Upper GI

Question 1

What are main causes of oesophagitis?

Answer 1

Viral (Herpes simplex or CMV) and gastric reflux
RF (same as reflux) = male, caucasian, overweight
Barrett’s Oesophagus = chronic reflux cam cause bening stricture (fibrosis).

Question 2

What are the two types of oesophageal cancer and what are they caused by?

Answer 2

1. Squamous cell carcinoma: from oesophagus cause by tobacco, hot drinks, male, black - can ulcer. Mostly middle & lower 1/3
2. Adenocarcinoma: caused by BO, lower oesoph (squamous mucosa replaced by columnar mucosa).

Question 3

What is the aetiology & pathology of chronic gastritis?

Answer 3

Aetiology: can be autoimmune (anti-parietal & anti-intrinsic factor Ab), H. Pylori (no pathology - increased risk of gastric cancer & MALT lymphoma), chemical injury e.g. NSAIDS
Pathology: inflammation of mucosa, glandular atrophy, intestinal metaplasia

Question 4

What is aetiology & pathology of acute gastritis?

Answer 4

Usually due to chemical injury e.g. NSAIDS, alcohol or H, pylori (more common in antrum).
Path: same as chronic except erosions and haemorrhages can occur.

Question 5

Where is peptic ulcer disease most common and what is it caused by?

Answer 5

Location: 1st part of duodenum, junction of antrum, and GOJ
Aetiology: hyperacidity, H pylori, reflux, drugs etc

Question 6

What distinguishes acute and chronic peptic ulcer disease?

Answer 6

Acute = full & thick coagulative necrosis of mucosa, necrotic debris
Chronic = clear cut edges overhanging bas,s carrying throughout entire gastric wall with

Question 7

Describe pathogenesis of Coeliac Disease:

Answer 7

gut reacts to gliadin (component of gluten) -> induces epithelial cells to express IL-15 -> activated CD8+ cells and intraepithelial lymphocytes -> these kill enterocytes

Question 8

How can you diagnosis Coeliac Disease?

Answer 8

Biopsy is diagnosis. Serology would show IgA antibodies to tissue transglutaminase (TTG) or IgA/G antibodies to deaminated gliadin. Or, anti-endomysial antibodies (highly specific but less sensitive).

Question 9

What are associated diseases with Coeliac Disease?

Answer 9

Dermatitis Herpetiformis (itchy rash), lymphocytic gastritis, lymphocytic colitis.
ALSO cancer: enteropathy-associated T cell lymphoma, small intenstinal adenocarcinoma. 
Long term comps: anaemia, female infertility, osteoporosis.

Question 10

What would you expect to see macroscopically in a diffuse-type gastric cancer (versus intestinal)?

Answer 10

linitis plastica - thickened wall. Occurs in Hereditary diffuse type HDGC.

Question 11

What mutation in hereditary HDGC?

Answer 11

germline CDH1/E-cadherin mutation.

Question 12

What are types of gastric cancer?

Answer 12

Adenocarcinoma = most common

- or endocrine/MALT lymphoma/ stromal tumours GIST

Question 13

What is aetiology of gastric cancer?

Answer 13

diet (smoked meat/fish/pickled veg), H. Pylori, bile reflux (post-Billroth II operation), hypochlorhydria (allows bacterial growth), hereditary (cadherin genes).

Question 14

What is aetiology of GOJ cancer?

Answer 14

BO, white, male, NO ASSOCIATION WITH H PYLORI

Question 15

What is aetiology of gastric body/antrum?

Answer 15

H. Pylori and diet (salt, low fruit & veg). NO ASSOCIATION WITH REFLUX.

Question 16

What is microscopy of intestinal cancer versus diffuse?

Answer 16

Well or moderately differentiated.