Chapter 15 GI Diseases (Excluding Oral Cavity) ESOPHAGUS A. Hiatal Hernia: 2 types: Figure 15-6 1. Sliding 95% of hernias.

Axial orientation

STOMACH A. Gastritis: Very common with aging. Usually chronic but may be acute.

Chronic gastritis .. over 50% of population over age 50 have or have had gastritis, Most are Asymptomatic. Most likely cause is Helicobacter pylori. Mucosal atrophy and metaplastic transformation into intestinal epithelium. Predisposes to peptic ulcers and gastric carcinoma. Acute gastritis .. related to NSAIDs, alcohol, smoking, antineoplastic drugs, infections and stress, shock, toxins, trauma

2. Rolling/paraesophageal non-axial,

B. Gastric Ulcers: Figure 15-15 B. Varices: Dilation of distal esophageal vessels seen in alcoholics and liver cirrhosis. Causes massive hemorrhage if they rupture. Chronic Peptic ulcers---acid and pepsin and H. pylori common etiology. Only 10-20% of persons with Hp develop ulcers. 98% occur near the duodenum. Clinical symptoms include post meal pain, weight loss, bloating, nausia C. Esophagitis: Most common cause is Gastroentestinal Reflux Disease (GERD). Highest in Iran and China. ~1% of US population. Excess gastric secretions. Mostly in adults over 40. Most significant outcome is Barrett Esophagitis ~10% of GERD have Barrett. Males 4x more than females. Barretts esophagus has30-40X increase in risk of developing adenocarcinoma. Acute ulcers----trauma, stress, drugs (NSAIDs, steroids, etc.)

C. Gastric Tumors 90-95% gastric tumors are adenocarcinomas. Prognosis poor (~20% 5 year) Cardia uncommon (~25%). 40% lessor curvature and 12% greater. Two types: a. intestinal---intestinal metaplasia, associated with gastritis Table 15-5. Over age 50, males more than females.

D. Esophogeal Cancer: Most (95%) squamous cell carcinoma. Adenocarcinomas seen ONLY with Barrett esophagitis. Etiology: long standing esophagitis, alcohol, smoking, Plummer-Vinson syndrome. Poor prognosis.

b. diffuse . not associated with gastritis. Younger than intestinal type, male=female. worse prognosis.

SMALL & LARGE INTESTINE: Inflammatory Disaease: Two most important types are Crohns disease & ulcerative colitis. See Table 15-10, Fig 15-32 A. Crohn disease: Affects the entire GI mucosal surface. Can affect the entire GI tract but most commonly the small and large intestines.Epidemiology ...... 3-5/100K people, 20-40 most common ages. Females > males.Whites > non-whites. 40-60% have non-caseating granulomas. 30% small bowel, 30% large bowel, 40% both. Creates "SKIP" lesions ("cobblestone" effect). About 50% have melena.

TUMORS :

A. Polyps: Non-neoplastic polyps represent about 90% of all polyps. Majority in people > 60 yrs. old. Most common type is Hyperplastic polyps. Generally no malignant potential. B. Adenomas These are benign neoplasms. Uncommon in small bowel. ~25% before age 40 but close to 50% over 60. Males = females. 4X increase in cancer risk.

B. Ulcerative colitis: Affects colon only. Usually starts in rectum and progresses proximal. No skip lesions. Has a greater cancer risk than Crohn disease. There are 2 syndromes to know where colonic polyps are inherited: Know these definitions: 1. Diverticlosis: 2. Peutz-Jeghers syndrome: 2. Bowel Obstructions: Figure 15-26 a. Hernias COLORECTAL CANCER: b. adhesions 98% adeno Ca. 15%of all cancer deaths. Most over age 60 (only 20% below 50. Slight male predominance. Iron deficiency anemia in males over 60 is considered colon cancer until proven otherwise! Most probably arise in preexisting adenomas. 1. Gardners syndrome:

c. intussusception

d. volvulus