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GI > Oral & oesophageal pathology > Flashcards

Oral & oesophageal pathology Flashcards

1
Q

Which type of oesophagitis is more common?

A

Chronic oesophagitis

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2
Q

What is reflux oesophagitis?

A

Inflammation of the oesophagus due to refluxed low pH gastric content.

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3
Q

What are the causes of reflux oesophagitis?

A

May be due to defective sphincter mechanism ± hiatus hernia.
Abnormal oesophageal motility.
Increased intra-abdominal pressure (pregnancy).

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4
Q

What happens during reflux oesophagitis on a microscopic level?

A

Basal cell hyperplasia - basal zone epithelial expansion and lengthening of papillae.
(Increased proliferation to compensate for increased cell desquamation)

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5
Q

What are some complications of reflux?

A

Ulceration (bleeding)
Stricture (abnormal narrowing of lumen)
Barrett’s oesophagus (replacement of stratified squamous epithelium by columnar epithelium)

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6
Q

What causes Barrett’s oesophagus?

A

Chronic inflammation due to persistent reflux of acid or bile.
May be due to differentiation from oesophageal stem cells.

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7
Q

What is Barrett’s oesophagus?

A

A protective response where the stratified squamous epithelium of the oesophagus is replaced by columnar epithelium - goblet cells.

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8
Q

What are some microscopic signs of Barrett’s oesophagus?

A

Red velvety mucosa in lower oesophagus - columnar lined mucosa with intestinal metaplasia.

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9
Q

What is the name for the disease in which there would be a spotty or corrugated (feline) oesophagus?

A

Allergic / eosinophilic oesophagitis

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10
Q

Who is more likely to be affected by allergic oesophagitis?

A

Males > females
Young
Asthma
Personal/family history of allergy

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11
Q

What test can differentiate GORD from eosinophilic oesophagitis?

A

pH probe is negative for reflux in allergic oesophagitis

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12
Q

How can eosinophilic oesophagitis be differentiated from eosinophilic gastritis?

A

The gastric & duodenal tissues are affected in EG no EO.

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13
Q

What is a typical presentation of allergic oesophagitis?

A

Intermittent dysphagia (particularly solids).
The solid food can cause chest pain, which can mimic a MI.
Heartburn
Some sort of allergy, e.g. asthma, eczema, hay fever.

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14
Q

What are the 2 types of malignant carcinomas of the oesophagus?

A

Squamous cell carcinoma

Adenocarcinoma

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15
Q

What are risk factors for oesophageal squamous cell carcinomas?

A 
>males
caucasians
obesity
smoking & alcohol
HPV
comments in lower 1/3rd of oesophagus - Barrett's oesophagus
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16
Q

Which type of malignant cancer does Barrett’s mainly predispose to?

A

Adenocarcinoma

Increased risk of developing dysplasia then adenocarcinoma of the oesophagus.

17
Q

Pathogenesis of adenocarcinoma?

A

Genetic factors / reflux disease -> Chronic reflux oesophagitis -> Barrett’s oesophagus -> low grade dysplasia -> high grade dysplasia -> adenocarcinoma.

18
Q

What are the mechanisms of metastases of oesophageal carcinomas?

A

Direct invasion
Lymphatic permeation
Vascular invasion

19
Q

What are some clinical presentations of oesophageal carcinoma?

A

Dysphagia - due to obstruction

General symptoms of malignancy - anaemia, weight loss, fatigue.

20
Q

Which type of carcinoma is 90% of all oral cancers?

A

squamous cell carcinoma (SCC)

21
Q

How can oral cancer present?

A

White / red / speckled / ulcer / lump

22
Q

Where are the most high risk sites of cancer in the mouth?

A

Floor of mouth
Lateral border of ventral tongue
Soft palate
Reto molar pad / tonsillar pillars

23
Q

Where are the rarer sites of oral cancer?

A

hard palate

dorsum of tongue

24
Q

How are SCC graded?

A

By degree of differentiation:
Well-differentiated tumour cells very obviously squamous with ‘prices’ and keritinization.

Moderately differentiated

Poorly differentiated, may be difficult to identify tumour cells as epithelial

25
Q

What are some histopathological features relating to the prognosis of SCC?

A
  1. tumour diameter
  2. depth of invasion
  3. pattern of invasion
  4. lymphovascular invasion
  5. neural invasion by tumour
  6. involvement of surgical margins
  7. metastatic disease
  8. extra-capsular spread of lymph node metastases
26
Q

What does TMN stand for?

A 
T = diameter of primary tumour (+) structures invaded
N = lymph node status
M = metastases
27
Q

What would cause more difficulty swallowing liquids than solids?

A

Neuromuscular conditions that cause abnormal peristalsis of the oesophagus = oesophageal dysmotility.

underlying cause - achalasia

28
Q

What is the classical picture a barium swallow would show of achalasia?

A

“bird’s beak”

29
Q

what does ‘halitosis’ mean? And which condition is it associated with?

A

bad breath - pharyngeal pouch (dysphagia, regurgitation, cough, halitosis)

GI (6 decks)

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