T5 - L1 Upper gastrointestinal pathology

Question 1

a normal oesophagus is a 25 cm long muscular tube mostly lined by what?

Answer 1

squamous epithelium

Question 2

what is the sphincter at the upper end of the oesophagus called?

Answer 2

cricopharyngeal

Question 3

what is the sphincter at the lower end of the oesophagus called?

Answer 3

gastro-oesophageal junction

Question 4

Distal 1.5-2cm of the oesophagus is situated below the diaphragm and lined by what?

Answer 4

glandular (columnar) mucosa

Question 5

where is the squamo-columnar junction found?

Answer 5

40 cm from the incisor teeth

Question 6

what is Oesophagitis?

Answer 6

Inflammation of the oesophagus - can be acute or chronic

Question 7

what is the aetiology of Oesophagitis?

Answer 7

• infection - chemical (ingestion of corrosive substances or reflux of gastric contents)

Question 8

what is the most common form of Oesophagitis?

Answer 8

Reflux oesophagitis

Question 9

what causes Reflux oesophagitis?

Answer 9

reflux of gastric acid (gastro-oesophageal reflux) and/or bile (duodeno-gastric reflux)

Question 10

what are the risk factors for Reflux oesophagitis?

Answer 10

• defective lower oesophageal sphincter - hiatus hernia - increased intra-abdominal pressure (e.g. tumour or ascites) - Increased gastric fluid volume due to gastric outflow stenosis

Question 11

what is a hiatus hernia?

Answer 11

part of the stomach moves up past the diaphragm into the chest/thorax

Question 12

what are the two types of hiatus hernia?

Answer 12

Sliding hiatus hernia Para-oesophageal hernia

Question 13

which type of hiatus hernia would have reflux symptoms?

Answer 13

Sliding hiatus hernia

Question 14

which type of hiatus hernia is at risk of a limited blood supply?

Answer 14

Para-oesophageal hernia

Question 15

what are features of a Para-oesophageal hernia?

Answer 15

• can become entrapped in the muscle
• blood supply can get limited leading to:

strangulation, ischaemia or infarction of the stomach

Question 16

which type of hiatus hernia can lead to reflux oesophagitis?

Answer 16

both types

• sliding hiatus hernia
• Para-oesophageal hernia

Question 17

what histological changes of the squamous epithelium would be able to be seen in reflux oesophagitis?

Answer 17

• basal cell hyperplasia
• elongation of papillae
• increased cell desquamation
• inflammation

Question 18

what histological changes of the lamina propria of the oesophagus, would be able to be seen in reflux oesophagitis?

Answer 18

Inflammatory cell infiltration (neutrophils, eosinophils, lymphocytes)

Question 19

what are some complications that can arise as a result of reflux oesophagitis?

Answer 19

• 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

Question 20

what is Barrett’s oesophagus?

Answer 20

arrett’s oesophagus is a condition where the cells of the oesophagus (gullet) grow abnormally.

Question 21

what is the cause of barrett’s oesophagus?

Answer 21

Longstanding gastro-oesophageal reflux

Question 22

what are the risk factors for barrett’s oesophagus?

Answer 22

Same as for reflux (male, Caucasian, overweight)

Question 23

on a macroscopic level, what change can be seen in barrett’s oesophagus?

Answer 23

squamo-columnar junction moves higher up the oesophagus

Question 24

in barrett’s oesophagus, squamous mucosa replaced by what?

Answer 24

columnar mucosa > “glandular metaplasia”

Question 25

barrett’s oesophagus provides an increased risk of what?

Answer 25

developing adenocarcinoma

Question 26

what are the two main histological types of Oesophageal carcinoma?

Answer 26

Squamous cell carcinoma

Adenocarcinoma [caused by Barrett’s oesophagus]

Question 27

what is the most common type of Oesophageal carcinoma

in the UK?

Answer 27

Adenocarcinoma

Question 28

why does an adenocarcinoma occur mainly in the lower oesophagus?

Answer 28

[Because that’s the site of Barrett’s oesophagus]

Question 29

what are the risk factors for squamous carcinoma of the oesophagus?

Answer 29

• tobacco
• alcohol
• nutrition
• thermal injury (hot beverage)
• HPV
• Ethnicity (black)

Question 30

how would the macroscopic appearance of oesophageal cancer be described?

Answer 30

polypoidal (difficulty swallowing)

stricturing (reduced lumen)

ulcerated

Question 31

what system is used to stage oesophageal cancer?

Answer 31

TMN system

pT = depth of invasion (pT1-4)

pN = regional lymph nodes (pN0 - no lymph node metatstasis, up to pN3)

M = distant metatstatsis

Question 32

in the TNM staging system, what would pT4 imply?

Answer 32

pT4: tumour invades adjacent structures

Question 33

in the TNM staging system, what would pN3 imply?

Answer 33

pN3: regional lymph node metastasis in 7 or more nodes

Question 34

in the TNM staging system, what would pM1 imply?

Answer 34

pM1: distant metastasis

Question 35

in the TNM staging system, what would cM0 imply?

Answer 35

cM0: no distant metastasis

Question 36

what are the 4 anatomic regions of the stomach?

Answer 36

cardia

fundus

body

antrum

Question 37

what is gastritis and how does it occur?

Answer 37

inflammation of the stomach

• increased aggression
• impaired defences

Question 38

what is acute gastritis usually due to?

Answer 38

chemical injury i.e.

• drugs e.g. NSAIDs
• Alcohol (western populations)
• intial response to helicobacter pylori

Question 39

what is chronic gastritis commonly due to?

Answer 39

autoimmune disease

bacterial infection (Helicobacter pylori)

chemical injury

Question 40

what classification of bacteria is Helicobacter pylori?

Answer 40

Gram negative spiral shaped bacterium

• 4 to 6 flagellae
• More common in antrum of stomach than body

Question 41

what are some complications of peptic ulcers?

Answer 41

• haemorrhage (acute and/or chronic → anaemia)
• perforation → peritonitis
• penetration into adjacent oragn
• stricturing (hour glass deformity)

Question 42

is a fastric ulcer or a duodenal ulcer more common?

Answer 42

duodenal ulcer