Theme 11 L1: Upper GI Pathology Flashcards
Oesophagitis:
- What is it?
- How is it classified?
- What is the aetiology?
- Inflammation of the oesophagus
- Acute or chronic
- Can be infectious (bacterial, viral e.g HSV1, fungal e.g candida) or chemical (ingestion of corrosive substances, reflux of gastric contents)
What is the commonest form of oesophagitis?
reflux oesophagitis
What is reflux oesophagitis caused by and what is the leading clinical symptom?
- caused by reflux of gastric acid and/or bile
- leading clinical symptom is heartburn
What are the risk factors for reflux oesophagitis?
- defective lower oesophageal sphincter
- hiatus hernia (stomach moving through diaphragm)
- increased intra abdominal pressure
- increased gastric fluid volume due to outflow stenosis
What are the complications of reflux oesophagitis?
- ulceration
- haemorrhage
- perforation
- benign stricture
- barrett’s oesophagus
What is the cause of Barrett’s oesophagus?
long standing gastro-oesophageal reflux
What are the risk factors for Barrett’s oesophagus?
- same as for reflux
- male, caucasion, overweight
What do we see macroscopically and histologically in Barrett’s oesophagus?
Macroscopy: proximal extension of the squamo-columnar junction
Histology: squamous mucosa replaced by columnar mucosa –> “glandular metaplasia”
Is Barrett’s oesophagus related to malignancy?
yes, it is a pre-malignant condition with an increased risk of developing adenocarcinoma
What are the two histological types of oesophageal carcinoma?
- Squamous cell carcinoma
2. Adenocarcinoma
Who is at risk of adenocarcinoma and what is the aetiology?
- obese, men, caucasians
- mainly lower oesophagus
- aetiology: Barrett’s oesophagus
Where are 85% of squamous carcinomas of the oesophagus?
middle and lower third
What are the risk factors for squamous carcinoma?
- tobacco and alcohol
- nutrition
- thermal injury (hot beverages)
- HPV
- male
- ethnicity
How do we stage oesophageal cancer?
T= primary tumour
T1-T4 based on depth of invasion
N= regional lymph nodes
N0-N3
M= distant metastasis
M0-M1
What is the aetiology behind acute gastritis?
- usually due to chemical injury e.g NSAIDs or alcohol
- initial response to helicobacter pylori infection
What is autoimmune chronic gastritis caused by?
anti-parietal and anti-intrinsic factor antibodies
What bacterial infection can cause chronic gastritis, gastric cancer and MALT lymphoma?
H.pylori
What is H.pylori?
gram -ve spiral shaped bacterium
What are the consequences of H.pylori?
- damages the epithelial lining leading to chronic inflammation
- results in glandular atrophy and intestinal metaplasia
What is peptic ulcer disease?
localised defect extending at least into sub mucosa
Where are the main sites of peptic ulcer disease?
- first part of duodenum
- junction of antral and body mucosa
- distal oesophagus (GOJ)
What are the main causes of peptic ulcer disease?
- hyperacidity
- H.pylori infection
- duodeno-gastric reflux
- drugs e.g NSAIDs
- smoking
What are the differences between gastric and duodenal ulcers?
- 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
What are the complications of peptic ulcer disease?
- haemorrhage
- perforation - peritonitis
- penetration into an adjacent organ
- stricturing - hour-glass deformity
What is the most common gastric cancer, and what are the lesser common?
Most common: adenocarcinoma
Less common: endocrine tumours, lymphomas, stromal tumours
What are the differences between an adenocarcinoma of the GOJ and an adenocarcinoma of the body/ antrum?
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
Why has there been a steady decline in gastric adenocarcinoma?
due to eradication of H.pylori infection
What is the aetiology behind gastric adenocarcinoma?
- diet
- H.pylori infection
- bile reflux
- hypochlorhydia
What conditions is H.pylori associated with?
gastritis
peptic ulcer disease
gastric adenocarcinoma
What are the two macroscopic subtypes of gastric adenocarcinoma?
- Intestinal type
- well or moderately differentiated
- may undergo intestinal metaplasia
- more common - Diffuse type
- poorly differentiated
- scattered growth
- cadherin loss / mutation
What is coeliac disease?
- a.k.a coeliac sprue or gluten sensitive enteropathy
- immune mediated
- ingestion of gluten containing foods
- genetic predisposition
What is the pathogenesis behind coeliac disease?
- Reaction to gliadin (the alcohol soluble component of gluten)
- Induces epithelial cells to express IL-15
- This activates proliferation of CD8+ IELs
- these are cytotoxic and kill enterocytes
What is the mechanism of coeliac disease?
gliadin induced IL15 secretion by epithelium
Which tests do we use to diagnose coeliac?
- non-invasive serologic tests
- IgA antibodies to tissue transglutaminase (TTG)
- IgA or IgG antibodies to deaminated gliadin
- tissue biopsy is diagnostic
The treatment of coeliac disease is a gluten-free diet. This reduces the risk of which long-term complications?
- anaemia
- female infertility
- osteoporosis
- cancer
What skin pathology is seen in 10% of patients with coeliac disease?
dermatitis herpetiformis
Which lymphocytic conditions are associated with coeliac disease?
lymphocytic gastritis and lymphocytic colitis
Which cancers can coeliac disease pre-dispose you to?
- enteropathy associated T-cell lymphoma
- small intestinal adenocarcinoma
Which histopathological features are associated with coeliac disease?
- villous atrophy
- crypt elongation
- increased IELs
- increased lamina propria inflammation
