Pathology of the Upper-GI Tract

Question 1

What is at the GOJ (gastro-oesophageal junction)?

Answer 1

The lower oesophageal sphincter

Question 2

Pyloric sphincter where?

Answer 2

End of stomach (end of pylorus)

Question 3

Oesophagus epithelium?

Answer 3

Stratified squamous

Question 4

PAthology of oesophageal reflux?

Answer 4

reflux of acid into oesophagus
thickening of squamous epithelium
Ulceration (stripping) of oesophageal epithelium in severe reflux cases

Question 5

Hyperplasia vs hypertrophy?

Answer 5

hyperplasia = increase in no.
hypertrophy = increase in size

Question 6

What is ulceration?

Answer 6

stripping of the epithelium which then exposes blood vessles, cells etc

Question 7

Complications if oesophageal reflux

Answer 7

ulceration and healing by fibrosis (forms stricturs, imparining motility and potential obstruction
Barretts oesophasgus,

Question 8

WHa is Barrett’s oesophagus?

Answer 8

metaplasia of the lower oesophagus (Stratified squamous to mucosal like the stomach)

Question 9

meatplasia - cancer journey

Answer 9

Normal healthy cells, metaplasia, dysplasia, neoplasia (cancerous)

Question 10

hat are planeth cells?

Answer 10

the regenarative cells of the (GI?) oesophagus

Question 11

Top 3 cancers in gi tract

Answer 11

1. Adenocarcinoma of the colon
2. Gastric cancer
3. Oesophageal cancer

Question 12

What cancer type develops from barrets oesophagus?

Answer 12

adenocarcinoma (the glandular one because the squamous epithelium that was there is now mucosal glandular epithelium)

Question 13

Risk factors for oesophageal cancer : quamoos/adenocarcinoma

Answer 13

Squamous: Heavy drinker, smoker, carciogenic foods eg smoked things

Adenocarcinoma: Barretts Oesophagus, obesity (pulls on LOS and makes reflux more likely). Also foods high in vitamin K eg banana (causes more acid)

Question 14

What tyoe of food in your diet puis more likely to cause oesophagela refulx?

Answer 14

high in vit K (potassium)

Question 15

How can oesophageal cancer spread?

Answer 15

Through blood, lymph and adjacent tissues

Question 16

What are the 3 pathologies of gastritis?

Answer 16

A = Autoimmune/atrophic
B = Bacterial (H.Pylori)
C = Chemical injury

Question 17

What to look for to decide what type of gastritis?

Answer 17

History (atopic conditons),

Question 18

B12 deficincy means which gastritis?

Answer 18

Autoimmune, because causes atrophy and loss on intrinsic factor, and therefore vitamin B12 (pernicious anaemia)

Question 19

Histological findings A gastritis

Answer 19

Atrophy of the gastric epithelium. So loss of specialised gastric epithelial cells, reduction in gastric acid secretion and loss of intrinsic factor production.

Question 20

How does H. Pylkori cause disease in the stomach?

Answer 20

Produces K, effect on epithelium, able to get closer to epithelium ()less acidic)

Question 21

Most common ype of gastritis?

Answer 21

Bacterial

Question 22

Treatment of bacterial gastritis

Answer 22

Omeprazole and antibiotics

Question 23

What is chemical gastritis usually casused by?

Answer 23

Drugs, inc. NSAIDs, alcohol

Question 24

What else can cause chemical gastriis

Answer 24

Bile reflux

Question 25

Chemical gastritis histology

Answer 25

“corckscrewing” of gastric epithelium. No inflammation or microorganisms.

Question 26

Peptic ulceratoin complications

Answer 26

Bleeding
Acute = haemorrhage
Chronic = anaemia

Perforation - Peritonitis

Healing by fibrosis - Obstruction

Question 27

What is melena?

Answer 27

Black stools due to old blood in the poo (from a gastric bleed lower down in the GI tract usually)

Question 28

Metaplastic change of gastric cancer

Answer 28

adenocarcinoma

Question 29

Where does stomach cancer spread to?

Answer 29

Direct: to surrounding tissues eg. pancreas
Lymphatic spread (regional lymph nodes)
Blood spread (to liver)
Transcoelemic spread

Question 30

Prognosis oesophpgeal vs stomach cancers

Answer 30

Both very poor.

Oesophageal 5 year = less than 15%

Gastric 5 year = less than 20%