Pathology of the Upper GI Tract Flashcards
What are the 5 commonest upper Gi conditions?
Oesophageal reflux Oesophageal cancer Gastritis Peptic ulceration Gastric cancer
What is oesophageal reflux? What is it caused by?
Reflux of gastric acid into oesophagus
Hiatus hernia
What is a hiatus hernia?
A hiatus hernia is when part of your stomach moves up into your chest via the oesophageal hiatus
What are the complitcations of oesophageal reflux?
Thickening of squamous epithelium
Ulceration of the oesophagus
Healing by fibrosis = Stricture formation
Barrett’s Oesophagus
What is barrett’s oesophagus?
metaplasia - squamous epithelium gets transformed to glandular epithelium
What is metaplasia
Abnormal change in the nature of a tissue
What is a major risk that comes with having barrett’s?
It is a pre-malignant condition
What is the 2 histological types of oesophageal cancer?
Squamous carcinoma
Adenocarcinoma - develops from barretts
Is oesophageal cancer linked with environmental factors?
yes
Risk factors for o. squamous carcinoma ?
Smoking
Alcohol
Dietary carcinogens
Risk factors for O. adenocarcinoma?
Barretts
Obesity
What is the local effects of o. cancer?
Obstruction
Ulceration
Perforation
What are the ways o.cancer can spread?
Direct to surrounding tissues
Lymphatic spread to regional lymph nodes
Blood spread to distant sites - liver
Prognosis for o. cancer?
Very poor - 5 yr survival rate less than 15%
What is the 3rd most common GI cancer?
oesophageal
What is gastritis?
Inflammation of the stomach mucosa
Types of gastritis?
Types ABC
Autoimmune
Bacterial
Chemical Injury
What happens in type A gastritis?
Autoantibodies attack parietal cells and intrinsic factor.
Causes atrophy of the specialised gastric epithelium and damages parietal cells
–> Decrease Acid Secretion & Loss of intrinsic factor
Which type of gastritis is commonest?
Type B (bacterial)
What bacteria is involved in type B gastritis?
Heliobactor Pylori (A gram -ve)
Where is H. pylori found?
Gastric mucus on surface of gastric epithelium
What does H.pylori do?
It releases ammonia
Stomach detects pH rise
Parietal cells release more acid
Increases acid = inflammation
How is type B gastritis treated?
Antibiotics
What causes Type C gastritis?
Drugs e.g. NSAIDS
Alcohol
Bile Reflux from Duodenum
What is a peptic ulceration?
An imbalance of acid secretion and the mucosal barrier = an ulcer
Where exactly do peptic ulcerations happen?
Lower oesophagus
Body + antrum of stomach
1st & 2nd parts of duodenum
What causes a peptic ulcer?
Too much acid
Acid in a place it shouldn’t
It’s usually associated with H.pylori infection
Complications of a peptic ulcer?
Bleeding
Perforation
Fibrosis
Describe the bleeding that comes with peptic ulcers.
Can be acute or chronic
Chronic is more common due to capillary damage. it leads to anemia
What happens due to perforations that come with peptic ulcers.
Gastric contents start to leak into the peritoneal cavity and cause peritonitis
Why does fibrosis occur? Consequences of it?
Attempt to heal
Can lead to an obstruction of the GI tract
How common is gastric cancer?
2nd commonest GI cancer
How does gastric cancer develop?
Metaplasia and dysplasia of the stomach epithelium
What is dysplasia?
the presence of cells of an abnormal type within a tissue
What is gastric cancer associated with?
Previous H.pylori infections
Histology of gastric cancer?
Adenocarcinomas
What types of spread is there with stomach cancer?
Direct - surrounding tissues
Regional - lymphatic
Blood - Liver
Transcoelomic - spread within the peritoneal cavity
Stomach cancer prognosis?
Very poor - 5 yr rate is less than 20%
