Barrett’s Esophagus
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Barrett’s Esophagus
Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine. This change is considered to be a premalignant condition because it is associated with a high incidence of further transition to esophageal adenocarcinoma, an often-deadly cancer. The main cause of Barrett's esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis. Barrett's esophagus is diagnosed by endoscopy: observing the characteristic appearance of this condition by direct inspection of the lower esophagus; followed by microscopic examination of tissue from the affected area obtained from biopsy. The cells of Barrett's esophagus are classified into four categories: nondysplastic, low-grade dysplasia, high-grade dysplasia, and fr ...
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Intestinal Metaplasia
Intestinal metaplasia is the transformation (metaplasia) of epithelium (usually of the stomach or the esophagus) into a type of epithelium resembling that found in the intestine. In the esophagus, this is called Barrett's esophagus. Chronic inflammation caused by ''H. pylori'' infection in the stomach and GERD in the esophagus are seen as the primary instigators of metaplasia and subsequent adenocarcinoma formation. Initially, the transformed epithelium resembles the small intestine lining; in the later stages it resembles the lining of the colon. It is characterized by the appearance of goblet cells and expression of intestinal cell markers such as the transcription factor, CDX2. Risk factors Although it was originally reported that people of East Asian ethnicity with gastric intestinal metaplasia are at increased risk of stomach cancer Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gas ...
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Carcinoma
Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis. Carcinomas occur when the DNA of a cell is damaged or altered and the cell begins to grow uncontrollably and become malignant. It is from the el, καρκίνωμα, translit=karkinoma, lit=sore, ulcer, cancer (itself derived from meaning ''crab''). Classification As of 2004, no simple and comprehensive classification system has been devised and accepted within the scientific community. Traditionally, however, malignancies have generally been classified into various types using a combination of criteria, including: The cell type from which they start; specifically: * Epithelial cells ⇨ carcinoma * Non-hematopoietic mesenchymal cells ⇨ sarcoma * Hematopoietic cells **Bone marrow-de ...
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Histopathology Of Barrett's Esophagus, Annotated
Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία ''-logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histological sections have been placed onto glass slides. In contrast, cytopathology examines free cells or tissue micro-fragments (as "cell blocks"). Collection of tissues Histopathological examination of tissues starts with surgery, biopsy, or autopsy. The tissue is removed from the body or plant, and then, often following expert dissection in the fresh state, placed in a fixative which stabilizes the tissues to prevent decay. The most common fixative is 10% neutral buffered formalin (corresponding to 3.7% w/v formaldehyde in neutral buffered water, such as phosphate buff ...
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Abdominal Obesity
Abdominal obesity, also known as central obesity and truncal obesity, is a condition when excessive visceral fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health. Abdominal obesity has been strongly linked to cardiovascular disease, Alzheimer's disease, and other metabolic and vascular diseases. Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes. Visceral fat, also known as organ fat or ''intra-abdominal fat'', is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat, which is found underneath the skin, and intramuscular fat, which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue (EWAT), and perirenal fat. An excess of adipose visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, ...
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Odynophagia
Odynophagia is pain when swallowing. The pain may be felt in the mouth or throat and can occur with or without difficulty swallowing. The pain may be described as an ache, burning sensation, or occasionally a stabbing pain that radiates to the back. Odynophagia often results in inadvertent weight loss. The term is from ''-'' 'pain' and ' 'to eat'. Causes Odynophagia may have environmental or behavioral causes, such as: * Very hot or cold food and drinks (termed cryodynophagia when associated with cold drinks, classically in the setting of cryoglobulinaemia). * Taking certain medications * Using drugs, tobacco, or alcohol * Trauma or injury to the mouth, throat, or tongue It can also be caused by certain medical conditions, such as: * Ulcers * Abscesses * Upper respiratory tract infections * Inflammation or infection of the mouth, tongue, or throat (esophagitis, pharyngitis, tonsillitis, epiglottitis) * Immune disorders * Oral or throat cancer See also * Phagophobia Phagophobia ...
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Sternum
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped roughly like a necktie, it is one of the largest and longest flat bones of the body. Its three regions are the manubrium, the body, and the xiphoid process. The word "sternum" originates from the Ancient Greek στέρνον (stérnon), meaning "chest". Structure The sternum is a narrow, flat bone, forming the middle portion of the front of the chest. The top of the sternum supports the clavicles (collarbones) and its edges join with the costal cartilages of the first two pairs of ribs. The inner surface of the sternum is also the attachment of the sternopericardial ligaments. Its top is also connected to the sternocleidomastoid muscle. The sternum consists of three main parts, listed from the top: * Manubrium * Body (gladiolus) * ...
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Hematemesis
Hematemesis is the vomiting of blood. It is always an important sign. It can be confused with hemoptysis (coughing up blood) or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of duodenum. It may be caused by ulcers, tumors of the stomach or esophagus, varices, prolonged and vigorous retching, gastroenteritis, ingested blood (from bleeding in the mouth, nose, or throat), or certain drugs. Hematemesis is treated as a medical emergency, with treatments based on the amount of blood loss. Investigations include endoscopy. Any blood loss may be corrected with intravenous fluids and blood transfusions. Patients may need to avoid taking anything by mouth. Definition Hematemesis is the vomiting of blood. This is usually vomit that contains bright red blood. Coffee ground vomiting is similar to hematemesis, but is distinct in not involving bright red blood. Hematemesis is always an importa ...
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Dysphagia
Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of Pharynx, pharyngeal sensation or various other inadequacies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing, and Globus Pharyngis, globus, which is the sensation of a lump in the throat. A person can have dysphagia without odynophagia (dysfunction without pain), odynophagia without dysphagia (pain without dysfunction) or both together. A psychogenic disease, psychogenic dysphagia is known as phagophobia. Classification Dysphagia is classified into the following major types: # Oropharyngeal dysphagia # Esophageal dysphagia, Esophageal and obstructive dysphagia # Neuromuscular symptom comp ...
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Heartburn
Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid (gastric reflux) into the esophagus. It is the major symptom of gastroesophageal reflux disease (GERD). Other common descriptors for heartburn (besides burning) are belching, nausea, squeezing, stabbing, or a sensation of pressure on the chest. The pain often rises in the chest (directly behind the breastbone) and may radiate to the neck, throat, or angle of the arm. Because the chest houses other important organs besides the esophagus (including the heart and lungs), not all symptoms related to heartburn are esophageal in nature. The cause will vary depending on one's family and medical history, genetics, if a person is pregnant or lactating, and age. As a result, the diagnosis will vary depending on the suspected organ and the inciting disease process. Work-up will vary depending on t ...
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Norman Barrett
Norman Rupert Barrett (16 May 1903 – 8 January 1979) was an Australian-born British thoracic surgeon who is widely yet mistakenly remembered for describing what became known as Barrett's oesophagus. Early life Norman Barrett was born on 16 May 1903 in Adelaide, South Australia, to Alfred and Catherine Barrett. His great uncle, James Barrett, was a doctor, and four of James's children became doctors. One of these children, Norman's uncle Sir James Barrett, was a founder of the Royal Australasian College of Surgeons and a Chancellor of Melbourne University. Norman moved to England at the age of 10, and was educated at The New Beacon, Eton College and Trinity College, Cambridge. He was given his lifelong nickname, Pasty, while at Eton. Career He trained at St. Thomas' Hospital, and graduated in 1928. He continued as resident assistant surgeon at St. Thomas' Hospital, and was elected as Fellow of the Royal College of Surgeons in 1930. He was awarded the postgraduate degree M Chir ...
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Surgeon
In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as physicians before specializing in surgery. There are also surgeons in podiatry, dentistry, and veterinary medicine. It is estimated that surgeons perform over 300 million surgical procedures globally each year. History The first person to document a surgery was the 6th century BC Indian physician-surgeon, Sushruta. He specialized in cosmetic plastic surgery and even documented an open rhinoplasty procedure.Ira D. Papel, John Frodel, ''Facial Plastic and Reconstructive Surgery'' His magnum opus ''Suśruta-saṃhitā'' is one of the most important surviving ancient treatises on medicine and is considered a foundational text of both Ayurveda and surgery. The treatise addresses all aspects of general medicine, but the translator G. D. Si ...
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Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. On the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise. Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medications. Medications that may cause or worsen the disease include benzodiazepines, calcium channel blockers, tricyclic antidepressants, NSAIDs, and certain asthma medicines. Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esoph ...
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