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YEAR 5: Histopathology - PK Edited > 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 body and fundus of the stomach have in abundance?

A

Specialised glands responsible for producing acid and enzymes

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4
Q

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

A

Pylorus and antrum (as less acidic than the body)

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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

What is the normal villous: crypt ratio?

A

2:1

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7
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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8
Q

What is the characteristic histological feature of acute oesophagitis?

A

Presence of lots of neutrophils

This is usually caused by GORD

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9
Q

What can acute oesophagitis result in?

A
  • Ulceration
  • Fibrosis
  • Haemorrhage
  • Perforation
  • Stricture
  • Barrett’s oesophagus
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10
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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11
Q

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

A

Intestinal metaplasia - goblet cells become visible

NOTE: metaplasia is reversible

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12
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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13
Q

What is squamous carcinoma of the oesophagus associated with?

A
  • Smoking and alcohol
  • It tends to affect the middle/lower oesophagus
  • It is the most common type of oesophageal cancer in Africa / developing countries
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14
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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15
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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16
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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17
Q

List some causes of chronic gastritis

A
  • 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

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18
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
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19
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

20
Q

List some other cause of gastritis.

A
  • CMV
  • Strongyloides
  • Crohn’s disease
21
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)
22
Q

Define gastric ulcer.

Define erosion

A

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

23
Q

What is the difference between acute and chronic ulceration?

A

Chronic ulcers are accompanied by scarring and fibrosis

24
Q

What must you do with all gastric ulcers?

A

They should all be biopsied to rule out malignancy.

25
Q

List some complications of gastric ulcers.

A

Bleeding (anaemia, shock)

Perforation (peritonitis)

26
Q

What type of cancer is gastric cancer?

A
  • 95% adenocarcinoma
  • 5% squamous cell carcinoma, lymphoma (MALToma), gastrointestinal stromal tumour (GIST), neuroendocrine tumours
27
Q

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

A
  • 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
28
Q

Name two types of diffuse adenocarcinoma of the stomach.

A
  • Linitis plastica
  • Signet ring cell carcinoma
29
Q

What is the overall survival rate of gastric cancer?

A

15%

30
Q

What is gastric lymphoma?

A
  • 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

31
Q

2 causes of 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
32
Q

List some other pathogens that affect the duodenum.

A
  • CMV
  • Cryptosporidium
  • Giardiasis
  • Whipple’s disease (Tropheryma whippelii)
33
Q

List some histological features of malabsorption.

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

34
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
35
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

36
Q

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

A

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

37
Q

What type of lymphoma is duodenal lymphoma?

A

T cell lymphoma / EATL (enteropathy associated T cell lymphoma)

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

38
Q

Commonest cause of oseophagitis?

A

GORD

39
Q

Name of when barrett’s oesophagus has goblet cells too? And when it doesn’t?

A

Intestinal metaplasia - w/ goblet cells
Gastric metaplasia - w/out goblet cells

40
Q

where does oesophageal adenocarcinoma usually affect, and what demographic?

A

lower 1/3
caucasians / west

41
Q

cells in acute gastritis vs chronic gastritis?

A

acute - neutrophils
chronic - lymphocytes

42
Q

complication of chronic gastritis?

A

ulcer formation but most importantly MALT lymphoma & cancer

43
Q

country with high incidence of gastric cancer?

A

Japan ?fermented foods

44
Q

Difference in cells between MALT lymphoma and EATL?

A

MALT - B cells
EATL - T cells

45
Q

management of MALT lymphoma

A

remove H pylori by triple therapy - PPI, clarythro + amox

46
Q

What is GIST?

A

GI Stromal tumour / spindle cell tumour
cells of cajal
Stain with CD117

47
Q

complication of coeliac?

A

10% progress to EATL if not treated adequately with diet

YEAR 5: Histopathology - PK Edited (29 decks)

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