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CP > pathology of the GI tract 1 > Flashcards

pathology of the GI tract 1 Flashcards

1
Q

What is gastro-oesophogeal reflux a precursor to?

A

barretts oesophagus

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2
Q

What is barretts oesophagus a precursor to?

A

oesophageal carcinoma

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3
Q

What epithelium is the normal oesophagus lined by?

A

layers of squamous epithelium

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4
Q

What is the oesophagus below the diaphragm lined by?

A

glandular (columnar) epithelium

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5
Q

What is oesophagitis?

A

Inflammation of the oesophagus

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6
Q

What are the two classifications of oesophagitis?

A

Acute and chronic

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7
Q

What causes oesophagitis?

A

infections (mainly in immunocompromised) e.g. viral (HSV1, CMV), fungal (candida), bacterial
chemical e.g. ingestion of corrosive substances, reflux of gastric content (most common cause)

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8
Q

What causes reflux oesophagitis?

A

reflux of gastric acid and/or bile

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9
Q

What are the risk factors for reflux oesophagitis?

A

defective lower oesophageal sphincter
hiatus hernia
increased intra abdominal pressure
increased gastric fluid vol due to gastric outflow stenoisis e.g. tumour

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10
Q

What is the leading clinical symptom for reflux oesophagitis?

A

heartburn - more burning that crushing pain unlike cardiac pain

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11
Q

What histological changes occur in reflux oesophagitis?

A

basal cell hyperplasia
elongation of papillae
scraping off of squamous cells
increase in number of inflammatory cells

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12
Q

What are the complications of reflux oesophagitis?

A

ulceration
haemorrhage (when ulcers goes into sub mucosa)
perforation
benign strictures (due to healing and contraction of scar tissue)
barretts oesophagus

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13
Q

What are the risk factors for barretts oesophagus and reflux oesophagitis?

A

male
caucasian
overweight

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14
Q

What is the histology of barretts oesophagus?

A

extension of sqaumo-columnar junction

squamous mucosa replaced by columnar mucosa = glandular metaplasia

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15
Q

What is important about the intestinal type of columnar mucosa in barretts oesophagus?

A

specialised barretts mucosa
contains goblet cells
used as diagnosis for barrets oesophagus

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16
Q

what are the two histological types of oesophageal carcinomas?

A

squamous cell carcinoma

adenocarcinoma

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17
Q

What group of people have higher incidence of adenocarcinomas?

A 
male
Caucasian
smokers
obese
people who has barrets oesophagus
18
Q

What does adenocarcinoma look like?

A 
plaque like
nodular
fungating
ulcerated
depressed
infiltrating
19
Q

What are the risk factors for squamous cell carcinoma?

A 
tobacco
alcohol
nutrition - source of nitrosamines
thermal injury - hot beverages
HPV
male
black ethinicity
20
Q

What are the histological features of squamous dysplasia?

A

atypical, large nuclei
more mitosis that are atypical and typical which rise
basement membrane not breached = dysplasia

21
Q

What staging is used for oesophageal carcinomas?

A

TNM

22
Q

What are the causes of chronic gastritis?

A 
Autoimmune
Bacterial infection e.g. h. pylori
Chemical injury
NSAIDS
Bile reflux
alcohol?
23
Q

What are the features of H. pylori and what does it do to the stomach?

A 
damages epithelium therefore chronic inflammation of the mucosa
most common in the antrum
glandular atrophy
replacement fibrosis
intestinal metaplasia
24
Q

What are the complications of H. pylori?

A

85% have no symptoms
gastric ulcers
duodenal ulcers
these predispose to gastric cancer

25
Q

What is peptic ulcer disease?

A

ulcers in the stomach extending at leas into the submucosa

26
Q

what are the major sites for peptic ulcers?

A

first part of duodenum
junction of antral and body mucosa
distil oesophagus

27
Q

What are the major factors that cause peptic ulcers?

A 
hyperacidity
h. pylori
duodeno-gastric reflux
drugs (NSAIDs)
smoking
28
Q

what is the histology of a acute gastric ulcer?

A

full thickness coagulative necrosis of mucosa/deep layers
covered with ulcer slough (necrotic debris, fibrin, neutrophils)
granulation tissue on ulcer floor
flattening of the mucosa

29
Q

what is the histology of chronic gastric ulcers?

A

clear cut edges overhanging the base
extensive granulation and scar tissue at ulcer floor
scarring through gastric wall
bleeding

30
Q

What are the complications of peptic ulcers?

A

haemorrhage (could lead to anaemia)
perforation → peritonitis
penetration into adjacent organs
stricturing → hour glass deformity

31
Q

What tends to cause gastric adenocarcinomas?

A 
diet (smoked/cured meat, pickled veg)
H. pylori
bile reflux
hypochlorhydria - allows bacterial growth
hereditary
32
Q

what is hypochlorhydria?

A

states where the production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low

33
Q

Who is most at risk of getting carcinoma of the gastric body/antrum?

A

those with h. pylori

those with a diet of high salt and low fruit and veg

34
Q

What are the 6 macroscopic subtypes of gastric cancer?

A 
superficial exophytic
flat/depressed
superficial excavated
exophytic
linitis plastica
excavated
35
Q

What are the 2 main histological subtypes of gastric cancer and describe them.

A

diffused type - scattered growth, poorly differentiated, ring cells, worse prognosis
intestinal type - tubular, glands, well differentiated, metaplasia

36
Q

What is used to stage gastric cancer?

A

TNM staging

37
Q

What is coeliac disease also known as?

A

coeliac sprue

gluten sensitive enteropathy

38
Q

What is coeliac disease?

A

immune mediated enteropathy
caused by ingestion of gluten products as they contain GLIADIN - causes cells to express IL-15
IL-15 causes the activation/proliferation of CD8 and IELs
CD8 are cytotoxic and kill enterocytes
This causes atrophy of the villi

39
Q

How does the diagnosis of coeliac disease come about?

A

commonly affects the ages of 30-60 years
Difficult to diagnose
can often be atypical presentation, silent disease, latent disease or symptomatic

40
Q

What is the treatment for coeliac disease?

A

gluten free diet

41
Q

How is coeliac disease diagnosed?

A

serologic tests e.g IgA/IgG

tissue biopsy

CP (50 decks)

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