Pathology of Upper GI Tract: Flashcards
What are examples pathological problems in the oesophagus
Oesophageal Reflux
Oesophageal Cancer
Define oesophageal reflux
Reflux of gastric acid into oesophagus
What is a posible cause of oesophageal reflux
Lower oesophageal spinchter doesn’t work
hiatus hernia
What happens to the lining of the oesophagus in oesophagus reflux
Thickening of squamous epithelium cells due to the healing process of fibrosis
(cant tolerate acid)
What are the complications of the healing process fibrosis in ooesophageal reflux
Impaired motility
Oesophageal obstruction
Stricture formation - abnormal narrowing
What are the further complications of oesophageal reflux
Ulceration (due to epithelium not being adapted to acid)
Barrets oesophagus
Define Barrets oesophagus
Type of metaplasia that has the transformation from squamous epithelium to glandular epithelium
What are the two histological types of oesophageal cancer
Squamous carcinoma
(develops near top)
Adenocarcinoma
(develops near bottom)
What is the risk factors of squamous oesophageal cancer
Smoking
Alcohol
Dietary carcinogens
What is the risk factors of adenocarcinoma oesophageal caner
Barrets oesophagus (premalignant)
Obesity
How is obesity a risk factor of oesophageal cancer
Abdominal obesity aplies pressure on the stomach pushing the stomach contents through oesophageal spinchter resulting in acid reflux
Obesity creates a pro-inflammatory environment
What is the three local effects causes by oesophageal cancer
Obstruction
Ulceration
perforation
What symptoms are causes by the local effect of obstruction in oesophageal cancer
Dysphagia - difficulty swallowing
Weightloss
How does the symptom of anaemia occur in oesophageal cancer
Due to the local effect of ulceration, resulting in large areas of cell death resulting in blood loss
What can occur due to the local effect of perforation in oesophageal cancer
Food passes down oesophagus and passes through perforation into the thorax
causing a potential abscess
What is the three ways oesophageal cancer can spread
Direct (to surrounding structures)
Lymphatic spread (to regional lymph nodes)
Blood spread
(Liver)
What is the prognosis of oesophageal cancer
Very poor
5 year survival rate less than 15%
Overall what are the indirect symptoms of oesophageal cancer
Weight loss
Dysphagia
Anemia
Abscess
What is the three pathologies Of Gastritis (inflammation of the stomach lining)
Autoimmune
Bacterial
Chemical injury
Define autoimmune gastritis
Specific autoimmune disease targeting stomach due to autoantibodies to parietal cells and intrinsic factor
(further associated with other autoimmune diseases)
What is the pathology of autoimmune gastritis
Atrophy of specialised acid secreting gastric epithelium and
Loss of specialised gastric epithelial cells
What is the affect of autoimmune gastritis
Decreased acid secretion
Loss of intrinsic factor
Vitamin B12 deficiency =pernicious anaemia
What is the most common type of gastritis
Bacterial
What bacteria causes bacterial gastritis
Heliobacter pylori
Gram negative
Where is Heliobacter Pylori found in Gastritis
Found in gastric mucus on the surface of the gastric epithelium
How does H. Pylor result in gastritis
Produces acute and chronic inflammatory response
Increases acid production
How does H. Pylori increase acid production
As antrum Inflammation increases gastrin production which therefore stimulates more acid production
How does H.Pylori protect itself in the stomach
H.Pylori release the enzyme urease which breaks down urea to ammonia and bicarbonate creating an alkaline environment around it
Located in the gastric mucus for protection
What are the causes of chemical gastritis
Drugs (NSAIDS)
Alcohol
Bile reflux
How does peptic ulceration occur
Due to Imbalance between acid secretion and mucosal barrier
- break down of mucosal barrier
- Acid in the wrong place
Where can peptic ulceration affect
Lower oesophagus
Body and antrum of stomach
First and second parts of duodenum
What is the most common aetiology of peptic ulceration
H.pylori infection resulting in an increase in gastric acid
What are the three ways complication can occur in Peptic ulceration
When bleeding occurs
Perforation
Healing by fibrosis
What are the two affects of bleeding in a peptic ulcer
Acute - Haemorrhage
Chronic - Anaemia
What is the potentially complication if perforation occurs in peptic ulcer
Release of gastric contents through perforation into the peritoneal cavity resulting in peritonitis
What is the affect of fibrosis healing in a peptic ulcer
Narrowing of alimentary tract, which can result in an obstruction
What is the associated aetiology of gastric cancer
Previous H.Pylori infection
What is the histology of gastric cancer
Adenocarcinoma
- Malignant tumour forms in the glandular epithelium
What are the symptoms of stomach cancer
Non specific
What is the four methods of spreading stomach cancer
Direct
(Spread to surrounding structures)
Lymphatic
Spread
(to regional lymph nodes)
Blood spread
(Liver)
Transcoelomic spread
(Spread within peritoneal cavity)
What is the prognosis of stomach cancer
Very poor
5 year survival rate less than 20%
What is all the aetiologies of peptic ulceration
H. Pylori infection resulting in an increase in gastric acid
NSAIDS
Smoking
Rare
- zollingers ellison syndrome
- hyperparathyrodism
- chrons disease
