1. Gastrointestinal Pathology I
Kristine Krafts, M.D.

2. GI Pathology Outline Esophagus Stomach Intestine Liver Gallbladder
Pancreas

3. GI Pathology Outline Esophagus Hiatal hernia Mallory-Weiss syndrome
Barrett esophagus
Carcinoma

4. Normal esophageal-gastric junction

5. Hiatal Hernia Dilated portion of stomach protrudes above diaphragm
Common! Usually asymptomatic.
Heartburn, reflux esophagitis
Danger: ulceration, bleeding

6. Sliding (L) and rolling (R) hiatal hernias

7. Mallory-Weiss Syndrome
GE junction tears
Severe vomiting (chronic alcoholics)
Symptoms: bleeding, pain, infection
Treatment: cauterization
Prognosis: usually heals; sometimes fatal

8. Mallory-Weiss tears

9. Mallory-Weiss tears

10. Barrett Esophagus
Replacement of squamous epithelium by columnar epithelium with goblet cells
Complication of long-standing reflux esophagitis
Danger: x risk of adenocarcinoma
Treatment: screen for high-grade dysplasia

11. Normal esophagus (L) and Barrett esophagus (R)

12. Barrett esophagus

13. Barrett esophagus

14. Esophageal Carcinoma Adenocarcinoma Squamous cell carcinoma
Commonest type in US
Risk factor: Barrett esophagus
Distal 1/3 of esophagus
Symptoms: insidious onset; late obstruction
Squamous cell carcinoma
Commonest type worldwide
Risk factors: esophagitis, smoking, alcohol, genetics
Middle 1/3 of esophagus
Symptoms: insidious onset; late obstruction

15. Adenocarcinoma of esophagus

16. Squamous cell carcinoma of esophagus

17. GI Pathology Outline
Esophagus
Stomach
Gastritis
Ulcers
Carcinoma

18. Gastritis Mucosal inflammation Asymptomatic, or epigastric pain
Causes: H. pylori, autoimmune, NSAIDs
Danger: intestinal metaplasia

19. Gastritis

20. Chronic gastritis

21. Helicobacter pylori organisms

22. Ulcer Erosion of mucosa into submucosa Causes: H. pylori, NSAIDs
Symptoms: epigastric pain
Danger: bleeding, perforation

23. Ulcer

24. Gastric Carcinoma Intestinal type Diffuse type
Arises in intestinal metaplasia
Risk factors: chronic gastritis, bad diet
Glandular morphology
Generally asymptomatic
Diffuse type
Arises from gastric glands
Risk factors undefined
Signet ring morphology
Generally asymptomatic

25. 25

26. Intestinal-type gastric carcinoma: glands

27. Diffuse gastric carcinoma: signet ring cells

28. Signet ring cell

29. Gastric carcinoma presenting as mass

30. Gastric carcinoma presenting as ulcer

31. Gastric carcinoma presenting as linitis plastica