UPPER GASTROINTESTINAL PATHOLOGY Flashcards
Oesophagitis and gastro-oesophageal reflux
Definition: Inflammation of the oesophagus- can be acute/chronic.
Most likely in immunosuppressed patients.
Infectious: Bacterial, viral (HSV1, CMV), fungal (candida) or Chemical: Ingestion of corrosive substances or Reflux of gastric contents
Reflux oesophagitis = commonest form. Caused by reflux of gastric acid/bile. Risk factors: defective lower oesophageal sphincter. Hiatus hernia
Complications are ulceration, haemorrhage, perforation
Histology = lamina propria infiltrated by inflammatory cells
“Heart burn” presenting symptom.
Barrett’s oesophagus
chronic reflux of gastric content into lower part of oesophagus. commonest in overweight male Caucasians
Squamous –> columnar lining transition moves proximally towards mouth.
Aetiology: barrettes –> low grade dysplasia –> high grade –> adenocarcinoma. Only a proportion develop to cancer.
Regular endoscopic surveillance is recommended
Oesophageal cancer
8th most common cancer in the World
2 main types
1) squamous cell carcinoma from normal squamous cells
2) adenocarcinoma developing from metaplastic cells from metaplastic
Staging uses TNM system
Eg T1 only invades first layer. N = regional lymph nodes. M = distant metastasis
Clinical: ulcers, mass, difficulty swallowing
Acute and chronic gastritis
inflammation of stomach lining and inflammatory response
Increased aggression = excessive alcohol, drugs, smoking, chemotherapy and infection causes damage to the lining of the stomach and impairs defences –> ischaemia
Acute cases usually due to NSAIDs
Chronic commonly caused by H. pylori or autoimmune.
Peptic ulceration
Localised defect extending at least into submucosa. Major sites = 1st part of duodenum
Gastric ulcer = increases with age, acid levels low.
Duodenal ulcer = increases with age up to 35. Acid levels elevated. More commonly caused by h.pylori.
Can cause extensive granulation and scar tissue at ulcer floor –> haemorrhage & anemia.
Present with vomiting
Gastric cancer
5th most common cancer in world
Most frequently: Adenocarcinoma. Less frequently: Endocrine tumours, MALT lymphomas, Stromal tumours (GIST)
commonest in White males. Association with GO reflux.
Diet (smoked meat/fish/pickled vegetables), H.pylori and germline CDH1/E mutation are risk factors.
Coeliac disease: small bowel
gluten sensitive Immune mediated enteropathy. It is a reaction to gliadin = Alcohol soluble component of gluten.
Induces epithelial cells to express IL-15 –>i increased CD8+ IELs = CYTOTOXIC and kill enterocytes.
test with serology. treatment = gluten free diet.
