Pathology of the Upper GIT Flashcards
What is the pH of the stomach?
pH 2
Why is the oesophageal sphincter so tight?
The oesophagus does not want to acid from the stomach so tight to prevent acid flowing up into it.
What type of tissue must line acid producing compartments and why?
Glandular epithelium that produces mucous to help protect the walls
What is oesophageal reflux?
Reflux of gastric acid into the oesophagus.
What is a hiatus hernia?
When there is a prolapse of acidic stomach mucosa into the oesophagus.
RECAP- Describe the lining of the oesophagus.
Stratified squamous non-keratinising but can make keratin
What happens if you continually get gastric acid on the squamous epithelium of the oesophagus?
There will be thickening of the squamous epithelium- hyperplasia
Define hyperplasia.
Increase in the number of cells
Define hypertrophy.
Increase in the size of cells.
What happens if there is severe oesophageal reflux?
Ulceration of the oesophageal epithelium.
What are two complications for oesophageal reflux?
Healing by fibrosis
Barrett’s oesophagus
Describe how healing by fibrosis can be a complication.
Mucous lined epithelium isn’t resistant to sharp foods like crisps which can scratch and cause pain/bleeding.
Therefore, fibroblasts produce collagen and materials to increase structural integrity but this can just cause oesophageal obstruction.
What occurs in Barrett’s oesophagus?
Change of the usual squamous epithelium of the oesophagus into glandular epithelium.
What is metaplasia?
Change in one type of epithelium in response to an environmental change
Is metaplasia reversible?
Yes
What happens if metaplasia is not treated?
It progresses onto dysplasia
What happens after dysplasia?
Neoplasia (cancer)
Metaplasia -> Dysplasia -> Neoplasia
What are some of the environmental factors that increase risks of oesophageal cancer by squamous carcinoma subtype.
Smoking
Alcohol
Dietary carcinogens
What are the two histological subtypes of oesophageal cancer?
Squamous carcinoma
Adenocarcinoma
Which histological subtype of oesophageal cancer develops from Barrett’s oesophagus?
Adenocarcinoma
What are some of the environmental factors that increase risks of oesophageal cancer by adenocarcinoma subtype.
Barrett’s metaplasia
Obesity
What are some of the local effects of oesophageal cancer?
Obstruction
Ulceration
Perforation
Where can the direct spread of oesophageal cancer spread to?
Surrounding tissues
How can oesophageal cancer spread quickly?
Good blood and lymphatic supply so cancer can travel into lymphatics.
Which organ can get affected by the oesophageal cancer spreading through the blood?
Liver
What is gastritis?
Stomach inflammation
What are the three subtypes of gastritis?
Autoimmune
Bacterial
Chemical injury
ABC
If people have an autoimmune disorder, will they be more or less likely to get another?
More likely
Which vitamin deficiency would be present in those with autoimmune gastritis?
Vitamin B12
As a GP, if someone with a pre-existing autoimmune condition came in with a stomach ache, what would be important to consider?
Autoimmune gastritis
Which bacteria causes bacterial gastritis?
Helicobacter pylori
What does H.pylori produce?
Potassium
Why does the production of potassium from H.pylori cause gastritis?
Binds to the sodium potassium pump and makes more acid in the stomach.
Which foods should those with gastritis avoid?
Potassium rich foods
-> a lot of people think you should avoid acidic foods but the stomach pH is 2 so the patient will not be eating foods with a pH less than that.
What could cause chemical injury gastritis?
Bile reflux
Drugs
Define atrophy.
Cells are smaller
Describe what happens to the epithelium in autoimmune gastritis.
Atrophy of specialised acid secreting gastric epithelium
Which type of gastritis is the most common?
Bacterial gastritis
Is Helicobacter bacteria gram positive or gram negative?
Gram negative
Which drugs treat bacterial gastritis?
Proton pump inhibitors and antibiotics
Which three things most often cause chemical gastritis?
Drugs (NSAIDs)
Alcohol
Bile reflux
Why will their be hyperplasia of the cell epithelium in chemical gastritis?
To produce more mucus to counteract the chemicals causing damage
When will peptic ulceration take place?
When there is an imbalance between the acid secretion and mucosal barrier.
Which organs does peptic ulceration affect?
Stomach
Duodenum
Oesophagus
Which part of the oesophagus can peptic ulceration occur in?
Lower oesophagus
Which parts of the stomach does peptic ulceration usually occur in?
Body and antrum
Which parts of the duodenum does peptic ulceration usually occur in?
First and second part
What usually causes peptic ulcertaion?
H.pylori
What are the complications of peptic ulceration?
Bleeding
Perforation
Healing by fibrosis
What can acute bleeding in patients with peptic ulceration cause?
Haemorrhage
If a patient has chronic bleeding from peptic ulceration, so a little bit of blood bleeding out continuously, what can this cause?
Anaemia
What can perforation cause?
Peritonitis
What can gastric cancer be associated with?
A previous H.pylori infection
What is meant by transcoelomic spread of cancer?
Spread of cancer from the organ directly into the peritoneal cavity
