UGIT path Flashcards
how long is the oesophagus
25 cm
what is the lining of the oesophagus
squamous epithelium
what i the sphincter at the end vs start of the oesophagus called
cricopharygneal upper
gastro-oesophageal lower
what is the distal oesophagus lined with
glandular collumnar mucosa
where is the squamocolumnar junction
40cm from the incisor teeth
what is the normal structure of the oesophagus
mucosa
submucosa
musculares propria
adventitia around each layer
what is oesophgitis - and common causes
inflammation of the oesophagus
infectious - bacterial/viral/fungal eg HSV1 or candida
chemical is most common - ingestion or reflux of gastric contents
what is the commonest form of oesophagitis
reflux of gastric acid or bile
what are the two types of hiatus hernia
sliding - reflux symptoms
para-oesophageal hernia - strangulation and reflux = ischameia and infarction of the stomach
what are some risk factors of reflux oesophagitis
defective lower sphincter
hiatus hernia
increased abdominal pressure
increased gastric fluid volume
what is the histology of reflux oesophagitis
inflammatory cells causing loose distinction between basal and lamina propria - infiltration of WBC’s
what are 5 complications of reflux oesophagitis
ulceration haemorrhage perforation benign structure Barrett oesophagus
what is barretts oesophagus
long standing gastro oesophageal reflux - proximal extension of the squamo-columnar junction = glandular metaplasia
what is the disease progression of barretts oesophagus to carcinoma
barretts
low grade dysplasia
high grade dysplasia
adenocarcinoma
describe oesophageal carcinoma and the two main types
squamous cell carcinoma - endemic tissue
adenocarcinoma - most common
what is the most common cause of adenocarcinoma
mainly lower oesophagus
more males in whites
barretts oesohpasgus, tobacco, obesity
what is preceded by squamous dysplasia
squamous carcinoma
what are some risk factors of squamous carcinoma
hot beverages, HPV, male, black
what is the staging system for oesophageal cancers
TNM
T - depth of invasion (grade of tumour)
N - regional lymph nodes
M - distant metastasis
what is the normal anatomy of the stomach
cardia - area around in GO sphincter
fundus - located in upper part of stomach
body - main
antrum - near the pylorus
what are the three stages of gastritis
normal - balance of aggressive and defensive forces
increased aggression - excessive alcohol, drugs ie aspirin, heavy smoking
impaired defences - ischameia, shock
describe the causes of acute gastritis
usually due to chemical injury - drugs alcohol - to helibactor pylori infection
describe the causes of chronic gastritis and risk
autoimmune - B12 deficiency
helibactor pylori
increased risk of gastric cancer and MALT lymphoma
describe the structure and mode of infection of helibactor pylori
gram negative spiral shaped bacterium - live on surface epithelium and protected by the overlying mucus barrier
infection damages epithelium leading to chronic inflammation = decreased acid levels
where is helibactor pylori infection most common
antrum of the stomach
what is peptic ulcer disease and the major sites of effect
localised defect extending at least into submucosa - part of the lining is erosion - full lining is ulcer
first part of duodenum
junction of astral and body mucosa
distal oesophagus
what are the main causes of peptic ulcer disease
anything increasing stomach acid secretion, H pylori infection
reflux, drugs, smoking, NSAIDS
what is the specific histology of acute peptic ulcer
full thickness coagulative necrosis of mucosa or deeper layers
what is the histology of chronic gastric ulcer
clear cut edges overhanging the base - extensive granulation and scar tissue
what are the complications of peptic ulcer
haemorrhage
peritonitis
penetration into adjacent organs
strictring - hour glass deformity - narrowing at centre of stomach
what are the differences between gastric and duodenal ulcer
gastric - low incidence, increases with ages, normal/low acid levels in blood group A
duodenal - higher incidence
increases up to 35 y/o - elevated gastric acid, mainly from h pylori gastritis
occurs in the bulbus in blood group O
what is the most frequent gastric cancer
adenocarcinoma
what are the differences in association between carcinoma of the GOJ and the gastric body/antrum
GOJ - associated with GO reflux not h Pylori/diet
gastric body/antrum - non association with GO reflex
what are the macroscopic subtypes of gastric cancer
plastica - ulceration involves all the stomach
polypoidal - polyps
ulcerated
what are the microscopic subtypes of gastric cancer
intestinal - well differentiated
diffuse type - poor differentiation cadherin gene mutation = linitis plastica
what does a loss in GDH1 gene lead to
cadherin (adhesion molecule) - diffuse type of microscopic gastric cancer
what is HDGC and the mutation
hereditary diffuse type gastric cancer
germline - CDH1 mutations - adhesion molecule
what type of pathology is coeliac disease
small bowel
what is coeliac disease and the pathogenesis
immune mediated enteropathy due to gluten
(gladin - causes epithelial cells to produce IL-15 = proliferation of CD8 intraepithelial lymphocytes - attacks tissue transglutaminase on bowel epithelium
what non invasive procedures are there for coeliac and what i stew gold standard test
IgA antibodies to tissue transglutaminase
IgA/G to deaminated gliadin
tissue biopsy gold standard
what are the clinical features and associations of coeliac disease
dermatitis herpeiformis
lymphocytic gastriis and lymphocytic colitis
what cancers are associated with coeliac disease
enteropathy associated t cell lymphoma
small intestinal adenocarcinoma
what is the treatment of coeliac and what risks does it reduce
gluten free diet - anaemia, female infertility, osteoporosis and cancer
what is the morphology of coeliac disease
finger like projections of epithelial cells
increased intraepithelial lymphocytes
increased lamina proprietary inflammation
