Upper Gastrointestinal Disease Flashcards
What are the different parts of the stomach?
Cardia
Fundus
Body
Pyloric antrum
Pylorus
Duodenum
What are normal features of a histology slide for the body of a stomach?
Lined by gastric mucosa columnar epithelium (foveolar, mucin secreting)
Specialised glands in the lamina propria
Muscularis mucosa
What are normal features of a histology slide of the antrum of a stomach?
Lined by gastric mucosa columnar epithelium (fovelolar, mucin secreting)
Non-specialised glands in the lamina propria (gastric pits)
Mucularis mucosa
What are normal features of a histology slide of the duodenum?
Glandular epithelium with goblet cells - Intestinal type epithelium.
Villous architecture: villous:crypt ratio of >2:1
What is this?
Acute oesophagitis
What is this?
Acute oesophagitis
What is reflux oesophagitis?
Gastro-oesophageal reflux disease
Commonest cause of oesophagitis
Reflux of acidic gastric contents
What are complications associated with reflux oesophagitis?
Ulceration:
- Necrotic slough
- Inflammatory exudate
- Granulation tissue
Fibrosis:
- Haemorrhage
- Perforation
- Stricture
- Barrett’s oesophagus
What is Barrett’s oesophagus?
Re-epithelialisation by metaplastic columnar epithelium usually with goblet cells - intestinal type epithelium.
AKA columnar lined oesophagus (CLO).
What is this?
Barrett’s oesophagus
What is this?
Normal
What is this?
Barrett’s oesophagus
What is this?
Barrett’s oesophagus with intestinal metaplasia
What is the sequelae of disease progression to neoplasia?
Metaplastic glandular epithelium - Intestinal type
Dysplasia - Changes showing some of the cytological and histological features of malignancy but no invasion through the basement membrane.
Adenocarcinoma: Invasion through the basement membrane.
What is squamous cell carcinoma of the oesophagus?
Associated with alcohol and smoking.
Mid/lower oesophagus.
Invasion into the submucosa.
What is this?
Squamous cell carcinoma of the oesophagus
What is this?
Squamous cell carcinoma of the oesophagus
What is the prognosis of oesophageal carcinoma?
Prognosis poor
Diagnosis of pre-invasive stage important
What is gastritis?
Inflammation of the gastric mucosa
- Acute gastritis: Acute insult
- Chronic gastritis: Chronic/persistent insult
What is this?
Gastritis
What are causes of acute gastritis?
Chemical:
- Aspirin/NSAIDs
- Alcohol
- Corrosives
Infection:
- e.g. Helicobacter pylori
What is this?
Acute gastritis
What are causes of chronic gastritis?
H. pylori associated:
Chemical (NSAIDs, bile reflux; antrum )
Autoimmune (body, auto-antibodies e.g. antiparietal)
Lymphocytes +/- Neutrophils
Mucosal Associated Lymphoid Tissue (MALT) induction
(ABC: Autoimmune, Bacterial, Drugs)
What is Helicobacter associated gastritis?
Caused by H. pylori.
Pattern: Chronic gastritis +/- activity
Outcome:
- CLO-IM-Dysplasia,
- Adenocarcinoma
- Lymphoma (MALToma)
What is this?
Helicobacter associated gastritis
How is Helicobacter associated with cancer?
Helicobacter infection is associated with an 8x increased risk of (non-cardia) gastric cancer.
cag-A-positive H.pylori have a needle like appendage that injects toxin into intercellular junctions allowing the bacteria to attach more easily.
This strain is associated with more chronic inflammation.
Treatment of the infection with antibiotics drastically reduces the risk of cancer.
What are other causes of gastritis?
Infection e.g. CMV, strongyloides (immunosuppression)
Inflammatory bowel disease: Crohn’s Disease
What is this?
Gastric ulcer
What is this?
Gastric ulcer
Why should all ulcers be biopsied?
To exclude malignancy.
What are complications associated with ulcers?
Bleeding:
- Anaemia
- Shock (massive haemorrhage)
Perforation:
- Peritonitis
What is intestinal metaplasia?
As in the oesophagus: Intestinal metaplasia in gastric mucosa in response to long term damage.
Increased cancer risk.
What is this?
Intestinal metaplasia
What is gastric epithelial dysplasia?
Abnormal epithelial pattern of growth.
Some of the cytological and histological features of malignancy are present, but no invasive through the basement membrane.
What is this?
Gastric epithelial dysplasia
What is the epidemiology of gastric cancer?
High incidence in Japan, Chile, Italy, China, Portugal, Russia.
More common in men (1.8:1 ♂:♀).
>95% of all malignant tumors in stomach are adenocarcinomas.
What is this?
Gastric cancer
What is this?
Gastric cancer
What is gastric cancer and how can it be split?
95% of stomach cancers are adenocarcinoma.
These are split morphologically into:
- Intestinal: Well differentiated.
- Diffuse: Poorly differentiated (Linitis plastica), includes signet ring cell carcinoma.
What is this?
Intestinal gastric cancer
What is this?
Diffuse gastric cancer
What are less common types of gastric cancer?
The remaining 5% is made up of:
- Squamous cell carcinoma
- Lymphoma (MALToma)
- Gastrointestinal stromal tumour (GIST)
- Neuroendocrine tumours
What is the overall survival of gastric cancer?
Overall survival rate is 15%
What is Gastric MALToma/Lymphoma and the treatment?
Chronic inflammation: Chronic immune stimulation
B cell (marginal zone) lymphocytes.
Treatment: If limited to the stomach and H.pylori is present - H.pylori eradication.
What is this?
Gastric MALToma/Lymphoma
What is this?
Gastric MALToma/Lymphoma
What are the associations between duodenitis, duodenal ulcers and H. Pylori?
Increased acid production in the stomach which spills over into duodenum.
Chronic inflammation and gastric metaplasia with helicobacter infection.
What is this?
Duodenal ulcer
Which pathogens are responsible for duodenal ulcers?
Immunosuppressed:
CMV
Cryptosporidiosis
Giardia lamblia infection
Whipple’s disease -Tropheryma whippelii.
What is seen on a histology slide for malabsorption?
Partial villous atrophy
Histology:
- Villous atrophy
- Crypt hyperplasia
- Increased Intraepithelial lymphocytes: Normal range less than 20 lymphocytes /100 enterocytes
