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YEAR 5: Histopathology > Histo: Upper GI Disease > Flashcards

Histo: Upper GI Disease Flashcards

1
Q

What is a key histological feature of the oesophageal mucosa?

A

Presence of submucosal glands

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2
Q

what is the Z-line?

A

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

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3
Q

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

A

Specialised glands responsible for producing acid and enzymes
* Parietal cells - produce HCL and IF
* Chief cells - produce pepsinogen and gastric lipase

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4
Q

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

A

Pylorus and antrum

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5
Q

What are the three layers of the gastric mucosa?

A
  • Columnar epithelium
  • Lamina propria
  • Muscularis mucosa
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6
Q

Describe the structure of the duodenal mucosa

A

Intestinal type - glandular epithelium with goblet cells
Villous architecture

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7
Q

What is the normal villous: crypt ratio?

A

2:1

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8
Q

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

A

Intestinal metaplasia

NOTE: goblet cells are NOT normally seen in the stomach

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9
Q

What is the most common cause of oesophagitis

A

Reflux oesophagitis/GORD

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10
Q

What is the characteristic histological feature of acute oesophagitis?

A

Presence of lots of neutrophils

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11
Q

What can acute oesophagitis result in?

A
  • Ulceration
  • Fibrosis
  • Haemorrhage
  • Perforation
  • Stricture
  • Barrett’s oesophagus
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12
Q

Define Barrett’s oesophagus.

A

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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13
Q

What are the 2 types of oesopahgeal metaplasia in Barrett’s

A

Gastic metaplasia: no goblet cells
Intestinal metaplasia: with goblet cells (associated with increased risk of cancer)

NOTE: metaplasia is reversible

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14
Q

Define dysplasia.

A

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

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15
Q

What is adenocarcinoma of the oesophagus associated with and which part does it affect?

A
  • Associated with reflux
  • Affects lower 1/3 of oesophagus
  • Most common type of oesophageal cancer in developed countries
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16
Q

Describe the main histological feature of oesophageal adenocarcinoma

A

Moderate to well-differentiated, mucin producing glands (intestinal type mucosa)
Usually adjacent regions of Barrett’s present

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17
Q

What is squamous carcinoma of the oesophagus associated with and which part does it affect?

A
  • Smoking and alcohol
  • It tends to affect the upper 2/3 of oesophagus
  • It is more common in Afro-Caribbeans
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18
Q

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

A

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

Intercellular bridges

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19
Q

How is eosinophilis oesophagitis treated?

A
  • 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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20
Q

What is the commonest cause of oesophageal varices?

A
  1. Cirrhosis of the liver (Most common)
  2. Portal vein thrombosis
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21
Q

List some causes of acute gastritis

A

Chemical: NSAIDS, alcohol, corrosives
Infection: H pylori

22
Q

List some causes of chronic gastritis

A
  • Autoimmune (e.g. pernicious anaemia, anti-parietal cell) - affects body
  • Bacterial (H. pylori) - affects antrum
  • Chemical (NSAIDs, bile reflux) - affects antrum

NOTE: the key inflammatory cells in chronic gastritis are lymphocytes

23
Q

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

A
  • 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
24
Q

What are some complications of H. pylori gastritis

A
  • Adenocarcinoma
  • MALT lymphoma

H. pylori asscoaited with 8x increased risk of gastric cancer

25
Q

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

A

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

26
Q

List some other cause of gastritis.

A
  • CMV
  • Strongyloides
  • Crohn’s disease
27
Q

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

A
  • Metaplasia-Dysplasia pathway (e.g. oesophageal cancer)
  • Adenoma-Carcinoma pathway (e.g. colon cancer)
28
Q

Define gastric ulcer.

A

A break in the gastric mucosa. 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

29
Q

What is the difference between acute and chronic ulceration?

A

Chronic ulcers are accompanied by scarring and fibrosis

30
Q

What must you do with all gastric ulcers?

A

They should all be biopsied to rule out malignancy.

31
Q

List some complications of gastric ulcers.

A

Bleeding - anaemia; massive haemorrhage and shock

Perforation - peritonitis

32
Q

What type of cancer is gastric cancer?

A
  • 95% adenocarcinoma
  • 5% squamous cell carcinoma, lymphoma (MALToma), gastrointestinal stromal tumour (GIST), neuroendocrine tumours
33
Q

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

A
  • Intestinal: well-differentiated, presence of gland producing mucin
  • Diffuse: poorly differentiated, composed of single cells with no attempt at gland formation
34
Q

Name two types of diffuse adenocarcinoma of the stomach.

A
  • Linitis plastica
  • Signet ring cell carcinoma
35
Q

What is the overall survival rate of gastric cancer?

A

15%

36
Q

What is gastric lymphoma/MALToma? How is it treated?

A
  • Lymphoma of the gastric mucosa that is driven by chronic inflammation (H. pylori gastritis)
  • Consists of lots of B lymphocytes (marginal zone)
  • Treatment: if limited to stomach and H. pylori present - H. pylori eradication

NOTE: if H. pylori is also present, crypts may also contain neutrophils

37
Q

What causes duodenitis and duodenal ulcers?

A
  • 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
38
Q

List some other pathogens that affect the duodenum.

A
  • CMV
  • Cryptosporidium
  • Giardiasis
  • Whipple’s disease (Tropheryma whippelii)
39
Q

List some histological features of coeliac disease.

A
  • 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

40
Q

What is lymphocytic duodenitis?

A
  • 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
41
Q

How is coeliac disease diagnosed?

A

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

42
Q

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

A

Tropical sprue

43
Q

What type of lymphoma is associated with coeliac disease

A

Enteropathy associated T cell lymphoma

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

44
Q

Which ethnicity is associated with each type of oesophageal cancer?

A

Adenocarcinoma - Caucasians
Squamous cell - Afro-Caribbean

45
Q

What are the SSx of squamous cell carcinoma?

A

Progressive dysphasia (solids –> liquids)
Odynophagia
Anorexia
Severe weight loss

Rapid growth and early spread to LNs, liver and proximal structures

46
Q

What cell types are associated with acute and chronic gastritis respectively?

A

Acute - neutrophils

Chronic - lymphocytes and plasma cells

47
Q

What is the management of H.pylori infection?

A

Triple therapy:
- PPI
- Clindamycin
- Amoxicillin

48
Q

Where is gastric cancer more commonly seen and what is thought to be the reason for this?

A

Japan/China - potentially due to increased amount of fermented foods eaten here

49
Q

How can duodenal and gastric ulcers be differentiated from one another in terms of presentation?

A

Gastric
- Sx worsen with food
- Relieved by antacids
- Mainly seen in older adults/elderly

Duodenal
- Sx alleviated by food/milk
- Worse at night
- Typically younger patients

50
Q

What would be seen on endoscopy of a gastric ulcer?

A

Punched out lesion with rolled margins

51
Q

What HLA alleles are associated with coeliac disease?

A

DQ2/8

52
Q

What proportion of coeliac patients will develop EATL if left untreated?

A

10%

YEAR 5: Histopathology (20 decks)

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