Upper GI

Question 1

What organs are in the upper GI tract?

Answer 1

Oesophagus
Stomach
Intestine.

Question 2

What is chronic gastritis?

Answer 2

Persistant inflammation of the stomach.
Compared to acute gastritis symptoms are less severe but last longer
Can cause dysplasia and carcinoma.

Question 3

What are the symptoms of chronic gastritis?

Answer 3

Upper abdominal pain.
Indigestion or bloating
Nausea or vomiting
Loss of appetite or weight loss. 
However can be asymptomatic.

Question 4

What causes chronic gastritis?

Answer 4

A- Autoimmune, causing pernicious anaemia.
B- Bacterial- Helicobacter pylori
Chemical- Alcohol, tobacco and caffeine.

Question 5

Explain helicobactar pylori

Answer 5

Bacteria that causes chronic gastritis.
Gram negative bacteria found in the stomach, particularly antrum.
Over half of the world population is affected by age 5.
Transmitted faecal-orally.
Linked with the development of duodenal ulcers and stomach cancer.

Question 6

What is the presence of H. pylori?

Answer 6

80% asymptomatic.
5-15% PUD
10% non ulcer dyspepsia.
1-3% gastric adenocarcinoma. 
0.5% gastric MALToma.

Question 7

What diseases is H. pylori connected to?

Answer 7

Chronic gasritis
Duodenal ulcer. 
Gastric ulcer
gastric carcinoma
MALT lymphoma.

Question 8

What are the effects of a H. pylori infection?

Answer 8

Body predominant- hypochlorhydira, gastric atrophy, intestinal metaplasia.
Antrum predominant infection- hyperchlorhydria.

Question 9

Where do peptic ulcers originate and what are their symptoms?

Answer 9

PUD usually occurs in the D1 or antrum.
Commonly caused by H pylori and NSAIDs.
Ulcers are usually solitary.
Symptoms include burning and aching- symptoms worse at night or after meals.

Question 10

What are some of the complications of peptic ulcers.

Answer 10

Prolonged bleeding leading to anaemic iron deficiency.
Massive haematemesis
Perforation leading to peritonitis.
Cancer at the edge of the ulcer.

Question 11

What is Barrett’s oesophagus.

Answer 11

When normal stratified squamous is replaced by columnar epithelium with goblet cells.
This is an adaptation from exposure to acid.
An example of metaplasia.
Can cause dysplasia- low grade invasive carcinoma and oesophageal adenocarcinoma.

Question 12

What are examples of oesophagus cancer? (UGIs)

Answer 12

Squamous carcinomas.

Adenocarcinoma (barretts)

Question 13

What are examples of stomach cancer

Answer 13

Adenocarcinoma

GIST- GI stromal tumours.

Question 14

What are examples of small bowel cancer?

Answer 14

Lymphoma
GIST
Neuroendocrine tumours.

Question 15

Explain squamous carcinoma.

Answer 15

Occurs most commonly in men over 45.

Risk factors include alcohol, tobacco, caustic injury and atalasia (food fails to pass into stomach)

Question 16

What are the symptoms of squamous carcinoma?

Answer 16

Dysphagia, weight loss, haemorrhage, sepsis, respiratory aspiration.

Question 17

Explain oesophageal carcinoma.

Answer 17

Caused by dysplastic change in Barrett’s oesophagus.
More common in males
Can be direct- into surrounding tissues.
Can be lymphatic- to paraoesphageal, parateacheal and cervial nodes.
Can be haematogenous- from liver to lung.

Question 18

Explain adenocarcinoma

Answer 18

Most common causes of gastric malignancies.
Percursor lessons are pernicious anaemia (atrophic gastritis), intestinal metaplasia, neoplastic polyps, helicobactar gastrisis.

Question 19

What are the symptoms of adenocarcinoma.

Answer 19

Weight loss
Anorexia
Anaemia
Haemorrhage

Question 20

Where can adenocarcinomas of the stomach spread to?

Answer 20

Direct infiltration- duodenum, pancreas, colon, liver, spleen.
Lymphatic spread- local and regional nodes, virchow’s node.
Haematogenous- liver to longs.
Transcoelomic
Omentum
Mesentery
Ovary- krukenberg tumour.

Question 21

What are the risk factors of small bowel neoplasia?

Answer 21

Crowns disease, coeliac, radiation, hereditary GI cancer- e.g familial adenomatous polyposis.

Question 22

Explain coeliac disease.

Answer 22

Extensive mucosal disease due to the sensitivity of gluten.
Immune mediated villous atrophy and malabsorption.
Can be diagnosed with a serological blood test (TTG) and biopsy.
Symptoms can be reveres within weeks of gluten being removed from diet.
Increase risk of adenocarcinoma and lymphoma in small bowel

Question 23

What are the symptoms of coeliac?

Answer 23

Pain and discomfort in digestive tract, chronic constipaition and diarrhoea, failure to thrive in children, anaemia and fatigue.