pathology of the upper GIT

Question 1

dyspepsia

Answer 1

heartburn/indigestion

Question 2

dysphagia

Answer 2

difficulty swallowing

Question 3

odynophagia

Answer 3

pain on swallowing

Question 4

fistulae

Answer 4

passage between organs

Question 5

haematemesis

Answer 5

vomiting of blood

Question 6

mucosal web

Answer 6

formation of mucosa over damage in the oesophagus causing a blockage

Question 7

schatzbi rings

Answer 7

caused by iron defiiency

mechanical obstruction of the oesophagus

Question 8

achalasia

Answer 8

increased sphincter tone
aperistalsis
dysphagia, belching

Question 9

oesophageal varices

Answer 9

tortuous, dilated veins caused by portal hypertension

usually due to increased pressure and resistance to blood flow through the portal veinous system and liver

Question 10

GORD

Answer 10

gastro-oesophageal reflux disease

reflux symptoms occurring at least once a week

Question 11

acid reflux

Answer 11

sensation/taste of acid in oesophagus/mouth
dyspepsia
often worse after eating or when lying down

Question 12

GORD is made worse by

Answer 12

overnight, pregnant, some foods (mint, citrus, chocolate, fried foods, carbonated drinks), alcohol, caffeine, smoking, NSAIDS

Question 13

causes of reflux

Answer 13

inadequacy of lower oesophageal sphincter

• transient lower oesophageal sphincter relaxation, mediated by vagal pathways, can be triggered by gastric distension or abrupt increase in intra-abdominal pressure
• hiatus hernia
• function causes - increased gastric falling, lower pH, delayed gastric emptying

Question 14

hiatal hernia

Answer 14

oesophagus passes through the hiatus in the crural part of the diaphragm
prolapse of part of the stomach into the thorax
causes reflux

Question 15

2 types of hiatal hernia

Answer 15

sliding and rolling

Question 16

rolling hernias usually occur in

Answer 16

more severe damage in the diaphragm

Question 17

consequences of GORD

Answer 17

acute or chronic inflammation - i.e. reflux oesophagatitis, which can lead to ulceration and reactive changes in pesophagitis including formation of strictures (narrowing)
chronic inflammation and exposure to low pH from acid gastric contents leads to chronic cellular injury and adaptation, including intestinal metaplasia, dysplasia and carcinoma

Question 18

morphology of GORD may be

Answer 18

mild moderate or severe

Question 19

mild GORD

Answer 19

hyperaemia, redness of the mucosa

minimal inflammation and mild hyperplasia

Question 20

moderate GORD

Answer 20

small erosions, more significant redness
more significant basal hyperplasia, papillary elongation, intraepithelial inflammatory cells including neutrophils and small numbers of eosinophils

Question 21

severe GORD

Answer 21

active inflammation, ulceration or barrett metaplasia

inflammatory cells are more prominent, ulceration, intestinal metaplasia in areas of Barrett’s

Question 22

barrett oesophagus

Answer 22

complication of chronic inflammation where oesophageal squamous mucosa undergoes metaplasia to intestinal type epithelium

Question 23

barrettt oesophagus increases risk of

Answer 23

oesophageal adenocarcinoma

Question 24

morphology of Barrett oesophagus

Answer 24

tongues of red, velvety mucosa extending upwards from the GOI, within residual islands of pale mucosa
intestinal metaplasia characterised by columnar cells with prominent intestinal type goblet cells
moderate to severe inflammation which may or may not include dysplasia

Question 25

eosinophilic oesophagitis

Answer 25

characteristic form of inflammation with numerous eosinophils, associated with atopic disease

Question 26

many patients with eosinophilic oesophagitis also have

Answer 26

other atopic diseases

atopic dermatitis, allergic rhinitis, asthma, or peripheral eosinophilia

Question 27

symptoms of eosinophilic oesophagitis

Answer 27

in addition ro GORD-like symptoms, patients may also have food impaction, dysphagia, and vomiting

Question 28

appearance of eosinophilic oesophagitis

Answer 28

stacked circular rings - referred to as feline oesophagus
strictures
linear furrows/ulcers
histologically - large numbers of intraepithelial eosinophils

Question 29

eosihophillic oesophagus is not associated with

Answer 29

increased risk of Barrett’s oesophagus or adenocarcinoma

Question 30

infective causes of oesophigitis

Answer 30

may be fungal - candida

or viral - HSV, CMV

Question 31

infective oesophagitis mainly seen in

Answer 31

immunocompromised patients

Question 32

oesophageal cancer is usually

Answer 32

adenocarcinoma or squamous cell carcinoma

Question 33

oesophageal adenocarcinoma risk factors

Answer 33

tobacco use, radiation, obesity
males
more common in caucasians

Question 34

oesophageal adenocarcinoma usually occurs in

Answer 34

distal third of the oesophagus and may extend into the stomach

Question 35

morphology of oesophageal adenocarcinoma

Answer 35

flat or raised patches which grow into large, ulcerating and fumigating masses
form glands and produce mucin, often have intestinal

Question 36

survival of oesophageal adenocarcinoma

Answer 36

usually present relatively late and have <25% 5 year survival

Question 37

oesophageal squamous cell carcinoma usually arises due to

Answer 37

alcohol and tobacco use
also associated with frequency consumption of hot beverages, caustic injury, achalasia, radiaition, chronic iron deficiency, HPV
more common in males

Question 38

oesophageal squamous cell carcinoma usually occurs in

Answer 38

the middle third of the oesophagus

Question 39

microscopic morphology of oesophageal squamous cell cancer

Answer 39

squamous differentiation

sheets and tongues of cells with dense cytoplasm, marked nuclear atypic, intercellular bridges

Question 40

oesophageal squamous cell cancer

Answer 40

patients usually present late
survival depends on stage at presentation
<20% 5 year survival