Histo: Upper GI Disease Flashcards
What is a key histological feature of the oesophageal mucosa?
Presence of submucosal glands
what is the Z-line?
The point in the oesophagus at which the epithelium transitions from being squamous to being columnar
What does the body and fundus of the stomach have in abundance?
Specialised glands responsible for producing acid and enzymes
Which part of the stomach tends to be affected by H. pylori-associated gastritis?
Pylorus and antrum (as less acidic than the body)
What are the three layers of the gastric mucosa?
- Columnar epithelium
- Lamina propria
- Muscularis mucosa
What is the normal villous: crypt ratio?
2:1
What does the presence of goblet cells in the stomach signify?
Intestinal metaplasia
NOTE: goblet cells are NOT normally seen in the stomach
What is the characteristic histological feature of acute oesophagitis?
Presence of lots of neutrophils
This is usually caused by GORD
What can acute oesophagitis result in?
- Ulceration
- Fibrosis
- Haemorrhage
- Perforation
- Stricture
- Barrett’s oesophagus
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)
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
Define dysplasia.
Changes showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane.
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 / developing countries
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
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.
What is the commonest cause of oesophageal varices?
- Cirrhosis of the liver (Most common)
- Portal vein thrombosis
List some causes of chronic gastritis
- Autoimmune (body, auto-antibodies e.g. antiparietal)
- Bacterial (H. pylori) or viral (CMV)
- Chemical (NSAIDs, bile reflux) or Crohn’s
- D (drugs, smoking and alcohol)
NOTE: the key inflammatory cells in chronic gastritis are lymphocytes
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.
Define erosion
The depth of the loss of tissue goes beyond the muscularis mucosa (into the submucosa)
Erosion is just the epithelium
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 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 - i.e. goblet cells and paneth cells present
- Diffuse: poorly differentiated, composed of single cells with no attempt at gland formation - this includes signet ring cell carcinoma
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 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
2 causes of 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
- Whipple’s disease (Tropheryma whippelii)
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
Tropical sprue is a malabsorption syndrome characterized by acute or chronic diarrhea. It is seen in the people of the tropical region in the absence of any specific cause of malabsorption.[1] It is thought to be infectious in etiology with a contribution of environmental factors
What type of lymphoma is duodenal lymphoma?
T cell lymphoma / EATL (enteropathy associated T cell lymphoma)
NOTE: lymphomas in the stomach due to H. pylori are B cell lymphomas
Commonest cause of oseophagitis?
GORD
Name of when barrett’s oesophagus has goblet cells too? And when it doesn’t?
Intestinal metaplasia - w/ goblet cells
Gastric metaplasia - w/out goblet cells
where does oesophageal adenocarcinoma usually affect, and what demographic?
lower 1/3
caucasians / west
cells in acute gastritis vs chronic gastritis?
acute - neutrophils
chronic - lymphocytes
complication of chronic gastritis?
ulcer formation but most importantly MALT lymphoma & cancer
country with high incidence of gastric cancer?
Japan ?fermented foods
Difference in cells between MALT lymphoma and EATL?
MALT - B cells
EATL - T cells
management of MALT lymphoma
remove H pylori by triple therapy - PPI, clarythro + amox
What is GIST?
GI Stromal tumour / spindle cell tumour
cells of cajal
Stain with CD117
complication of coeliac?
10% progress to EATL if not treated adequately with diet
