12 Upper Gastrointestinal Disease Flashcards

1
Q

Aims and Objectives

A

By the end of this talk, you should:
be aware of inflammatory conditions in the upper GI tract
in particular, know about Barrett’s oesophagus, peptic ulcer disease and coeliac disease
be aware of the types of neoplasia in the upper GI tract
know how malignant tumours spread, using stomach cancer as an example

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic gastritis

A

Ongoing inflammation of the stomach mucosa

Compared to acute gastritis, symptoms are less severe but more persistent

Can provide an environment in which dysplasia and carcinoma can arise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic gastritis

A
Symptoms include:
upper abdominal pain 
indigestion or bloating 
nausea and vomiting 
belching 
loss of appetite or weight loss 

However, it may be asymptomatic!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chronic gastritis

A
Causes include:  A, B, C and other
Bacterial- Helicobacter pylori infection
Chemical
Alcohol
Tobacco
Caffeine
A- Autoimmune
		Can lead to pernicious anaemia

Psychological stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

H.pylori

A

Gram-negative bacterium found in the stomach, particularly antrum
infects over half the world’s population and by age 5.
infection probably acquired via faecal-oral route
untreated, infection persists throughout life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

H.Pylori - Discovery

A

It was identified in 1982 by Australian scientists Barry Marshall and Robin Warren
Found that it was present in patients with chronic gastritis and gastric ulcers, conditions not previously believed to have a microbial cause.
It is also linked to the development of duodenal ulcers and stomach cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

H. pylori

A
Clinical presentation
80% asymptomatic
5-15% peptic ulcer disease
10% non-ulcer dyspepsia
1-3% gastric adenocarcinoma
0.5% gastric MALToma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

H. Pylori - importance

A

Strongly associated with Chronic Gastritis
Strongly associated with duodenal ulcer
Fairly strongly associated with gastric ulcer
Associated with gastric carcinoma
Associated with gastric MALT lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Peptic ulcer

A

Peptic ulcer disease (PUD) usually occurs in D1 or antrum (4:1).
Common causes are H. pylori (80 -100% DU, 65% gastric) and NSAIDs
Most ulcers are solitary
Symptoms include
Pain (gnawing, burning, aching)
Worse at night
Worse after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Peptic ulcer - complications

A
Complications include:
Bleeding leading to iron deficiency anaemia
Massive haematemesis
Perforation leading to peritonitis
Long term cancer at edge of ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Barrett’s oesophagus

A

Normal lining of the oesophagus stratified squamous epithelium.
In Barrett’s oesophagus replaced by columnar epithelium with goblet cells (usually found lower in the gastrointestinal tract).
Thought to be an adaptation to chronic acid exposure from reflux oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Barrett’s oesophagus

A

Process of dysplasia: low grade to high grade to invasive carcinoma
Strong association (about 0.5% per patient-year) with oesophageal adenocarcinoma
Need for surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Upper GI malignancy

Types of cancer

A

Oesophagus
Squamous carcinoma
Adenocarcinoma (Barrett’s)

Stomach
Adenocarcinoma
GI Stromal Tumours (GIST)

Small Bowel
Lymphoma
GI Stromal Tumours (GIST)
Neuroendocrine Tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oesophageal carcinoma

A

Squamous cell carcinoma
Adults over 45
M:F 4:1
Risk factors include alcohol, tobacco, caustic injury, achalasia.
Insidious onset with late symptoms
Dysphagia, weight loss, haemorrahge, sepsis, respiratory fistula with aspiration
Overall 5 year survival of 9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Oesophageal carcinoma

A

Adenocarcinoma – now more common
Largely from dysplastic change in Barrett’s oesophagus
M:F 7:1
Present with dysphagia, weight loss, haematemesis, chest pain, vomiting.
5 year survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Oesophageal carcinoma

A
DIRECT
into surrounding tissues
LYMPHATIC 
to paraoesophageal, paratracheal and cervical node groups
HAEMATOGENOUS 
to liver or lung
17
Q

Adenocarcinoma stomach

A
Adenocarcinoma – 90% of gastric malignancies
Precursor lesions
Pernicious anaemia (atrophic gastritis)
Intestinal metaplasia
Neoplastic polyps
Helicobacter associated gastritis
18
Q

Adenocarcinoma stomach

A

2nd commonest carcinoma worldwide
East Asia, South America (Andes), Eastern Europe
declining incidence
Early symptoms resemble gastritis

19
Q

Adenocarcinoma stomach

A

Advanced symptoms
Weight loss, anorexia, anaemia, heamorrhage
Fungating exophytic growth
Prognosis depends on depth of invasion
5 year survival (early) after surgery 90%
Overall 5 year survival 30%

20
Q

Adenocarcinoma stomach

A
Direct infiltration
Duodenum, pancreas, colon, liver, spleen
Lymphatic spread
Local and regional nodes
 Virchow's node
Haematogenous
Liver, lungs
Transcoelomic
 Omentum
 Mesentery
 Ovary (Krukenberg tumour)
21
Q

Small Bowel Neoplasia

A
Relatively rare compared to other GI malignancy
Different subtypes include:
adenocarcinoma (rare)
gastrointestinal stromal tumor
lymphoma 
carcinoid (neuroendocrine) tumor
22
Q

Small bowel neoplasia

A

Risk factors for small intestine cancer include:
Crohn’s disease
Coeliac disease
Radiation exposure
Hereditary gastrointestinal cancer syndromes e.g. familial adenomatous polyposis

23
Q

Coeliac disease

A

Extensive mucosal disease related to sensitivity to gluten
Prevalence in white Europeans of 0.5 – 1%
Immune mediated villous atrophy and malabsorption
Can be diagnosed via serological blood test (TTG) and biopsy -

24
Q

Coeliac disease

A
Symptoms include 
pain and discomfort in the digestive tract, 
chronic constipation and diarrhoea, 
failure to thrive (in children), 
anaemia 
fatigue 

Intestinal damage begins to heal within weeks of gluten being removed from the diet

Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel

25
Q

Upper GI Disease

A
What we’ve covered:
Chronic gastritis
H. pylori
Peptic ulcer disease
Barrett’s oesophagus
GI malignancy and it’s spread
Coeliac disease