GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

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GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

Pathology

Peritoneum and peritoneal cavity

Peritonitis

Pneumoperitoneum

Upper gastrointestinal tract disorders

Cleft lip and palate

Congenital diaphragmatic hernia

Esophageal web

Tracheoesophageal fistula

Pyloric stenosis

Sialadenitis

Parotitis

Oral candidiasis

Ludwig angina

Aphthous ulcers

Temporomandibular joint dysfunction

Dental abscess

Gingivitis and periodontitis

Dental caries disease

Oral cancer

Warthin tumor

Barrett esophagus

Achalasia

Plummer-Vinson syndrome

Mallory-Weiss syndrome

Boerhaave syndrome

Gastroesophageal reflux disease (GERD)

Zenker diverticulum

Diffuse esophageal spasm

Esophageal cancer

Eosinophilic esophagitis (NORD)

Gastritis

Gastric dumping syndrome

Peptic ulcer

Gastroparesis

Cyclic vomiting syndrome

Gastroenteritis

Gastric cancer

Lower gastrointestinal tract disorders

Gastroschisis

Imperforate anus

Omphalocele

Meckel diverticulum

Intestinal atresia

Hirschsprung disease

Intestinal malrotation

Necrotizing enterocolitis

Intussusception

Tropical sprue

Small bowel bacterial overgrowth syndrome

Celiac disease

Short bowel syndrome (NORD)

Lactose intolerance

Whipple's disease

Protein losing enteropathy

Microscopic colitis

Crohn disease

Ulcerative colitis

Bowel obstruction

Intestinal adhesions

Volvulus

Gallstone ileus

Abdominal hernias

Femoral hernia

Inguinal hernia

Small bowel ischemia and infarction

Ischemic colitis

Familial adenomatous polyposis

Peutz-Jeghers syndrome

Gardner syndrome

Juvenile polyposis syndrome

Colorectal polyps

Colorectal cancer

Carcinoid syndrome

Irritable bowel syndrome

Gastroenteritis

Diverticulosis and diverticulitis

Appendicitis

Anal fissure

Anal fistula

Hemorrhoid

Rectal prolapse

Liver, gallbladder and pancreas disorders

Crigler-Najjar syndrome

Biliary atresia

Gilbert's syndrome

Dubin-Johnson syndrome

Rotor syndrome

Jaundice

Cirrhosis

Portal hypertension

Hepatic encephalopathy

Hemochromatosis

Wilson disease

Budd-Chiari syndrome

Non-alcoholic fatty liver disease

Cholestatic liver disease

Hepatocellular adenoma

Autoimmune hepatitis

Alcohol-induced liver disease

Alpha 1-antitrypsin deficiency

Primary biliary cirrhosis

Primary sclerosing cholangitis

Hepatitis

Neonatal hepatitis

Reye syndrome

Benign liver tumors

Hepatocellular carcinoma

Gallstones

Biliary colic

Acute cholecystitis

Ascending cholangitis

Chronic cholecystitis

Gallstone ileus

Gallbladder cancer

Cholangiocarcinoma

Acute pancreatitis

Pancreatic pseudocyst

Chronic pancreatitis

Pancreatic cancer

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Gastrointestinal system pathology review

Congenital gastrointestinal disorders: Pathology review

Esophageal disorders: Pathology review

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

Inflammatory bowel disease: Pathology review

Malabsorption syndromes: Pathology review

Diverticular disease: Pathology review

Appendicitis: Pathology review

Gastrointestinal bleeding: Pathology review

Colorectal polyps and cancer: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review

Pancreatitis: Pathology review

Gallbladder disorders: Pathology review

Jaundice: Pathology review

Viral hepatitis: Pathology review

Cirrhosis: Pathology review

Assessments

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

USMLE® Step 1 questions

0 / 18 complete

Questions

USMLE® Step 1 style questions USMLE

of complete

A 62-year-old man presents to the emergency department with severe abdominal pain and vomiting this morning. He states he has had abdominal pain for the past several weeks, with the pain acutely worsening today with radiation to the left shoulder. He reports the vomit was dark brown and had a granular consistency. Past medical history is significant for hypertension and hypercholesterolemia. He was also admitted for alcoholic pancreatitis approximately six weeks ago.The patient has smoked 1 pack of cigarettes daily for 30 years. He reports drinking 3-4 beers daily. Temperature is 37°C (98.6 °F), pulse is 111/min, respirations are 24/min, and blood pressure is 92/62 mmHg. Physical examination shows a pale man in acute distress. Abdominal examination is notable for diffuse tenderness to palpation, with rebound and rigidity. Laboratory results are shown below:

 
Laboratory value  Result
 CBC, Serum 
 Hemoglobin  10.1  g/dL 
 Hematocrit  30% 
 Leukocyte count  14,000 /mm3 
 Platelet count  160,000/mm3 
 Serum
               Sodium  132 mEq/L 
           Potassium  4.2 mEq/L 
              Chloride  95 mEq/L 
                 BUN                    67 mg/dL  
             Creatinine  2.6 mg/dL 
              Albumin  3.7  g/dL 
                 AST  60 U/L 
                 ALT  30 U/L 
    Alkaline Phosphatase  110 U/L 
           Bilirubin, total  .7 mg/dL 
              Lipase  100 U/L 
Abdominal imaging is most likely to reveal which of the following findings?    

Transcript

Content Reviewers

Yifan Xiao, MD

Contributors

David G. Walker

Filip Vasiljević, MD

Sam Gillespie, BSc

Ursula Florjanczyk, MScBMC

A 61-year-old man, named Shawn, comes to the emergency department because of substernal chest pain and heartburn.

He mentions that his symptoms worsen typically after coffee, heavy meals or during times of stress.

He also feels the pain at night when he is lying in bed and has previously been woken from sleep by discomfort.

He has not noticed any dyspnea, diaphoresis, or palpitations but is currently experiencing some nausea and a sour taste in his mouth. Shawn also denies a history of previous cardiovascular conditions. His ECG is normal.

Shawn has gastroesophageal reflux disease, or GERD. GERD is a condition caused by a transient lower esophageal sphincter relaxation, which enables stomach contents and acid to re-enter esophagus and damage esophageal mucosa.

As a result, people with GERD present with symptoms such as retrosternal chest pain, heartburn, regurgitation, and dysphagia.

It’s important to note that GERD symptoms tend to worsen after eating, when lying down, or bending over.

Now, if stomach acid gets to the throat, it can cause laryngopharyngeal reflux, which has a different set of symptoms such as acidic taste in the mouth, sore throat, chronic cough, and hoarseness.

In the mouth, gastric acid can even damage tooth enamel. Finally, if inhaled, stomach acid can cause pneumonia and asthma.

GERD is commonly associated with conditions such as decreased esophageal motility, gastric outlet obstruction, and hiatal hernia.

Risk factors for GERD include lifestyle habits such as caffeine, alcohol, and smoking; use of some medications, such as antihistamines and calcium channel blockers; but also, obesity; pregnancy; and Zollinger-Ellison syndrome.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Gastroesophageal Reflux Disease" New England Journal of Medicine (2008)
  4. "Gastroesophageal Reflux Disease" New England Journal of Medicine (2008)
  5. "Barrett's oesophagus" The Lancet (2009)
  6. "Barrett's oesophagus and oesophageal adenocarcinoma: time for a new synthesis" Nature Reviews Cancer (2010)
  7. "Barrett's oesophagus: from metaplasia to dysplasia and cancer" Gut (2005)
  8. "Inflammation, atrophy, and gastric cancer" Journal of Clinical Investigation (2007)
  9. "Ménétrier disease and gastrointestinal stromal tumors: hyperproliferative disorders of the stomach" Journal of Clinical Investigation (2007)
  10. "MANAGEMENT OF PATIENTS WITH ZOLLINGER-ELLISON SYNDROME" Annual Review of Medicine (1995)
  11. "Guide to the Use of Proton Pump Inhibitors in Adult Patients" Drugs (2008)
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