G.I disease 1- Upper

Question 1

Normal Oesophagus features

Answer 1

Two sphincters:
Cricopharyngeal
Lower end (gastro-oesophageal)

Stratified squamous epithelium

DIstal 2cm is lined by columnar epithelia (glandular)

Question 2

Oesophagitis

Answer 2

can be acute/chronic

Aetiology:

• Infectious
  
  • Bacterial, viral (HSV1, CMV), fungal (candida)
• Chemical
  
  • Ingestion of corrosive substances
  • Reflux of gastric contents

Question 3

Reflux oesaphagitis

Answer 3

Caused by reflux of gastric acid (gastro-oesophageal reflux) and/or bile (duodeno-gastric reflux)

Question 4

Risk factors for reflux oesaphagitis

Answer 4

Defective lower oesophageal sphincter
Hiatus hernia
Increased intra-abdominal pressure
Increased gastric fluid volume due to gastric outflow stenosis

Leading clinical symptom: “heartburn”

Question 5

what is a hiatus hernia (sliding and paraoesophageal)

Answer 5

Abnormal bulging of a part of the stomach through the diaphragm

Sliding= reflux symptoms

Paraoesophageal = strangulations (blood supply compromised –> necrosis of stomach)

Question 6

Reflux Oesophagitis histology

Answer 6

Squamous epithelium
-Basal cell hyperplasia, elongation of papillae, increased -cell desquamation

Lamina propria
-Inflammatory cell infiltration (neutrophils, eosinophils, -lymphocytes)

Question 7

Complications of Reflux oesophagitis

Answer 7

Ulceration: Squamous epithelium perforation…healing by fibrosis –> Strictures- narrows –> dysphagia
Perforation
Haemorrhage
Barrett’s oesophagus:

Question 8

Barrett’s oesophagus:

Answer 8

Long standing reflux gastro-oesophageal reflux
Macroscopically: proximal extension of Squamo-Columnar junction (junction is higher up) –> METAPLASIA
Squamous –> Columnar (in attempt to withstand the acid)

Question 9

Barrett’s oesophagus risk factors

Answer 9

Male

Question 10

Types of columnar epithelium in Barrett’s oesophagus

Answer 10

It can change to resemble:
Gastric cardia
Gastric body
Intestinal type epithelia ‘specialised Barrett’s mucosa’ (contains paneth cells and goblet cells you don’t find in stomach)

Question 11

Barrett’s oesophagus increases risk of

Answer 11

As it is a premalignant condition it increases the chances of developing adenocarcinoma

Regular endoscopies for early diagnosis

Question 12

Progress of Barrett’s oesophagus

Answer 12

Barrett’s oesophagus –> low grade-dysplasia –> high grade dysplasia –> adenocarcinoma

Question 13

Types of Oesophageal Carcinoma

Answer 13

Squamous cell carcinoma

Adenocarcinoma

Question 14

Macroscopic Oesophageal Carcinoma

Answer 14

Stricturing
Polypoidal (difficulty swallowing)
Ulcerated

Question 15

Risk factors for Squamous carcinoma

Answer 15

Tobacco and alcohol
Nutrition (potential sources of nitrosamines)
Thermal injury (hot beverages)
HPV
Male
Ethnicity (black)

Happens slightly higher up in the oesophagus

Question 16

Staging of carcinomas

Answer 16

TNM staging
pT= depth of invasion of the primary tumour

T= How advanced primary tumour is 
N= Whether you have positive lymph nodes
M= any metastasis

Question 17

Gastritis Pathology (aggression and defensive forces)

Answer 17

Inc aggression:

• Excessive alcohol
• Drugs
• Heavy smoking
• Corrosive
• Radiation
• Chemotherapy
• Infection

Impaired defences:

• Ischaemia
• Shock
• Delayed emptying
• Duodenal reflux
• Impaired regulation of pepsin secretion

Question 18

Chronic gastritis other causes

Answer 18

Autoimmune
Bacterial infection (H.Pylori)
Chemical (direct injury)

Question 19

H.Pylori and its complications

Answer 19

Leads to glandular atrophy –> cells replaced by fibrosis and intestinal metaplasia

complications:

• gastric ulcers
• Duodenal ulcers
• Gastric cancers
• Malt (Mucosa associated lymphoma tissue) -neoplastic

Question 20

Peptic ulcer definition

Major sites of ulcers?

Answer 20

Localised defect that erodes through the full thickness of the mucosa at least into the submucosa

Major sites of ulcers:

• First part of duodenum
• Junction of antral and body mucosa
• Distal oesophagus (GOJ)

Question 21

Peptic ulcer aetiological factors

Answer 21

Smoking
NSAIDS
H.Pylori
Gastr-Oesophageal reflux
Hyperacidity

Question 22

Chronic peptic ulcers

Answer 22

Can go into muscularis propria

Question 23

Complications of peptic ulcers

Answer 23

Haemorrhage (acute/ and chronic –> anaemia)
Perforation –> perotinitis
Penetration into nearby organs
Strictures

Question 24

Gastric cancers

Answer 24

Common: Adenocarcinoma

Less common: Stromal
MALT
Endocrine tumours

Question 25

Intestinal and diffuse type carcinomas

Answer 25

FIND OUT MORE INFO

Question 26

Hereditary diffuse type gastric cancer (HDGC)

Answer 26

E-Cadherin mutation

Question 27

Coeliac disease

Answer 27

Immune mediated condition
Sensitivity to Gliadin (Small bowel expresses IL-15 –> epithelial cells cause proliferation of CD8 lymphocytes –> destroy enterocytes and reduce Vili (atrophy) and flatten –> dec surface area –> malabsorption

Question 28

Coeliac disease diagnosis

Answer 28

Tissue biopsy

Silent disease: Positive serology/atrophy but no symptoms
Latent: positive serology but not atrophy
Symptomatic: Anaemia, chronic diarrhoea, bloating and chronic fatigue

If left undiagnosed can lead to carcinomas e.g adeno, Enteropathy associated T-cell lymphoma