Pathology of upper GI

Question 1

What is Barrett’s oesophagus?

Answer 1

Metaplasia of squamous epithelia to glandular epithelia

Pre-malignant condition

Question 2

How does oesophageal reflux affect oesophageal epithelium?

Answer 2

Reflux of gastric acid into oesophagus
Thickening of squamous epithelium
Ulceration of oesophageal epithelium
Ulceration heals by fibrosis and leads to stricture and obstruction

Question 3

What are the 2 main types of oesophageal cancer?

Answer 3

Squamous carcinoma

Adenocarcinoma

Question 4

What are the main risk factors for oesophageal squamous carcinoma?

Answer 4

Smoking
Alcohol
Dietary carcinogens

Question 5

What are the main risk factors for oesophageal adenocarcinoma?

Answer 5

Barrett’s metaplasia

Obesity

Question 6

What are the local effects of oesophageal cancer?

Answer 6

Obstruction
Ulceration
Perforation

Question 7

How may oesophageal cancer spread?

Answer 7

Directly
Lymph
Blood

Question 8

What is the 5ys of oesophageal cancer?

Answer 8

<15%

Question 9

What is the effect of autoimmune gastritis?

Answer 9

Autoantibodies attack parietal cells and intrinsic factor

May result in further autoimmune diseas, decreased acid secretion and loss of intrinsic factor

Question 10

What is bacterial gastritis?

Answer 10

Helicobacter Pylori
Found in gastric mucus
Increases acid production

Question 11

What is chemical gastritis?

Answer 11

Can be drug induced (NSAIDs)
Alcohol
Bile reflux from duodenum into stomach

Question 12

How does peptic ulceration usually happen?

Answer 12

Imbalance between

Often H. Pylori associated

Question 13

What is the most common kind of gastric cancer?

Answer 13

Adenocarcinoma

Question 14

How does gastric cancer usually develop?

Answer 14

Metaplasia and hyperplasia

Associated with previous H. Pylori infection

Question 15

What is the 5ys of gastric cancer?

Answer 15

20%

Question 16

What is the classic triad for achalasia?

Answer 16

Loss of peristalsis
Increased LOS tone
Inadequate relaxation of LOS

Question 17

What may gastric ulcers lie over?

Answer 17

Gastric carcinoma

Question 18

What are some possible causes of oesophageal dysphagia?

Answer 18

Benign stricture
Malignant stricture
Motility disorders
Eosinophilic oesophagitis
Extrinsic compression

Question 19

What are the main tests for dyphagia?

Answer 19

Endoscopy preferred

Barium swallow

Question 20

What does manometry assess?

Answer 20

Sphincter tonicity
Relaxation of sphincters
Oesophageal motility

Question 21

Give an example of hypermotility.

Answer 21

Diffuse oesophageal spasm

Corkscrew appearance on Ba swallow

Question 22

What is achalasia?

Answer 22

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

Question 23

What are the pharma options to treat motility disorders?

Answer 23

Nitrates

CCBs

Question 24

How does GORD happen without anatomical abnormalities?

Answer 24

Transient relaxation of LOS increases
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearing

Question 25

What is the main anatomical cause of GORD?

Answer 25

Hiatus hernia distorts OG junction

Question 26

What bad does GORD actually do? (pathophysiology)

Answer 26

Mucosa exposed to acid Increased cell loss and regenerative activity Inflammation Erosive oesophagitis

Question 27

What are some complications of GORD?

Answer 27

Ulceration Stricture Glandular metaplasia Carcinoma

Question 28

What is Barrett's oesophagus?

Answer 28

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

Question 29

How do cells change in Barrett's oesophagus?

Answer 29

Squamous to mucin-secreting columnar epithelial cells in LO

Question 30

Can Barrett's oesophagus lead to dysplasia or adenocarcinoma?

Answer 30

Yes

Question 31

How is Barrett's oesophagus treated?

Answer 31

Endoscopic mucosal resection (EMR)

Question 32

How can GORD be treated apart form just lifestyle changes?

Answer 32

Alginates (Gaviscon) Ranitidine Proton pump inhibitors (Omeprazole) Fundoplication (Anti-reflux surgery)

Question 33

What is the most common kind of oesophageal cancer?

Answer 33

Adenocarcinoma

Question 34

Where do squamous cell carcinomas usually occur in the oesophagus?

Answer 34

Proximal two thirds

Question 35

Where do adenocarcinomas usually occur in the oesophagus?

Answer 35

Distal third

Question 36

What are the main mets sites for oesophageal cancer?

Answer 36

Hepatic Brain Lung Bone

Question 37

What are some good tests for staging oesophageal cancer?

Answer 37

CT Endoscopic USS PET scan Bone scan

Question 38

How does eosinophilic oesophagitis present?

Answer 38

Dysphagia | Food bolus