Oesophageal and gastric pathology left over Flashcards
Define an ulcer
An ulcer is a local defect of the mucous membrane or the skin due to gradual disintegration of the surface epithelial cells
What is the mechanism of action of a PPI?
-Binds irreversibly to H+/ATPase enzyme (proton pump) on gastric parietal cells and blocks secretion of H+, which combine in the stomach with Cl- to form HCL
What is the action of HCL in the stomach?
-Activates pepsinogen to pepsin which helps in proteolysis
-Antimicrobial
How can NSAIDs cause PUD?
-Prostaglandins are important for gastric mucosal protection: NSAIDS suppress their production (cyclooxygenase inhibitors)
-Topical irritant effect on epithelim
-Reduced gastric mucosal blood flow
Why can hypercalcaemia cause peptic ulcer?
Hypercalcaemia –> increased gastrin release –> increased HCL production
What are the common causes of hypercalcamiea?
-Hyperparathyroidism
-Malignancy
-Renal failure
How can you localise parathyroid glands?
-Sestamibi scan (pre operative)
-Frozen section (intra operative)
What is the epithelium of gastric mucosa in the antrum?
-Simple columnar with mucosal and goblet cells
What immune endocrine diseases and malignancy associated with helicobacter infections?
-Hashimoto’s thyroiditis
-MALT
-Adenocarcinoma
What is the histology of a parathyroid adenoma?
-Uniform, polygonal chief cells with small, centrally placed nuclei
-A few nests of larger oxyphil cells are present as well. Uncommonly, adenomas are composed entirely of this cell type (oxyphil adenomas)
-A rim of compressed, non-neoplastic parathyroid tissue, generally separated by a fibrous capsule, is often visible at the edge of the adenoma
Where can you find the parathyroid gland if you do not see them in the normal position?
-The superior mediastinum: the thymus originates from the third branchial arch, so it occasionally drags the inferior glands down to the mediastinum
How would you treat a parathyroid adenoma?
Excision
What is the treatement of hypercalcaemia?
-Hydration
-Forced diuresis
-Bisphosphonates: IV pamidronate
-Calcitonin
What is the normal lining of the oesophagus?
-Non keratinised stratified squamous
What would be the cause of a pleural effusion in a pateitn with oesophageal adenocarcinoma
-Spread of cancer cells to pleura
-Lung mets
-Obstruction of thoracic duct
In pt with pleural effusion and oesophageal carcinoma, what pathological test would you want to do?
Effusion cytology
How can you treat such a pleural effusion
Palliative treatments
-Thoracocentesis
-Indwelling pleural catheters
-Pleurodesis
-Pleuroperitoneal shunting
What is troponin?
A complex of three regulatory proteins (Troponin C, I and T) that is integral to muscle contraction
Where is troponin found?
Cardiac muscle and skeletal muscle
What is the pathogenesis of gastric carcinoma?
-Believed to develop by a sequence of pathological changes
-Normal mucosa –> chronic gastritis –> intestinal metaplasia –> dysplasia –> intramucosal carcinoma –> invasive gastric carcinoma
Patient with LIF pain and gastric cancer. Surgery was done (gastrectomy with splenectomy) pathology report inside
On entering you are given a histopath report showing:
–> signet ring carcinoma
–> positive lymph nodes
–> margin positive
–> spleen involved
Discuss the report with the family
Discuss the pathology report with the family
–> cancer of the stomach
–> incomplete resection
–> high possibility of recurrence
–> patient will require further resection and chemotherapy
Describe the classification of gastric cancer
WHO classification
–> Tubular adenocarcinoma: made up of different sized small branching tubules
–> Papillary adenocarcinoma: this tumour grows outward from stomach wall and contains finger-like growths that stick out into stomach cavity.
–> Mucinous addenomacrcinoma: lots of mucin (main substance in mucus) outside the cancer cells
–> Poorly cohesive carcinomas (including signet ring cell carcinoma and others): these are arranged into clumps of cancerous cells
–> mixed carcinoma: mix of types of adenocarcinoma of the stomach
Describe the lauren classification
-Intestinal type: tumours are well differentiated, slow growing and tend to form glands. Found more often in men than women and occurs more in older people
-Diffuse type: tumour cells are poorly differentiated, behave aggressively and scatter throughout stomach (ratbher than form gladns). Metastasises much quicker than intestinal type
7-10 days later after gastric ca the patient had axillary vein thrombosis, what predisposes to that?
-Hypercoagulable state in malignancy
-Venous stasis from virchow LN
6 months later the patient came with ascites, deranged LFT, hepatic metastasis. What 2 pasthagolical tests would you do?
-Ascitic tap and cytology
-Liver biopsy from metastasis
-FNA from left supraclavicular lymph node
How would you treat the patient with metastatic gastric ca with hepatic mets and ascies?
-Feeding jejunostomy
-Palliation of ascites by repeated tapping
-Anticipatory medications for symptom control
-Palliative chemotherapy
What is the mechanism of malignant ascites in cirrhotic liver?
-Hypoalbuminaemia leading to raised oncoting pressure
-Portal hypertension leading to ascites
What is the borrmann classification of gastric ca?
-Polypoid growth
-Fungating growth
-Ulcerating growth
-Diffusely infiltrating growth (linitis plastica)
Which para-neoplastic syndromes are associated with gastric ca?
-acanthosis nigricans
-Dermatomyositis
What are the procedure specific complications of total gastrectomy?
Early:
–> anastamotic leak
–> pancreatitis
–> cholecystitis
–> haemorrhage
–> infection
Late
–> dumping syndrome
–> vitamin B12 defiency (lack of intrinsic factor)
–> metabolic bone disease
–> recurrence of malignancy
What is dumping syndrome?
-Loss of the resevoir function of the stomach (e.g. following gastrectomy) results in rapid transit of highly osmotically active substances into the duodenum following meals and may cause ‘dumping syndrome’
-Early dumping: 30-60 minutes following meal, rapid transit of hyperosmolar gastric contents into the small bowel results in a fluid shift from the intravascular compartment to the gastric luman and small bowel distension, colicky abdominal pain, diarrhoea and vasomotor symptoms, such as tachycardia and postural hypotension
-Late dumping: 1-3 hours following meals. Rapid transit of carbohydrate into the small bowel results in sudden absorption of high levels of glucose and compensatory hyperinsulinaemia resulting in subsequent hypoglycaemia
