Chapter Summary

Congenital and mechanical disorders of the esophagus include tracheoesophageal fistula (associated with esophageal atresia and aspiration), esophageal webs (associated wrth iron deficiency anemia and increased risk of ancer), and achalasia (associated with increased risk of cancer). Achalasia is due to failure of the lower esophageal sphincter to relax with swallowing.

Esophageal bleeding can be due to laceration at the gastroesophageal junction produced by severe vomiting (Mallory-Weiss syndrome) or esophageal varices that develop secondary to portal hypertension.

Caslroesophageal reflux disease is esophageal irritation and inflammation due to reflux of gastric secretions into the esophagus. Barrett's esophagus is metaplasia of the squamous esophageal mucosa to a more protective columnar type because of chronic exposure to gastric secretions.

Esophageal carcinoma may be either squamous-cell carcinoma or adenocarcinoma. Squamous-cell carcinoma is the most common form in the world and is associated with heavy smoking, heavy alcohol use, achalasia, and Plummer-Vinson syndrome. Adenocarcinoma involves the distal esophagus and usually arises in areas of Barrett's esophagus.

Pyloric stenosis is a congenital stenosis of the pylorus due to marked muscular hypertrophy of the pyloric sphincter, resulting in gastric outlet obstruction, Congenital diaphragmatic hernia is a congenital defect in the diaphragm, resulting in herniation of the abdominal organs into the thoracic cavity.

Menetrier disease is a form of hypertrophic gastropathy with enlarged rugal folds that an produce decreased acid production, a protein-losing enteropathy, and increased risk of cancer. Zollinger-Ellison syndrome is a form of hypertrophic gastropathy with enlarged rugal folds that occurs secondary to gastrin stimulation by a pancreatic gastrinoma.

j Acute hemorrhagic gastritis is acute inflammation, erosion, and hemorrhage of the gastric mucosa due to a breakdown of the mucosal barrier and acid-induced injury. Gastric stress ulcers are multiple, j small, round, superficial ulcers of the stomach and duodenum.

Chronic gastritis is a chronic inflammation of the gastric mucosa resulting in eventual atrophy. Chronic gastritis is subdivided into a fundic type, which is related to autoantibodies to parietal cells and/or intrinsic factor, and an antral type, which is related to Helicobacter pylori gastritis.

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