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Flashcards in GIT Deck (373)
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1

Major risk factor for squamous cell carcinoma of the mouth

Smoking 

2

– “White plaque on the oral mucosa that can not be removed with scraping”

– Involves the buccal mucosa, tongue or floor of mouth

Leukoplakia 

3

Predisposing factors of leukoplakia 

Tobaccouse

– Ill-fittingdentures/persistent irritants

– HPVinfection

4

 Poorly circumscribed red, velvety eroded area

– AKA-“Erythroplasia” in mouth

Erythroplakia 

5

Erythroplakia vis leukoplakia 

Malignant transformation in >50% in erythoplakia, lower in leukoplakia 

6

White confluent fluffy/hairy hyperkeratotic thickenings

Oral hairy leukoplakia 

7

Oral hairy leukoplakia sene in

HIV

– Epstein Barr Virus (EBV) related in majority of cases

8

Histo of hairy leukoplakia 

marked hyperkeratosis with acanthosis

9

Is there malignant risk for hairy leukoplaki

No

10

Oral cavity bx needed for 

Benign squamous process

• Inflammatory or reactive

– Benign squamous papilloma

– Squamous dysplasia (pre-cancerous)

• Low-grade dysplasia

• High-grade dysplasia

– Invasive squamous cell carcinoma

11

Esophageal lesion path overview 

12

Esophageal atresia 

disruption of elongation and separation of esophagus and trachea during embryogenesis

13

Reasons for esophageal atresia

Maternal polyhydramnios, single umbilical artery

14

Sx of esophageal atresia 

Choking, cyanosis and excessive drooling

15

Stomach protrudes through an enlarged esophageal hiatus in the diaphragm (Sliding vs Paraesophageal types)

Hiatal hernia

16

Sx of hiatal hernia 

Reflux of gastric contents due to incompetence of the lower esophageal sphincter (LES)

– Epigastricpain,heartburn(sliding-type)

– Volvulus, strangulation and perforation (paraesophageal-type)

17

Incomplete relaxation of LES in response to swallowing – Functionalesophagealobstruction

Achalasia/cardiospasm 

18

Three main features of achlasia 

 

– Aperistalsis

– Partial or incomplete relaxation of LES

– Increased resting tone of LES

19

Main form of achalisa 

 Loss of intrinsic inhibitory innervation of LES and smooth muscle

– Loss or absence of ganglion cells in myenteric plexus

20

Secondary form of achlasia 

Impaired function from a variety of causes e.g. Chagas due to Trypanosoma cruzi, polio, paraneoplastic syndrome, sarcoidosis

21

Clinical features of achalisa 

– Dysphagia

– Odynophagia

– Refluxofcontents

– Vomiting

– Aspirationpneumonia

• Progressive dilatation of esophagus above the LES

22

Dx of achlasia 

Manometry

23

Longitudinal mucosal tears at esophagogastric junction

• Inadequaterelaxation  of LES during vomiting

– Common in alcoholics after bout of severe retching

• Tear may be only mucosal or transmural, leading to hematemesis

– Usually heal, but can be fatal

 Mallory Weis Tear 

24

 Dilated tortuous veins (collaterals) in the lower esophagus

– Associated withportal  hypertension(30-60%cirrhoticpts)

• Overlying mucosa may be normal, inflamed or ulcerated

• Usually no symptoms until they rupture

– Responsible for 50% deaths in pts with advanced cirrhosis

Esophageal varices 

25

Causes of esophagitis 

• IRRITANTS

– Alcohol, acids, alkalis etc.

– Gastroesophageal reflux esophagitis/disease (GERD)

• INFECTIONS

– Herpes simplex virus, Cytomegalovirus, Candida, etc.

• ALLERGIC

– Eosinophilic esophagitis

• UREMIA

• ANTICANCER THERAPY

26

Reflux esophagitis 

CNS depressants, hypo- thyroidism, pregnancy, alcohol, tobacco, nasogastric intubation.

27

Endoscopy of reflux esophagitis see

Irregularareaof hyperemia (vascular congestion) at the EGJ

28

• Inflammation–eosinophils,lymphocytes+/-neutrophils

• Elongation of lamina propria papillae

• Basal zone hyperplasia

Reflux esophagitis 

29

– Dyspepsia

– Burning sensation

– Waterbrash “sour

brash”

– Symptoms increase after lying down or after a large meal

– Nocturnal cough

Reflux esophagitis 

30

Complications of reflux esophigitis 

– Bleeding

– Stricture formation

– Aspiration pneumonia

– Barrett’s esophagus & Adenocarcinoma