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GI lectures > Pathology of oesophagus and mouth > Flashcards

Pathology of oesophagus and mouth Flashcards

1
Q

what is reflux oesophagitis?

A

inflammation of oesophagus due to refluxed low pH content

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2
Q

what might cause reflux oesophagitis?

A

defective sphincter motility +/- hiatus hernia
abnormal esophageal motility
increased intra-abdominal pressure (pregnancy)

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3
Q

what will be seen microscopically in oesophagitis?

A

bazal zone epithelial expansion

intraepithelial neutrophils, lymphocytes and eosinophils

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4
Q

what will be seen histologically in oesophagitis?

A

basal zone expansion

lengthening of papillae

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5
Q

what can cause a tissue to change?

A

continuous stress

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6
Q

list 3 complications of reflux

A

ulceration (discontinuity in epithelial surface)
stricture (due to healing/scarring of ulcer causing dysphagia etc)
Barrets Oesophagus

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7
Q

what is Barrets oesophagus?

A

replacement of stratified squamous epthelium by columnar epithelium due to persistant reflux of acid or bile

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8
Q

what does barrets oesophagus do to the epithelium of the oesophagus?

A

red velvety mucosa replaces squamous

squamous mucosa replaced by columnar mucosa which is genetically unstable

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9
Q

what is another name for allergic oesophagitis?

A

eosinophilic oesophagitits

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10
Q

when is allergic oesophagitis more common?

A

family history of allergy
asthma
young
males more than females

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11
Q

what are the findings in allergic oesophagitis?

A

pH probe negative for reflux
increased eosinophils in blood and intraepithelium
corrugated (feline) or spotty oesophagus (oesophagus looks like trachea)

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12
Q

how is allergic oesophagitis treated?

A

steroids
chromoglycate
monteleukast

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13
Q

what is the most common benign oesophageal tumour?

A

squamous papilloma

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14
Q

list 4 other benign oesophageal tumours

A

leiomyomas
lipomas
fibrovascular polyps
granular cell tumours

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15
Q

what are the 2 types of oesophageal tumours?

A

squamous cell carcinoma

adenocarcinoma

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16
Q

who is squamous cell carcinoma more common in?

A 
males
smokers
drinkers
Vit A/zinc deficiency
HPV
17
Q

what is the pathogenesis of squamous cell carcinoma?

A

normal > GORD > severe dyspasia

18
Q

what physical problems can oesophageal squamous cell carcinomas cause?

A

dysphagia

eventually cant swallow solid foods

19
Q

what does squamous cell carcinoma look like histologically?

A

keratinised pearls

20
Q

who is adenocarcinoma more common in?

A

Caucasian males
obese
the West
People with Barrets oesophagus

21
Q

where is an adenocarcinoma most likely to arise?

A

lower 1/3rd of oesophagus

22
Q

describe the pathogenesis of adenocarcinoma

A

genetic factor, reflux disease etc > chronic reflux > Barrets oesophagus > low grade dysplasia > high grade dysplasia > adenocarcinoma

23
Q

name 3 mechanisms of metasteses in carcinoma of the oesophagus

A

direct invasion
lymphatic permeation
vascular invasion

24
Q

where can an oesophageal carcinoma directly invade?

A

trachea (produces fistula)
causes aspiration pneumonia, sepsis, death etc
Heart
Anything nearby

25
Q

the oesophagus is enriched in lymph nodes, true or false?

A

true

this is why carcinoma can spread via lymph nodes

26
Q

how might a carcinoma of the oesophagus present?

A

dysphagia (due to obstruction)

General malignancy symptoms (anaemia, weight loss, lethargy etc)

27
Q

what type are 90% of oral cancers?

A

squamous cell carcinoma

as smoking etc damages eithelium

28
Q

how might an oral SCC present?

A

white, red, speckled, ulcer, lump

29
Q

what can cause an oral SCC?

A 
tobacco
alcohol
betel quid (rare)
HPV
other rare causes
30
Q

how are SCCs graded?

A

by degree of differentiation

  • well differentiated tumour cells, obviously squamous with prickles and keratinization
  • moderately differentiated
  • moderately differentiated, difficult to identify as epithelial
31
Q

what histopathological features can affect the prognosis of SCC?

A

tumour diameter
depth of invasion
pattern of invasion (cohesive or non-cohesive)
Lymphovascular invasion

32
Q

what is TNM system?

A

staging of tumours
T = diameter of tumour, structures invaded
N = lymph node status
M = metasteses

33
Q

what types of treatment are there for SCC?

A

surgery

+/- adjuvant therapy

34
Q

what is the 5 year survival from SCC and why?

A

40-50%

due to late detection

35
Q

Barrets oesophagus causes increased risk of dysplasia and carcinoma, true or false?

A

true

36
Q

is barrets oesophagus kept under surveillance?

A

yes

GI lectures (75 decks)

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