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MedEd + PathSoc + Laz's Qs + Romesh Path > Histopathology 11: Upper G.I pathology > Flashcards

Histopathology 11: Upper G.I pathology Flashcards

1
Q

In which part of the stomach does H.Pylori tend to reside ?

A

Pyloric antrum and pyloric canal

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2
Q

List the 3 layers of tissue seen on histology of the antrum and body of the stomach ?

A
  • Collomnar epithelium
  • Lamina propria (with specialised acid secreting glands)
  • Muscularis mucosa
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3
Q

What is the normal villous: Crypt ratio in the duodenum ?

A

villous: crypt 2:1

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4
Q

What do goblet cells in the stomach suggest ?

A

Intestinal Metaplasia

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5
Q

Which risk factors are associated with squamous cell carcinoma of the oesophagus ?

A
  • Smoking and alcohol

- More common in afro-carribeans

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6
Q

Which risk factors are associated with adenocarcinoma of the oesophagus ?

A
  • Barret’s oesophagus
  • GORD
  • smoking
  • obesity
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7
Q

Which cancer is more common in the distal 1/3 of the oesophagus ?

A

Adenocarcinoma

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8
Q

Which cancer is more common in the middle 1/3 of the oesophagus ?

A

Squamous cell carcinoma

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9
Q

List 3 causes of acute gastritis ?

A
  • NSAIDS
  • Alcohol
  • H.Pylori
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10
Q

List 3 causes of chronic gastritis ?

A
  • H.Pylori
  • Alcohol
  • Pernicious anaemia
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11
Q

What does the presence of lymphoid follicles (MALT) in the stomach suggest ?

A
  • H.Pylori infection

- Increased risk of lymphoma (MALToma)

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12
Q

What is meant by intestinal metaplasia of the stomach ?

A

-Goblet cells present in the stomach

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13
Q

Which type of cancer is most common in the stomach ?

A

Adenocarcinoma

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14
Q

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

A

Enteropathy associated T cell lymphoma (EATL)

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15
Q

What are the 3 main histological features of coeliac?

A

Crypt hyperplasia

Villous atrophy

Increased numbers of intraepithelial lymphocytes

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16
Q

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

A

Coeliac

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17
Q

How are the villi damaged in coeliac disease?

A

Cytotoxic T cells

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18
Q

What is the diffuse pattern of gastric adenocarcinoma?

A

Signet ring cells

Poorly differentiated

19
Q

What is the intestinal pattern of gastric adenocarcinoma?

A

Well-differentiated

20
Q

What is the difference between gastic dysplasia and gastric Ca?

A

Invasion of basement membrane

21
Q

What is the key cytological feature of gastric epithelial dysplasia?

A

High nuclear cytoplasmic ratio

22
Q

Why might you biopsy a gastric ulcer?

A

ALL gastric ulcers should be biopsied to exclude malignancy

23
Q

What are the 3 main causes of acute / chronic gastritis?

A

Acute:
Aspirin/NSAIDs
Alcohol
H pylori

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

24
Q

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

A

Ulceration
Haemorrhage
Perforation
Stricture

25
Q

What is oesophagitis mainly caused by

A

Reflux

Corrosives

26
Q

Complications of oesophagitis?

A

Barretts (metaplastic columnar lined oesophagus (CLO))

Malignancy

Stricture

Haemorrhage

27
Q

Types of barretts? Which is more likely to become malignant?

A
  1. Columnar metaplasia
  2. Columnar metaplasia + goblet cells = intestinal type change

2 is more likely to have malignant transformation

28
Q

What is methylene blue used for

A

ulcers

29
Q

Oesophageal malignancies + epideidemiology + cause?

A

Upper / mid oesophagus = SCC

  • Most common worldwide
  • assc w/ cigarette and alcohol consumption

Distal oesophagus = adenocarcinoma

  • Columnar epithelial transformation
  • most common in UK due to GORD / oesophagitis
30
Q

Causes of oesophageal varicies?

A

Any cause of portal HTN:

  • Cirrhosis
  • Portal vein thrombosis
  • IVC obstruction
31
Q

Mx of MALToma?

A

triple threat h.pylori eradication:

- PPI + Calrithromycin + Amox / metronidazole

32
Q

What type of cancers are gastric cancers?

A

95% = adenocarcinomas

5% = SCC, Lymphoma, GIST

33
Q

What are signet rings found in?

A

Diffuse gastric adenocarcinomas

34
Q

Biopsy revealing regular stratified squamous cells w/ mucuous glands located in submucosa are found in which organ?

A

Lower oesophagus

35
Q

How is coeliac diagnosed?

A

Bloods:
Anti-endomysial Ab +ve
Anti-TTG +ve (more sensitive)

Gold standard:
OGD w/ duodenal biopsy on a gluten rich diet (vilious atrophy) and off gluten diet (normal villi)

36
Q

Difference in increased intraepithelial lymphocytes seen in coeliac v cancer?

A

in coeliac it is caused by CD8+ T cells

In lymphoma it is B cells

37
Q

Lymphocytic duodenitis v Coeliac?

A

Both have increased intraepithelial lymphocytes

Lymphocytic duodentitis doesn’t have changes to villous architecture

38
Q

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

A

cag-A positive

39
Q

Histopathology of adenocarcinoma v SCC?

A

Adenocarcinoma:

  • Gland forming
  • Mucin secreting

SCC:

  • Make keratin (even in non-keratinised tissues)
  • Inter-celular bridges
40
Q

What are the two cancerous pathways in the GI system?

A

Metaplasia-dyplasia pathway eg oesophageal cancer, gastric cancer

Adenoma-carcinoma pathway eg colon cancer

41
Q

What is tropical sprue?

A
  • Tropical sprue is another cause of malabsorption with very similar histology to coeliac disease
    • commonly found in tropical regions
    • marked with abnormal flattening of villi and inflammation of lining of small intestine
42
Q

What cancer is associated w achalasia?

A

Squamous cell carcinoma (even though this is in the bottom 1/3rd of oesophagus)

43
Q

Ulcer v Erosion

A

Only loss of surface epithelium (mucosa) = erosion

Depth of tissue loss goes beyond mucosa (into submucosa and beyond) = ulcer

MedEd + PathSoc + Laz's Qs + Romesh Path (99 decks)

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