Histo: Upper GI Disease Flashcards by Sanjana Murali

What is a key histological feature of the oesophageal mucosa?

Presence of submucosal glands

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what is the Z-line?

The point in the oesophagus at which the epithelium transitions from being squamous to being columnar

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What does the body and fundus of the stomach have in abundance?

Specialised glands responsible for producing acid and enzymes

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Which part of the stomach tends to be affected by H. pylori-associated gastritis?

Pylorus and antrum

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What are the three layers of the gastric mucosa?

Columnar epithelium
Lamina propria
Muscularis mucosa

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What is the normal villous: crypt ratio?

2:1

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What does the presence of goblet cells in the stomach signify?

Intestinal metaplasia

NOTE: goblet cells are NOT normally seen in the stomach

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What is the characteristic histological feature of acute oesophagitis?

Presence of lots of neutrophils

This is usually caused by GORD

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What are the complications of acute oesophagitis?

Ulceration
Fibrosis
Haemorrhage
Perforation
Stricture
Barrett’s oesophagus

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Define Barrett’s oesophagus

Metaplastic process by which the normal sqaumous epithelium of the lower oesophagus is replaced by columnar epithlieum

NOTE: this is also known as columnar-lined epithelium (CLO)

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What are the two forms of metaplasia in barrett’s oesophagus?

Gastric metaplasia - without goblet cells

Intestinal metaplasia - with goblet cells

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What further degree of metaplasia is associated with an even greater risk of cancer than Barrett’s oesophagus?

Intestinal metaplasia - goblet cells become visible

NOTE: metaplasia is reversible

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Define dysplasia.

Changes showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane.

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What is the most common oesophageal carcinoma in developed countries?

Adenocarcinoma of the oesophagus - associated with reflux and mainly found int eh lower oesophagus

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What is squamous carcinoma of the oesophagus associated with?

Smoking and alcohol
It tends to affect the middle/lower oesophagus
It is the most common type of oesophageal cancer in Africa

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What are the main histological features of squamous cell carcinoma of the oesophagus?

Cells produce keratin (normal oesophageal squamous epithelium is non-keratinised)

Intercellular bridges

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How is eosinophilis oesophagitis treated?

Steroids
Allergen removal

NOTE: this is associated with an allergic reaction (asthma of the oesophagus). It is due to allergy to food causing muscle spasm and dysphagia.

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What is this?

Oesophageal varices

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What is the commonest cause of oesophageal varices?

Cirrhosis of the liver (Most common)
Portal vein thrombosis

What are the common causes of acute gastritis?

List some causes of chronic gastritis

Autoimmune (body, auto-antibodies e.g. antiparietal)
Bacterial (H. pylori)
Chemical (NSAIDs, bile reflux)

NOTE: the key inflammatory cells in chronic gastritis are lymphocytes

What is the type of pattern seen in H.pylori gastritis?

Chronic gastritis +/- activity

What are the outcomes of H.pylori gastritis?

CLO-IM-dysplasia

Adenocarcinoma

Lymphoma (MALToma)

What is mucosa-associated lymphoid tissue and what is their presence indicative of?

Chronic gastritis caused by H. pylori infection induces lymphoid tissue in the stomach
The presence of lymphoid follicles in a stomach biopsy, is highly suggestive of H. pylori infection
This is important because it is associated with an increased risk of lymphoma

Name a key virulence factor that enables *H. pylori* to cause chronic infection.

Cag-A positive *H. pylori* has a needle-like appendage that injects toxins into intercellular junctions allowing bacteria to attach more easily

List some other cause of gastritis.

* CMV * Strongyloides * Crohn's disease

What are the two pathways that lead to the development of GI cancer?

* Metaplasia-Dysplasia pathway (e.g. oesophageal cancer) * Adenoma-Carcinoma pathway (e.g. colon cancer)

Define gastric ulcer.

The depth of the loss of tissue goes beyond the muscularis mucosa (into the submucosa) NOTE: if you only get loss of surface epithelium with or without involvement of the lamina propria then it is an erosion

What is the difference between acute and chronic ulceration?

Chronic ulcers are accompanied by scarring and fibrosis

What must you do with all gastric ulcers?

They should all be biopsied to rule out malignancy.

List some complications of gastric ulcers.

Bleeding (anaemia, shock) Perforation (peritonitis)

What is the incidence of gastric cancer?

High incidence in Japan, Chile, Italy, China, Portugal China and Russia

What type of cancer is gastric cancer?

* 95% adenocarcinoma * 5% squamous cell carcinoma, lymphoma (MALToma), gastrointestinal stromal tumour (GIST), neuroendocrine tumours

What are the two main morphological subtypes of gastric adenocarcinoma? What are their key features?

* Intestinal: well-differentiated, presence of big gland containing mucin * Diffus: poorly differentiated, composed of single cells with no attempt at gland formation

Name two types of diffuse adenocarcinoma of the stomach.

* Linitis plastica * Signet ring cell carcinoma

What is the overall survival rate of gastric cancer?

15%

What type of lymphoma is a gastric MALToma?

contained of B-cell marginal zone lymphocytes

What is gastric lymphoma?

* Lymphoma of the gastric mucosa that is driven by chronic inflammation (*H. pylori gastritis*) * Consists of lots of B lymphocytes (marginal zone) NOTE: if *H. pylori* is also present, crypts may also contain neutrophils

What causes duodenitis and duodenal ulcers?

* Caused by increased acid produced in the stomach that spills into the duodenum * It can also occur due to chronic inflammation and gastic metaplasia with *H. pylori* infection

List some other pathogens that affect the duodenum.

* CMV * Cryptosporidium * Giardiasis *lambalia* infection * Whipple's disease (*Tropheryma whippelii*) * Immunosuppressed

List some histological features of malabsorption.

* Villous atrophy * Crypt hyperplasia * Increased intraepithelial lymphocytes (\>20 per 100 enterocytes) NOTE: the T cell response to gliadin in Coeliac disease is responsible for the damage to villi

What is lymphocytic duodenitis?

* When you get the inflammatory changes (increased intraepithelial lymphocytes) without architectural changes * Many people with this condition either have coeliac disease or will go on to develop coeliac disease

How is coeliac disease diagnosed?

Antibodies: anti-tTG, anti-endomysial Duodenal biopsy NOTE: duodenal biopsy will be normal in people with coeliac disease who have been following a strict gluten-free diet

Which other condition has very similar clinical and histological features to coeliac disease?

Tropical sprue

What type of lymphoma is duodenal lymphoma?

T cell lymphoma NOTE: lymphomas in the stomach due to *H. pylori* are B cell lymphomas

What patients are most likely to get duodenal MALToma?

Patients with coeliac disease