01b: Upper GI Pathology

Question 1

T/F: Necrosis is a pathological feature of esophagitis.

Answer 1

True - reflux of acid/pepsin causes necrosis of mucosal surface layers

Question 2

Esophagitis: what’s the mechanism of stricture formation?

Answer 2

Healing of ulcers with fibrosis of lamina propria

Question 3

T/F: Granulation tissue and acute inflammatory exudate are commonly found in mild/acute esophagitis.

Answer 3

False - these are changes seen in severe esophagitis

Question 4

Aside from (X), the most prevalent cause of esophagitis, list the other common conditions you would put on your differential.

Answer 4

X = GERD

1. Eosinophilic esophagitis
2. Infectious esophagitis
3. Chemical esophagitis

Question 5

Patient presents with dysphagia and endoscopic findings demonstrate “ribbed” appearance of esophagus, termed “feline trachea”. What’s the likely diagnosis?

Answer 5

Eosinophilic esophagitis

Question 6

What would you see on biopsy in patient with eosinophilic esophagitis?

Answer 6

Hyperplastic (reparative) changes in squamous mucosa with dense infiltrate of eosinophils

Question 7

List the agents responsible for infectious esophagitis. Star the most common

Answer 7

1. Candida*
2. CMV
3. Herpes

Question 8

List the two criteria required for diagnosis of Barrett’s esophagus.

Answer 8

1. Endoscopic evidence of columnar epithelial lining

2. Histo evidence of intestinal metplasia on biopsy

Question 9

Cells with (X) characteristics are indicative of dysplastic changes in Barrett’s mucosa.

Answer 9

X = enlarged, hyperchromatic ovoid nuclei (with increased mitotic activity)

Question 10

Risk of cancer in patients with Barrett’s is (X)%. And in those with high-grade dysplasia is (Y)%.

Answer 10

X = under 2
Y = 16-30

Question 11

T/F: Barrett’s esophagus is the only recognized risk factor for adenocarcinoma of esophagus.

Answer 11

True

Question 12

Squamous carcinoma of esophagus related to which risk factors?

Answer 12

1. EtOH, smoking

2. Nutritional deficiencies

Question 13

List the 3 main categories/etiologies of chronic gastritis.

Answer 13

1. H. pylori
2. Chemical (NSAIDs)
3. Autoimmune

Question 14

T/F: All individuals infected with H. pylori show histological abnormalities.

Answer 14

True

Question 15

Describe histological changes in acute H. pylori infection:

Answer 15

1. Mucus depletion

2. Reparative changes of surface/crypt epithelium (due to PMN infiltration)

Question 16

The intensity of an acute H. pylori infection depends on which factors?

Answer 16

1. Number of H. pylori

2. Presence of Cag A (toxin) strains of bacteria

Question 17

Multifocal gastric atrophy (MAG) is a long-term consequence of (X). Describe this condition.

Answer 17

X = H. pylori infection

Loss of specialized glands in antrum, body, and fundus

Question 18

Patients with MAG are at higher risk of which cancer? What are the changes leading up to this?

Answer 18

Gastric

1. Atrophic gastric mucosa
2. Intestinal metaplasia in that area
3. Dysplasia

Question 19

List pathway of progression from H. pylori infection to duodenal ulcer.

Answer 19

1. Infection
2. Chronic gastritis
3. Diffuse antral gastritis
4. Duodenitis
5. Gastric metaplasia
6. Duodenal Ulcer

Question 20

List pathway of progression from H. pylori infection to gastric adenocarcinoma.

Answer 20

1. Infection
2. Chronic gastritis
3. MAG
4. Dysplasia
5. Adenocarcinoma

Question 21

List pathway of progression from H. pylori infection to lymphoma.

Answer 21

1. Infection
2. Chronic gastritis
3. Maltoma
4. Low-grade, then high-grade lymphoma

Question 22

T/F: Maltomas regress in response to H. pylori eradication by antibiotics.

Answer 22

True