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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
Where is the most common place in which squamous cell carcinomas form in the oesophagus?
Upper oesophagus as this is where smoking and alcohol are more likely to affect
26
Describe the pathophysiology of squamous cell carcinoma?
Normal squamous cells Severe dysplasia (Carcinoma in situ) Carcinoma
27
What are some common pathological characteristics of a squamous cell carcinoma tumour?
A large ulcerating tumour with central cell necrosis, leading to compression of the oesophageal lumen
28
Who is most at risk of adenocarcinoma of the oesophagus?
Caucasian, obese males
29
Where is the most common site of adenocarcinoma in the oesophagus?
Lower 1/3rd of the oesophagus due to reflux
30
What condition can increase the risk of adenocarcinoma greatly?
Barret's oesophagus
31
What are the 3 main ways in which oesophageal carcinomas can spread?
Local invasion Lymphatic permeation Vascular invasion (Haematogenous)
32
What are some common clinical presentations of oesophageal carcinoma?
Dysphagia Anaemia Weight loss Loss of appetite or energy
33
What is a Mallory Weiss tear?
A tear in the lower oesophageal wall, usually caused by excessive vomiting in alcohol poisoning or excessive coughing, leading to an oesophageal haemorrhage
34
How may liver cirrhosis affect the oesophagus?
It can cause the development of varices in the oesophagus
35
What are some common pathologies affecting the stomach?
Gastritis Peptic ulcer disease Gastric malignancy
36
What is gastritis?
Gastritis is an inflammatory disorder of the stomach
37
What are the 3 main classes of gastritis?
Acute Chronic Immune
38
What are some common causes of acute gastritis?
Irritant chemical injury Severe burns Shock Trauma Head injury
39
What are the 3 types of chronic gastritis causes?
Autoimmune Bacterial Chemical
40
What causes autoimmune gastritis?
The presence of anti-parietal and anti-intrinsic factor auto-antibodies, which leads to atrophy and metaplasia in the body of the stomach
41
What are some common complications of autoimmune gastritis?
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
Which bacteria is the most common cause of bacterial gastritis?
Helicobacter pylori (H. pylori)
43
Where do H. pylori inhabit in the stomach?
The niche between the epithelial cell surface and mucus barrier
44
What are some characteristics of H. pylori bacteria?
They are gram negative, microaerophilic (Some CO2) curvilinear rob shaped bacteria
45
How can H. pylori infection lead to gastritis?
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
How can H.pylori lead to gastric ulceration?
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
What are some common causes of chemical gastritis?
NSAIDs Alcohol Bile reflux
48
What occurs in chemical gastritis?
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
What re the 3 main forms of immune gastritis?
Lymphocytic gastritis Eosinophilic gastritis Granulomatous gastritis
50
What is meant by peptic ulceration?
Breaching of the gastrointestinal mucosa as a result of acid and pepsin attack
51
What are some common sites of peptic ulcer disease?
Duodenum (superior) Stomach Oesophago-gastric junction Stoma
52
Describe the pathophysiology of peptic ulcer disease
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
What are some possible complications of peptic ulceration?
Perforation of stomach Penetration of surrounding organs Haemorrhage Stenosis of stomach of duodenum Intractable pain
54
What are benign gastric tumours known as?
Gastric polyps
55
What are the 2 main types of benign gastric polyps?
Hyperplastic polyps Cystic fundic gland polyps
56
What are the 3 main classes of malignant gastric tumour?
Carcinomas Lymphomas Gastrointestinal stromal tumours
57
What tumour type is the most common malignancy of the stomach?
Adenocarcinoma
58
What is the most common pathophysiological pathway of gastric adenocarcinoma?
H.pylori infection Chronic gastritis Intestinal metaplasia Dysplasia Carcinoma
59
What are some possible aetiological conditions of gastric adenocarcinoma?
H.pylori infection Pernicious anaemia Partial gastrectomy Lynch syndrome Menetrier's disease
60
What are the 2 sub-types of gastric adenocarcinomas?
Intestinal type - Exophytic polypoid mass (Cauliflower) causing volcano-like lesions with rolled raised edges Diffuse type - Expands and infiltrates the stomach, causing thickening
61
What are the 4 ways in which gastric adenocarcinomas can spread?
Local invasion Lymphatic spread Haematogenous spread Transcoelemic spread
62
What is meant by transcoelomic spread?
Spread through the coelomic fluid (Peritoneal)
63
What are Kruckenberg metastases?
Ovarian metastases from the transcoelomic spread of gastric adenocarcinomas
64
What are gastric lymphomas also known as?
Maltomas
65
What is a gastric lymphoma?
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
What are Gastrointestinal stromal tumours?
These are tumours derived from the gut pacemaker cells
67
What is achalasia?
This is failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter
68
What causes achalasia?
This is caused by degeneration of the ganglia from Auerbach's plexus
69
How will achalasia present?
Heartburn Nausea Vomiting Dysphagia
70
What investigations are performed in achalasia?
Oesophageal manometry Barium swallow (Bird beak appearance)
71
How is achalasia treated?
Balloon (Pneumatic) dilatation - 1st line Heller cardiomyotomy - 2nd line
72
What are some clinical features of gastric cancer?
Dyspepsia Epigastric pain Anorexia Weight loss Nausea Vomiting Haematemesis Melaena Progressive dysphagia
73
What is the management option for gastric cancer?
Gastrectomy
74
What is gastroparesis?
This is delayed gastric emptying caused by closure of the pyloric sphincter
75
What are some causes of gastroparesis?
Idiopathic Diabetes mellitus Medications e.g. opiates, anticholinergics
76
What are some clinical features of gastroparesis?
Bloating Early satiety Nausea Vomiting Weight loss Abdominal pain
77
What is the main investigation in gastroparesis?
Oesophageal manometry

Gastrointestinal (22 decks)

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