Mallory-Weiss tears

• what is it? 
• what is it most associated with?

• Longitudinal tears in the esophagus near the gastroesophageal junction 
• severe retching or vomiting secondary to acute alcohol intoxication

• Linear, longitudinally oriented 
• range in length from millimeters to several centimeters

• cytotoxic chemotherapy
• radiation therapy
• graft-versus-host disease (GVHD)

• HSV
• CMV
• fungal infections (Candida)

• Reflux of gastric contents into the lower esophagus
• Causes: Esophagitis
• Found in:
  • adults over 40 
  • infants and children

• sliding hiatal hernia
• alcohol
• cigarette smoking
• obesity
• CNS depressants
• pregnancy
• delayed gastic emptying
• increased gastric volume

• leukoplakia
• ulcers
•  fibrosis
• esophageal stricture which lead to dysphagia.

• secondary to or a complication of chronic GERD
• represents replacement of squamous epithelium with intestinal metaplasia containing Goblet cells

• Due to: 
  • Change of squamous cell to intestinal goblet cells in lower third of esophagus

• Ulcerations

• Fibrosis

• Strictures

• Dysphagia

• Leukoplakia

• Metaplasia

• Malignancy

• transient mucosal inflammatory process
• can be be asymptomatic 
• can cause variable degrees of 
  • epigastric pain
  • nausea
  • vomiting

• aspirin
• NSAIDs
• alcohol
• cigarettes
• H. pylori infection

• neutrophils  above the basement membrane 
• With more severe, erosions and hemorrhage 

• loss of the superficial epithelium
• Hemorrhage may occur and cause dark punctae or spots like coffee grains.

Bleeding  

• Most frequent complication ; May be life-threatening; May be the first indication of an ulcer 

Perforation 

• Accounts for two thirds of ulcer deaths ; Is rarely first indication of an ulcer 

Obstruction 

• Mostly in chronic ulcers ; Secondary to edema or scarring; associated with pyloric channel ulcers ;May occur with duodenal ulcers 
• Causes incapacitating, crampy abdominal pain; rarely cause total obstruction and intractable vomiting

• Cause: H.pylori inf (90%) or Autoimmune gastritis (10%)

• H. pylori organisms are present
  • duodenal ulcers *most
  • gastric ulcers 
  • chronic gastritis (antrum- 90% of cases)

• characterized by 
  • (1) antibodies to parietal cells + loss of intrinsic factor +  achlorhydria 
  • (2) vitamin B 12 def - pernicious anemia. May cause atrophic glossitis and peripheral neuropathy

• associated with H. pylori-induced chronic gastritis + NSAIDs use

• Causes: nonbacterial infectious gastroenteritis
• Get it by:
  • Contaminated food or water, schools, hospitals, nursing wards, and cruise ships. 
• Clinical
  • Nausea, vomiting, watery diarrhea, and abdominal pain.

• most common cause of severe childhood diarrhea and diarrheal mortality world wide. 
• Children between 6 and 24 months of age are most vulnerable
• Outbreaks in hospitals and daycare centers are common
• successfully infects and destroys mature enterocytes in the small intestine, and the villus surface is repopulated by immature, secretory cells. 
• Loss of absorptive function and net secretion of water and electrolytes.

• Transmural inflammation on any part of GI
• due to-not clear: bacterial, dietary factors, stress

• Inflammation limited to the mucosa of colon and the superficial submucosa

• defects in host interactions with intestinal microbiota
• intestinal epithelial cell dysfunction
• aberrant mucosal immune responses

• Embolism or thrombosis 
• hernia intussusception
• volvulus

• Marked dilation or varicosity of hemorrhoidal venous plexus
• very common

• Usually associated with liver cirrhosis
• bleeding from the varices is a common cause of death with cirrhosis of the liver.

• Squamous cell carcinoma

• In Japan, Chile, Costa Rica, and Eastern Europe the incidence = 20x higher. US rates dropped.

• signet-ring cell morphology
• desmoplastic reaction 
• linitis plastica

• A polyp = descriptive term for elevation of the intestinal surface
• Can be pedunculated/ sessile
• Can be neoplastic or non-neoplastic

• benign tumor-like nodule 
• It is an overgrowth of mature cells + tissues normally present in the affected part, but with disorganization and with one element predom
• occur 
  • sporadically 
  • genetically determined
  • acquired syndromes

• focal malformations of the mucosal epithelium + lamina propria
• Clinical
  • sporadic or in clinical syndromes
  • Typically pedunculated
  • Most in the rectum
  • Most with rectal bleeding
  • Dysplasia occurs in a small proportion of juvenile polyps

• Auto dominant syndrome  
• multiple GI hamar polyps + mucocutaneous pigmentation

• Epithelial proliferations that represent a "piling up" of goblet cells and absorptive cells
• found in:
  • People in their 60s, 70s
•  Lesions = without malignant potential

• Tubular, Tubulovillous adenoma, Villous adenoma
  • precursors to colorectal adenocarcinomas

• intra-epithelial neoplasms 
• Range: small, pedun polyps to large, sessile 

• distributed equally over the entire length of the colon
• Colon cancer can metastasize to the lymph node, lung, liver, and brain
• Elevated carcinoembryonic antigen (CEA) is seen in about 25% of patients.

• Size 
  • ie, while cancer is extremely rare in adenomas less than 1 cm in diameter, some studies suggest that nearly 40 % of lesions larger than 4 cm in diameter contain foci for cancer
• high-grade dysplasia is a risk factor for progression to cancer.

a protein that contributes to epithelial intercellular adhesion, seems to be a key step in the development of diffuse gastric cancer.

• Cecal and other right-sided colon cancers 
• clinical attention by appearance of 
  • fatigue and weakness due to iron deficiency anemia
• It is a clinical maxim that the underlying cause of iron deficiency anemia in an older man or postmenopausal woman is GI cancer until proven otherwise.
• Left-sided colorectal adenocarcinomas may produce 
• occult bleeding, changes in bowel habits, or cramping left lower quadrant discomfort

• presence of epithelial dysplasia
• the majority don't  progress to adenocarcinoma
• Clinical
  • silent (except! large polyps that produce occult bleeding and anemia)
• Test: 
  • positive guaiac test - blood in stool
• Location
  • 50% found in therectosigmoid region
  • 50% evenly distributed throughout colon

• 2/3 of all benign adenomas
• Appearance:
  • < 2cm in diameter 
  • pedunculated
  • Large tumors show a range of dysplasia

• Found: predominantly in the rectosigmoid colon 
• Appearance
  • large (60% > 2cm)
  • sessile
  • elevated lesions
  • 1/3 contain foci of carcinoma 
  • higher potential for malignant than tubular adenomas

• Inflammatory polyp 
• Most common site is the rectal mucosa
• may be a reaction to local irritation

• Inflammatory polyp
• Associated with ulcerative colitis 
• consists of granulation tissue; residual and regenerating mucosa

• aphthous ulcer 
• transmural inflammation 
• leathery edema 
• nodular lymphoid aggregates 
• non-caseating granulomas in submucosa “skip lesions” 
• cobblestone appearance 
• abdominal pain, diarrhea, fever, malabsorption 
• if in small intestine, bleeding intestinal obstruction, fistulae 
• creeping fat; mesenteric fat extends around the serosal surface

• in the USA - low incidence, more in males, Caspian sea area, Iran, Central Asia, Mongolia No. China-esophageal cancer belt with incidence 30-70 x greater
• distribution suggests environmental factors 

Clinical

• alcohol, cigarette smoking, nitrosamines, 
• Plummer Vinson syndrome, chronic esophagitis, achalasia, esophageal stricture
• dysphagia, cachexia, anorexia, poor survival