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Upper Gastrointestinal PathologyKristine Krafts, M.D.

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GI Pathology Outline

• Esophagus• Stomach• Intestine• Liver• Gallbladder• Pancreas

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GI Pathology Outline

• Esophagus• Hiatal hernia• Mallory-Weiss syndrome• Barrett esophagus• Carcinoma

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Normal esophageal-gastric junction

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• Dilated portion of stomach protrudes above diaphragm

• Common! Usually asymptomatic.

• Heartburn, reflux esophagitis

• Danger: ulceration, bleeding

Hiatal Hernia

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Sliding (L) and rolling (R) hiatal hernias

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• GE junction tears

• Severe vomiting (chronic alcoholics)

• Symptoms: bleeding, pain, infection

• Treatment: cauterization

• Prognosis: usually heals; sometimes fatal

Mallory-Weiss Syndrome

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Mallory-Weiss tears

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Mallory-Weiss tears

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• Replacement of squamous epithelium by columnar epithelium with goblet cells

• Complication of long-standing reflux esophagitis

• Danger: 30-100x risk of adenocarcinoma

• Treatment: screen for high-grade dysplasia

Barrett Esophagus

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Normal esophagus (L) and Barrett esophagus (R)

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Barrett esophagus

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Barrett esophagus

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Adenocarcinoma

• Commonest type in US

• Risk factor: Barrett esophagus

• Distal 1/3 of esophagus

• Symptoms: insidious onset; late obstruction

Squamous cell carcinoma

• Commonest type worldwide

• Risk factors: esophagitis, smoking, alcohol, genetics

• Middle 1/3 of esophagus

• Symptoms: insidious onset; late obstruction

Esophageal Carcinoma

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Adenocarcinoma of esophagus

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Squamous cell carcinoma of esophagus

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GI Pathology Outline

• Esophagus• Stomach• Gastritis• Ulcers• Carcinoma

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• Mucosal inflammation

• Asymptomatic, or epigastric pain

• Causes: H. pylori, autoimmune, NSAIDs

• Danger: intestinal metaplasia

Gastritis

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Gastritis

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Chronic gastritis

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Helicobacter pylori organisms

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• Erosion of mucosa into submucosa

• Causes: H. pylori, NSAIDs

• Symptoms: epigastric pain

• Danger: bleeding, perforation

Ulcer

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Ulcer

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Intestinal type

• Arises in intestinal metaplasia

• Risk factors: chronic gastritis, bad diet

• Glandular morphology

• Generally asymptomatic

Diffuse type

• Arises from gastric glands

• Risk factors undefined

• Signet ring morphology

• Generally asymptomatic

Gastric Carcinoma

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Intestinal-type gastric carcinoma: glands

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Diffuse gastric carcinoma: signet ring cells

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Signet ring cell

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Gastric carcinoma presenting as mass

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Gastric carcinoma presenting as ulcer

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Gastric carcinoma presenting as linitis plastica

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