Histopathology 11: Upper G.I pathology Flashcards
In which part of the stomach does H.Pylori tend to reside ?
Pyloric antrum and pyloric canal
List the 3 layers of tissue seen on histology of the antrum and body of the stomach ?
- Collomnar epithelium
- Lamina propria (with specialised acid secreting glands)
- Muscularis mucosa
What is the normal villous: Crypt ratio in the duodenum ?
villous: crypt 2:1
What do goblet cells in the stomach suggest ?
Metaplasia
Which risk factors are associated with squamous cell carcinoma of the oesophagus ?
- Smoking and alcohol
- More common in afro-carribeans
Which risk factors are associated with adenocarcinoma of the oesophagus ?
- Barret’s oesophagus
- GORD
- smoking
- obesity
Which cancer is more common in the distal 1/3 of the oesophagus ?
Adenocarcinoma
Which cancer is more common in the middle 1/3 of the oesophagus ?
Squamous cell carcinoma
List 3 causes of acute gastritis ?
- NSAIDS
- Alcohol
- H.Pylori
List 3 causes of chronic gastritis ?
- H.Pylori
- Alcohol
- Pernicious anaemia
What does the presence of lymphoid follicles (MALT) in the stomach suggest ?
- H.Pylori infection
- Increased risk of lymphoma
What is meant by intestinal metaplasia of the stomach ?
-Goblet cells present in the stomach
Absence of Ganglion cells in the myenteric plexus
Hirsprung’s disease
Which type of cancer is most common in the stomach ?
Adenocarcinoma
Which complication is associated with Ulcerative colitis ?
Toxic megacolon
Which drug is used to induce remission in Crohn’s ?
Prednisolone
Which drug is used to induce remission in UC ?
Mesalazine
can also use prednisolone
Which drugs form part of the maintenance therapy for Crohn’s ?
Azathioprene
Methotrexate
Infliximab
(hydrocortisone)
Which drugs form part of the maintenance therapy for UC ?
Mesalazine
Azathioprene
Hydrocortisone
what is the z-line in the oesophagus
point at which epithelium transitions from squamous to columnar
features of acute oesophagitis
lots of neutrophils
usually caused by GORD
can cause: ulceration, fibrosis
complications: haemorrhage, perforation, stricture, barretts oesophagus
what is barretts oesophagus
normal squamous epithelium in the lower oesophagus replaced by columnar epithelium
(aka CLO)
when goblet cells become visible = intestinal metaplasia
higher risk of cancer
metaplasia - dysplasia - cancer
what is dysplasia
changes showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane
features of SCC of the oesophagus
associated with smoking and alcohol
mid/lower oesophagus
cells make keratin
IC bridges
causes of acute gastritis
chemical:
- aspirin/ alcohol/corrosives
infection:
- H pylori
features of chronic gastritis
H pylori associated chemical (NSAIDS, bile reflux) AI lymphocytes MALT - lymphoma
what 2 pathways lead to the development of GI cancer
metaplasia - dysplasia pathway (eg oesophageal)
adenoma - carcinoma pathway (eg colonic)
define an ulcer
the depth of loss of tissue goes beyond the muscularis mucosa (into the submucosa)
complications include bleeding and perforation
features of gastric cancer
M>F
adenocarcinoma in 90%
intestinal - well diff, big glands of mucin
diffuse - poorly diff, composed of single cells
5% = SCC, lymphoma, GIST, neuroendocrine
causes of duodenitis
increased acid production in the stomach that spills into the duodenum H Pylori CMV cryptosporidium giardiasis
what happens in coeliacs disease
villous atrophy and crypt hyperplasia
T cell response to gliadin in Coeliacs disease causes damage to villi
increased intraepithelial lymphocytes
lymphocyte duodenitis
Ab - endomysial + tissue transglutaminase
increased risk of GIT cancers
MALTomas associated with coeliacs disease found in the duodenum - T cell lymphomas
