Histopathology 11: Upper G.I pathology

Question 1

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

Answer 1

Pyloric antrum and pyloric canal

Question 2

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

Answer 2

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

Question 3

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

Answer 3

villous: crypt 2:1

Question 4

What do goblet cells in the stomach suggest ?

Answer 4

Metaplasia

Question 5

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

Answer 5

• Smoking and alcohol

- More common in afro-carribeans

Question 6

Which risk factors are associated with adenocarcinoma of the oesophagus ?

Answer 6

• Barret’s oesophagus
• GORD
• smoking
• obesity

Question 7

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

Answer 7

Adenocarcinoma

Question 8

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

Answer 8

Squamous cell carcinoma

Question 9

List 3 causes of acute gastritis ?

Answer 9

• NSAIDS
• Alcohol
• H.Pylori

Question 10

List 3 causes of chronic gastritis ?

Answer 10

• H.Pylori
• Alcohol
• Pernicious anaemia

Question 11

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

Answer 11

• H.Pylori infection

- Increased risk of lymphoma

Question 12

What is meant by intestinal metaplasia of the stomach ?

Answer 12

-Goblet cells present in the stomach

Question 13

Absence of Ganglion cells in the myenteric plexus

Answer 13

Hirsprung’s disease

Question 14

Which type of cancer is most common in the stomach ?

Answer 14

Adenocarcinoma

Question 15

Which complication is associated with Ulcerative colitis ?

Answer 15

Toxic megacolon

Question 16

Which drug is used to induce remission in Crohn’s ?

Answer 16

Prednisolone

Question 17

Which drug is used to induce remission in UC ?

Answer 17

Mesalazine

can also use prednisolone

Question 18

Which drugs form part of the maintenance therapy for Crohn’s ?

Answer 18

Azathioprene
Methotrexate
Infliximab

(hydrocortisone)

Question 19

Which drugs form part of the maintenance therapy for UC ?

Answer 19

Mesalazine
Azathioprene
Hydrocortisone

Question 20

what is the z-line in the oesophagus

Answer 20

point at which epithelium transitions from squamous to columnar

Question 21

features of acute oesophagitis

Answer 21

lots of neutrophils
usually caused by GORD
can cause: ulceration, fibrosis
complications: haemorrhage, perforation, stricture, barretts oesophagus

Question 22

what is barretts oesophagus

Answer 22

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

Question 23

what is dysplasia

Answer 23

changes showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane

Question 24

features of SCC of the oesophagus

Answer 24

associated with smoking and alcohol
mid/lower oesophagus
cells make keratin
IC bridges

Question 25

causes of acute gastritis

Answer 25

chemical:
- aspirin/ alcohol/corrosives
infection:
- H pylori

Question 26

features of chronic gastritis

Answer 26

H pylori associated 
chemical (NSAIDS, bile reflux)
AI 
lymphocytes 
MALT - lymphoma

Question 27

what 2 pathways lead to the development of GI cancer

Answer 27

metaplasia - dysplasia pathway (eg oesophageal)

adenoma - carcinoma pathway (eg colonic)

Question 28

define an ulcer

Answer 28

the depth of loss of tissue goes beyond the muscularis mucosa (into the submucosa)
complications include bleeding and perforation

Question 29

features of gastric cancer

Answer 29

M>F
adenocarcinoma in 90%
intestinal - well diff, big glands of mucin
diffuse - poorly diff, composed of single cells
5% = SCC, lymphoma, GIST, neuroendocrine

Question 30

causes of duodenitis

Answer 30

increased acid production in the stomach that spills into the duodenum 
H Pylori 
CMV 
cryptosporidium 
giardiasis

Question 31

what happens in coeliacs disease

Answer 31

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