Pathology of upper GI Flashcards
What is Barrett’s oesophagus?
Metaplasia of squamous epithelia to glandular epithelia
Pre-malignant condition
How does oesophageal reflux affect oesophageal epithelium?
Reflux of gastric acid into oesophagus
Thickening of squamous epithelium
Ulceration of oesophageal epithelium
Ulceration heals by fibrosis and leads to stricture and obstruction
What are the 2 main types of oesophageal cancer?
Squamous carcinoma
Adenocarcinoma
What are the main risk factors for oesophageal squamous carcinoma?
Smoking
Alcohol
Dietary carcinogens
What are the main risk factors for oesophageal adenocarcinoma?
Barrett’s metaplasia
Obesity
What are the local effects of oesophageal cancer?
Obstruction
Ulceration
Perforation
How may oesophageal cancer spread?
Directly
Lymph
Blood
What is the 5ys of oesophageal cancer?
<15%
What is the effect of autoimmune gastritis?
Autoantibodies attack parietal cells and intrinsic factor
May result in further autoimmune diseas, decreased acid secretion and loss of intrinsic factor
What is bacterial gastritis?
Helicobacter Pylori
Found in gastric mucus
Increases acid production
What is chemical gastritis?
Can be drug induced (NSAIDs)
Alcohol
Bile reflux from duodenum into stomach
How does peptic ulceration usually happen?
Imbalance between
Often H. Pylori associated
What is the most common kind of gastric cancer?
Adenocarcinoma
How does gastric cancer usually develop?
Metaplasia and hyperplasia
Associated with previous H. Pylori infection
What is the 5ys of gastric cancer?
20%
What is the classic triad for achalasia?
Loss of peristalsis
Increased LOS tone
Inadequate relaxation of LOS
What may gastric ulcers lie over?
Gastric carcinoma
What are some possible causes of oesophageal dysphagia?
Benign stricture Malignant stricture Motility disorders Eosinophilic oesophagitis Extrinsic compression
What are the main tests for dyphagia?
Endoscopy preferred
Barium swallow
What does manometry assess?
Sphincter tonicity
Relaxation of sphincters
Oesophageal motility
Give an example of hypermotility.
Diffuse oesophageal spasm
Corkscrew appearance on Ba swallow
What is achalasia?
Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS
What are the pharma options to treat motility disorders?
Nitrates
CCBs
How does GORD happen without anatomical abnormalities?
Transient relaxation of LOS increases
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearing
What is the main anatomical cause of GORD?
Hiatus hernia distorts OG junction
What bad does GORD actually do? (pathophysiology)
Mucosa exposed to acid
Increased cell loss and regenerative activity
Inflammation
Erosive oesophagitis
What are some complications of GORD?
Ulceration
Stricture
Glandular metaplasia
Carcinoma
What is Barrett’s oesophagus?
Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
How do cells change in Barrett’s oesophagus?
Squamous to mucin-secreting columnar epithelial cells in LO
Can Barrett’s oesophagus lead to dysplasia or adenocarcinoma?
Yes
How is Barrett’s oesophagus treated?
Endoscopic mucosal resection (EMR)
How can GORD be treated apart form just lifestyle changes?
Alginates (Gaviscon)
Ranitidine
Proton pump inhibitors (Omeprazole)
Fundoplication (Anti-reflux surgery)
What is the most common kind of oesophageal cancer?
Adenocarcinoma
Where do squamous cell carcinomas usually occur in the oesophagus?
Proximal two thirds
Where do adenocarcinomas usually occur in the oesophagus?
Distal third
What are the main mets sites for oesophageal cancer?
Hepatic
Brain
Lung
Bone
What are some good tests for staging oesophageal cancer?
CT
Endoscopic USS
PET scan
Bone scan
How does eosinophilic oesophagitis present?
Dysphagia
Food bolus
