GASTROINTESTINAL TRACT

Dr KS Mun Dept of Pathology, U.M.

CONTENTS:
I. Upper gastrointestinal tract (GIT) Stomach & Duodenum Small intestine Large intestine

II.

III. IV.

Signs & Symptoms:

Dysphagia Heartburn Abdominal pain Diarrhoea Steatorrhoea Blood loss & anaemia Weight Loss

Upper GIT
Mouth: lips, oral mucosa, teeth & gums Pharynx & oesophagus Salivary glands

MOUTH

Cleft lip & palate

Sporadic or sex-linked or AD (low penetrance) A/w infections e.g. Rubella Tutankhamun and Tad Lincoln

Caries & gingivitis

Caries: acid destruction of calcified component of teeth Acute gingivitis: Borrelia vincentii Chronic gingivitis: gum adjacent to plaque

Gingivitis
Gingival staining:

Lead poisoning (Burtonsline) Gingival hyperplasia: Leukemia, drugs (phenytoin)

Reparative
Minor trauma is frequent Excessivesurplustissue:epulis(congenital, giant cell, angiomatous tumour of pregnancy, hemangiomas, fibromas)

Angular cheilitis
Painful cracks at

mouth angles > a/w Staph aureus May have underlying Fe and Vit B deficiency

Aphtous stomatitis
Common: 40% population Single to multiple ulcers: shallow, necrotic base, haemorhagic rim Immunological, inflammatory bowel disease, uncertain

Syphilis
Primary chancre Secondary white

snailtrack ulcers Congenital Hutchinsons teeth & Mulberry molars

Herpetic stomatitis
Herpes simplex virus Vesiculation & ulceration > in childhood May develop later on lips (herpes labialis)

Oral candidiasis
Oral thrush Candida albicans Normal flora in 40% population Extends into oesophagus Neonates, immunocompromised, patients on broad spectrum antibiotics

Leukoplakia
Clinical term Patches of squamous

hyperkeratosis & hyperplasia dysplasia premalignant Heavy smoking, poor dental hygiene, alcohol, betel quids Oral hairy leukoplakia: EBV & HIV

Lip carcinoma
More common Sunlight exposure > in elderly > on lower lip Well differentiated

squamous cell carcinoma with lymphatic spread

Intra-oral carcinoma
Buccal mmucosa & tongue (posterior ) > Indians: 5% of all tumours Can be painless Presentation: > late Squamous cell carcinoma with local and

lymphatic / direct spread UV light, chronic irritation, smoking, betel quids, alcohol abuse Prognosis: site, differentiation, stage

Intra-oral carcinoma

PHARYNX

Pharyngitis
Viral (commonest) - cold, influenza, measles, infectious mononucleosis Streptococcal - scarlet fever, acute glomerulonephritis, rheumatic fever

Pharyngitis
Ulcerative - diphtheria, agranulocytosis, leukemia, bone marrow failure

Tonsilitis
Part of pharyngitis Anatomically predisposed chronic inflammation enlargement

Nasopharyngeal carcinoma
Geographical variation Eskimos, south Chinese A/w Epstein-Barr virus HLA-A2, HLABW46

OESOPHAGUS

Heterotopic tissue
Gastric mucosa:

- > fundic-type - ulcers, strictures

Oesophageal atresia
Atresia:

- failure of embryological canalisation - rarely agenesis - A/w tracheal fistula

Diverticula
Outpouchings of wall of hollow viscus Saccular dilatation or mucosal herniation May be formed by pulsion or traction Distended by retained food dysphagia

Hiatus hernia
Commonest mechanical disorder Portion of stomach above diaphragm Sliding (90%) vs. rolling Congenital short oesophagus or acquired ( abdominal pressure + aging) regurgitation & oesophagitis

Varices
Localised dilatation of lower oesophageal veins Site for portosystemic shunting Traumatised haemorrhage

Oesophagitis
Acute: - > fungal, viral in the immunocompromised - ingestion of corrosives Chronic: - Non-specific: peptic acid regurgitation - Specific: rare, e.g. TB, Crohnsdisease

Reflux oesophagitis
Squamoid mucosa is easily damaged by gastric acid A/w hiatus hernia, abnormality GIT motility

Reflux oesophagitis
Squamous mucosa + regurgitated acid accelerated desquamation cell injured 1. basal layer hyperplasia + inflammation 2. ulcer, haemmorrhage, perforation heal: fibrosis, stricture, re-epithelialisation

Barretts oesophagus
Re-epithelialisation

by columnar glandular cells Gastric or intestinal metaplasia bile reflux

Risk of malignancy

100x general population

Benign tumours
Uncommon, 5% of all oesophageal tumours Mostly leiomyoma Rare lipoma, haemangioma, fibromas Squamous papilloma: a/w HPV infection

Squamous carcinoma
M > F; 80 85% of oesophageal ca. Geographical variation ~ Europe 5 : 100 000; China 100 : 100 000 Upper ofoesophagus;%05inmiddle 60% polypoidal or fungating; rest diffuse SCC with direct & lymphatic spread Insidious onset; multifactorial Risks: tannic acid, lack of riboflavin/ vitamin A/ zinc, fungus, opium use, thermal injury, smoking, alcohol, HPV

Squamous carcinoma

Adenocarcinoma
Lower CloselyrelatedtoBarretts

SALIVARY GLAND

Sialadenitis
Bacterial infection

uncommon Usually ascending infection, mumps risk in xerostomia, Sjgrens Recurrent: duct obstruction, saliva hyposecretion tumour

Pleomorphic adenoma
> parotid gland ofsalivarytumours Benign mixed epithelial

& stromal (myxoid, cartilaginous) tumour Prone to recur if resection is incomplete Small proportion undergoes malignant change

Warthins tumour
Adenolymphoma Benign, 5 10% of total Double-layer of epithelial cells covering dense lymphoid stroma

Muco-epidermoid tumour
Maybe malignant or benign Mixture of mucinsecreting cells, squamoid cells, intermediate cells Malignant: squamoid > mucinous cells

Adenoid cystic carcinoma

Malignant A/w perineural disease Small epithelial cells in islands & microcysts