中国医科大学：《病理学》课程教学课件（PPT讲稿，英文）Chapter 8 gastrointestinal disease

Chapter 8The diseases of digestive systemTreZenkerdiverticulumTracheo-esophagealfistulaTraction diverticulunner-VinsonsyndromeWeb(PluStrictureSclerodermeRelux esophagitisMallory-Weisssyndrome (laceration)BarelceonhanTeDiaphragnVaricesStomachNon-neoplasticdisordersoftheesophagus

Chapter 8 The diseases of digestive system

8.1.1ESOPHAGITIS1.reflux esophagitisDefinition: esophageal irritation and inflammation due to reflux ofgastric secretions into the esophagusPathologicchanges.Eosinophiles,with or withoutneutrophils,in the epithelial福layerBasal zone hyperplasia福Elongation of lamina propria papillaeIntraepithelial neutrophils are markers of more severe injury福Presentation: heartburn and reguritationComplications: bleeding, stricture, bronchospasm and asthma,barrett esophagus

1. reflux esophagitis Definition: esophageal irritation and inflammation due to reflux of gastric secretions into the esophagus Pathologic changes:  Eosinophiles, with or without neutrophils, in the epithelial layer  Basal zone hyperplasia  Elongation of lamina propria papillae  Intraepithelial neutrophils are markers of more severe injury Presentation: heartburn and reguritation Complications: bleeding, stricture, bronchospasm and asthma, barrett esophagus 8.1.1 ESOPHAGITIS

2.BarretesophagusDefinition: metaplasia of the squamous eosphagealmucosa to a more protective columnar typebecause of chronic exposure to gastric secretionsCause:gastroesophageal reflux disease福Gross: irregular gastroesophageal junction withtongues of red granular mucosa extending up intothe esophagusIncreased risk of dysplasia and esophagealadenocarcinoma

2.Barret esophagus Definition: metaplasia of the squamous eosphageal mucosa to a more protective columnar type because of chronic exposure to gastric secretions Cause: gastroesophageal reflux disease Gross: irregular gastroesophageal junction with tongues of red granular mucosa extending up into the esophagus Increased risk of dysplasia and esophageal adenocarcinoma

Esophageal carcinomaSquamous cell carcinomaAdenocarcinomaEpidemiologyArises inthe distal esophagusThe most common type of esophageal cancerAssociatedwithBarrettesophagusMales>females; age usually>50and dysplasiaRisk factorsPrognosis: poorHeavy smoking and alchol useAchalasiaPlummer-vinson syndromeUpperthird20%TylosisADENOCARCINOMAPriorlye ingestion(%06)Middle third50%Presentation(10%)Often asymptomatic until late in the courseLowerthird30%Progressive dysphagiaWeight loss and anorexiaBleedingHoarseness or cough (advanced cancers)Diagnosis: endoscopy and biopsyTreatment:surgeryPrognosis: poorFIGURE18.3Carcinoma oesophagus-sites of predilection for squamous cellcarcinoma and adenocarcinoma

Esophageal carcinoma Squamous cell carcinoma Epidemiology The most common type of esophageal cancer Males>females; age usually>50 Risk factors Heavy smoking and alchol use Achalasia Plummer-vinson syndrome Tylosis Prior lye ingestion Presentation Often asymptomatic until late in the course Progressive dysphagia Weight loss and anorexia Bleeding Hoarseness or cough (advanced cancers) Diagnosis: endoscopy and biopsy Treatment: surgery Prognosis: poor Adenocarcinoma Arises in the distal esophagus Associated with Barrett esophagus and dysplasia Prognosis: poor

A.POLYPOIDB.ULCERATINGC.DIFFUSETYPEFUNGATINGTYPEINFILTRATINGTYPEFIGURE18.4Macroscopictypesof squamouscell carcinomaof theoesophagus

Parietal (oxyntic)cellsChief(zymogen)cellsEndocrinecellsMucin-secretingcellsFundusShorttubularCardiaglandsenCARDIACMUCOSABODY-FUNDICMUCOSABodyLefPylorusDOPyloricantrumvatGreatercuryD2D3D4MucouscellsLongtubularglandsPYLORIC MUCOSAFIGURE18.5Anatomical subdivisions of the stomach correlated with histological appearance of gastric mucosa in different regionsD1.D2,D3andD4arethefirsttofourthpartsoftheduodenum

8.1.2GASTRITISTABLE18.2:Classification of GastritisA.ACUTE GASTRITIS1.Acute H.pylori gastritis2.Other acute infective gastritis bacteria, viruses, fungi,parasites)3.Acute non-infective gastritisB. CHRONIC GASTRITIS:Body-fundic predominant1.TypeA (autoimmune)2.TypeB(H.pylori-related):Antral-predominantgastritis3.Type AB(environmental):Antral-bodygastritis4.Chemical (reflux)gastritis:Antral-bodypredominant5.Uncommon forms ofgastritis

8.1.2 GASTRITIS

inflammation of gastric mucosaacutegastritispathogens clearacute inflammation (neutrophilschronicgastritisautoimmunebilious duodenal secretion reflexHPinfection

inflammation of gastric mucosa acute gastritis pathogens clear acute inflammation (neutrophils ) chronic gastritis autoimmune bilious duodenal secretion reflex HP infection

l.acutegastritisDefinition: acute inflammation, erosion, and hemorrhageof the gastric mucosa due to a breakdown of themucosal barrier and acid-induced injuryEtiology: chronic aspirin or NSAID use/ Alcohol use/Smoking/ Postsurgery/ Burns/ Ischemia/ Stress/Uremia/ ChemotherapyPresentationEpigastric abdominal painGastric hemorrhage, hematemesis, and melena

1. acute gastritis Definition: acute inflammation, erosion, and hemorrhage of the gastric mucosa due to a breakdown of the mucosal barrier and acid-induced injury Etiology: chronic aspirin or NSAID use/ Alcohol use/ Smoking/ Postsurgery/ Burns/ Ischemia/ Stress/ Uremia/ Chemotherapy Presentation Epigastric abdominal pain Gastric hemorrhage, hematemesis, and melena

()acuteirritatedgastritispathogens: diet2) lesions: edema,hyperemia, hypersection of mucus, erosion

(1) acute irritated gastritis 1）pathogens：diet 2）lesions：edema, hyperemia, hypersection of mucus, erosion