2.TRAKTUS DIGESTIVUS
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Transcript of 2.TRAKTUS DIGESTIVUS
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TRAKTUSDIGESTIVUS
Pieri Kumaladewi, Dr, SpPA (UGM)
Wien Wiratmoko, Dr, SpPA(UNAIR)
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Upper digestive tract
I. Diseases of the Mouth & Jaw
A. Congenital DisordersB. Inflammatory disorders
C. Tumors and tumor-like conditions
II. Diseases of the Salivary GlandsA. Sialadenitis
B. Acute parotitis
C. Sjogren syndromeD. Mucocele
E. Ranula
F. Tumors of the salivary gland
III. Diseases of the EsophagusA.Tracheoesophageal fistula
B. Esophageal diverticulaC. Achalasia
D. Esophageal varices
E. Hiatus hernia
F. Inflammatory and related disorders
of the esophagus
G. Carcinoma of the esophagus
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I.A. CONGENITAL DISORDERS
SCHISIS / CLEFT MICROGNATHIA
* Failure of mesodermal penetrance betweenthe maxillary, median nasal, and lateral nasal.
- Unilateral/ Bilateral
- Simplex/ complex: Labioschisis
LabiognatoschisisLabiognatopalatoschisis
Oblique facial clef
- Sporadic/ congenital
- May be it is associated with other anomalies
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TONGUE
CONGENITAL DISORDER OF THE TONGUEMICROGLOSSI MACROGLOSSI MEDIAN RHOMBOID GLOSSITIS
TIE TONGUE BIFID TONGUE
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I.B. INFLAMMATORY DISORDERS
1. Herpes Labialis
- most common lesion caused by HSV (HSV-1)- tends to recur, with activation by febrile illness, trauma, sunshine,
menstruation
2. Aphthous stomatitis
- characterized by painful, recurrent, erosive oral ulceration
3. Oral candidiasis (thrush, moniliasis)- local lesion, white, membranous, caused by Candida albicans
- occurs most commonly in debilitated infants and children,
immunocompromized patient, and diabetics
4. Acute necrotizing ulcerative gingivitis (trench mouth, Vincent infection,
fusospirochetosis)- severe gingival inflammation occuring in patient with decresed
resistance to infection
- due to concurrent infection with symbiotic bacteria (Fusobacterium
species and Borrelia vincentii)
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Glositistuberculosa Glositisluetica
Geographic tongue Hairry tongue
GLOSSITIS
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3. Odontogenic tumors
a. Odontoma: hamartoma derived from odontoblastic epithelium
b. Ameloblastoma:
- epithelial tumor arising from precursor cells of the enamel organ
- usually before age 35, and most fequently in mandible- irregular local extension
4. Oral cancer
- mostly squamous cell carcinoma
- often associated with abuse of tobacco and alcohol
- may be associated with irritants: pipe smoking, chewing tobacco
or betel nuts
I.C. TUMORS & TUMOR-LIKE CONDITIONS
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LEUKOPLAKIA
- white patches of keratosis- premalignant lesion
- hyperkeratosis, hyperplasia of the squamous epithelium
- dysplastic changes
SQUAMOUS CELL CARCINOMA
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Malignant tumors:NPC, squamous cell ca, lymphoma
Pharyngitis-Viral pharyngitis: common feature of the CC, influenza, measles, etc
-Streptococcal pharyngitis: less common but more important than viral
pharyngitis because the complicationrheumatic fever, acute
proliferative glomerulonephritis, Henoch Schonlein purpura
-Ulcerative pharyngitis & tonsillitisdiphtheria
Tonsilitis:-Follicular tonsilitis, streptococcus/ Borrelia / virus
-Parenkhimal tonsilitis: quincy, Peritonsiler abses
-Angina agranulositic netropenic
-Tonsilitis morbili: Warthin Finkeldey giant cells
Pharynx & Tonsil
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A. Sialadenitis
B. Mucocele
C. Ranula
D. TumorsPleomorphic adenoma (Mixed tumor)
Warthin tumor / adenolymphoma / Papillary cystadenomalymphomatosum
OncocytomaAdenoid cystic carcinoma
Mucoepidermoid tumor
II. Diseases of the SALIVARY GLAND
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II. A. Sialadenitis
Acute
- Suppurative parotitis- Non-suppurative parotitis
- Parotitis epidemica / Mumps: paramyxovirus
Orchitis/ Oophoritis
- Cytomegalic inclusion disease
Chronic1. SJOGRENS SYNDROME :
- Autoimmune disease
- Keratoconjungtivitis sicca
- Xerostomia
- Parotitis hyperplasia
2. MIKULICZ SYNDROME :- Idiophatic
- Keratoconjungtivitis sicca
- Xerostomia
- Unilateral parotitis hyperplasia
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Mucocele A cyst-like pool of mucus, lined by granulation tissue,
near a minor salivary gland
Results from mucus leakage caused by rupture ofobstructed or traumatized ducts
Ranula
Is a large mucocele, of salivary gland of origin,characteristically localized to the floor of the mouth
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Tumors of the Salivary Glands
1. Pleomorphic adenoma (Mixed tumor)
2. Warthin tumor / adenolymphoma / Papillary
cystadenoma lymphomatosum3. Oncocytoma
4. Adenoid cystic carcinoma
5. Mucoepidermoid tumor
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Anatomy of parotid gland
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Anatomy of parotid gland
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Pleomorphic adenoma (parotid)
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Pleomorphic adenoma (gross)
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Pleomorphic adenoma
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Warthin tumor
Benign tumor mostly occur in parotid gland
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Warthin tumor
Cystic spaces lined by double-layered eosinophilic epithelium,
and all embedded in lymphoid stroma
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Oncocytoma
Mostly in parotid gland
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Oncocytoma
Large granular appearing, eosinophilic-staining epithelial cells
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Adenoid cystic carcinoma
Minor salivary gland
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Adenoid cystic carcinoma
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Adenoid cystic carcinoma
Most characteristic appearance consists of cribriform pattern
with masses of small, dark-staining cells arrayed arround
cystic spaces
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Adenoid cystic carcinoma
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Mucoepidermoid tumor(Palatal gland)
Mostly in parotid gland
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III. Diseases of the Esophagus
A.1. Tracheoesophageal fistula
Congenital disorder, is suggested in a newborn by copious salivation associated with
choking, coughing, and cyanosis on attempts at food intake
The most common variant (90%),the lower portion of the esophagus communicates
With the trachea near the tracheal bifurcation, the upper esophagus ends in a blindpouch
Associated abnormality: maternal polyhydramnion
The second most common variant,fistulous connection
between the upper esophagus and the trachea; the lower
esophageal segment is not connected to the upper esophagus
The third variant, fistulous connection between
the tachea and a completely patent esophagus
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III. Diseases of the Esophagus
A.2. Heterotopic tissue
patches of fundic-type gastric mucosa are
occasionally found above the distal sphincter
separated from the columnar lining of the distalesophagus
congenitally misplaced gastric tissue (heterotopic)
can lead to ulceration and stricturing due to
local acid/pepsin secretion
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III. Diseases of the Esophagus
B. Esophageal diverticula
- Outpouchings of the wall of hollow viscus
- herniation of the mucosa or full thickness
- effects: dysphagia, diverticulitis
- pharyngoesophageal diverticula
-Traction: external forces pulling on the wall
(true divericula)
-Pulsion: forcible distention (false diverticula):result from periesophageal inflammation and
scarring
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III. Diseases of the Esophagus
C. Achalasia
-Contractility of the lower esophagus is lost and
there is failure of relaxation at the sphincter
(cardiospasm)
-Mechanism: fibrosis and atrophy of smooth muscle
(reduced number number of ganglion cells in the
myenteric plexus: Chagas disease & other
unknown etiology).
-Clinically: slowing / retention of the food
dilatationdysphagia
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III. Diseases of the Esophagus
D. Esophageal varices
-Localized dilatation of veins
-Portal hypertension
-cirrhosis hepatis
- Haematemesis
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III. Diseases of the esophagus
E. HIATUS HERNIA
The presence of part of the stomach above the diaphragmatic orifice, mostly acquired
Increased intra-abdominal pressure and loss of diaphragmatic muscular tone with aging
herniation of the stomach and subsequent retraction of the esophagus.
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III. Diseases of the Esophagus
F. Inflammatory and related disorders
of the esophagus
1. Gastroesophageal reflux
2. Barrets esophagus3. Candida esophagitis
4. Viral esophagitis
5. Esophageal stricture
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III. Diseases of the Esophagus
F. 1. Gastroesophageal reflux
Reflux of gastric acid contents into the esophagusesophagitis,stricture, ulceation, or columnar metaplasia (Barrets esophagus)
Usually characterized by burning pain (often manifests by substernalpain or heartburn) relieved by antacids
Often precipitated by assuming recumbent position
Associated:
- most commonly with hiatal hernia and incompetent lower
esophageal sphincter
- with excessive use of alcohol & tobacco, and with increased gastric
volume
- with pregnancy and scleroderma
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III. Diseases of the Esophagus
F.2. BARRETS ESOPHAGUS
Columnar metaplasia (often of intestinal type with prominent goblet cells) ofesophageal squamous epithelium.
Complication of long-standing gastroesophageal reflux, to be a well-known
precursor of esophageal adenocarcinoma
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III. Diseases of the Esophagus
F. 3. Candida esophagitis
Etiology: Candida (Monilia) albicans
Manifest clinically by white adherent mucosal patches and
painful, difficult swallowing
Often assciated with:
- antibiotic therapy
- diabetes mellitus
- malignancy
- immunodeficiency
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III. Diseases of the Esophagus
F. 4.a. Viral esophagitis
Herpetic esophagitis Characterized by painful and difficult swallowing
Tends to occur in immunosuppressed patient, causedby HSV-1 infection
Cytomegalovirus (CMV) infection Less common
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III. Diseases of the Esophagus
F. 4.b. Other esophagitis
Less common form of esophagitisCaused by: uremia, radiation therapy, graft-versus-host
(GVH) disease
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III. Diseases of the Esophagus
F. 5. Esophageal stricture
Most often results from prolonged esophageal
gastric acid reflux
May also be caused by suicidal or accidental
ingestion of corrosive agent (acid or alkaline)
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III. Diseases of the Esophagus
G. Carcinoma of the esophagus
Aggressive tumor manifest clinically by dysphagia, weight loss,
and anorexia, and occasionally by pain or hematemesis
In the USA the incidence of SC and adenocarcinoma are equal
May be manifest pathologically by protrusion into the
esophageal lumen
Spread by local extension to adjacent structure: trachea,
bronchi, aorta, or diffuse infiltration into esohageal wall
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III. Diseases of the Esophagus
G.1. Squamous Cell Carcinoma
Arises most frequently in the upper and middle thirdsof the esophagus
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III. Diseases of the Esophagus
G2. Adenocarcinoma
Arises most frequently in the lower third, and mostly from
aberrant gastric mucosa or Barrets esophagus
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Part 2
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Pathology ofthe
LOWER ALIMENTARY TRACT
I. Diseases of the Stomach
II. Diseases of the Small Intestine
III. Diseases of the Colon
IV. Diseases of the Appendix
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STOMACH
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I. Diseases of the Stomach
A. Congenital Pyloric Stenosis
B. Gastritis
C. Peptic Ulcer of the StomachD. Malignant Tumor of the Stomach
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I. Diseases of the Stomach
A. Congenital Pyloric Stenosis
Is caused by hypertrophy of circular muscular layer of the pylorusoften results as papable mass
obstruction of gastric outletepisodes of projectile vomiting
(beginning in the first 2 weeks of life)
Much more common in boys
Is corrected by surgical incision of the hypertrophied muscle
I Diseases of the Stomach
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a. Causes
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cigarette smoking
- heavy alcohol intake- Burn injury (severe)Curling ulcer
- Brain injuryCushing ulcer
b. Characteristic
- focal damage of mucosa with acute inflammation, necrosis,and hemorrhage
- may be manifest as gastric ulceroften multiple
I. Diseases of the Stomach
B. Gastritis:1. Acute (erosive) gastritis
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Acute gastritis
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- Helicobacter pyloriassociated gastritis- gramneg. organism, in the surface
epithelium beneath the mucous barrier
- cells desquamation and lead to polymorph
and chronic inflammatory cells- predominantly affects the anthrum
- most common form of gastritis
- often has increased gastric acid
- young adulthood and early middle age- associated with gastric cancer
I. Diseases of the Stomach
B. Gastritis: 2. Chronic gastritis
HISTOLOGIC PICTURE OF CHRONIC
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HISTOLOGIC PICTURE OF CHRONIC
GASTRITIS
Early stage: inflammation affects the superficial parts ofthe mucosal layers superficial chronic gastritis
Next stage: the inflammation affects all mucous andsubmucous layerswith germinal center
1. Inflammatory cells: activenetrophil (+)2. Metaplasia: intestinal metaplasiapre-malignant
condition
3. Glandular atrophy: glandular tissue is reduced in
amount and undergoes to intestinal metaplasia
4. H. pylori
5. Dysplasia:carcinoma
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ATROPHIC
GASTRITIS
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H.pylori
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H. PYLORY AND CHRONIC GASTRITIS
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OTHER GASTRITIS
Eosinophyillic gastritis: food allergy ?
Granulomatus gastritis: tuberculosis,
syphilis, sarcoidosis, fungi, Crohn disease
Reflux gastritis: duodenal and bile reflux
Menetrier disease (giant hypertrophic
gastritis)
M t i di
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Menetrier disease(HYPERTROPHIC GASTROPATHY)
Severe hyperplasia of mucosal layer
cells + glandular atrophyextremeenlargement of gastric rugae
Hypertrophic gastropathy + hyper-secretion: mucosal cells, parietal andchief cells hyperplasia.
Gastrinomaexcessive gastrinexcretiongastric glandularhyperplasia (Zollinger-Ellisonsyndrome)
Sometimes with severe loss of plasmaproteins from the altered mucosa
Risk of peptic ulcer
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I. Diseases of the Stomach
C. Peptic Ulcer of the Stomach
Most often at or near lesser curvature, in the anthral & pre-pyloric
region
Is not a precursor lesion of Ca of the stomach
Is not dependent on increased gastric acid secretionbut rarely
occur in association with absolute achlorhydria
Middle-later age group
Male > female, 1.5 to 2:1
Often solitary
>50% 4cm 0,6 cm ulcer
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PEPTIC ULCER
Etiopathogenic mechanism:
- H. pylori : 90-100% duodenal ulcer, 70% gastric ulcer; bacterial
urease & protease break down glycoprotein in gastric mucus
interfering with epithelial protection
- NSAID
- alcohol, smoke, blood-group, HLA-B5
- Increased permeability of the gastric mucosa to hydrogen ion
back diffusion of H2 ioninjury to gastric mucosa- Bile-induced gastritis leading to gastric ulceration
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PEPTIC ULCER
Complications:
1.Bleeding2.Perforation
3.Obstruction: due to Edema or cicatrix
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G STRIC ULCER
Destruction of mucosa and sub-mucous Almost always single, 2-3 cm,
Type:
Acute peptic ulcer: both mucous andsub-mucous layer are involved, 1 cm,
single/ multiple
Chronic peptic ulcer: penetrated and
destroy the muscle coat.
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ACUTE GASTRIC ULCER
Multiple
Gastric > duodenum
Erosionulceration
1 cm, circular, rarely invade to mucosal layer
Etiology Shock, burning ulcer, sepsis, severe trauma
High intracranial pressure Cushing ulcer
Proximal the duodenum + severe burning
ulcer/traumaCurling ulcer NSAID
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TRIGER F CTORS OF PEPTIC ULCER
Cylindric epithelia
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PEPTIC ULCER
Necrotic debris
Granulation tissue with lymphocytic infiltratio
Glands hyperplasia
Edema
I Diseases of the stomach
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POLYP- Polypoid mass
>90% non neoplasm (inflammatory/ hyperplasia)
Sessile / pedunculated
20-25% multiple
Mostly occur in chronic gastritis
No malignant potential
ADENOMA
neoplasm5-10% of gastric polyp
Sessile / pedunculated
distalantrum predominant
Six decade, Male: female = 2:1 Some cases origin from chronic gastritis with intestinal
metaplasia
I. Diseases of the stomach
D. Tumors of the stomach (benign)
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I. Diseases of the stomach
D. Tumors of the stomach (malignant)
90-95% of gastric malignancy High incidence: japan, Chili, Costa Rica, China
Location: - 40-50% pylorus/anthrum; 25% cardia
- 40% minor curvature; 12% c. major
- Etiology:
- Diet
- Chronic atrophic gastritis
- H. pylori infection
- partial gastrectomy
- Gastric Adenoma- Genetic : A blood group, family factor
GASTRIC CANCER
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GASTRIC CANCER
Invasion
Early ( mucosa and sub- mucosa) Advanced (invade the sub- mucosa)
Macroscopic growth
Exophytic
flat/ depressed Excavation
Linitis plastica tumor cells diffusely infiltrategastric wall leather bottle appearance
Histology intestinal gland type
Diffuse: signet-ring cell
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The Growth of Gastric Cancer
Other gastric tumors
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Other gastric tumors
MALIGNANT LYMPHOMA
40% malignant lymphoma of GIT 5% of gastric malignancy
B cell type predominant, MALT origin
CARCINOID TUMORCarcinoid syndrome
Low grade malignancy
Metastasis to the liver Multiple lesions
LEIOMYOMA
SECONDARY TUMORS (METASTASIS)
rare
Mostly from leukemia or general lymphoma From breast / lung cancerdiffuselinitis
plastica
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GASTRIC CARCINOMA
Prognosis:
Depend on the depth of tumor invasion
and metastasis process
Adenocarcinoma, NOS
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Adenocarcinoma, NOS
ULCUS CARCINOMATOSA
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ULCUS CARCINOMATOSA
Diseases of the Intestine
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REDUPLICATION STENOSIS DIVERTICULUM ATRESIA
A. CONGENITAL ABNORMALITIES
Diseases of the Intestine
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HERNIA
Mechanic obstruction
-atresia-stenosis
-stricture
-hernia
-volvulus
-invagination / intususeption
Neurogenic obstruction-paralytic - adinamic
-spastic - dinamic
Vascular obstruction
-trombosis-embolism
Diseases of the Intestine
B. INTESTINAL OBSTRUCTION
Invagination/ intususeption Volvulus
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Invagination/ intususeption Volvulus
Vascular obstruction HaemorrhoidIntern/ extern
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II. Diseases of the Small Intestine
A. Peptic Ulcer
B. Crohn Disease
C. Meckel Diverticulum
D. Malabsorption syndrome
E. Tumors of the Small Intestine
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II. Diseases of the Small Intestine
A. Peptic Ulcer of the Intestine
Most frequently in the first portion of duodenum
Is not a precursor of malignancy
Is always associated with hypersecretion of gastric acid
and pepsin increased frequency in persons of blood group O
genetic factors?
Often complicated by hemorrhage with melena,
perforation, obstruction
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II. Diseases of the Small Intestine
A. Peptic Ulcer of the Intestine
Sometimes associated with:
Aspirin or other NSAID
Smoker: the incidence is two-fold greater
Zollinger-Ellison syndromegastric acid hypersecretiondue to
gastrin secreting islet cell tumor of the pancreas
Primary hyperparathyroidisme
Multiple Endocrine Neoplasia (MEN Wermer syndrome), an
autosomal dominant syndrome characterized by pituitary, thyroid,
parathyroid, adrenal cortical, and pancreatic islet cell adenoma, orhyperplasias associated with hypergastrinemia and peptic ulcer
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II. Diseases of the Small Intestine
B. Crohns Disease
Chronic inflammatory condition of unknown etiology
Tends to affect young people in 2ndand 3rddecades of life
Occurs most frequently in Jewish descent
Cinical manifestations:
Abdominal pain and diarrhea
Malabsorption
Fever
Intestinal obstruction resulting from fibrous tissue
Fistulas: inter-intestine, between intestinebladder, vagina, skin
II. Diseases of the Small Intestine
B Crohns Disease
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B. Crohn s Disease
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Crohn Disease Ulcerative Colitis
May involve any portion of the gastrointestinal
tract, usually the ileocecal region, small intestine,or colon.
Chronic inflammatory reaction extends through
the entire thickness of the intestinal wall.
Fistulous tracts between loops of intestines, or
between the intestine and other site; skip lesionswith mucosal cobblestone appearance.
Non-caseating granulomatous inflammation with
lymphocytic infiltration, fibrosis, and thickening of
intestinal wall.
Incidence of secondary malignancy is much lowerthan in ulcerative colitis
Affects only colon.
Inflammation and ulceration
limited to mucosa and submucosa
Crypt abscess, pseudopolyp
Greatly increased incidence ofcolon cancer in longstanding
cases
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Comparison of the lesions
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II. Diseases of the Small Intestine
C. Meckel Diverticulum
Most common congenital anomaly of the small intestine
Remnant of embryonic vitelline duct distal small bowel
May contain ectopic gastric, duodenal, colon, pancreatic
tissue Usually asymptomatic, ectopic tissue productcom-
plication (peptic ulceration bleedingperforation)
Occasionally associated with: intussusception and
volvulus
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II. Diseases of the Small Intestine
D. Malabsorption syndrome
Sensitivity to gluten in cereal product
Clinically: weight loss, weakness, diarrhea with pale, bulky, frothy,
foul smelling stools
Growth retardation and general failure to thrive
Most often become symptomatic in infancy when cereals are first
added to the diet
Diagnosisbiopsyblunting of small intestinal villi
10-15%small intestinal malignancy: most often enteropathy-type
T cell lymphoma
II. Diseases of the Small Intestine
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Disorders Morphologic Features CommentsCeliac disease Flat mucosal surface with marked
villous atrophy
Gluten sensitivity
Tropical sprue Micros: no changeabnormalities
similar to those of celiac disease
Probable infectious origin;
often respond to antibiotics
Whipple disease PAS+ macrophages in mucosal
Tropheryma whippeliiEM
Most common: small intestine;
arthralgia, cardiac & neuro. S
Disaccharidase
deficiency
No characteristic histologic change Sited in brush border of
mucosal cell of small intestine;
Lactase def.
milk intoleranceAbetalipoproteinemia No characteristic features in the in-
testine; circulating acanthocytes
Hereditary deficiency of apo-
protein-B
Intestinal
lymphangiectasia
Generalized dilatation of the small
intestinal lymphatics
Marked gastrointestinal pro-
tein losshypoproteinemia
D. Malabsorption syndrome
MALABSORPTION
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8/10/2019 2.TRAKTUS DIGESTIVUS
88/106
Coeliac disease
Tropical sprue
Whipples disease
Secondary malabsorptiona. Interference with digestion
-Mucosa destruction
-Hepatic/ pancreatic disease-Resection of bowel
-Congenital disaccharidase
defect
-Drug influence
Primary syndromes
b. Diminish of absorption
-intestinal stasis
-chronic obstruction
c. Altered transport
-Lymphatic obstruction
-Mesenteric blood supply disease
-Abetalipoproteinemia
II. Diseases of the Small Intestine
E T f th ll i t ti
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8/10/2019 2.TRAKTUS DIGESTIVUS
89/106
E. Tumors of the small intestine
Make up a small percentage of the gastrointestinal tumor
Carcinoid tumor:- most frequenty in appendix (in small intestine: 30%)
- slow growing, low-grade malignancy (of appendix almost never
metastasizes
- carcinoid syndrome: caused by elaboation of vasoactive peptides
and amines, especially serotonin, manifest clinically by:
(1) cutaneous flushing
(2) watery diarrhea and abdominal cramp
(3) bronchospasm
(4) valvular lesions of the right side of the heart
Other tumors: lymphoma, adenocarcinoma (rare)
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90/106
III Di f th C l
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91/106
III. Diseases of the Colon
A. Hirschprung disease
B. Diverticula
C. Vascular diseases of the colon
D. Inflammatory disorders of the colon
E. Tumors
III. Diseases of the Colon
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92/106
A. Hirschprung disease
Dilatation of colon due to the absence of ganglion cellsof the submucosal and myenteric neural plexuses
Dilatation is proximal to aganglionic segment
III. Diseases of the Colon
B Di ti l
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93/106
B. Diverticula
Most common in old person, and almost always multiple Most frequently involve the sigmoid colon
Type: pulsion/false diverticula pockets of mucosa and
submucosa
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94/106
Diverticulosis of the Sygmoid
III. Diseases of the Colon
-
8/10/2019 2.TRAKTUS DIGESTIVUS
95/106
C. Vascular diseases of the colon
III. Diseases of the Colon
D I fl t di d f th l
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96/106
D. Inflammatory disorders of the colon
ENTERITIS TUBERCULOSA
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97/106
ENTERITIS TUBERCULOSA
Primer: milk + mycobacterium tuberculosa
Secunder: sputum + mycobacterium tuberculosa
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98/106
Ulcerative Colitis
III. Diseases of the Colon
E T
-
8/10/2019 2.TRAKTUS DIGESTIVUS
99/106
E. Tumors
III. Diseases of the Colon: E. Tumors:Intestinal Polyps
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8/10/2019 2.TRAKTUS DIGESTIVUS
100/106
Type Comments
Non-neoplastic polypsHyperplastic polyp
Inflammatory polyp
- Lymphoid polyp
- Inflammatory pseudopolyp
Hamartomatous polyp
- Juvenile polyp
- Peutz-Jeghers polyp
No clinical significance
Rectal mucosa; may be reactive
@ ulcerative colitis and others, granulation tissue
Most frequently in children
@ Peutz-Jeghers syndrome
Neoplastic polyps
Tubular adenoma
Tubulovillous adenoma
Villous adenoma
Often multiple (hereditary multiple polyposissyndrome)increased risk of malignancy
Greater malignant potential
High potential for malignant change
Intestinal Polyps
-
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101/106
Familial Adenomatous Polyposis
Adenomatous polyp
-
8/10/2019 2.TRAKTUS DIGESTIVUS
102/106
Adenomatous polyp
Dukes Stage
-
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103/106
ASTLER - COLLER
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104/106
Five-year survival rate
Atumor terbatas di mukosa - 100%
B1 sampai dengan muskularis propria,
belum sampai ke limfonodi 67%
B2menembus muskularis propria,belum sampai ke limfonodi 54%
C1sampai dengan muskularis propria,
sudah sampai limfonodi 43%
C2menembus muskularis propria,
sudah sampai limfonodi 22%
Dmetastasis jauh sangat rendah
IV Di f th A di
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105/106
IV. Diseases of the Appendix
A.Inflammatory diseases
1. Acute appendicitis
2. Chronic appendicitis
B.Tumors of the appendix
The most common : carcinoid tumor
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8/10/2019 2.TRAKTUS DIGESTIVUS
106/106