Pathology of Upper GI Tract:

Question 1

What are examples pathological problems in the oesophagus

Answer 1

Oesophageal Reflux

Oesophageal Cancer

Question 2

Define oesophageal reflux

Answer 2

Reflux of gastric acid into oesophagus

Question 3

What is a posible cause of oesophageal reflux

Answer 3

Lower oesophageal spinchter doesn’t work

hiatus hernia

Question 4

What happens to the lining of the oesophagus in oesophagus reflux

Answer 4

Thickening of squamous epithelium cells due to the healing process of fibrosis

(cant tolerate acid)

Question 5

What are the complications of the healing process fibrosis in ooesophageal reflux

Answer 5

Impaired motility
Oesophageal obstruction
Stricture formation - abnormal narrowing

Question 6

What are the further complications of oesophageal reflux

Answer 6

Ulceration (due to epithelium not being adapted to acid)

Barrets oesophagus

Question 7

Define Barrets oesophagus

Answer 7

Type of metaplasia that has the transformation from squamous epithelium to glandular epithelium

Question 8

What are the two histological types of oesophageal cancer

Answer 8

Squamous carcinoma
(develops near top)

Adenocarcinoma
(develops near bottom)

Question 9

What is the risk factors of squamous oesophageal cancer

Answer 9

Smoking
Alcohol
Dietary carcinogens

Question 10

What is the risk factors of adenocarcinoma oesophageal caner

Answer 10

Barrets oesophagus (premalignant)

Obesity

Question 11

How is obesity a risk factor of oesophageal cancer

Answer 11

Abdominal obesity aplies pressure on the stomach pushing the stomach contents through oesophageal spinchter resulting in acid reflux

Obesity creates a pro-inflammatory environment

Question 12

What is the three local effects causes by oesophageal cancer

Answer 12

Obstruction
Ulceration
perforation

Question 13

What symptoms are causes by the local effect of obstruction in oesophageal cancer

Answer 13

Dysphagia - difficulty swallowing

Weightloss

Question 14

How does the symptom of anaemia occur in oesophageal cancer

Answer 14

Due to the local effect of ulceration, resulting in large areas of cell death resulting in blood loss

Question 15

What can occur due to the local effect of perforation in oesophageal cancer

Answer 15

Food passes down oesophagus and passes through perforation into the thorax

causing a potential abscess

Question 16

What is the three ways oesophageal cancer can spread

Answer 16

Direct (to surrounding structures)

Lymphatic spread (to regional lymph nodes)

Blood spread
(Liver)

Question 17

What is the prognosis of oesophageal cancer

Answer 17

Very poor

5 year survival rate less than 15%

Question 18

Overall what are the indirect symptoms of oesophageal cancer

Answer 18

Weight loss
Dysphagia
Anemia
Abscess

Question 19

What is the three pathologies Of Gastritis (inflammation of the stomach lining)

Answer 19

Autoimmune
Bacterial
Chemical injury

Question 20

Define autoimmune gastritis

Answer 20

Specific autoimmune disease targeting stomach due to autoantibodies to parietal cells and intrinsic factor
(further associated with other autoimmune diseases)

Question 21

What is the pathology of autoimmune gastritis

Answer 21

Atrophy of specialised acid secreting gastric epithelium and
Loss of specialised gastric epithelial cells

Question 22

What is the affect of autoimmune gastritis

Answer 22

Decreased acid secretion

Loss of intrinsic factor
Vitamin B12 deficiency =pernicious anaemia

Question 23

What is the most common type of gastritis

Answer 23

Bacterial

Question 24

What bacteria causes bacterial gastritis

Answer 24

Heliobacter pylori

Gram negative

Question 25

Where is Heliobacter Pylori found in Gastritis

Answer 25

Found in gastric mucus on the surface of the gastric epithelium

Question 26

How does H. Pylor result in gastritis

Answer 26

Produces acute and chronic inflammatory response Increases acid production

Question 27

How does H. Pylori increase acid production

Answer 27

As antrum Inflammation increases gastrin production which therefore stimulates more acid production

Question 28

How does H.Pylori protect itself in the stomach

Answer 28

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

Question 29

What are the causes of chemical gastritis

Answer 29

Drugs (NSAIDS) Alcohol Bile reflux

Question 30

How does peptic ulceration occur

Answer 30

Due to Imbalance between acid secretion and mucosal barrier - break down of mucosal barrier - Acid in the wrong place

Question 31

Where can peptic ulceration affect

Answer 31

Lower oesophagus Body and antrum of stomach First and second parts of duodenum

Question 32

What is the most common aetiology of peptic ulceration

Answer 32

H.pylori infection resulting in an increase in gastric acid

Question 33

What are the three ways complication can occur in Peptic ulceration

Answer 33

When bleeding occurs Perforation Healing by fibrosis

Question 34

What are the two affects of bleeding in a peptic ulcer

Answer 34

Acute - Haemorrhage Chronic - Anaemia

Question 35

What is the potentially complication if perforation occurs in peptic ulcer

Answer 35

Release of gastric contents through perforation into the peritoneal cavity resulting in peritonitis

Question 36

What is the affect of fibrosis healing in a peptic ulcer

Answer 36

Narrowing of alimentary tract, which can result in an obstruction

Question 37

What is the associated aetiology of gastric cancer

Answer 37

Previous H.Pylori infection

Question 38

What is the histology of gastric cancer

Answer 38

Adenocarcinoma | - Malignant tumour forms in the glandular epithelium

Question 39

What are the symptoms of stomach cancer

Answer 39

Non specific

Question 40

What is the four methods of spreading stomach cancer

Answer 40

Direct (Spread to surrounding structures) Lymphatic Spread (to regional lymph nodes) Blood spread (Liver) Transcoelomic spread (Spread within peritoneal cavity)

Question 41

What is the prognosis of stomach cancer

Answer 41

Very poor | 5 year survival rate less than 20%

Question 42

What is all the aetiologies of peptic ulceration

Answer 42

H. Pylori infection resulting in an increase in gastric acid NSAIDS Smoking Rare - zollingers ellison syndrome - hyperparathyrodism - chrons disease