Pathology of Upper GI Tract Flashcards
What anatomy is included in the upper GI tract?
Oesophagus
Oesophageal sphincter
Stomach
Pyloric sphincter
Duodenum
Explain oesophageal reflux
Reflux of gastric acid into oesophagus
Acid degrades top keratin layer which provides strength and structure
What does oesophageal reflux cause?
Thickening of oesophageal epithelium
Ulceration of epithelium when severe
What are some complications of oesophageal reflux?
Healing by fibrosis causing stricture, impaired motility and obstruction
Barrett’s oesophagus
Explain Barrett’s Oesophagus
Type of metaplasia where transformation from squamous epithelium to glandular epithelium
Is a pre-malignant condition
Is oesophageal cancer common?
Third most common cancer of the alimentary tract
What are the histological types of oesophageal cancer?
Squamous carcinoma (from squamous)
Adenocarcinoma (from glandular)
What are the risk factors for squamous carcinoma?
Smoking
Alcohol
Dietary carcinogens
What are the risk factors of adenocarcinoma?
Barrett’s metaplasia
Obesity
What is the difference of location between squamous carcinoma and adenocarcinoma?
Squamous - upper GI tract
Adenocarcinoma - lower GI tract
What are some local effects of oesophageal cancer?
Obstruction
Ulceration
Perforation
Where can oesophageal cancer spread to?
Direct to surrounding tissues
Lymphatic spread to regional lymph nodes
Blood spread to liver
What is the outcome/ Prognosis of oesophageal cancer?
Very poor - only 5 year survival rate less than 15%
Need 6 cycles of neoadjuvant chemo then surgery
What are the 3 types of gastritis?
Autoimmune (A)
Bacterial (B)
Chemical injury (C)
Explain autoimmune gastritis
Organ specific autoimmune disease
Autoantibodies to parietal cells and intrinsic factor
Associated with other autoimmune diseases
What is gastritis?
Inflammation of the stomach
Describe the pathology of autoimmune gastritis
Atrophy of specialised acid secreting gastric epithelium
Loss of specialised gastric epithelium cells
What does loss of specialised gastric epithelial cells cause in autoimmune gastritis?
Decreased acid secretion
Loss of intrinsic factor so vitamin B12 deficiency
What is vitamin B12 deficiency called?
Pernicious anaemia
Describe the histology of autoimmune gastritis
Makes intestinal metaplasia
Loss of specialised glands and chronic inflammation
Glands disappear to be replaced by lymphocytes
What is the most common type of gastritis?
Bacterial gastritis
Explain bacterial gastritis
Helicobacter pylori related - gram negative
Found in gastric mucus on surface of gastric epithelium
What does bacterial gastritis cause?
Produces acute and chronic inflammatory response
Increased acid production
What could chemical gastritis be caused by?
Drugs - NSAIDs
Alcohol
Bile reflux
Describe the features of chemical gastritis
No inflammation
No organisms
Corkscrewing - hyperplasia of cells
Dilated blood vessels at surface
Explain peptic ulceration
Imbalance between acid secretion and mucosal barrier
Usually h. pylori associated - increased gastric acid
Where does peptic ulceration affect?
Oesophagus - lower
Body and antrum of stomach
First and second parts of duodenum
What are some complications of peptic ulceration?
Bleeding - acute haemorrhage or chronic causing anaemia
Perforation - peritonitis
Healing by fibrosis - obstruction
Is gastric cancer common?
Second most common alimentary cancer
What is gastric cancer associated with?
H.pylori
Explain gastric cancer development
Develops through phases of intestinal metaplasia and dysplasia
Describe the histology of gastric cancer
Adenocarcinoma
Where can stomach cancer spread to?
Direct to surrounding tissues
Lymphatic to regional lymph nodes
Blood spread to liver
Trans-coelomic spread within peritoneal cavity
What is the prognosis of stomach cancer?
Very poor - 5 year survival rate less than 20%
