Upper GI Flashcards
What are the normal histological characteristics of the Oesophagus?
- Squamous stratified epithelium (no goblet cells) in upper Part
then
Z -line/ squamo-columnar junction
then Columnar epitheium
Recall the different anatomical parts of the stomach
What are the normal histological features of the body of the stomach?
No goblet cells
What is the normal histology of the gastric antrum?
Non-specialised glands (compared to specialised glands in body)
(still no goblet cells)
What are the normal histological features of the duodenum?
What is the commonest cause of oesophagitis?
Reflux (= GORD)
What are some of the complications of Reflux oesophagitis?
- ulceration
- haemorrhage
- perforation
- stricture
- Barrett’s oesophagus
What is Barrett’s oesophagus?
What is the main complication?
Replacement of squamous epithelium by
metaplastic columnar epithelium (in 10% of patients with symptomatic GORD)
2 types:
without goblet cells: gastric metaplasia
with goblet cells: intestinal type metaplasia (even higher risk of Cancer)
Main risk : development of Cancer
Explain the asociation between Barrets Oesophagus and Oedophageal adenocarcinoma
Metaplasia (Barret’s) can lead to –> Dysplasia –> Cancer
Therefore adenocarcinoma usually seen in distal 1/3 of oesophagus
(Adenocarcinoma more common thatn squamous cell in developed countries)
What is the most common oesophageal cancer in developing countries?
What are the risk factors?
What is the main location this is found?
Squamous cell oesophageal carcinoma
Usually in middle 1/3 (50%), Upper 1/3. 20%, lower 1/3 30%
Associated with Alcohol and Smoking, more common in Afro-carribbeans
What is the main aetiological difference between acute vs. chronic gastritis?
Acute = due to an acute insult
Chronic = chornic or persistent insult
What are the main causes of acute gastritis?
Chemical
- aspirin/NSAIDs
- alcohol
- corrosives
Infection
e.g. Helicobacter
pylori
What are the main causes of chronic gastritis?
- Autoimmune (antiparietal antibodies etc. body)
- Bacterial (H. pylori; antrum )
- Chemical (NSAIDs, bile reflux; antrum )
What pattern od disease does Helicobacter pylori usually produce?
Causes chronic gastritis +/- activity
* +/- ulcers
Explain the relationship between chronic H.pylori infection and cancer
H.pylori infection causes and 8x risk of non-cardia gastric cancers (incl. adenocarcinoma) due to
- Ulcers –> malignancy
- MALT –> lymphoid tissue in stomach and risk of MALT lymphoma
What is the definition of a gastruc ulcer? How does it differn from an erosion?
Breach though the muscularis mucosa into submucosa
(a erosion does not breach through the muscularis mucosa)
What investigations should be done in all gastric ulcers?
Biopsy and histology to exclude malignancy
(If non-malignant: ulcer biopsy shows Punched out lesions with rolled margins)
What are the main differnet types of gastric carcinomas?
> 95% of gastric carcinomas are Adenocarcinomas
can be
1. Intestinal (well-differentiated, goblet cells present –> following intestinal metplasia or)
2. Diffuse (poorly differentiated, no gland formation)
What is MALT lymphoma of the Stomach associated with?
Chronic inflammation (particularly H.pylori) causes chronic antigen stimmulation
How can gastritis/ gastric H.pylori infection cause duodenal disease?
Increased acid
production in the
stomach which spills
over into duodenum
How many cases of Duodenitis also have duodenal ulcers present?
Usually if left untreated, many progress to ulcer
73.5% progress to ulcer,
mainly erosive
duodenitis (biopsy –
neutrophils)
What are the characteristics of MALT associated with Coeliacs?
MALToma associated with Coeliac is
* in the duodenum
* T-cell origin
* (Enteropathy Aassociated T-cell Lymohoma -EATL (is thechniacally different form MALT, as EATL usually high-grade non-Hodgekin lymphoma, MALT arises from a different location and is usually low-grade non-Hodgekin lymphoma)
