T5 - L1 Upper gastrointestinal pathology Flashcards
a normal oesophagus is a 25 cm long muscular tube mostly lined by what?
squamous epithelium
what is the sphincter at the upper end of the oesophagus called?
cricopharyngeal
what is the sphincter at the lower end of the oesophagus called?
gastro-oesophageal junction
Distal 1.5-2cm of the oesophagus is situated below the diaphragm and lined by what?
glandular (columnar) mucosa
where is the squamo-columnar junction found?
40 cm from the incisor teeth
what is Oesophagitis?
Inflammation of the oesophagus - can be acute or chronic
what is the aetiology of Oesophagitis?
- infection - chemical (ingestion of corrosive substances or reflux of gastric contents)
what is the most common form of Oesophagitis?
Reflux oesophagitis
what causes Reflux oesophagitis?
reflux of gastric acid (gastro-oesophageal reflux) and/or bile (duodeno-gastric reflux)
what are the risk factors for Reflux oesophagitis?
- defective lower oesophageal sphincter - hiatus hernia - increased intra-abdominal pressure (e.g. tumour or ascites) - Increased gastric fluid volume due to gastric outflow stenosis
what is a hiatus hernia?
part of the stomach moves up past the diaphragm into the chest/thorax
what are the two types of hiatus hernia?
Sliding hiatus hernia Para-oesophageal hernia
which type of hiatus hernia would have reflux symptoms?
Sliding hiatus hernia
which type of hiatus hernia is at risk of a limited blood supply?
Para-oesophageal hernia
what are features of a Para-oesophageal hernia?
- can become entrapped in the muscle
- blood supply can get limited leading to:
strangulation, ischaemia or infarction of the stomach
which type of hiatus hernia can lead to reflux oesophagitis?
both types
- sliding hiatus hernia
- Para-oesophageal hernia
what histological changes of the squamous epithelium would be able to be seen in reflux oesophagitis?
- basal cell hyperplasia
- elongation of papillae
- increased cell desquamation
- inflammation
what histological changes of the lamina propria of the oesophagus, would be able to be seen in reflux oesophagitis?
Inflammatory cell infiltration (neutrophils, eosinophils, lymphocytes)
what are some complications that can arise as a result of reflux oesophagitis?
- ulceration
- haemorrhage (inflammation erodes the blood vessel)
- perforation (if ulceration continues through muscular layer)
- benign stricture (segmental narrowing) (if a ulceration heals via firbosis it can become more narrow)
- barrett’s oesophagus
what is Barrett’s oesophagus?
arrett’s oesophagus is a condition where the cells of the oesophagus (gullet) grow abnormally.
what is the cause of barrett’s oesophagus?
Longstanding gastro-oesophageal reflux
what are the risk factors for barrett’s oesophagus?
Same as for reflux (male, Caucasian, overweight)
on a macroscopic level, what change can be seen in barrett’s oesophagus?
squamo-columnar junction moves higher up the oesophagus
in barrett’s oesophagus, squamous mucosa replaced by what?
columnar mucosa > “glandular metaplasia”
barrett’s oesophagus provides an increased risk of what?
developing adenocarcinoma
what are the two main histological types of Oesophageal carcinoma?
Squamous cell carcinoma
Adenocarcinoma [caused by Barrett’s oesophagus]
what is the most common type of Oesophageal carcinoma
in the UK?
Adenocarcinoma
why does an adenocarcinoma occur mainly in the lower oesophagus?
[Because that’s the site of Barrett’s oesophagus]
what are the risk factors for squamous carcinoma of the oesophagus?
- tobacco
- alcohol
- nutrition
- thermal injury (hot beverage)
- HPV
- Ethnicity (black)
how would the macroscopic appearance of oesophageal cancer be described?
polypoidal (difficulty swallowing)
stricturing (reduced lumen)
ulcerated
what system is used to stage oesophageal cancer?
TMN system
pT = depth of invasion (pT1-4)
pN = regional lymph nodes (pN0 - no lymph node metatstasis, up to pN3)
M = distant metatstatsis
in the TNM staging system, what would pT4 imply?
pT4: tumour invades adjacent structures
in the TNM staging system, what would pN3 imply?
pN3: regional lymph node metastasis in 7 or more nodes
in the TNM staging system, what would pM1 imply?
pM1: distant metastasis
in the TNM staging system, what would cM0 imply?
cM0: no distant metastasis
what are the 4 anatomic regions of the stomach?
cardia
fundus
body
antrum
what is gastritis and how does it occur?
inflammation of the stomach
- increased aggression
- impaired defences
what is acute gastritis usually due to?
chemical injury i.e.
- drugs e.g. NSAIDs
- Alcohol (western populations)
- intial response to helicobacter pylori
what is chronic gastritis commonly due to?
autoimmune disease
bacterial infection (Helicobacter pylori)
chemical injury
what classification of bacteria is Helicobacter pylori?
Gram negative spiral shaped bacterium
- 4 to 6 flagellae
- More common in antrum of stomach than body
what are some complications of peptic ulcers?
- haemorrhage (acute and/or chronic → anaemia)
- perforation → peritonitis
- penetration into adjacent oragn
- stricturing (hour glass deformity)
is a fastric ulcer or a duodenal ulcer more common?
duodenal ulcer
