1. Upper GI Tract Pathology Flashcards
Oesophageal reflux pathology:
- What is oesophageal reflux?
- What happens to oesophagus squamous epithelium?
- What happens to oesophageal epithelium when severe reflux?
- Reflux of gastric acid into oesophagus - hiatus hernia.
- Thickens
- ulcerates
What are the complications of oesophageal reflux?
- Healing by fibrosis which can lead to:
- Stricture formation
- impaired oesophageal motility
- oesophageal obstruction - Barrett’s oesophagus
What is Barrett’s oesophagus?
Type of metaplasia - transformation from squamous epithelium to glandular epithelium. Response in some patients to oesophageal reflux. Pre-malignant condition.
What can Barrett’s oesophagus lead to?
Adenocarcinoma
Oesophageal cancer:
- What are the two histological types?
- How common is it?
- Prognosis?
- Squamous carcinoma & Adenocarcinoma
- Third common alimentary canal cancer.
- Very poor
What are the risk factors for oesophageal cancer?
Linked to environment
Squamous carcinoma: smoking, alcohol, dietary carcinogens.
Adenocarcinoma: Barrett’s oesophagus, obesity
What are the local effects of oesophageal cancer
Obstruction, ulceration, perforation
How does oesophageal cancer spread?
Local - to surrounding tissues.
Lymphatic - to regional lymph nodes.
Blood - to liver
Define gastritis.
‘Gastritis’ indicates inflammation associated with mucosal injury.
What are the 3 types of gastritis?
- Autoimmune (type A)
- Bacterial (type B)
- Chemical injury (type C)
What is the commonest type of gastritis?
Bacterial (H. Pylori specifically)
Define autoimmune gastritis.
Organ-specific autoimmune disease. Autoantibodies to parietal cells & intrinsic factor. Associated with other autoimmune diseases.
Describe the pathology of autoimmune gastritis.
Atrophy of specialised acid secreting gastric epithelium. Loss of specialised epithelial cells (parietal cells) leads to decreased acid secretion & loss of intrinsic factor (vit B12 deficiency: pernicious anaemia).
- Which bacterium is related to bacterial gastritis, what kind of bacteria is it?
- Where is this bacterium found?
- What does this bacterium produce?
- What does it cause in the stomach?
- Helicobacter pylori. Gram negative bacterium.
- Found in gastric mucus on surface of gastric epithelium.
- Produces acute & chronic inflammatory response.
- Increased acid production.
What causes chemical gastritis?
Drugs: non-steroidal anti-inflammatory drugs (NSAIDs)
Alcohol
bile reflux
Peptic ulceration:
- What causes it?
- Which organs does it affect?
- Which bacterium is it usually associated with?
- Imbalance between acid secretion & mucosal barrier
- Lower oesophagus, body & antrum of stomach, first & second parts of duodenum
- H. pylori (as pylori causes increased gastric acid production)
What are the complications of peptic ulceration?
- Bleeding: acute = haemorrhage, chronic = anaemia
- Perforation (untreated ulcer burns through the mucosal wall in e.g. the stomach or colon allowing gastric contents to leak into the abdominal cavity): can cause peritonitis (infection of peritoneum).
- Obstruction either due to healing by fibrosis or an active ulcer is surrounded by oedema.
Pathology of gastric cancer:
- how common is it?
- How does it develop?
- Which bacterium is associated with?
- which histological type is it?
- second commonest cancer of alimentary tract.
- develops through phases of intestinal metaplasia & dysplasia
- associated with previous H. pylori infection
- adenocarcinoma (type of cancer that starts in the mucous glands)
Regarding spread of stomach cancer:
- Direct?
- lymphatic?
- blood spread?
- transcoelomic spread?
- spread to surrounding tissues
- spread to regional lymph nodes
- liver
- spread within peritoneal cavity
