GI Flashcards
What type of epithelium is found in the oesophagus?
Squamous stratified epithelium (NO GOBLET CELLS), separated from columnar epithelium of the stomach via squamo-columnar junction/ Z-line.
What is the commonest cause of oesophagitis?
Reflux oesophagitis (GORD).
What are the complications of reflux oesophagitis?
Ulceration, haemorrhage leading to haematemesis/melaena, Barrett’s oesophagus, stricture, perforation.
How is GORD classified
Los Angeles Classification of severity
How is reflux oesophagitis (GORD) managed?
Lifestyle changes (stop smoking, weight loss), PPI/H2 receptor antagonists.
What is Barrett’s oesophagus?
Intestinal metaplasia of squamous mucosa to columnar epithelium (with goblet cells) following chronic GORD. -> upwards migration of the SCJ
What percentage of people with symptomatic GORD develop Barrett’s oesophagus?
10%
What can Barrett’s oesophagus lead to?
Adenocarcinoma: metaplasia → dysplasia → cancer.
Presence of what feature confers a higher risk of development into cancer
NB Presence of goblet cells is intestinal metaplasia – confers even higher
risk of development into Ca .
Which part of the oesophagus does oesophageal adenocarcinoma usually affect?
the distal 1/3 of the oesophagus. (Associated with Barrett’s oesophagus)
What are the risk factors for oesophageal adenocarcinoma?
Barrett’s oesophagus, smoking, obesity, prior radiation therapy.
Which population is most commonly affected by oesophageal adenocarcinoma?
Caucasians, M»F.
What are the risk factors for squamous cell oesophageal carcinoma?
Alcohol and smoking (most common), achalasia of cardia, Plummer-Vinson syndrome, nutritional deficiencies, nitrosamines, HPV (in high prevalence areas).
Which population is most commonly affected by squamous cell oesophageal carcinoma?
Afro-Caribbeans, M>F.
Epidemiology of squamous cell oesophageal carcinoma
6x more common in Afro-Caribbeans, M>F
Where is squamous cell oesophageal carcinoma usually found?
Middle 1/3 (50%), Upper 1/3 (20%), Lower 1/3 (30%).
What are the common presentations of squamous cell oesophageal carcinoma?
Progressive dysphagia (solids then fluids), odynophagia (pain), anorexia, severe weight loss.
Prognosis of squamous cell oesophageal carcinoma
Rapid growth and early spread (to LNs, liver and directly to proximal
structures) —> palliative care
What causes oesophageal varices and how do they present?
Engorged dilated veins, Usually due to portal hypertension (back pressure). Patient vomits large volumes of blood.
How are oesophageal varices managed in an emergency?
Emergency endoscopy followed by sclerotherapy/banding.
What type of epithelium lines the stomach?
Gastric mucosa ((NO GOBLET CELLS), with columnar epithelium (mucin secreting) and glands.
What do parietal cells in the stomach secrete?
HCl and intrinsic factor (IF).
What do chief cells in the stomach secrete?
Pepsinogen.
What are the characteristics of acute gastritis?
Presence of neutrophils due to insults such as aspirin, NSAIDs, corrosives (bleach), acute H. pylori infection, severe stress (burns).
What are the characteristics of chronic gastritis?
Presence of lymphocytes and plasma cells due to insults such as H. pylori (tends to be antral), autoimmune conditions (e.g., pernicious anaemia), alcohol, smoking.
What are the complications of chronic gastritis?
May lead to gastric ulcer formation, induce lymphoid tissue in stomach increasing future risk of MALT lymphoma due to H.pylori, and result in intestinal metaplasia → dysplasia → cancer.
What defines a gastric ulcer?
A breach through the muscularis mucosa into the submucosa (otherwise it’s an erosion, not an ulcer).
What are the symptoms of a gastric ulcer?
Epigastric pain, possibly with weight loss. Pain is worse with food and relieved by antacids.
What are the risk factors for gastric ulcer?
H. pylori infection, smoking, NSAIDs, stress, delayed gastric emptying. Occurs mainly in elderly.
How is a gastric ulcer diagnosed?
Biopsy for H. pylori histology status. Punched out lesion with rolled margins.
What are the complications of a gastric ulcer?
Anaemia (IDA), perforation (seen on erect CXR), and malignancy.
Where is the incidence of gastric cancer higher and what is the primary type of tumour?
Higher incidence in Japan, China where more fermented/pickled food is eaten. >95% of tumours in the stomach are adenocarcinomas.
What are the types of gastric adenocarcinoma?
Intestinal type (well differentiated, goblet cells present following intestinal metaplasia) and diffuse type (poorly differentiated, no gland formation – includes signet ring cell carcinoma).
What causes gastric (MALT) lymphoma and how is it managed?
Caused by H. pylori – chronic antigen stimulation. Managed by removing the cause (H. pylori) using triple therapy: PPI, Clarithromycin, and Amoxicillin.
How common are duodenal ulcers compared to gastric ulcers?
Duodenal ulcers are 4 times more common than gastric ulcers.
What are the symptoms of a duodenal ulcer?
Epigastric pain, worse at night, relieved by food and milk.
What age group is most commonly affected by duodenal ulcers?
Younger adults.
What are the risk factors for duodenal ulcers?
H. pylori, drugs, aspirin, NSAIDs, steroids, smoking, increased acid secretion.
What are the complications of duodenal ulcers?
Anaemia (IDA) and perforation (seen on erect CXR).