33 GIT Flashcards
SIALADENITIS
Inflammation of the salivary gland
Most commonly due to an obstructing stone (sialolithiasis) leading to Staphylococcus
aureus infection; usually unilateral
mucocele
results from blockage of salivary duct
renula
like mucocele but when sublingual duct affected
connect 2 bellies of myloid muscle
non specific bacterial sialadanitis in location?
submandibular
viral location
parotid
tumors of salivary gland list
benign and malignant
bening
pleopmorphic adenoma
warthin tumor
malignant
mucoepidermoid carcinoma
adenoid cystic carcinoma
acinic cell tumor
most benign and malignat tumors arise from
benign from bigger gland
malignat from smaller
PLEOMORPHIC ADENOMA
define
where
capsule?
A. Benign tumor composed of stromal (e.g., cartilage) and epithelial tissue; most
common tumor of the salivary gland
B; Usually arises in parotid; presents as a mobile, painless, circumscribed mass at the
angle of the jaw
C, High rate of recurrence; extension of small islands of tumor through tumor capsule
often leads to incomplete resection (Fig. 10.5).
D. Rarely may transform into carcinoma, which presents with signs of facial nerve
damage (facial nerve runs through parotid gland)
WARTHIN TUMOR
define
where
risk factor
laterality
A. Benign cystic tumor with abundant lymphocytes and germinal centers (lymph
node-like stroma); 2nd most common tumor of the salivary gland
B, Almost always arises in the parotid
male smokers
bilateral
MUCOEPIDERMOID CARCINOMA
Malignant tumor composed of mucinous and squamous cells; most common
malignant tumor of the salivary gland
Usually arises in the parotid; commonly involves the facial nerve
congenital anomalies of esophagus
ectopic gastric tissue
congenital cysts
impaired diaphram so hernia
esophageal web
achalasia
achalasia
define
causes plus type
clinical
may develop
A. Disordered esophageal motility with inability to relax the lower esophageal
sphincter (LES)
B. Due to damaged ganglion cells in the myenteric plexus
1. Ganglion cells of myenteric plexus are located between the inner circular
and outer longitudinal layers of the muscularis propria and are important for
regulating bowel motility and relaxing the l.ES.
2. Damage to ganglion cells can be idiopathic (primary ) or secondary to a known insult {e.g.,
Trypanosoma cruzi infection in Chagas disease),
C. Clinical features
1. Dysphagia for solids and liquids
2. Putrid breath
3. High LES pressure on esophageal manometry
4. ‘Bird-beak’ sign on barium swallow study
5. Increased risk for esophageal squamous cell carcinoma
may develop squamous cell carcinoma
hiatal hernia
types
complications
axial/sliding
paraesophageal / non axial
complications
ulceration
obstruction
reflux esophagitis
diverticula
define
types
outpouching of esophageal mucosa
zenker
traction
epiphrenic
ZENKER DIVERTICULUM
where
cause of zenker
aka
A, Outpouching of pharyngeal mucosa through an acquired defect in the muscular
wall (false diverticulum)
B, Arises above the upper esophageal sphincter at the junction of the esophagus and
pharynx
C, Presents with dysphagia, obstruction, and halitosis (bad breath)
cause
ues stenosis
pulsation diverticula
traction diverticula
where
cause
symproms
midpoint
caused by tb infection mediastinal lymadenopathy
asymptomatic
MALLORY-WEISS SYNDROME
define
caused by
present as
risk or may develop what syndrome
A, Longitudinal laceration of mucosa at the gastroesophageal (GE) junction
B Caused by severe vomiting, usually due to alcoholism or bulimia
C. Presents with painful hematemesis
D. Risk of Boerhaave syndrome—rupture of esophagus leading to air in the
mediastinum and subcutaneous emphysema
ESOPHAGEAL VARICES
A. Dilated submucosal veins in the lower esophagus
B. Arise secondary to portal hypertension
1. Distal esophageal vein normally drains into the portal vein via the left gastric
vei 11.
2, In portal hypertension, the left gastric vein backs up into the esophageal vein,
resulting in dilation (varices).
C. Asymptomatic, but risk of rupture exists
1. Presents with painless hematemesis
2. Most common cause of death in cirrhosis
esophagitis types
reflux esophagitis or gerd
infectious and chemical esophagitis
GASTROESOPHAGEAL REFLUX DISEASE (GERD )
A. Reflux of acid from the stomach due to reduced LES tone
B. Risk factors include alcohol, tobacco, obesity, fat-rich diet, caffeine, and hiatal
hernia.
C. Clinical features
1. Heartburn (mimics cardiac chest pain)
2. Asthma (adult-onset) and cough
3. Damage to enamel of teeth
melena
4. Ulceration with stricture and Barrett esophagus are late complications.
BARRETT ESOPHAGUS
define
types
criteria to diagnose
A. Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to
nonciliated columnar epithelium with goblet cells
seen in 10% of patients with GERD
1. Response of lower esophageal stem cells to acidic stress
B. May progress to dysplasia and adenocarcinoma
long segment and short segment
>< 3cm
criteria
endoscopy
histology
tumors of esophagus
most where
benign or mal common
3 morphologic patterns
metastasise locations
types
middle most tumors
benign most
3 morphologic
flat
protruded most
excavated or ulcerated
metastasis
upper cervical
middle mediastinal
lower celiac
adenocarcinoma
define
where
is a malignant proliferation of glands; most common type of esophageal carcinoma in the West
Arises from preexisting Barrett esophagus; usually involves the lower one-third
of the esophagus
Squamous cell carcinoma
define
where
is a malignant proliferation of squamous cells; most common esophageal cancer worldwide
Usually arises in upper or middle third of the esophagus;
major risk, factors Include
i. Alcohol and tobacco (most common causes)
ii. Very hot tea
III. Achalasia
iv. Esophageal web (e.g., Plummer-Vinson syndrome)
v. Esophageal injury (e.g., lye ingestion)
