Professional Documents
Culture Documents
RAJEEV KUMAR, MD
GI SYSTEM
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World wide most common esophageal cancer is Squamous cell carcinoma. In the
Western world there is equal incidence of Sq cell carcinoma and adenocarcinoma.
Sq cell carcinoma of Esophagus: Usually occurs at upper and middle third of
esophagus. Risk factors: Alcohol and Tobacco are the most common risk factors.
Others are Achalasia, Nitrosamine containing foods, Lye, Chronic intake of Hot and
spicy foods.
Adenocarcinoma of Esophagus: Most common at lower third of esophagus. Most
common risk factor is -------------Patients are usually have few symptoms until very late in the course of disease with
symptoms being Progressive dysphagia, weight loss and fatigue. These patients have
poor prognosis, about 80% of the patient dying in the first yr because of late
presentation and its difficult to excise this much big tumor at the diagnosis.
This is the reason why periodic endoscopic surveillance with biopsy is necessary in
patients with chronic GERD.
Achalasia: Inability of LES to relax with swallowing due to reduced no. of ganglion cells
in myenteric plexus.
Etiology: Unknown in most cases
Chagas disease: Common in South America
Peptic ulcers are usually solitary, arising from exposure of the mucosal epithelium
to acid-peptic secretions. Peptic ulcer disease (PUD) occurs most often in middle
aged to older adults. The most common anatomic sites are the duodenum and the
stomach, in ratio of 4:1. H. Pylori infection is present in virtually all patients with
duodenal ulcers and 70% with gastric ulcer. Other important factors contributing to
the etiology are chronic NSAID and aspirin use, smoking, steroids.
Diagnosis: Endoscopy with or without Biopsy
Treatment: 1) Acid suppression with H2 blockers/ PPIS etc
2) Triple therapy for eradication of H. Pylori. This includes combination
of two antibiotics from Metronidazole, Amoxycillin, Clarithromycin with a PPI.
Gastric Peptic Ulcer: Located mainly at lesser curvature of the Antrum. These are
small (<3cm), solitary, round to oval shapes ulcers with sharply demarcated,
overhanging margins giving a punched out appearance.
Classic presentation: Burning epigastric pain which worsens with eating.
Associated with wait loss
Duodenal Peptic Ulcer: More commonly located at the anterior wall of first part of
duodenum. Besides H Pylori other factor contributing to the etiology are : Increased
gastric acid secretion, increased rate of gastric emptying, Blood group O, MEN type
1( parathyroid, pancreatic cancer, pituitary adenoma), Zollinger-Ellison syndrome.
Classic presentation: Burning pain 1-3 hrs after eating which is relieved by food.
Complication of PUD: Hemorrhage, Anemia( Iron deficiency anemia), Perforation,
Pyloric obstruction.
Malignant transformation is rare when it is there it is usually associated with gastric
ulcer with underlying chronic gastritis.
Zollinger-Ellison Syndrome: It is tumor of gastrin secreting cell of the pancreas
( Pancreatic gastrinoma) resulting in secretion of excessive gastrin which promotes
parietal cell hyperplasia and increased gastric acid secretion. Patient usually presents
with intractable peptic ulcer disease and diarrhea. 25 % of the Gastrinomas are part
of MEN-1.
Pyloric stenosis: Congenital hypertrophic pyloric stenosis usually presents at 2-3 wks
of age with palpable mass in he abdomen and obstruction with associated
regurgitation and persistent projectile vomiting. Waves of peristalsis are visible on
abdomen. Treatment is surgical splitting of the muscle.
Whipple Disease: Rare Infectious disease Involving almost all body organs
including small intestine, joints, lung, heart, liver, spleen and CNS. More common
in white males of ages 30-50 yrs with male to female ratio 8-9:1. Presenting with
Malabsorption, wt loss and diarrhea, GI bleeding and arthralgias. Etiology is a PASpositive, rod shaped bacilli. On microscopy: Small Bowel Lamina Propria filled with
macrophages stuffed with bacilli. Treatment: Antibiotics
Distribution
Mouth to anus
RectumColon
Most Common
site
Terminal Ileum
Rectum
Lesions
Skip/ discontinuous
Continuous
Gross
Extensive ulceration
pseudopolyps
Micro
Crypt Abscesses
Inflammation
Transmural
Complications
Toxic Megacolon
Cancer Risk
Slight 1-3%