Pathology of Upper GI Tract

Question 1

What are the symptoms of oral cancer? [5]

Answer 1

1. pain in tongue
2. lumps
3. ulcer that will not heal within 2/3 weeks
4. earache
5. dizzy

Question 2

What is the treatment of oral cancer? [1]

Answer 2

hemiglesectomy, sometimes teeth and jaw

Question 3

What 2 types of cancer does HPV cause in the GI system? [2]

Answer 3

1. tonsillar cancer
2. oropharyngeal cancer

Question 4

What is the mucosa of the oesophagus? [1]

Answer 4

non-keratinised stratified squamous epithelium

Question 5

What are the layers of the oesophagus (inner to outer)? [4]

Answer 5

1. mucosa
   
   • epithelium
   • lamina propria
   • muscularis mucosa
2. submucosa
3. muscularis propria
   
   • upper [skeletal]
   • middle [transitional]
   • lower [smooth muscle]
4. adventitia

Question 6

What is diverticula? [1]

Answer 6

when a sac forms in the alimentary canal at a weak point and this sac becomes infected

Question 7

What are the histological features of reflux oesophagitis? [3]

Answer 7

1. acid and digestive enzymes injure the squamous epithelium lining the oesophagus
2. increased numbers of inflammatory cells
3. hyperplastic basal layer

Question 8

What histological features would suggest candida oesophagitis and what is this called? [1]

Answer 8

active chronic inflammation with many neutrophils especially near the luminal surface of epithelium = oral thrush

Question 9

What are the histological features of oesophageal ulcer in metastatic gastric cancer? [2]

Answer 9

1. inflammatory exudate and cells (“slough”)
2. atypical squamous cells

Question 10

What does eosinophilic gastritis look like on endoscopy? [1]

Answer 10

ring like treachealisation

Question 11

What are the risk factors for the following oesophageal cancers:

1. squamous carcinoma? [2]
2. adenocarcinoma? [2]

Answer 11

1. smoking and alcohol
2. obesity and gastro-oesophageal reflux

Question 12

What is Barrett’s oesophagus? [2]

Answer 12

1. metaplastic response to mucosal injury, e.g. from long-term GORD
2. squamous cells become glandular, usually intestinal with goblet cells
3. associated with the development of benign strictures but also with adenocarcinoma

Question 13

What are the major cytological differences between the appearance of low and high grade dysplasia?

1. low grade? [2]
2. high grade? [6]

Answer 13

1. low grade:
   
   • cells polarised
   • nuclei stratified
2. high grade:
   
   • nuclei rounder (polarity lost)
   • vesicular
   • prominent nucleoli,
   • abnormal mitoses
   • necrosis

Question 14

What are the causes of:

1. acute gastritis? [3]
2. chronic gastritis? [3]

Answer 14

1. acute gastritis:
   
   • alcohol
   • NSAIDs
   • severe trauma (burns/surgery)
2. chronic gastritis:
   
   • autoimmune
   • bacterial (H. pylori)
   • chemical

Question 15

What is the cause of autoimmune atrophic gastritis and pernicious anaemia? [3]

Answer 15

1. autoimmune destruction of parietal cells due to auto-antibodies against intrinsic factor (resulting in malabsorption of vitamin B12) and
2. anti-parietal cell antibodies in the blood

Question 16

What are the complications of autoimmune gastritis? [4]

Answer 16

1. complete loss of parietal cells with pyloric and intestinal metaplasia
2. achlorhydria → bacterial overgrowth
3. hypergastrinaemia → endocrine cell hyperplasia/carcinoids
4. persistent inflammation which can lead to epithelial dysplasia and may lead to cancer

Question 17

What is Zollinger-Ellison Syndrome and what does it lead to? [3]

Answer 17

hypersecretion of gastrin by an endocrine tumour (gastrinoma) in pancreas or duodenum that leads to increased gastric acid output and florid peptic ulceration

Question 18

What is a peptic ulcer? [1]

Answer 18

breach in the protective mucosal lining of the GI tract caused by either pepsin and acid being at abnormally high concentrations or if the normal protective mechanisms (bicarbonate) are reduced due to H. pylori or NSAIDs

Question 19

What are the risk factors for peptic ulcers? [5]

Answer 19

1. H. pylori
2. use of NSAIDs
3. alcohol
4. smoking
5. increasing age

Question 20

What factor does epithelial cells secrete in H. Pylori gastritis and what does this attract? [2]

Answer 20

IL-8 → attract neutrophils (active chronic inflammation)

Question 21

Describe the features of the following 2 patterns of H. pylori gastritis:

1. Antral-predominant gastritis? [2]
2. Pangastritis? [3]

Answer 21

1. Antral-predominant gastritis
   
   • hypergastrinaemia,
   • duodenal ulceration
2. Pangastritis
   
   • hypochlorydria,
   • multifocal atrophic gastritis,
   • IM,
   • cancer (intestinal type)

Question 22

What are the complications of peptic ulceration? [3]

Answer 22

1. haemorrhage
2. perforation
3. fibrosis (leading to stenosis)

Question 23

Chemical gastritis:

1. characteristic morphology? [6]
2. what area of the stomach is most common affected? [1]
3. causes? [4]

Answer 23

1. characteristic morphology:
   
   • few inflammatory cells
   • surface congestion oedema
   • elongation of gastric pits
   • tortuosity
   • reactive hyperplasia/atypia
   • ulceration
2. antrum more commonly affected
3. causes:
   
   • bile reflux
   • NSAIDs
   • alcohol
   • oral iron

Question 24

In which direction does gastric cancer spread in? [1]

Answer 24

distal → proximal

Question 25

Diffuse gastric cancer can cause what types of metastases? [3]

Answer 25

1. metastasis to ovaries (Krukenberg tumour)
2. supraclavicular lymph node (Virchow’s node)
3. umbilical metastasis (Sister Joseph nodule)

Question 26

What are the characteristic cells present in diffuse gastric cancer? [1]

Answer 26

individual malignant cells with mucin vacoules (“signet ring” cells)

Question 27

What is linitis plastica? [1]

Answer 27

1. “leather bottle stomach”
2. when diffuse gastric cancer invades extensively without being endoscopically obvious

Question 28

What is the treatment for familial gastric cancer? [1]

Answer 28

prophylactic total gastrectomy