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STOMACH
Amr Mahmoud
Outlines
Learn basics of 3 tumours
A.
B.
Oral cancer is associated with people who smoke and drink alcohol.
Dentists are campaigning for early detection
2 cancer with dismal prognosis: oesophageal cancer and gastric cancer
Oral Cavity
Congenital Disorders: Cleft Lip/Palate
Developmental disorder
Angular Cheilitis
Candida Albicans
White plaques
Oral Cancer
Epidemiology:
3% malignancies
50 80 males
50% cases attributed smoking, drinking
Types:
90% Squamous carcinoma
OTHERS:
Nasopharyngeal carcinoma: China, associated with EBV
Leukoplakia
Erythroplakia
High risk
Chronic irritation
<5% malignant potential
Particularly on atrophic epithelium
on floor of mouth, under-surface
and lateral margins of tongue
Prognosis:
Good: mouth and anterior 2/3 of tongue
Mucocele
Usually CaCo3/CaPo4
Clinical picture:
Types:
Retention: (due to obstruction)
Histology:
Cystic space lined by granulation tissue
Sjogren Syndrome
Middle age F
Keratoconjuctivitis Sicca (dry eyes) or Xerostomia (dry mouth)
Epithelial
Histology:
Encapsulated
Epithelial elements: epithelial/myoepithelial
Stromal element: myxoid/ cartilaginous
Complications
Recurrence due to
Seeding of tumour
Incomplete excision
Cartilage
Warthins Tumour
Incidence:
5% of all salivary tumours; 2nd
commonest
Clinical appearance:
Painless mass
Benign
Histology:
Papillary cystic structure
Epithelial element double layer
epithelium/oesinophilic cytoplasm
Lymphoid stroma/germinal centres
Histology:
Cyst like spaces /cribriform pattern
Rich in glucosamine
Histology:
Stratified squamous epithelium
Transition to columnar epithelium at the oesophago-gastric junction (OGJ)
Congenital Disorders
Atresia
Diverticula
Several types:
Complications:
Clinically:
Aspiration
Treatment:
Urgent surgical intervention
Regurgitation
Aspiration pneumonia
Miscellaneous Conditions
Oesophageal Haemorrhage
Causes:
Reflux Oesophgitis
Varices: distended veins of portosystemic anastomosis most
commonly due to cirrhosis
Ulcerating cancer
Foreign body
Mallory Weiss Syndrome / Boerhaave
syndrome due to rupture of
oesophageal mucosa due to repeated
vomiting or trauma
Achalasia
Failure of relaxation of lower
oesophageal sphincter - dilatation of
oesophagus
Also caused by Chagas disease
Histology:
Reflux oesophagitis
Heart Burn
Prevalence:
Very common: up to 36% of western population! but not all present with symptoms!
Definition:
Chronic inflammation due to regurgitation of gastric contents (chronic oesophagitis)
Causes:
Life style: smoking, alcohol, caffeine
Increased intra-abdominal pressure: pregnancy
Defect in lower oesophageal sphincter
Hiatus hernia
Protrusion of stomach into thorax
Very common
a) Sliding 90%
b) Para-oesophageal 10%
Complications
Mucosal ulceration
Pain
Fe def. anaemia
Fibrosis- stricture
Barretts Oesophagus
Diagnosis:
Normal
Barretts
Oesophagus
Oesophageal Cancer
Morphology:
Fungating/polypoid
Ulcerating
Diffusely infiltrating/circumferential
Clinical Presentation:
Dysphagia
Odynophagia (painful swallowing)
Weight loss
Prognosis:
Adenocarcinoma
Lower oesphagus
Barretts oesophagus
Middle oesophagus
Aetiology:
Alcohol/Tobacco synergy
against acid
Inflammatory Disorders
Indigestion
Epigastric pain: suggestive of
ulcer
Acute gastritis
Acute inflammation
Causes:
Histology:
Depend on severity: acute inflammation, ulcerations and erosions
Heals by resolution and re-epithelialization
Can cause massive haemorrhage
Chronic Gastritis
Autoimmune Gastritis
Auto antibodies against parietal cells and intrinsic
factor
Associated with other autoimmune diseases such
as Hashimoto of thyroid
Usually body
Characteristics:
Diagnosis:
Intestinal metaplasia
Complications:
Pernicious anaemia
Aetiology:
Aetiology:
Acute gastritis
Morphology:
Usually less 20mm
Clear edge vs. malignant ulcer
Histology:
Necrotic base/granulation tissue heals
by fibrosis
Complications:
Perforation, stenosis
Haemorrhage
Non-epithelial/mesenchymal
Malignant Tumours
Majority Adenocarcinoma
Lymphoma: less common
Incidence:
Age 50-70, M: F = 3: 2
Geographical variation high incidence Japan, China & Columbia
Incidence declining elsewhere
Clinical presentation:
Gastric Adenocarcinoma
Aetiology:
Familial
Diet:
Nitrates and nitrosamines in salty and smoked food and smoking
Fruits, vegetable & antioxidants: protective
Chronic inflammation:
EBV infection
Gastric adenoma (associated with dysplasia)
70%
30%
H pylori
Spread:
Other Tumours
Lymphomas
New entity
H-pylori related
Usually good prognosis; treatable
with eradication of H pylori
Transition to high grade lymphoma is
rare