2. Retrosternal Px: "Retro" means behind/ behind the sternum - heartburn can cause retrosternal px
3. Hematemesis: vomiting blood
The Esophogus: Congenital Disorders
1. Tracheoesophageal Fistula / Atresia
Tracheoesophageal Fistula: most common congenital disorder, occasionally the trachea & esophagus do not completely separate & become the same tube. This opening allows anything swallowed into the pharynx to enter the lungs. Another possible outcome is atresia
Atresia: no lumen / lumen is a channel or tube in body
The Esophagus: Motor Disorders
1. Achalasia
2. Scleroderma
1. Achalasia: Absence of peristalsis, failure of the cardiac sphincter to relax, leads to a functional obstruction of the esophagus
2. Scleroderma: overproduction of collagen within the wall of esophagus, the added collagen affects the function of the sphincters & interferes with peristalsis
The Esophagus: Reflux Esophagitis
Injury to the esophagus caused by regurgitation of the gastric contents
Pathogenesis: triggers include chocolate, alcohol, fatty foods, caffeine & cigarettes, all of which can decrease the tone of the cardiac sphincter, allowing reflux of gastric contents into the esophagus
Clinical manifestations: presents as a burning chest px, "heartburn" especially @ night when supine
The Esophagus: Hiatal Hernia
Herniation of the stomach through an enlarged esophageal hiatus in the diaphragm
Sliding hernia: excess abdominal pressure, comes and goes
Paraesophageal hernia: not sliding, it can get stuck
The Esophagus: Esophageal Varices
can be caused by coughing up blood
varicose veins in the esophagus - caused by increased hydrostatic pressure
The Esophagus: Neoplasms
Leiomyomas is a benign smooth muscle tumor
The Stomach: Clinical Manifestations
Pain & dyspepsia: px in the stomach /upset stomach ("pep" refers to stomach)
Loss of appetite
Bleeding: ulcer
Gastric mass
The Stomach: Acute Erosive Gastritis
The presence of focal necrosis of the mucose in an otherwise normal stomach
Erosion: epithelial and some of the tunica mucosa / shallow: affects just the inside layers
Ulcer: full thickness of the tunica mucosa / affects all the layers of the stomach
*The distinction between an erosion & an ulcer is based on depth
Pathogenesis of Acute Erosive Gastritis
B) drugs: aspirins, NSAID's, coricosteroids & cigarettes
stress ulcers: trauma, burns, emotional stress, surgery
trauma to the CNS: not as clearly linked to acute erosive gastritis
hypersection of gastric acid: not as clearly linked to acute erosive gastritis
Pathology & Clinical Manifestations of Acute Erosive Gastritis
Pathology: hemorrhaging leads to sloughing of dead tissue and further injury to the stomach wall
Clinical Manifestations: anything from a vague discomfort to hemorrhaging
The Stomach: Peptic Ulcer Disease
deeper injury than acute erosive gastritis
breaks in the mucosa of the stomach & small intestine but can occur anywhere in the GI tract that is exposed to acidic gastric juice
Peptic Ulcer Disease Pathogenesis
Hypersecretion of acid
Decreased mucosal resistance: same drugs as erosion; aspirins, NSAID's, coricosteroids, & cigarettes
Helicobacter pylori infection: found in almost all patients with duodenal ulcers. However, not all people with H. pyolri have ulcers - the mechanism is unclear. Fecal: oral route of infection
Clinical Manifestations of Peptic Ulcer Disease
Px esp @ night
Hemorrhage: affects 20% of patients. Most common complication
Perforation: a hole / the leaking of gastric contents into abdominal cavity poses a risk of serious infection
Pyloric Obstruction: ulcers adjacent to the pyloric sphincter may lead to spasm of the pyloric sphincter
The Stomach: Bezoars
foreign bodies in stomach altered by digestive process
Phytobexoar: food
Trichobezoar: giant hair balls / usually goes along with some kind of mental disease / can become malnourished / causes obstruction
The Small Intestine Clinical Manifestations
Malabsorption
Obstruction (failure of peristalsis)
Intestinal perforation (hole)
Intestinal hemorrhage (bleeding)
Diarrhea (doesn't absorb properly)
Dysentry (a type of diarrhea with blood & mucus @ times)
The Small Intestine: Congenital Disorders
Atresias: complete occlusion (blocked off) of the lumen
Stenonsis: incomplete stricture (blockage), narrows but does not occlude the lumen
Duplications: extra section that may or may not communicate with main passageway. / Retained material may rot & lead to an infection w/serious consequences
The Small Intestine: Ischemia
Decreased blood flow to the intestines from any cause can lead to ischemic bowel disease
secondary to atherosclerosis
The Small Intestine: Malabsorption
less than optimal absorption of any basic nutrients
The Small Intestine: Mechanical Obstruction Etiology (3 causes of mechanical obstruction)
A (1) luminal mass, an (2) intrinsic lesion of the bowel wall, or (3) extrinsic compression
The Small Intestine: Mechanical Obstruction: 4 Different Types
1. Intussusception: telescoping of the bowel into itself / vascular supply may also be compromised leading to ischemia
2. Volvulus: segment of the bowel twists on its mesentry /primary affects blood flow
3. Adhesions: arise from fibrous scar caused by previous surgery or peritonitis, kinking, manipulating, or compressing
4. Hernias: loops of small bowel passing through unintended openings
The Small Intestine: Enteritis (food poisoning)
Bacteria: common ones is E. Coli, Salmonella
The Large Intestine: Congenital Megacolon
Colonic dilatation secondary to defective innervation
failure of the complete development of the nervous system within the gut leading to a failure of peristalsis
The Large Intestine: Diverticular Disease
acquired herniation of the mucosa and submucosa through the muscular layer of the colon
Diverticulosis: the presence of diverticula / vegetarians are 3x less likely to develop the disease than meat eaters - red meat & a ow fiber diet increase intraluminal pressure
Diverticulitis: inflammation at the base of the diverticulum secondary to reatined fecal material leading to necrosis
The Large Intestine: Polyps in the Colon
a tumorous mass that protrudes into the gut
Non-neoplastic polpys: represent 90% of all cases & occur in >50% of patients > 60 years
Neoplastic polyps (adenomas): occur w/increasing frequency as age increases
The Appendix: Apppendicitis
Affects 10% of the population w/a peak incidence inthe 20's and 30's
Acute Appendicitis: obstruction of the appendix /
50-80% of the time w/a fecalith, but may be a gallstone, tumor, or ball of worms. /
If appendix ruptures the contents are released into the peritoneal cavity rapidly leading to sepsis and death
The Appendix: Cirrhosis
Among the top 10 causes of death in the western world.
Alcohol abuse is the leading cause
Pathogenesis: progressive fibrosis that ultimately destroys the entire architecture of the liver
The Appendix: Hepatitis
inflammation of the liver
Biliary Tract: Cholelithiasis (gallstones)
100,000 new cases per year
affecting 10% of adults in the northern hemisphere
1,000 deaths per year due to gallstone disease or complications of surgery
stones may be found in the gallbladder or biliary tract
pathogenesis: too much cholesterol
Biliary Tract: Cholecystitis
inflammation of the gall bladder secondary to prolonged blockage of the cystic duct
Biliary Tract: Pancreatitis Acute & Chronic
Glandular organ
Acute: leakage of prancreatic enzymes into pancreatic and peripancreatic tissue, often secondary to gall stones
