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Gastrointestinal > Oesophageal and gastric pathology > Flashcards

Oesophageal and gastric pathology Flashcards

1
Q

What are some pathologies affecting the oesophagus?

A

Oesophagitis
Barret’s oesophagus
Eosinophilic oesophagitis
Oesophageal tumours
Oesophageal varices
Mallory-Weiss Tear

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2
Q

What is meant by oesophagitis?

A

Oesophagitis is an inflammatory disorder of the oesophagus

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3
Q

What are the 2 classes of oesophagitis?

A

Acute
Chronic

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4
Q

What are the most common causes of acute oesophagitis?

A

Ingestion of corrosive chemicals
Infection in immunosuppressed patients

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5
Q

What are some examples of infections that can lead to acute oesophagitis?

A

Candidiasis
Herpes
CMV

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6
Q

What is the most common cause of chronic oesophagitis?

A

Reflux disease (Reflux oesophagitis)

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7
Q

Which other GI disease disease can lead to chronic oesophagitis?

A

Crohn’s disease

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8
Q

What is meant by reflux oesophagitis?

A

Inflammation of the oesophagus due to refluxed low pH gastric content

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9
Q

What are some possible aetiologies of gastric reflux?

A

Defective sphincter mechanisms
Hiatus hernia
Abnormal oesophageal motility
Increased intra-abdominal pressure (Pregnancy, obesity)

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10
Q

What occurs pathologically in reflux oesophagitis?

A

Degradation of epithelial cells means that the basal cells attempt to expand and renew the epithelium
When erosion continues, there is an influx of immune cells as the epithelium can no longer be renewed at a fast enough rate
This can cause ulceration

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11
Q

What are some complications of reflux oesophagitis?

A

Ulceration
Bleeding
Stricture (Narrowing)
Barret’s oesophagus

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12
Q

What is Barret’s oesophagus?

A

A condition characterised by the replacement of stratified squamous epithelium by columnar epithelium
This is a form of metaplasia and is thus premalignant

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13
Q

What are some common causes of Barret’s oesophagus?

A

Persistent reflux of acid or bile
Expansion of columnar epithelium from glands
Differentiation from oesophageal stem cells

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14
Q

How will Barret’s oesophagus appear on endoscopy?

A

This will show a red velvet appearance in the lower oesophagus
This is because the blood vessels are more visible to see through the single layer columns epithelium

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15
Q

What are some possible consequences of Barret’s oesophagus?

A

This leas to an unstable mucosa after repeated damage, which increases the risk of developing dysplasia and carcinoma, and thus requires surveillance

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16
Q

What is eosinophilic oesophagitis?

A

This is an allergic form of oesophagitis in which inflammation occurs in response to an allergen, usually dietary

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17
Q

Who is most at risk of eosinophilic oesophagitis?

A

Young men with a family history of atopy

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18
Q

What are some clinical findings that show eosinophilic oesophagitis?

A

Raised blood eosinophils
Furrowed (Ridged) oesophagus, which looks like a trachea upon endoscopy
No signs of reflux on endoscopy

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19
Q

What are some treatment options for eosinophilic oesophagitis?

A

Dietary elimination
Pharmacological treatment (e.g. steroids, chromoglycate, montelukast)

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20
Q

What is the most common benign oesophageal tumour type?

A

Squamous papilloma

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21
Q

What is the clinical presentation of oesophageal squamous papilloma?

A

They are usually asymptomatic, however, as they grow they can lead to dysphagia
Usually HPV related

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22
Q

What are some examples of highly rare oesophageal benign tumours?

A

Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours

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23
Q

What are the 2 most common forms of malignant tumour types of the oesophagus?

A

Squamous cell carcinoma
Adenocarcinoma

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24
Q

What are some common causes of squamous cell carcinoma?

A

Vitamin A deficiency
Zinc defeicny
Tannic acid (Strong tea)
Smoking
Alcohol
HPV
Oesophagitis
Genetics

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25
Q

Where is the most common place in which squamous cell carcinomas form in the oesophagus?

A

Upper oesophagus as this is where smoking and alcohol are more likely to affect

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26
Q

Describe the pathophysiology of squamous cell carcinoma?

A

Normal squamous cells
Severe dysplasia (Carcinoma in situ)
Carcinoma

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27
Q

What are some common pathological characteristics of a squamous cell carcinoma tumour?

A

A large ulcerating tumour with central cell necrosis, leading to compression of the oesophageal lumen

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28
Q

Who is most at risk of adenocarcinoma of the oesophagus?

A

Caucasian, obese males

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29
Q

Where is the most common site of adenocarcinoma in the oesophagus?

A

Lower 1/3rd of the oesophagus due to reflux

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30
Q

What condition can increase the risk of adenocarcinoma greatly?

A

Barret’s oesophagus

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31
Q

What are the 3 main ways in which oesophageal carcinomas can spread?

A

Local invasion
Lymphatic permeation
Vascular invasion (Haematogenous)

32
Q

What are some common clinical presentations of oesophageal carcinoma?

A

Dysphagia
Anaemia
Weight loss
Loss of appetite or energy

33
Q

What is a Mallory Weiss tear?

A

A tear in the lower oesophageal wall, usually caused by excessive vomiting in alcohol poisoning or excessive coughing, leading to an oesophageal haemorrhage

34
Q

How may liver cirrhosis affect the oesophagus?

A

It can cause the development of varices in the oesophagus

35
Q

What are some common pathologies affecting the stomach?

A

Gastritis
Peptic ulcer disease
Gastric malignancy

36
Q

What is gastritis?

A

Gastritis is an inflammatory disorder of the stomach

37
Q

What are the 3 main classes of gastritis?

A

Acute
Chronic
Immune

38
Q

What are some common causes of acute gastritis?

A

Irritant chemical injury
Severe burns
Shock
Trauma
Head injury

39
Q

What are the 3 types of chronic gastritis causes?

A

Autoimmune
Bacterial
Chemical

40
Q

What causes autoimmune gastritis?

A

The presence of anti-parietal and anti-intrinsic factor auto-antibodies, which leads to atrophy and metaplasia in the body of the stomach

41
Q

What are some common complications of autoimmune gastritis?

A

Pernicious (Macrolytic) anaemia due to B12 deficiency, as intrinsic factor is responsible for B12 absorption

Increased risk of gastric malignancy due to metaplasia

Sub-acute combined degeneration of the spinal cord (SACDC) as antibodies also lead to the demyelination of spinal cord neurones

42
Q

Which bacteria is the most common cause of bacterial gastritis?

A

Helicobacter pylori (H. pylori)

43
Q

Where do H. pylori inhabit in the stomach?

A

The niche between the epithelial cell surface and mucus barrier

44
Q

What are some characteristics of H. pylori bacteria?

A

They are gram negative, microaerophilic (Some CO2) curvilinear rob shaped bacteria

45
Q

How can H. pylori infection lead to gastritis?

A

H.pylori infects the stomach layer and secretes IL-8, which excites an early acute inflammatory response and then, if not cleared, can lead to chronic inflammation

46
Q

How can H.pylori lead to gastric ulceration?

A

H.pylori causes the activation of neutrophils, which migrate through the stomach epithelium, therefore destroying some epitehlial cells and causing gaps, through which stomach acids and peptidases can move

47
Q

What are some common causes of chemical gastritis?

A

NSAIDs
Alcohol
Bile reflux

48
Q

What occurs in chemical gastritis?

A

Chemicals such as NSAIDS, alcohol and bile reflux cause direct injury to the mucus layer, which can lead to hyperplasia, congestion and some inflammation as well as ulceration

49
Q

What re the 3 main forms of immune gastritis?

A

Lymphocytic gastritis
Eosinophilic gastritis
Granulomatous gastritis

50
Q

What is meant by peptic ulceration?

A

Breaching of the gastrointestinal mucosa as a result of acid and pepsin attack

51
Q

What are some common sites of peptic ulcer disease?

A

Duodenum (superior)
Stomach
Oesophago-gastric junction
Stoma

52
Q

Describe the pathophysiology of peptic ulcer disease

A

A combination of sustained acid secretion and mucosal defence failure leads to gastric metaplasia and H.pylori infection, which then leads to inflammation, epithelial damage and finally ulceration

53
Q

What are some possible complications of peptic ulceration?

A

Perforation of stomach
Penetration of surrounding organs
Haemorrhage
Stenosis of stomach of duodenum
Intractable pain

54
Q

What are benign gastric tumours known as?

A

Gastric polyps

55
Q

What are the 2 main types of benign gastric polyps?

A

Hyperplastic polyps
Cystic fundic gland polyps

56
Q

What are the 3 main classes of malignant gastric tumour?

A

Carcinomas
Lymphomas
Gastrointestinal stromal tumours

57
Q

What tumour type is the most common malignancy of the stomach?

A

Adenocarcinoma

58
Q

What is the most common pathophysiological pathway of gastric adenocarcinoma?

A

H.pylori infection
Chronic gastritis
Intestinal metaplasia
Dysplasia
Carcinoma

59
Q

What are some possible aetiological conditions of gastric adenocarcinoma?

A

H.pylori infection
Pernicious anaemia
Partial gastrectomy
Lynch syndrome
Menetrier’s disease

60
Q

What are the 2 sub-types of gastric adenocarcinomas?

A

Intestinal type - Exophytic polypoid mass (Cauliflower) causing volcano-like lesions with rolled raised edges

Diffuse type - Expands and infiltrates the stomach, causing thickening

61
Q

What are the 4 ways in which gastric adenocarcinomas can spread?

A

Local invasion
Lymphatic spread
Haematogenous spread
Transcoelemic spread

62
Q

What is meant by transcoelomic spread?

A

Spread through the coelomic fluid (Peritoneal)

63
Q

What are Kruckenberg metastases?

A

Ovarian metastases from the transcoelomic spread of gastric adenocarcinomas

64
Q

What are gastric lymphomas also known as?

A

Maltomas

65
Q

What is a gastric lymphoma?

A

A tumour derived from the mucosa associates lymphoid tissue, usually caused by H.pylori infection due to mutation of clonal B-cells caused by continuous inflammation

66
Q

What are Gastrointestinal stromal tumours?

A

These are tumours derived from the gut pacemaker cells

67
Q

What is achalasia?

A

This is failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter

68
Q

What causes achalasia?

A

This is caused by degeneration of the ganglia from Auerbach’s plexus

69
Q

How will achalasia present?

A

Heartburn
Nausea
Vomiting
Dysphagia

70
Q

What investigations are performed in achalasia?

A

Oesophageal manometry
Barium swallow (Bird beak appearance)

71
Q

How is achalasia treated?

A

Balloon (Pneumatic) dilatation - 1st line
Heller cardiomyotomy - 2nd line

72
Q

What are some clinical features of gastric cancer?

A

Dyspepsia
Epigastric pain
Anorexia
Weight loss
Nausea
Vomiting
Haematemesis
Melaena
Progressive dysphagia

73
Q

What is the management option for gastric cancer?

A

Gastrectomy

74
Q

What is gastroparesis?

A

This is delayed gastric emptying caused by closure of the pyloric sphincter

75
Q

What are some causes of gastroparesis?

A

Idiopathic
Diabetes mellitus
Medications e.g. opiates, anticholinergics

76
Q

What are some clinical features of gastroparesis?

A

Bloating
Early satiety
Nausea
Vomiting
Weight loss
Abdominal pain

77
Q

What is the main investigation in gastroparesis?

A

Oesophageal manometry

Gastrointestinal (22 decks)

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