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GI PATHOLOGY PICS

SPLENOMEGALY PORTAL htn

Inguinal hernia

MOUTH AND ESOPHAGUSPATHOLOGY

ESOPHAGUS

• Congenital Anomalies

• Achalasia

• Hiatal Hernia

• Diverticula

• Laceration

• Varices

• Reflux

• Barretts

• Esophagitis

• Neoplasm: Benign, Sq. Cell Ca., Adenoca.

Achalasia and cardiospasmAchalasia (of cardia)Aperistalsis of esophagusMegaesophaguscongenital cardiospasm

Esophagitis:•chemical•peptic•postoperative•regurgitant

Ulcer of esophagusfungalpepticUlcer of esophagus due to ingestion of:aspirinchemicalsmedicinesE code to identify cause, if induced by chemical or drug

Rupture of esophagus:traumatic perforation of esophagus

•regurgitantE code to identify cause, if induced by chemicaltuberculous esophagitis

Stricture and stenosis of esophagusCompression of esophagusObstruction of esophaguscongenital stricture of esophagus

Dyskinesia of esophagusCorkscrew esophagusCurling esophagusEsophagospasmSpasm of esophaguscardiospasm

Diverticulum of esophagus, acquiredDiverticulum, acquired:

epiphrenicpharyngoesophagealpulsionsubdiaphragmatictraction

Zenker's (hypopharyngeal)Esophageal pouch, acquiredEsophagocele, acquiredcongenital diverticulum of esophagus

Gastroesophageal laceration-hemorrhage syndromeMallory-Weiss syndrome

Paterson-Kelly syndrome

BALLOON DILATATION

Weaken the LES by tearing its muscle fibers.

MODIFIED HELLER APPROACH

There are THREE major kinds of hiatus hernia:

The most common (95%) is the sliding hiatus hernia,where the gastroesophageal junction moves above thediaphragm together with some of the stomach.

The second kind is rolling (or paraesophageal) hiatushernia, when a part of the stomach herniates throughhernia, when a part of the stomach herniates throughthe esophageal hiatus and lies beside the esophagus,without movement of the gastroesophageal junction. Itaccounts for the remaining 5% of hiatus hernias.

A third kind, a combination of the first and second kinds

PARAESOPHAGEAL HIATALHERNIA

The fundus and possibly portions of the stomach’sgreater curvature, rolls through the esophagealhiatus and into the thorax beside the esophagus

In a rolling or Paraesophageal hiatal hernia theherniated portion of the stomach may be smallor quite large.Reflux is rarely a concern with this type ofReflux is rarely a concern with this type ofhernia but the risks of volvulus (boweltwisting), obstruction, and strangulationare high.The development of iron deficiency anemia iscommon because of slow bleeding secondaryto venous obstruction causing the gastricmucosa to become engorged and ooze

DIVERTICULA

• ZENKER (HIGH)

• TRACTION (MID)

• EPIPHRENIC (LOW)

• TRUE vs. FALSE?• TRUE vs. FALSE?

Epiphrenic diverticulum: due to dysfunction of the lower esophageal sphincter, as in achalasia

Zenker's diverticulum, also pharyngoesophagealdiverticulum, also pharyngeal pouch,

is a diverticulum of the mucosa of the pharynx, just abovethe cricopharyngeal muscle(i.e. above the upper sphincter ofthe esophagus).

It is a false diverticulum (not involving all layers of theesophageal wall).

treated by neck Surgery to resect the diverticulum and incisethe cricopharyngeus smuscle

the currently preferred treatment is endoscopic stapling (i.e.closing off the diverticulum via a stapler inserted through atube in the mouth). This may be performed through afibreoptic endoscope. endoscopic laser, which recent evidencesuggests is less effective than stapling

DIVERTICULUMPLURAL =

DIVERTICULADIVERTICULA

A large hiatus hernia onX-ray marked by openX-ray marked by openarrows in contrast to theheart borders marked byclosed arrows

A COMPARISON OF THE NORMAL STOMACH, SLIDINGHIATAL HERNIA AND ROLLING HIATAL HERNIA