors Causes of haematemesis

Diseases of the esophagus

I. Hiatal hernia Sliding HParaesophageal H

II. Esophageal varices Causes

III. Esophagitis Causes: Reflux Gastric intubation Ingestion of irritant substance Infection (viral, bact, fungal) Cytotoxic/ radiation ttt

Reflux esophagitis: Def Causes Morphology Complications: (PU - Perforation- Barrett’s- Precancerous)

IV. Barrett’s esophagus IV. Barrett’s esophagus

V. Esphageal tumors Esophageal tumors BenignEpithelialMesenchymalMalignantEpithelialMesenchymal

Carcinoma of the esophagus Squamous cell carcinoma (90%): PF Sites Morphology Adenocarcinoma PF Site Morphology

Carcinoma of the esophagus

Effects of esophageal carcinoma Dysphagia Cachexia Hematemesis Tracheo-esophageal fistula Spread:

VI. Dysphagia In the wall (stricture) In the lumen (obstruction) Pressure from outside

Diseases of the stomach

Gastric mucosal barrier

I. Pyloric stenosis Congenital Acquired

II. GastritisAcuteChronic Chronic superficial gastritis Chronic atrophic gastritis

Acute gastritis Causes:  NSAI  Alcohol  Smoking  Infection  Stress  Cancer chemottt  Suicide attempts

Acute gastritis

Chronic gastritis Def Causes (AI, H.pylori, smoking, alcohol) Types:

Chronic superficial gastritis

Chronic Atrophic gastritis Gross m/p Gastric atrophy Metaplasia

H. pylori Pathogenesis Effects

III. Gastric ulcer Acute gastric ulcer

Peptic ulcer (chronic gastric ulcer) Def Sites P F

Pathogenesis of peptic ulcer Damaging forces: e.g. H.pylori Genetic, hormonal Enviromental Stress Mucosal defenses: Mucin Bicarbonate sec Epithelial barrier

Peptic ulcer (morphology)

Complications Bleeding (hematemesis- melena) Perforation Fibrosis----- (stenosis) Malignant transformation

IV. Tumors of stomach Benign Epithelial : Adenoma Mesenchymal Leiomyma, fibroma, lipoma, GIST Malignant Epithelial: *Adenocarc. *Mucinous carcinoma, *Signet ring carcinoma, *Undifferentiated carcinoma Mesodermal Lymphosarc. Carcinoid Lymphoma GIST

Gastric adenoma (polyp)

Gastrointestinal stromal tumors (GIST) Definition: (interstitial cells of Cajal) Age> 40 ys Sites60% gastric Morphology Effects

Morphology of GIST

Gastric carcinoma Incidence old male gp A Aetiology:  PF : Diet as nitrates Dried salted fish& meat Decreased intake of fresh veg& fruits:  Precancerous lesions (gastritis- ulcer- polyp)

Gastric carcinoma (sites) 50% 25%

Gastric carcinoma/ Gross 1- polypoid2-ulcerative

3- infiltrative (Linitis plastica/ leather bottle st)

Gastric carcinoma m/p 1-Adenocarc. 2-Mucinous carc. 3-Signet ring carc.

Spread & metastases Direct spread Lymphatic spread Blood spread Transcoelomic spread Effects & Complications (bleeding-obstruction- hypoHCL- cachexia)

V. Haematemeis Defintion Causes

Haematemesis Local causes 1- esophgeal2- gastric3- duodenal General causes Blood diseases & vitamin def.

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