*Oesophageal and Stomach Disorders (lectures 3 and 4) Flashcards

1
Q

What mucosa lines the normal oesophagus?

A

Stratified squamous epithelium

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2
Q

What tends to cause acute oesophagitis?

A

Rare but usually caused by corrosion following chemical ingestion or infection in immunocompromised patients e.g. candidiasis, herpes

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3
Q

What tends to cause chronic oesophagitis?

A

Reflux disease - “reflux oesophagitis)

Rarely, caused by crohns

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4
Q

What is reflux oesophagitis?

A

Inflammation of oesophagus due to refluxed low pH gastric content

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5
Q

Microscopic appearance of reflux oesophagitis?

A

Basal zone epithelial expansion (hyperplasia)

Intraepithelial neutrophils, lymphocytes and eosinophils

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6
Q

What is Barrett’s oesophagus?

A

Replacement of stratified squamous epithelium by columnar epithelium with intestinal metaplasia

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7
Q

How does the metaplasia occur in Barrett’s oesophagus?

A

Due to expansion of columnar epithelium from gastric glands or from submucosal glands
Due to differentiation from oesophageal stem cells

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8
Q

What is allergic oesophagitis?

Other name

A

An inflammatory condition in which the walls of the oesophagus become filled with eosinophils
“eosinophillic” oesophagitis

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9
Q

What type of patients does allergic oesophagitis tend to occur in?

A

Those with a personal/ family history of allergy e.g. asthma
Young
Males more than females

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10
Q

pH probe of allergic oesophagitis?

A

Negative for reflux

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11
Q

Blood test in a patient with allergic oesophagitis?

A

Increased eosinophils

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12
Q

Appearance of an allergic oesophagitis?

A

Corrugated or “spotty” oesophagus

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13
Q

Treatment for allergic oesophagitis?

A

Steroids/ chromoglycate/ montelukast

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14
Q

What benign tumours are most commonly found in the oesophagus?
What are they associated with

A

Squamous papillloma
Rare
HPV

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15
Q

Other benign tumours of the oesophagus apart from squamous papilloma?

A
Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours
VERY rare
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16
Q

What is the commonest type of oesophageal cancer in males?

A

Squamous cell carcinoma

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17
Q

Causes of squamous cell carcinoma?

A
Vitamin A, zinc deficiency
Tannic acid/ strong tea
Smoking, alcohol
Oesophagitis
Genetic
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18
Q

What is commonest type of oesophageal cancer in caucasians?

A

Adenocarcinoma

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19
Q

Steps to developing adenocarcinoma of oesophagus?

A

genetics, reflux, etc. - chronic reflux oesophagitis - barretts oesophagus - low grade dysplasia - high grade dysplasia - adenocarcinoma

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20
Q

What type of cancers are the majority of oral cancers?

A

Squamous cell carcinoma

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21
Q

What parts of the mouth is it rare to develop cancer on?

A

Hard palate

Dorsum of tongue

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22
Q

Causes of squamous cell carcinoma of the oral cavity?

A
Tobacco
Alcohol
Betel quid
Viral? (HPV)
Chronic infections?
Nutritional deficiencies
?genetics
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23
Q

Staging system for oral cancer?

A

TNM system

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24
Q

Treatment of oral cancer?

A

Surgery +/- adjuvant therapy

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25
Q

What is another name for dyspepsia?

A

Indigestion

26
Q

What is dyspepsia?

A

pain or discomfort in the upper abdomen after eating and sometimes accompanied by nausea, vomiting or a feeling of unease or fullness

27
Q

What is the name given to epigastric pain or burning?

A

Epigastric pain syndrome

28
Q

What is the name given to postprandial fullness?

A

Postprandial distress syndrome

29
Q

What is the name given to early satiety?

A

Postprandial distress syndrome

30
Q

What are the 2 different categories of causes of dyspepsia?

A

Organic (25%)

Functional (75%)

31
Q

What are 3 organic causes of dyspepsia?

A

Peptic ulcer disease
Drugs (esp NSAIDS, COX2 inhibitors)
Gastric cancer

32
Q

What is functional dyspepsia?

A

Same symptoms of dyspepsia but no evidence of culprit disease
(associated with other functional gut disorders e.g. IBS)

33
Q

Difference between dyspepsia/ indigestion and heartburn/ reflux?

A

Heartburn is an unpleasant condition that occurs when acid from the stomach leaks into the oesophagus and rises upwards to cause pain and discomfort in the chest. Indigestion is a general term for pain or discomfort felt in the stomach and under the ribs.

34
Q

What are ALARM Symptoms related to dyspepsia?

A
Anaemia
Loss of weight
Anorexia
Recent onset/ progressive symptoms
Melaena/ haematemesis
Swallowing difficulty
35
Q

Action required if patient has dyspepsia with alarm symptoms?

A

Refer to hospital

36
Q

Action if patient has dyspepsia with no alarm symptoms?

A

Check H pylori status
Eradicate if infected (cures ulcer disease, removes risk of gastric cancer)
If HP -ve, treat with acid inhibition as required

37
Q

What is the Rome III diagnostic criteria for Functional dyspepsia?

A

Presence of at least one of the following:
Bothersome postprandial fullness
Early satiation
Epigastric pain
Epigastric burning
And
No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
Symptom onset 6 months ago with criteria fulfilled for past 3 months

38
Q

What happens to patients with peptic ulcer diseases pain when they eat?

A

It is either aggravated or relieved

39
Q

What type of course does peptic ulcer disease lead?

A

A relapsing and remitting chronic illness

40
Q

Is peptic ulcer disease genetic?

A

Family history is common

41
Q

What are 2 major causes of peptic ulcer disease?

A

H pylori
NSAIDs
possibly also gastric dysmotility and outflow obstruction

42
Q

What % of DU and GU does H pylori cause?

A

90% of DU
60% of GU
(NSAIDs cause most of the rest)

43
Q

What is a peptic ulcer?

A

a lesion in the lining (mucosa) of the digestive tract, typically in the stomach or duodenum, caused by the digestive action of pepsin and stomach acid.

44
Q

When is H pylori usually acquired?

A

Infancy

45
Q

What is the appearance of H pylori?

A

Gram negative microaerophilic flagellated bacillus

46
Q

How is H. pylori spread?

A

Oral-oral/ faecal-oral route

47
Q

What are the consequences of being infected by H pylori?

A

Usually no pathology
20-40% = peptic ulcer disease
1% = gastric cancer

48
Q

What do G cells in the stomach do?

A

Produce gastrin in response to a higher pH (this is a hormone that stimulates the parietal cells to increase secretion of HCl)

49
Q

How does H pylori affect gastrin production?

A

It increases the production of gastrin and therefore increases acid production and leads to an ulcer

50
Q

How does intense infection with H pylori affect the stomach?

A

It causes gastric atrophy
This results in the distal part of the stomach producing lots of gastrin trying to drive the stomach to produce acid but they can’t due to atrophy - this can lead to gastric carcinoma

51
Q

What mucosal appearance does chronic gastritis tend to have?

A

A cobble stone appearance

52
Q

Diagnosis of H pylori infection? (4)

A

Gastric biopsy (urease test, histology, culture/ sensitivity)
Urease breath test (need to stop PPI) (helicobacter produces large amounts of urease)
FAT (faecal antigen test)
Serology (IgA) - not accurate with increasing patient age so doesn’t tend to get done

53
Q

Treatment of peptic ulcer disease?

A
All PPI
All tested for H pylori
If +ve eradicate and confirm
Withdraw NSAIDs
Change lifestyle e.g. diet
Surgery is sometimes performed
54
Q

Do PPIs and H2RAs heal ulcers?

A

yes - PPIs do it better

55
Q

Eradication therapy for H pylori?

A

Tripel therapy for 1 week = commenest
2 week regimens = higher eradication rates but poorer compliance
(dual therapy is not recommend)

56
Q

Triple therapy for H pylori?

A

PPI bd + amoxicillin 1g bd + clarithromycin 500mg bd
PPI bd + metronidazole 400mg bd + clarithromycin 250mg bd
Usually for 1 week but there are 2 week regimens

57
Q

Complications of peptic ulcer disease?

A

Anaemia, bleeding, perforation (doesn’t happen often), gastric outlet/ duodenal obstruction - fibrotic scar

58
Q

Post-therapy follow up for DU?

A

Uncomplicated DU requires no f/u unless ongoing symptoms

59
Q

Post-therapy follow up for GU?

A

F/u endoscopy at 6-8 weeks

Ensure healing and no malignancy

60
Q

does achlorhydria increase risk of gastric cancer?

A

Yes e.g. pernicious anaemia, previous gastric surgery

61
Q

What is Correa’s hypothesis of gastric cancer?

A

A combination of H pylori, smoking and salt causes the following changes:
Normal - chronic gastritis - atrophy - intestinal metaplasia - dysplasia - neoplasia

62
Q

What type of patients with H pylori are prohibited from developing gastric cancer?

A

Those with H/ pylori who have had a previous peptic ulcer