Lecture 10 Pathology of the Upper Gastrointestinal Tract

Question 1

Define hiatus hernia

Answer 1

loss of oesophageal sphincter and herniation of proximal portion of the stomach

Question 2

What are the complications of oesophageal reflux

Answer 2

Stricture formation
Impaired motility
Obstruction
Barrett’s oesophagus

Question 3

What is Barrett’s Oesophagus

Answer 3

• Type of metaplasia (transformation squamous epithelium to glandular epithelium which resembles intestinal epithelium) is response the oesophageal reflux

Question 4

What are the 2 histological types of oesophageal cancer

Answer 4

Squamous

Adenocarcinoma

Question 5

Risk factors for squamous cancer

Answer 5

– Smoking
– Alcohol
– Dietary carcinogens

Question 6

Risk factors for adenocarcinoma

Answer 6

Obesity

Barrett’s oesophagus

Question 7

Local effects of oesophageal cancer

Answer 7

• Obstruction
• Ulceration- blood loss  anaemia
• Perforation- erode through hole in oesophageal wall into the thorax

Question 8

Spread of oesophageal cancer

Answer 8

•	Direct  
–	To surrounding tissues
•	Lymphatic spread 
–	To regional lymph nodes
•	Blood spread  
–	Liver

Question 9

What are the 3 types of gastritis

Answer 9

Autoimmune
Bacterial
Chemical injury

Question 10

Describe autoimmune gastritis

Answer 10

• Organ-specific autoimmune disease
• Autoantibodies to parietal cells and intrinsic factor
• Associated with other autoimmune diseases

Question 11

What is the pathology of autoimmune gastritis

Answer 11

• Atrophy (loss) of specialised acid secreting gastric epithelium
• Loss of specialised gastric epithelial cells
– Decreased acid secretion
– Loss of intrinsic factor
• Vitamin B12 deficiency (pernicious anaemia)

Question 12

What is bacterial gastritis related to

Answer 12

Helicobacter pylori

Question 13

Where is helicobacter pylori found in gastritis

Answer 13

Gastrc mucus on surface of gastric epithelium

Question 14

What effect does the presence of H. pylori have on the body

Answer 14

Release urease which is converted in ammonia and increases pH which causes the release of are acid to bring down the pH

Question 15

What chemicals can causes gastritis

Answer 15

Alcohol

NSAIDS

Question 16

Complications of peptic ulceration

Answer 16

bleeding
Perforation
Healing by fibrosis-obstruction

Question 17

Spread of stomach cancer

Answer 17

•	Direct 
–	Spread to surrounding tissues
•	Lymphatic 
–	Spread to regional lymph nodes
•	Blood spread
–	Liver
•	Transcoelomic spread
–	Spread within peritoneal cavity