Ch17-GI - GI GI • ESOPHAGUS • STOMACH • SMALL/LARGE...

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Unformatted text preview: GI GI • ESOPHAGUS • STOMACH • SMALL/LARGE BOWEL • APPENDIX, PERITONEUM ESOPHAGUS • Congenital Anomalies • Achalasia • Hiatal Hernia • Diverticula • Laceration • Varices • Reflux • Barretts • Esophagitis • Neoplasm: Benign, Sq. Cell Ca., Adenoca. ANATOMY • 25 cm. • UES/LES • Mucosa/Submucosa/Muscularis/Adventitia* Inf. Thyroid Arts. R. Bronch. Art. Thoracic. Aor. Left Gastric Art. Variations: Inf, Phrenic Celiac Splenic Short Gast. DEFINITIONS • Heartburn (GERD/Reflux) • Dysphagia • Hematemesis • Esophagospasm (Achalasia) CONGENITAL ANOMALIES • ECTOPIC TISSUE (gastric, sebaceous, pancreatic) • Atresia/Fistula/Stenosis/”Webs” • Schiatzki “Ring” in lower esophagus MOST COMMON MOTOR DISORDERS • Achalasia • Hiatal Hernia (sliding [95%], paraesophageal) • “ZENKER” diverticulum • Esophagophrenic diverticulum • Mallory-Weiss tear ACHALASIA • “Failure to relax” – Aperistalsis – Incomplete relaxation of the LES – Increased LES tone • INCREASE : Gastrin, serotonin, acetylcholine, Prostaglandin F2α, motulin, Substance P, histamine, pancreatic polypeptide • DECREASE : N.O., VIP – Progressive dysphagia starting in teens – Mostly UNCERTAIN etiology HIATAL HERNIA • Diaphragmatic muscular defect • WIDENING of the space which the lower esophagus passes through • IN ALL cases, STOMACH above diaphragm • Usually associated with reflux • Very common Increases with age • Ulceration, bleeding, perforation, strangulation DIVERTICULA • ZENKER (HIGH) • TRACTION (MID) • EPIPHRENIC (LOW) • TRUE vs. FALSE? DIVERTICULUM LACERATION • Tears are LONGITUDINAL (lower esophagus) • Usually secondary to severe VOMITING • Usually in ALCOHOLICS • Usually MUCOSAL tears • By convention, they are all called: MALLORY-WEISS VARICES • THREE common areas of portal/caval anastomoses – Esophageal – Umbilical – Hemorrhoidal • 100% related to portal hypertension • Found in 90% of cirrhotics • MASSIVE, SUDDEN, FATAL hemorrhage is the most feared consequence VARICES VARICES ESOPHAGITIS • GERD/Reflux Barrett’s • Barrett’s • Chemical • Infectious REFLUX/GERD • DECREASED LES tone • Hiatal Hernia • Slowed reflux clearing • Delayed gastric emptying • REDUCED reparative ability of gastric mucosa REFLUX/GERD • Inflammatory Cells – Eosinophils – Neutrophils – Lymphocytes • Basal zone hyperplasia • Lamina Propria papillae elongated and congested, due to regeneration REFLUX/GERD BARRETT’S ESOPHAGUS • Can be defined as intestinal metaplasia of a normally SQUAMOUS esophageal mucosa. The presence of GOBLET CELLS in the esophageal mucosa is DIAGNOSTIC....
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This note was uploaded on 01/25/2012 for the course PDBIO 305 taught by Professor Woods,a during the Fall '08 term at BYU.

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Ch17-GI - GI GI • ESOPHAGUS • STOMACH • SMALL/LARGE...

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