Pathology of Common UGI Conditions Flashcards
Hiatal hernia
Abnormal passage of a segment of stomach above the diaphragm
Normal stomach is entirely below the diaphragm
2 types of hiatal hernias
Sliding
Paraesophageal (nonaxial)
4 complications from hiatal hernias
Ulceration
Bleeding
Perforation
Strangulation of paraesophageal hernias
Achalasia
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
Esophagitis (and 3 causes)
Inflammation and epithelial damage of esophagus
Inflammation can be from infection, irritant, or autoimmune
Causes: gastroesophageal reflux, infection, eosinophilic esophagitis
Eosinophilic esophagitis
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
5 factors that contribute to GERD
Low resting tone in LES Delayed esophageal clearance Delayed gastric emptying Increased abdominal pressure Increased acid production
Water brash
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
5 complications from GERD
Stricture (scarring only if you lose the mucosa) Ulceration Bleeding Barrett Esophagus Adenocarcinoma
Biopsy of GERD will show what 3 things
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
What is Barrett’s esophagus
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
Long vs short segment Barrett’s
Long segment: Barrett’s mucosa extends 3 cm or more from GE junction
Short segment: less than 3 cm
Dysplasia from Barrett’s
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
2 types of esophageal carcinoma
Squamous cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
Upper 2/3 of esophagus
Most common world wide
Risk factors: tobacco and alcohol
Adenocarcinoma
Distal 1/3 of esophagus
Most common in Western countries
Risk factor: Barrett’s
Gastritis
Inflammation/irritation of the gastric mucosa
Many causes
Several different classification schemes
Most take into account the acuity of the presentation and histologic features
Acute gastritis
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
Chronic gastritis
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
Chronic active gastritis
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
4 tests for H pylori
Serology
Urea breath test
Stool antigen test
Biopsy
Reactive gastropathy
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
Peptic ulcer disease
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
Ulcer vs erosion
Ulcer: full thickness of the mucosa
Erosion: limited to the superficial mucosa
4 complications from PUD
Perforation
Hemorrhage
Obstruction (stenosis)
Penetration
2 types of gastric polyps
Neoplastic (benign adenomas or malignant)
Non-neoplastic (hyperplastic or fundic gland polyps)
2 types of malignant gastric neoplasms
Carcinoma (adenocarcinoma)
Lymphoma
