GASTROINTESTINAL TRACT

Dr KS Mun Dept of Pathology, U.M.

CONTENTS:
I. Upper gastrointestinal tract (GIT)‫‏‬ Stomach & Duodenum Small intestine Large intestine

II.

III. IV.

Signs & Symptoms:
      Dysphagia Heartburn Abdominal pain Diarrhoea Steatorrhoea Blood loss & anaemia  Weight Loss

Upper GIT
 Mouth: lips, oral mucosa, teeth & gums  Pharynx & oesophagus  Salivary glands

MOUTH .

Rubella  Tutankhamun and Tad Lincoln .Cleft lip & palate  Sporadic or sex-linked or AD (low penetrance)‫‏‬  A/w infections e.g.

Caries & gingivitis  Caries: acid destruction of calcified component of teeth  Acute gingivitis: Borrelia vincentii  Chronic gingivitis: gum adjacent to plaque .

drugs (phenytoin) .Gingivitis  Gingival staining: Lead poisoning (Burton’s‫‏‬line)  Gingival hyperplasia: Leukemia.

Reparative  Minor trauma is frequent  Excessive‫‏‬surplus‫‏‬tissue:‫‏‬epulis‫“(‏‬congenital”. fibromas)‫‏‬ . hemangiomas.‫‏‬ giant cell. angiomatous tumour of pregnancy.

Angular cheilitis  Painful cracks at mouth angles  > a/w Staph aureus  May have underlying Fe and Vit B deficiency .

inflammatory bowel disease.Aphtous stomatitis  Common: 40% population  Single to multiple ulcers: shallow. uncertain . necrotic base. haemorhagic rim  Immunological.

Syphilis  Primary chancre  Secondary white “snail‫‏‬track”‫‏‬ ulcers  Congenital Hutchinson’s‫‏‬ teeth & Mulberry molars .

Herpetic stomatitis     Herpes simplex virus Vesiculation & ulceration > in childhood May develop later on lips (herpes labialis)‫‏‬ .

immunocompromised. patients on broad spectrum antibiotics .Oral candidiasis  Oral thrush  Candida albicans  Normal flora in 40% population  Extends into oesophagus  Neonates.

alcohol. poor dental hygiene.Leukoplakia  Clinical term  Patches of squamous hyperkeratosis & hyperplasia  ± dysplasia  premalignant  Heavy smoking. betel quids  Oral hairy leukoplakia: EBV & HIV .

Lip carcinoma  More common  Sunlight exposure  > in elderly  > on lower lip  Well differentiated squamous cell carcinoma with lymphatic spread .

betel quids. chronic irritation. smoking. stage .Intra-oral carcinoma  Buccal mmucosa & tongue (posterior ⅓)  > Indians: 5% of all tumours  Can be painless  Presentation: > late  Squamous cell carcinoma with local and lymphatic / direct spread  UV light. alcohol abuse  Prognosis: site. differentiation.

Intra-oral carcinoma .

PHARYNX .

influenza.Pharyngitis  Viral (commonest) .scarlet fever. acute glomerulonephritis.cold. infectious mononucleosis  Streptococcal . measles. rheumatic fever .

bone marrow failure .Pharyngitis  Ulcerative . leukemia. agranulocytosis.diphtheria.

Tonsilitis  Part of pharyngitis  Anatomically predisposed  chronic inflammation  enlargement .

Nasopharyngeal carcinoma  Geographical variation  Eskimos. HLABW46 . south Chinese  A/w Epstein-Barr virus   HLA-A2.

OESOPHAGUS .

> fundic-type .Heterotopic tissue  Gastric mucosa: .ulcers. strictures .

Oesophageal atresia  Atresia: .rarely agenesis .failure of embryological canalisation .A/w tracheal fistula .

Diverticula  Outpouchings of wall of hollow viscus  Saccular dilatation or mucosal herniation  May be formed by pulsion or traction  Distended by retained food  dysphagia .

Hiatus hernia  Commonest mechanical disorder  Portion of stomach above diaphragm  Sliding (90%) vs. rolling  Congenital short oesophagus or acquired ( abdominal pressure + aging)  regurgitation & oesophagitis .

Varices  Localised dilatation of lower oesophageal veins  Site for portosystemic shunting  Traumatised  haemorrhage .

Crohn’s‫‏‬disease .g. viral in the immunocompromised .ingestion of corrosives  Chronic: .Oesophagitis  Acute: .> fungal.Non-specific: peptic acid regurgitation .Specific: rare. e. TB.

Reflux oesophagitis  Squamoid mucosa is easily damaged by gastric acid  A/w hiatus hernia. abnormality GIT motility .

haemmorrhage. re-epithelialisation . basal layer hyperplasia + inflammation 2. ulcer. stricture. perforation  heal: fibrosis.Reflux oesophagitis Squamous mucosa + regurgitated acid  accelerated desquamation  cell injured  1.

Barrett’s oesophagus  Re-epithelialisation by columnar glandular cells  Gastric or intestinal metaplasia  ± bile reflux  Risk of malignancy 100x  general population .

.

fibromas  Squamous papilloma: a/w HPV infection . haemangioma.Benign tumours  Uncommon. 5% of all oesophageal tumours  Mostly leiomyoma  Rare lipoma.

Squamous carcinoma  M > F. fungus. HPV . lack of riboflavin/ vitamin A/ zinc. smoking. opium use. multifactorial  Risks: tannic acid. 80 – 85% of oesophageal ca.‫‏%05‏‬in‫‏‬middle‫‏⅓‏‬  60% polypoidal or fungating. rest diffuse  SCC with direct & lymphatic spread  Insidious onset. China 100 : 100 000  Upper ⅔‫‏‬of‫‏‬oesophagus. alcohol.  Geographical variation ~ Europe 5 : 100 000. thermal injury.

Squamous carcinoma .

Adenocarcinoma  Lower ⅓  Closely‫‏‬related‫‏‬to‫‏‬Barrett’s‫‏‬ .

SALIVARY GLAND .

Sialadenitis  Bacterial infection     uncommon Usually ascending infection. mumps  risk in xerostomia. saliva hyposecretion ≡‫‏‬tumour . Sjögren’s Recurrent: duct obstruction.

Pleomorphic adenoma  > parotid gland  ⅔‫‏‬of‫‏‬salivary‫‏‬tumours  Benign mixed epithelial & stromal (myxoid. cartilaginous) tumour  Prone to recur if resection is incomplete  Small proportion undergoes malignant change .

5 – 10% of total  Double-layer of epithelial cells covering dense lymphoid stroma .Warthin’s tumour  Adenolymphoma  Benign.

squamoid cells.Muco-epidermoid tumour  Maybe malignant or benign  Mixture of mucinsecreting cells. intermediate cells  Malignant: squamoid > mucinous cells .

Adenoid cystic carcinoma  Malignant  A/w perineural disease  Small epithelial cells in islands & microcysts .