Histopathology 10 - Upper GI disease

Question 1

What is the “Z line” in the GI tract?

Answer 1

Normal appearance of squamo-columnar junction

Question 2

Where is the cardia portion of the stomach?

Answer 2

Junction between oesophagus and stomach

Question 3

What are the 3 layers of the stomach wall?

Answer 3

Gastric mucosa (columnar)
Lamina propria (containing glands) 
Muscularis mucosae

nb: difference between mucosa and mucosae

Question 4

In a normal duodenum, what is the villous:crypt ratio?

Answer 4

2:1

Question 5

Where are goblet cells usually found?

Answer 5

Intestine

Question 6

What is the most common cause of acute oesophagitis?

Answer 6

GORD

Question 7

If reflux oesophagitis causes a perforation of the oesophagus, what will be the result?

Answer 7

Mediastinitis

Question 8

What are the most common complications to remember of most GI pathologies?

Answer 8

Ulceration
Haemorrhage
Perforation
Stricture

Question 9

How is Barrett’s oesophagus different from metaplasia?

Answer 9

Reversible

Question 10

What is gastric metaplasia?

Answer 10

Metaplastic change in oesophagus without goblet cells

Question 11

What is intestinal type metaplasia?

Answer 11

Replacement of squamous epithelium with metaplastic columnar epithelium WITH goblet cells present

Question 12

What is the most common sequence of pathological progression to cancer in the upper GIT?

Answer 12

Metaplasia –> dysplasia –> Cancer

Question 13

What is the most common type of oesophageal carcinoma in developed coutries?

Answer 13

Adenocarcinoma

Question 14

Where does adenocarcinoma of the oesophagus usually develop?

Answer 14

Lower oesophagus

Question 15

Which type of oesophageal cancer is most strongly associated with GORD?

Answer 15

Adenocarcinoma

Question 16

What is the most common type of oesophageal cancer in developing coutries?

Answer 16

Squamous cell carcinoma

Question 17

Which type of oesophageal cancer is most associated with smoking and alcohol?

Answer 17

Squamous cell carcinoma

Question 18

Where in the oesophagus does squamous cell carcinoma tend to present?

Answer 18

Mid/lower oesophagus

Question 19

Why is prognosis for oesophageal cancer particularly poor?

Answer 19

Most patients are not suitable for resection surgery

Question 20

What other condition are oesophageal varices particularly associated with?

Answer 20

Portal vein stenosis

Question 21

What are the 3 main causes of acute gastritis?

Answer 21

Aspirin/NSAIDs
Alcohol
H pylori

Question 22

What are the 3 major causes of chronic gastritis?

Answer 22

ABC
Autoimmune (antiparietal cell Ig)
Bacterial (H pylori, affects antrum)
Chemical (NSAIDs, bile reflux, affects antrum)

Question 23

Which types of neoplasm is H pylori associated with?

Answer 23

Adenocarcinoma

Lymphoma (MALToma)

Question 24

How do H pylori inject toxin into the mucosa?

Answer 24

Via cag-A needle appendage

Question 25

Which strain of H pylori is associated with more aggressive chronic gastritis?

Answer 25

cag-A positive

Question 26

Why might you biopsy a gastric ulcer?

Answer 26

ALL gastric ulcers should be biopsied to exclude malignancy

Question 27

What will be the result of a perforated gastric ulcer?

Answer 27

Peritonitis

Question 28

What is gastric epithelial dysplasia?

Answer 28

Abnormal epithelial pattern of growth

Question 29

What is the key cytological feature of gastric epithelial dysplasia?

Answer 29

High nuclear cytoplasmic ratio

Question 30

What is the difference between gastic dysplasia and gastric Ca?

Answer 30

Invasion of basement membrane

Question 31

What type of carcinoma is the most common type of gastric cancer?

Answer 31

Adenocarcinoma

Question 32

Where is gastric cancer most common?

Answer 32

Japan, by far

Question 33

What are the morphological categories of gastric cancer?

Answer 33

Intestinal | Diffuse

Question 34

What is the intestinal pattern of gastric adenocarcinoma?

Answer 34

Well-differentiated

Question 35

What is the diffuse pattern of gastric adenocarcinoma?

Answer 35

Signet ring cells | Poorly differentiated

Question 36

What is linitis plastica?

Answer 36

No focal lesion in stomach, but whole thing is thickened and static - due to diffuse adenocarcinoma

Question 37

What is a gastrointestinal stromal tumour? (GIST)

Answer 37

Tumour of the interstitial cells of Cajal in the stomach - a SARCOMA

Question 38

What is the cause of gastric MALToma?

Answer 38

Chronic inflammation, usually due to H pylori

Question 39

What are gastric MALTomas composed of?

Answer 39

B cells

Question 40

What is the first-line treatment of gastric MALToma?

Answer 40

H pylori treatment

Question 41

Which type of gastrointestinal tract ulcers are always benign?

Answer 41

Duodenal

Question 42

What is cryptosporidiosis?

Answer 42

Protozoal GIT infection seen in immunosuppressed patients

Question 43

Where does giardia lamblia infection cause pathology?

Answer 43

Villi of GIT

Question 44

What is the route of transmission of giardia?

Answer 44

Faeco/oral route

Question 45

How are the villi damaged in coeliac disease?

Answer 45

Cytotoxic T cells

Question 46

In what condition are increased numbers of intraepithelial lymphocytes in the GIT seen?

Answer 46

Coeliac

Question 47

What are the 3 main histological features of coeliac?

Answer 47

Crypt hyperplasia Villous atrophy Increased numbers of intraepithelial lymphocytes

Question 48

Which two antibodies are required for diagnosis of coeliac disease?

Answer 48

``` Endomysial Tissue transglutaminase (TTG) ```

Question 49

Where is MALToma associated with coeliac likely to be located?

Answer 49

Duodenum

Question 50

What is the type of MALToma as a result of coeliac disease called?

Answer 50

Enteropathy associated T cell lymphoma