Esophagus

Connects pharynx-stomach

skeletal and smooth m.

upper and lower (contracted) sphincter

voluntary

trigeminal (V), glossopharyngeal (IX), vagus (X),

hypoglossal (XII)

involuntary

peristalsis by brainstem through vagu

difficulty swallowing

choking, coughing, sensation of food

stickin in throat

• cranial n defects
• cancer
• structure, scarring, achalasia
• autoimmunity
• esophageal diverticula

aka diaphragmatic hernia

protrusion of stomach through hiatus

heartburn, belching, or chest pain

Gastroesophageal Reflux Disease

(GERD)

movement of stomach contents into esophagus

d/t increased relaxation of lower sphincter

inflammation and swelling of esophagus

caused by:

GERD,  infection, radiation, erosion effects of medications

change in epithelium, recognized by endoscopy

confirmed intestinal metaplasia by biopsy

d/t long term acid exposure

Pre malignant condition!

squamous cell

adenocarcinoma

most common esophageal cancer

squamous cell metaplasia 2° to GERD

dysphagia, severe weight loss, pain in throat/chest area, hoarsness

inflammation and erythema of gastric mucosa

alcohol, bacteria, increased acid secretion

heartburn, nausea, vomiting (blood)

chronic gastritis

non-erosive inflammatory changes to mucosa w/ glandular atrophy

h. pylori

autoimmune

chemical

inc. risk of gastric and duodenal ulceration

urease positive

tx: PPI, antibiotics, and bismuth

serum antiparietal and antiIF antibodies-->decr.

B12 and perc. anemia

T lymph. contribute to destruction and atrophy

peptic ulcer disease

ulceration of stomach and duod. d/t secretions

men>>women (55-70 yo)

char: coffe ground hematemisis, pain, anemia

h. pylori and NSAID use

Peptic ulcer disease

gastrin producing tumors in pancrease and duod.

char: incr. gastrin = incr. acid

Resistant to tx.

Most common intestinal obst. in infants (1-2 wks)

hypertrophy and hyperplasia of m causing obstruction

projectile vomitting

reduced contraction and emptying d/t decr. n. stimulation

neuropathic (diabetes)

neurologic or brain disorders (parkinson's)

autoimmune (scleroderma)

unknown

scars and fibrous tissue (ulcers)

high incidence and high death rate, but not in US

Adenocarcinoma most common!!

variable degree, 10-20% americans

Diagnosis of exclusion (signs/symptoms)

char:  altered motility

causes:  seritonin, stress

crohn's dis, and ulcerative colitis (COLON, but also other tissues)

Recurrent granulatomas disease of ENTIRE GI 

char: cobblestone lesions (SKIP LESIONS)

women>men  (teens-30's)

symp:  pain, rectal bleeding, weight loss, skin lesions, fever

char: pinpoint mucosal hemorrhage, crypt abcesses

inc. risk of colon cancer

women>>men (15 25, 55-65)

AKA gastroenteritis

infectious disease of the bowel caused by virus, bacteria, and protozoa

contracted via oral-fecal rt.

results in loss of H2O, malabsorption, osmotic diarrhea, bowel hyperactivity

causes:  rotavirus, adenoviruses, and caliciviruses

1 week, supportive therapy

less common,

result in loss of H2O, malabsorption, diarrhea, sepsis, perforation

mucosal layer of colon herniates through outer musc. layer (sigmoid colon)

Common: 5-10% > 45, 80% > 85

char:  inflamm in diverticuli--> perforation

Common 5-30 yo, or any age

char:  inflam. necrosis, peforation

abrupt onset of pain (periumbilical-> RUQ)

use history and CT

inflam. of peritoneum related to infection or other irritation

necrotic tissue, toxin, trauma

sim. symptoms as appendicitis

Large Volume Diarrhea

(LVDia)

2 types: secretory, osmotic

may be combined

Secretory LVDia

bacterial toxins

malabsorptive

unabsorbed salts

decreased transit time

smaller vol, higher frequency and urgency, tenesmus, awakening at night

related to IBD

result in strangulation -> necrosis

causes:  post-op adhesion

hernia entrapment

twisting of bowel

bowel section into lumen

bezoar

neurologic/muscular impairment of peristalsis

AKA ileus

frequent after surgery, inflam, toxins, irritants, vasc. insuf.

Rare in sm. int, common in colon and rectum

types:  adenomatous polyp

malignant adenocarcinoma

adenomatous polyps

common benign lesions,  raised or on stalk

precursor to malignant tumor

2nd most common cause of cancer death

incr. w/ age (>50), IBD, and genes

char: rectal blood, change in bowel habits

T4 (CD4)

B lymphocytes

Macrophages

ELISA confirmed by western blot

antibodies w/i 6 weeks

ampicillin-->rash

also, no steriods!

mumps--> elevated amylase

also see orchitis

bronchodilators and ribavirin

palivizumab--> prophylactically

oct/nov

> 50 yoa