pathology of the upper GIT Flashcards
dyspepsia
heartburn/indigestion
dysphagia
difficulty swallowing
odynophagia
pain on swallowing
fistulae
passage between organs
haematemesis
vomiting of blood
mucosal web
formation of mucosa over damage in the oesophagus causing a blockage
schatzbi rings
caused by iron defiiency
mechanical obstruction of the oesophagus
achalasia
increased sphincter tone
aperistalsis
dysphagia, belching
oesophageal varices
tortuous, dilated veins caused by portal hypertension
usually due to increased pressure and resistance to blood flow through the portal veinous system and liver
GORD
gastro-oesophageal reflux disease
reflux symptoms occurring at least once a week
acid reflux
sensation/taste of acid in oesophagus/mouth
dyspepsia
often worse after eating or when lying down
GORD is made worse by
overnight, pregnant, some foods (mint, citrus, chocolate, fried foods, carbonated drinks), alcohol, caffeine, smoking, NSAIDS
causes of reflux
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
hiatal hernia
oesophagus passes through the hiatus in the crural part of the diaphragm
prolapse of part of the stomach into the thorax
causes reflux
2 types of hiatal hernia
sliding and rolling
rolling hernias usually occur in
more severe damage in the diaphragm
consequences of GORD
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
morphology of GORD may be
mild moderate or severe
mild GORD
hyperaemia, redness of the mucosa
minimal inflammation and mild hyperplasia
moderate GORD
small erosions, more significant redness
more significant basal hyperplasia, papillary elongation, intraepithelial inflammatory cells including neutrophils and small numbers of eosinophils
severe GORD
active inflammation, ulceration or barrett metaplasia
inflammatory cells are more prominent, ulceration, intestinal metaplasia in areas of Barrett’s
barrett oesophagus
complication of chronic inflammation where oesophageal squamous mucosa undergoes metaplasia to intestinal type epithelium
barrettt oesophagus increases risk of
oesophageal adenocarcinoma
morphology of Barrett oesophagus
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
eosinophilic oesophagitis
characteristic form of inflammation with numerous eosinophils, associated with atopic disease
many patients with eosinophilic oesophagitis also have
other atopic diseases
atopic dermatitis, allergic rhinitis, asthma, or peripheral eosinophilia
symptoms of eosinophilic oesophagitis
in addition ro GORD-like symptoms, patients may also have food impaction, dysphagia, and vomiting
appearance of eosinophilic oesophagitis
stacked circular rings - referred to as feline oesophagus
strictures
linear furrows/ulcers
histologically - large numbers of intraepithelial eosinophils
eosihophillic oesophagus is not associated with
increased risk of Barrett’s oesophagus or adenocarcinoma
infective causes of oesophigitis
may be fungal - candida
or viral - HSV, CMV
infective oesophagitis mainly seen in
immunocompromised patients
oesophageal cancer is usually
adenocarcinoma or squamous cell carcinoma
oesophageal adenocarcinoma risk factors
tobacco use, radiation, obesity
males
more common in caucasians
oesophageal adenocarcinoma usually occurs in
distal third of the oesophagus and may extend into the stomach
morphology of oesophageal adenocarcinoma
flat or raised patches which grow into large, ulcerating and fumigating masses
form glands and produce mucin, often have intestinal
survival of oesophageal adenocarcinoma
usually present relatively late and have <25% 5 year survival
oesophageal squamous cell carcinoma usually arises due to
alcohol and tobacco use
also associated with frequency consumption of hot beverages, caustic injury, achalasia, radiaition, chronic iron deficiency, HPV
more common in males
oesophageal squamous cell carcinoma usually occurs in
the middle third of the oesophagus
microscopic morphology of oesophageal squamous cell cancer
squamous differentiation
sheets and tongues of cells with dense cytoplasm, marked nuclear atypic, intercellular bridges
oesophageal squamous cell cancer
patients usually present late
survival depends on stage at presentation
<20% 5 year survival
