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D.HAMMOUDI.MD
GI PATHOLOGY PICS
SPLENOMEGALY PORTAL htn
Inguinal hernia
MOUTH AND ESOPHAGUSPATHOLOGY
ESOPHAGUS
• Congenital Anomalies
• Achalasia
• Hiatal Hernia
• Diverticula
• Laceration
• Varices
• Reflux
• Barretts
• Esophagitis
• Neoplasm: Benign, Sq. Cell Ca., Adenoca.
Achalasia and cardiospasmAchalasia (of cardia)Aperistalsis of esophagusMegaesophaguscongenital cardiospasm
Esophagitis:•chemical•peptic•postoperative•regurgitant
Ulcer of esophagusfungalpepticUlcer of esophagus due to ingestion of:aspirinchemicalsmedicinesE code to identify cause, if induced by chemical or drug
Rupture of esophagus:traumatic perforation of esophagus
•regurgitantE code to identify cause, if induced by chemicaltuberculous esophagitis
Stricture and stenosis of esophagusCompression of esophagusObstruction of esophaguscongenital stricture of esophagus
Dyskinesia of esophagusCorkscrew esophagusCurling esophagusEsophagospasmSpasm of esophaguscardiospasm
Diverticulum of esophagus, acquiredDiverticulum, acquired:
epiphrenicpharyngoesophagealpulsionsubdiaphragmatictraction
Zenker's (hypopharyngeal)Esophageal pouch, acquiredEsophagocele, acquiredcongenital diverticulum of esophagus
Gastroesophageal laceration-hemorrhage syndromeMallory-Weiss syndrome
Paterson-Kelly syndrome
BALLOON DILATATION
Weaken the LES by tearing its muscle fibers.
MODIFIED HELLER APPROACH
There are THREE major kinds of hiatus hernia:
The most common (95%) is the sliding hiatus hernia,where the gastroesophageal junction moves above thediaphragm together with some of the stomach.
The second kind is rolling (or paraesophageal) hiatushernia, when a part of the stomach herniates throughhernia, when a part of the stomach herniates throughthe esophageal hiatus and lies beside the esophagus,without movement of the gastroesophageal junction. Itaccounts for the remaining 5% of hiatus hernias.
A third kind, a combination of the first and second kinds
PARAESOPHAGEAL HIATALHERNIA
The fundus and possibly portions of the stomach’sgreater curvature, rolls through the esophagealhiatus and into the thorax beside the esophagus
In a rolling or Paraesophageal hiatal hernia theherniated portion of the stomach may be smallor quite large.Reflux is rarely a concern with this type ofReflux is rarely a concern with this type ofhernia but the risks of volvulus (boweltwisting), obstruction, and strangulationare high.The development of iron deficiency anemia iscommon because of slow bleeding secondaryto venous obstruction causing the gastricmucosa to become engorged and ooze
DIVERTICULA
• ZENKER (HIGH)
• TRACTION (MID)
• EPIPHRENIC (LOW)
• TRUE vs. FALSE?• TRUE vs. FALSE?
Epiphrenic diverticulum: due to dysfunction of the lower esophageal sphincter, as in achalasia
Zenker's diverticulum, also pharyngoesophagealdiverticulum, also pharyngeal pouch,
is a diverticulum of the mucosa of the pharynx, just abovethe cricopharyngeal muscle(i.e. above the upper sphincter ofthe esophagus).
It is a false diverticulum (not involving all layers of theesophageal wall).
treated by neck Surgery to resect the diverticulum and incisethe cricopharyngeus smuscle
the currently preferred treatment is endoscopic stapling (i.e.closing off the diverticulum via a stapler inserted through atube in the mouth). This may be performed through afibreoptic endoscope. endoscopic laser, which recent evidencesuggests is less effective than stapling
DIVERTICULUMPLURAL =
DIVERTICULADIVERTICULA
A large hiatus hernia onX-ray marked by openX-ray marked by openarrows in contrast to theheart borders marked byclosed arrows
A COMPARISON OF THE NORMAL STOMACH, SLIDINGHIATAL HERNIA AND ROLLING HIATAL HERNIA