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Clinical Pathology > Theme 11 L1: Upper GI Pathology > Flashcards

Theme 11 L1: Upper GI Pathology Flashcards

1
Q

Oesophagitis:

  1. What is it?
  2. How is it classified?
  3. What is the aetiology?
A
  1. Inflammation of the oesophagus
  2. Acute or chronic
  3. Can be infectious (bacterial, viral e.g HSV1, fungal e.g candida) or chemical (ingestion of corrosive substances, reflux of gastric contents)
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2
Q

What is the commonest form of oesophagitis?

A

reflux oesophagitis

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3
Q

What is reflux oesophagitis caused by and what is the leading clinical symptom?

A
  • caused by reflux of gastric acid and/or bile

- leading clinical symptom is heartburn

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4
Q

What are the risk factors for reflux oesophagitis?

A
  • defective lower oesophageal sphincter
  • hiatus hernia (stomach moving through diaphragm)
  • increased intra abdominal pressure
  • increased gastric fluid volume due to outflow stenosis
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5
Q

What are the complications of reflux oesophagitis?

A
  • ulceration
  • haemorrhage
  • perforation
  • benign stricture
  • barrett’s oesophagus
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6
Q

What is the cause of Barrett’s oesophagus?

A

long standing gastro-oesophageal reflux

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7
Q

What are the risk factors for Barrett’s oesophagus?

A
  • same as for reflux

- male, caucasion, overweight

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8
Q

What do we see macroscopically and histologically in Barrett’s oesophagus?

A

Macroscopy: proximal extension of the squamo-columnar junction
Histology: squamous mucosa replaced by columnar mucosa –> “glandular metaplasia”

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9
Q

Is Barrett’s oesophagus related to malignancy?

A

yes, it is a pre-malignant condition with an increased risk of developing adenocarcinoma

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10
Q

What are the two histological types of oesophageal carcinoma?

A
  1. Squamous cell carcinoma

2. Adenocarcinoma

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11
Q

Who is at risk of adenocarcinoma and what is the aetiology?

A
  • obese, men, caucasians
  • mainly lower oesophagus
  • aetiology: Barrett’s oesophagus
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12
Q

Where are 85% of squamous carcinomas of the oesophagus?

A

middle and lower third

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13
Q

What are the risk factors for squamous carcinoma?

A
  • tobacco and alcohol
  • nutrition
  • thermal injury (hot beverages)
  • HPV
  • male
  • ethnicity
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14
Q

How do we stage oesophageal cancer?

A

T= primary tumour
T1-T4 based on depth of invasion

N= regional lymph nodes
N0-N3

M= distant metastasis
M0-M1

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15
Q

What is the aetiology behind acute gastritis?

A
  • usually due to chemical injury e.g NSAIDs or alcohol

- initial response to helicobacter pylori infection

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16
Q

What is autoimmune chronic gastritis caused by?

A

anti-parietal and anti-intrinsic factor antibodies

17
Q

What bacterial infection can cause chronic gastritis, gastric cancer and MALT lymphoma?

A

H.pylori

18
Q

What is H.pylori?

A

gram -ve spiral shaped bacterium

19
Q

What are the consequences of H.pylori?

A
  • damages the epithelial lining leading to chronic inflammation
  • results in glandular atrophy and intestinal metaplasia
20
Q

What is peptic ulcer disease?

A

localised defect extending at least into sub mucosa

21
Q

Where are the main sites of peptic ulcer disease?

A
  • first part of duodenum
  • junction of antral and body mucosa
  • distal oesophagus (GOJ)
22
Q

What are the main causes of peptic ulcer disease?

A
  • hyperacidity
  • H.pylori infection
  • duodeno-gastric reflux
  • drugs e.g NSAIDs
  • smoking
23
Q

What are the differences between gastric and duodenal ulcers?

A
  • duodenal ulcers are more common
  • acid levels in duodenal ulcers might be elevated, whereas in gastric ulcers they might be low
  • duodenal ulcers are seen in blood group O and gastric ulcers in blood group A
  • gastric ulcrs are caused by NSAIDs, duodenal ulcers are caused by H.pylori
24
Q

What are the complications of peptic ulcer disease?

A
  • haemorrhage
  • perforation - peritonitis
  • penetration into an adjacent organ
  • stricturing - hour-glass deformity
25
Q

What is the most common gastric cancer, and what are the lesser common?

A

Most common: adenocarcinoma

Less common: endocrine tumours, lymphomas, stromal tumours

26
Q

What are the differences between an adenocarcinoma of the GOJ and an adenocarcinoma of the body/ antrum?

A

Adenocarcinoma of GOJ:

  • no association with H.pylori / diet
  • association of GO reflux
  • increasing incidence

Adenocarcinoma of body/antrum:

  • associated with H.pylori/ diet
  • no association with GO reflux
  • decreasing incidence
27
Q

Why has there been a steady decline in gastric adenocarcinoma?

A

due to eradication of H.pylori infection

28
Q

What is the aetiology behind gastric adenocarcinoma?

A
  • diet
  • H.pylori infection
  • bile reflux
  • hypochlorhydia
29
Q

What conditions is H.pylori associated with?

A

gastritis
peptic ulcer disease
gastric adenocarcinoma

30
Q

What are the two macroscopic subtypes of gastric adenocarcinoma?

A
  1. Intestinal type
    - well or moderately differentiated
    - may undergo intestinal metaplasia
    - more common
  2. Diffuse type
    - poorly differentiated
    - scattered growth
    - cadherin loss / mutation
31
Q

What is coeliac disease?

A
  • a.k.a coeliac sprue or gluten sensitive enteropathy
  • immune mediated
  • ingestion of gluten containing foods
  • genetic predisposition
32
Q

What is the pathogenesis behind coeliac disease?

A
  1. Reaction to gliadin (the alcohol soluble component of gluten)
  2. Induces epithelial cells to express IL-15
  3. This activates proliferation of CD8+ IELs
    - these are cytotoxic and kill enterocytes
33
Q

What is the mechanism of coeliac disease?

A

gliadin induced IL15 secretion by epithelium

34
Q

Which tests do we use to diagnose coeliac?

A
  • non-invasive serologic tests
  • IgA antibodies to tissue transglutaminase (TTG)
  • IgA or IgG antibodies to deaminated gliadin
  • tissue biopsy is diagnostic
35
Q

The treatment of coeliac disease is a gluten-free diet. This reduces the risk of which long-term complications?

A
  • anaemia
  • female infertility
  • osteoporosis
  • cancer
36
Q

What skin pathology is seen in 10% of patients with coeliac disease?

A

dermatitis herpetiformis

37
Q

Which lymphocytic conditions are associated with coeliac disease?

A

lymphocytic gastritis and lymphocytic colitis

38
Q

Which cancers can coeliac disease pre-dispose you to?

A
  • enteropathy associated T-cell lymphoma

- small intestinal adenocarcinoma

39
Q

Which histopathological features are associated with coeliac disease?

A
  • villous atrophy
  • crypt elongation
  • increased IELs
  • increased lamina propria inflammation

Clinical Pathology (57 decks)

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