Pathology of Common UGI Conditions

Question 1

Hiatal hernia

Answer 1

Abnormal passage of a segment of stomach above the diaphragm

Normal stomach is entirely below the diaphragm

Question 2

2 types of hiatal hernias

Answer 2

Sliding

Paraesophageal (nonaxial)

Question 3

4 complications from hiatal hernias

Answer 3

Ulceration
Bleeding
Perforation
Strangulation of paraesophageal hernias

Question 4

Achalasia

Answer 4

Functional disorder of the esophagus characterized by increased resting tone and incomplete relaxation of LES preventing food from entering the stomach
Can be primary (unknown cause) or secondary (ex: Chaga’s, malignancy, sarcoidosis)
See bird beak sign on radiology

Question 5

Esophagitis (and 3 causes)

Answer 5

Inflammation and epithelial damage of esophagus
Inflammation can be from infection, irritant, or autoimmune
Causes: gastroesophageal reflux, infection, eosinophilic esophagitis

Question 6

Eosinophilic esophagitis

Answer 6

Type of esophagitis that is characterized by numerous eosinophils within the squamous mucosa and associated with dysphagia
Presents with: dysphagia, rings in the esophagus
More common in males
Biopsy needed to confirm presence of eosinophils

Question 7

5 factors that contribute to GERD

Answer 7

Low resting tone in LES
Delayed esophageal clearance
Delayed gastric emptying
Increased abdominal pressure
Increased acid production

Question 8

Water brash

Answer 8

In GERD
Hot sensation in the stomach, followed by a large amount of watery liquid in the mouth
Usually tastes bitter
From excess saliva and stomach acid

Question 9

5 complications from GERD

Answer 9

Stricture (scarring only if you lose the mucosa)
Ulceration
Bleeding
Barrett Esophagus
Adenocarcinoma

Question 10

Biopsy of GERD will show what 3 things

Answer 10

Increased inflammatory cells in epithelial layer (eosinophils, neutrophils, excess T cells)
Basal cell hyperplasia exceeding 15-20% of epithelial thickness
Elongation of lamina propria papillae extending into upper 1/3 of epithelium

Question 11

What is Barrett’s esophagus

Answer 11

Distal squamous mucosa of esophagus is replaced by metaplastic columnar epithelium
Response to prolonged injury, columnar epithelium may be more resistant to acid
Risk for dysplasia and subsequent esophageal adenocarcinoma

Question 12

Long vs short segment Barrett’s

Answer 12

Long segment: Barrett’s mucosa extends 3 cm or more from GE junction
Short segment: less than 3 cm

Question 13

Dysplasia from Barrett’s

Answer 13

Dysplastic epithelium that does not invade the lamina propria
Usually patchy and irregular
May appear thickened or as a mass
Dysplasia is assessed as low or high grade based on histologic assessment

Question 14

2 types of esophageal carcinoma

Answer 14

Squamous cell carcinoma

Adenocarcinoma

Question 15

Squamous cell carcinoma

Answer 15

Upper 2/3 of esophagus
Most common world wide
Risk factors: tobacco and alcohol

Question 16

Adenocarcinoma

Answer 16

Distal 1/3 of esophagus
Most common in Western countries
Risk factor: Barrett’s

Question 17

Gastritis

Answer 17

Inflammation/irritation of the gastric mucosa
Many causes
Several different classification schemes
Most take into account the acuity of the presentation and histologic features

Question 18

Acute gastritis

Answer 18

Sudden onset of inflammation and related symptoms
Often with erosions or ulcer
Rarely biopsied
Causes: NSAIDs, alcohol, acid, cocaine, stress (trauma, burns, critically ill, shock, sepsis), severely debilitated patients

Question 19

Chronic gastritis

Answer 19

Ongoing irritation/inflammation of the stomach due to several causes
Some have acute inflammation as well
Types: chronic active gastritis (Helicobacter), chronic autoimmune gastritis, reactive gastropathy, specific forms of gastritis

Question 20

Chronic active gastritis

Answer 20

Persistent inflammation of the gastric mucosa with varying degrees of acute inflammation
Related to H pylori infection
Typically affects antrum, may extend to the body
Increased risk of gastric carcinoma and gastric lymphoma

Question 21

4 tests for H pylori

Answer 21

Serology
Urea breath test
Stool antigen test
Biopsy

Question 22

Reactive gastropathy

Answer 22

Chronic irritation of the gastric mucosa due to irritant
Usually with minimal inflammation
Causes: NSAIDs, bile reflux, chronic alcohol
Basically a catch all term when you dont know whats going on

Question 23

Peptic ulcer disease

Answer 23

Acid induced ulceration of the mucosa and wall of the stomach or duodenum
Often associated with H pylori
Peptic: related to digestive juices containing pepsin

Question 24

Ulcer vs erosion

Answer 24

Ulcer: full thickness of the mucosa
Erosion: limited to the superficial mucosa

Question 25

4 complications from PUD

Answer 25

Perforation
Hemorrhage
Obstruction (stenosis)
Penetration

Question 26

2 types of gastric polyps

Answer 26

Neoplastic (benign adenomas or malignant)

Non-neoplastic (hyperplastic or fundic gland polyps)

Question 27

2 types of malignant gastric neoplasms

Answer 27

Carcinoma (adenocarcinoma)

Lymphoma