Pathology 1 - Non-Neoplastic Diseases of the Upper GI Flashcards
Most common cause of esophagitis and most common GI ailment
Gastro-esophageal reflux disease (esophagitis)
Gastro-esophageal reflux disease (GERD) symptoms
May be asymptomatic OR
* heartburn
* dysphagia (difficulty swallowing)
* chest/epigastric pain
Gastro-esophageal reflux disease (GERD) main causes (2)
GERD is caused by reflux of of gastric juices or bile into the esophagus because of:
1. abnormal tone of the lower esophageal sphincter
2. increased abdominal pressure (due to smoking, obesity, pregnancy, etc)
GERD macroscopic findings on endoscopic examination (2)
Hyperemia (redness)
Erosions/ulcers
GERD complications
- Hematemesis (vomiting blood)
- Melena (black, sticky stools)
- Strictures (narrowing)
- Barret esophagus (precursor to carcinoma)
To what treatments does GERD respond to?
Antacids
Proton pump inhibitors
Severity of symptoms in GERD is not closely related to histologic damage. Normally, there are none or only few intraepithelial eosinophils. What other microscopic findings are associated with GERD (2)
- elongated lamina propria papillae
- thickened basal cell layer
Eosinophilic esophagitis (definition)
Allergic inflammatory disease of the esophagus in response to food allergens (eg. soy products, cow milk)
Eosinophilic esophagitis is usually associated with a few other conditions (allergy symptoms)… (4)
- atopic dermatitis (rash)
- allergic rhinitis
- asthma
- modest peripheral eosinophilia
Eosinophilic esophagitis symptoms (3)
- dysphagia
- food impaction
- GERD-like symptoms
Eosinophilic esophagitis on endoscopic examination
Shows rings in upper and mid portions of the esophagus called feline trachealization
Eosinophilic esophagitis treatment (3)
Systemic corticosteroids
Diet
Topical corticosteroids
Eosinophilic esophagitis on microscopic examination
Numerous intraepithelial eosinophils
Summarize the main differences in location between GERD & eosinophilic esophagitis.
GERD: distal esophagus
EE: entire esophagus
Chemical Esophagitis (definition)
Esophageal mucosa can be damaged by chemicals such as:
* alchohol
* corrosive acids or alkalis
* hot fluids
* heavy smoking
* pills
* chemotherapy
* radiation
* graft-vs-host disease
Chemical esophagitis (main symptom)
Pain
Chemical esophagitis symptoms (if severe) (3)
hemorrhage
stricture
perforation
Chemical esophagitis on endoscopic examination (2)
nonspecific ulceration
acute inflammation
Infectious Esophagitis (definition)
Damage to esophageal mucosa in debilitated, immunosuppressed patients (e.g. post-transplant, HIV, malignancies)
Fungal organisms that cause infectious esophagitis (2)
- Candida (most common)
- Mucormycosis & aspergillosis
Viruses that cause infectious esophagitis (2)
CMV
HSV
Endoscopic findings for HSV vs CMV (infectious esophagitis)
HSV: punched out ulcers
CMV: shallow ulcerations
Infectious esophagitis: HSV microscopic findings
Inflammation (neutrophils, histiocytes) at the edge of the ulcer
Cytopathic effect in epithelial cells (ground glass viral inclusions, multinucleation, nuclear molding)
Infectious esophagitis: CMV microscopic findings
Nuclear and cytoplasmic inclusions (Owl’s eyes) within capillary endothelium and stromal cells
What is gastritis?
Mucosal injury due to imbalance between defensive and damaging forces of the stomach mucosa.
Gastropathy
a condition that damages the stomach lining, or mucosa, without causing much inflammation
Active vs Chronic gastritis (microscopy)
Active: Lots of inflammation (neutrophils) in lamina propria and glands
Chronic: Lots of lymphocytes and plasma cells in lamina propria
Gastropathy (microscopy)
Regeneration but very little inflammation
Reactive (chemical) gastropathy symptom
Abdominal pain
Reactive gastropathy (chemical) causes
NSAIDs
Alcohol
Bile
Stress-induced injury
Acute mucosal erosion, hemorrhage or ischemia
Acute mucosal erosion or hemorrhage will first show gastropathy and eventually…
become acute gastritis
Severe gastritis can lead to…
peptic ulcers
4 causes of chronic gastritis
- Helicobacter pylori gastritis
- Autoimmune gastritis
- Chronic NSAID usse
- Radiation injury and chronic bile reflux
Risk factors for Helicobacteri pylori (chronic active gastritis)
- Poverty
- Household crowding
- Limited education
- Poor sanitation
- Geography
What do Helicobacteri pylori (chronic gastritis) look like under the microscope?
Spiral-shaped/curved spiral bacterium
Why is gastritis secondary to H. pylori considered both chronic and active?
Neutrophil AND lymphocyte/plasma cell infiltration is present on light microscopy
H. pylori is usually acquired in…
childhood
H. pylori gastritis symptoms
Asymptomatic OR dyspepsia AND/OR epigastric pain
May present with peptic ulcer
Treatment of gastritis secondary to H. pylori
- Antibiotics
- Proton pump inhibtors (to reduce acid)
True or false: Patients with gastritis secondary to H. pylori with intestinal metaplasia and low-grade lymphomas respond poorly to treatment.
False! With antibiotics and proton-pump inhibitors these patients can improve (metaplasia is reversible and lymphomas are reversible with antibiotics)!
10% of chronic gastritis are caused by…
autoimmune gastritis
Autoimmune gastritis definition
Autoimmune process: Antibodies to parietal cells and intrinsic factor cause inflammation of gastric body with loss of parietal and chief cells.
Describe the inflammation of autoimmune gastritis
- Full thickness deep chronic inflammation
- Lymphocytes, plasma cell infiltration (rarely neutrophils)
- Atrophic and inflamed glands
- Disappearance of parietal and chief cells
Autoimmune gastritis is a risk factor for… (2)
adenocarcinoma
carcinoid tumours
Peptic ulcer disease
A breach in the integrity of the mucosa (extends beyond muscularis mucosa) caused by an imbalance in damaging and defense mechanisms of the mucosa
Most peptic ulcers occur in…
duodenum
In decreasing order of frequency, peptic ulcer location
- Duodenum
- Stomach
- Esophagus (GERDs)
Important differential diagnosis for peptic ulcer disease
Ulcerated tumours, most frequently an ulcerated adenocarcinoma
Microscopic appearance of peptic ulcer
Necrotic ulcer base is composed of granulation tissue overlaid by degraded blood
When do we most suspect and ulcerated tumour?
If the suspected ulcer/tumour is in the stomach!
Fundamental cause of peptic ulcer disease
Gastric acid
How can we differentiate a peptic ulcer from an ulcerated tumour?
Peptic ulcer:
- Small (<2cm)
- Regular borders, punched out
- Edges of ulcer are level with mucosa or slightly elevated
- Gastric rugae reach the edge of the ulcer
- Bottom is smooth, sometimes covered by a blood clot
Ulcerated tumour
- Large (>2cm)
- Irregular, thick, undurated borders
- Elevated edges
- Thick border of the ulcer separates it from the rugae
- Rough, irregular bottom with necrotic tissue
Celiac disease is an inflammatory disease of…
the small intestine
2 non-neoplastic diseases of the small bowel
- Diahrreal disease (celiac disease)
- Infectious endocarditis (giardasis)
Define celiac disease
Immune-mediated destructive inflammation triggered by gluten-containing food (wheat, rye or barley)
Explain the pathogenesis of celiac disease
Celiac disease is an immune reaction to a metabolite of gluten, particularly gliadin peptide.
Deaminated gliadin can react with antigen presenting cells to produce a T-cell mediated response.
Classic presentation of celiac disease
- Malabsorption
- Steatorrhea
- Abdominal discomfort
- Iron deficiency anemia
Risk factors for celiac disease
- Genetic predisposition (HLA-DQ2 or HLA-DQ8)
- Other autoimmune diseases (thyroiditis)
- European ancestry
Celiac disease treatment
Strict gluten-free diet
Celiac disease long-term risk
Lymphoma
Small bowel adenocarcinoma
Celiac disease on light microscopy
- Atrophic, thickened and shortened villi
- T-Lymphocyte infiltration in epithelium
- Expanded lamina propria with chronic inflammatory infiltrate
- Seen mainly in distal duodenum or proximal jejunum
How can we detect celiac disease on serology
IgA anti-TTG antibodies
Infectious enterocolitis mostly affects…
the large intestine
Giardia lamblia is also known as…
beaver fever
Giardia lamblia is a…
protozoa parasite (most common pathogenic parasite in humans) spread through fecally contaminated water
Symptoms of giardia lamblia infection
Acute or chronic malabsorptive diarrhea, failure to thrive
Giardia lamblia infection can lead to decreased…
decreased brush border enzymes (lactase) and lead to intolerance
Giardia lamblia microscopy
Non-invasive organisms on duodenal biopsy slides
