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Gastrointestinal Pathology Part 1

Gastroesophageal Reflux Disease (GERD)


- Burning epigastric pain
- Exacerbated by eating spicy foods & recumbent position
- Relieved by antacids

Increased abdominal pressure: Obesity, pregnancy
Hiatal hernia - Sliding, rolling (para-oesophageal)
1. Prolonged recurrent GE reflux
2. Inflammation and ulceration of squamous epithelial lining of the lower
segment of the oesophagus. (distal oesophagus)
3. Reepithelialization and in growth of pluripotent stem cells
( squamous epithelium replaced by metaplastic columnar epithelium of
the intestinal type - shows a greater resistance to acid injury than
squamous epithelium. )
4. In an environment of sustained low pH , these cells undergo dysplasia


SQUAMOUS CELL CARCINOMA ADENOCARCINOMA
upper and middle thirds of the
oesophagus
lower third of the oesophagus

Peptic ulcer
Common sites :
1. 1
st
portion of the duodenum
2. Lesser curvature of the stomach
3. Antral region of stomach (98% of the peptic ulcers present in duodenum
or stomach ; ration of duodenal and gastric ulcers is about 4 : 1 )
4. Distal oesophagus / gastroesophageal junction - due to GERD / Barretts
5. Margins of gastrojejunostomy
6. Meckels diverticulum


Gastric ulcers Duodenal Ulcers
Lesser curvature of stomach
Pyloric antrum
Anterior / Posterior wall of proximal
duodenum
Bleeding from left gastric artery
Perforation
Obstruction
Risk of malignancy !!!
Bleeding from gastroduodenal artery
Perforation
Obstruction
Almost never malignant !!!
- Burning epigastric pain soon after
eating.
- Pain increases with food intake
- Pain is relieved by antacids
- Patient is afraid to eat and loses
weight.
- No night pain
- Melena : Less common
- Vomiting and haematemesis : More
common

- Burning epigastric pain 1-3 hours
after eating
- Pain decreases with food intake
- Pain is relieved by antacids
- Patient does not lose weight
- Patient wakes at night due to pain.
(night pain)
- Melena : More common
- Vomiting and haematemesis : Less
common

Features Benign ulcer Malignant ulcer
Age Comparatively younger age Older age
Sex Clear cut male predominance Slight male
predominance
Site Usually along lesser
curvature of pylorus and
antrum
Along greater curvature
of stomach
Size Benign ulcers are generally
less than 4 cm
Generally more than 4
cm
Ulcer base Clear , rarely haemorrhagic Necrotic debris may be
present
Mucosal folds Radiating from the ulcer
crater
Interrupted , flattening of
the rugae around the
ulcer due to infiltration
by malignant cells
Margins No or minimal heaping Heaping prominent
Barium meal Sharply , punched out lesion Irregular lesion