Upper GI

Question 1

Describe the normal oesophageal epithelium

Answer 1

starts as squamous epithelium
Z line - transition
Becomes columnar epithelium

Question 2

What is the Z line

Answer 2

the point at which the epithelium transitions from squamous to columnar

Question 3

What does the esophageal epithelium contain

Answer 3

submucosal glands

Question 4

what does the gastric columnar epithelium of the body and fundus of the stomach contain/produce?

Answer 4

SPECIALISED GLANDS

Produce acid + intrinsic factor

Question 5

what is the function of intrinsic factor

Answer 5

accompanies B12 for absorption in the terminal ilieum

Question 6

what happens without intrinsic factor?

Answer 6

in pernicious anaemia, antibody against intrinsic factor

means B12 cannot be absorbed > anaemia

Question 7

What kind of epithelium lines the stomach?

Answer 7

gastric mucosa columnar epithelium

Question 8

What does the epithelium in the pylorus and antrum produce?

Answer 8

gastrin

Question 9

Describe the epithelium in the normal duodenum

Answer 9

Glandular epithelium

wtih goblet cells

Question 10

What is the villous to crypt ratio in the duodenum

Answer 10

villous : crypt = 2:1

Question 11

Why are villi important

Answer 11

for absorption

so if this ratio diminishes, it means malabsorption is occurring > find underlying disease

Question 12

Are goblet cells normally seen in stomach?

Answer 12

NO > feature of metaplasia

Question 13

What usually causes oesophagitis

Answer 13

GORD

Question 14

what are unwanted consequences of GORD

Answer 14

Ulceration, fibrosis, haemorrhage, perforation, stricture,

BARRETS OESOPHAGUS

Question 15

what is barret’s oesophagus

Answer 15

normal squamous epithelium of the lower oesophagus is replaced by METAPLASIC columnar epithelium

Question 16

what are the three layers in the oesophagus

Answer 16

epithelium (squamous/columnar)
submucosa
Muscolaris

Question 17

is Barrets reversible

Answer 17

YES

Question 18

What occurs in intestinal metaplasia

Answer 18

GOblet cells become visible in the stomach

Question 19

explain the transition from healthy oesophagus to cancer

Answer 19

acid rises up from stomach e.g. gord > metaplasia from squamous to columnar > persists > dysplasia

Question 20

What is the most common type of oesophageal cancer in West

Answer 20

ADENOCARCINOMA

Question 21

what are RF for adenocarcinoma

Answer 21

Barrett’s

GORD

Question 22

Where does adenocarcinoma occur

Answer 22

Lower 1/3 of oesophagus

Question 23

What is seen on histology of the adenocarcinoma

Answer 23

glandular (columnar) epithelium

Question 24

What part of the oesophagus is most affected in adenocarcinoma

Answer 24

lower 1/3

Question 25

WHere is SCC the most common tuype of oesophageal cancer

Answer 25

In developing countries

Question 26

what is oesophageal SCC associated with

Answer 26

smoking, alcohol

Question 27

what part of the oesophagus is most affected in SCC

Answer 27

lower 2/3

Question 28

what is seen on histology of SCC

Answer 28

keratrinised cells, IC bridges

Question 29

What is gastritis

Answer 29

inflammation of gastric mucosa

Question 30

what are causes of gastritis

Answer 30

ABC Autoimmune Bacteria: H pylori Chemicals: alcohol, NSAIDS, corrosives

Question 31

What is an example of c hornic gastritis causing severe damage

Answer 31

chronic gastritis associated with H pylori induces lymphoid tissue in stomach > dev elipmeent of lympohoid follicles > increased risk of MALT lymphoma

Question 32

What is the MOA of H pylori

Answer 32

bind to epithelial cells | inject. toxins into theme

Question 33

summarise consequences of H pylori gastritis

Answer 33

dysplasia adenocarcinoma lymphoma (MALToma)

Question 34

what is the toxin secreted by H pylori

Answer 34

Cag A

Question 35

what is a gastric ulcer

Answer 35

depth of tissue loss beyond the mucosa, into the submucosa

Question 36

what is an erosion

Answer 36

loss of surface epithelium and lamina propria (NOT beyond the mucosa)

Question 37

what is the difference between an acute and chronic ulcer

Answer 37

a chronic ulcer presents with SCARRING and FIBROSIS

Question 38

what should you do for all patients presenting with an ulcer

Answer 38

BIOPSY it | TO EXCLUDE MALIGNANCY

Question 39

what is the most common type of malignant gastric cancer

Answer 39

ADENOCARCINOMA

Question 40

what are the two types of gastric adenocarcinoma

Answer 40

intestinal | diffuse

Question 41

describe an intestinal gastric adenocarcinomna

Answer 41

has all features of intestinal mucosa well differentiated presence of glands containing muciin

Question 42

describe an diffuse gastric adenocarcinomna

Answer 42

no identifiable features, poorly differentiated | composed of single cells, no attempt at gland fomrartion

Question 43

what are the two types of diffuse adenocarcinoma

Answer 43

Linitis plastica | Signet ring cell carcinoma

Question 44

what are histological features of coeliac

Answer 44

villous atrophy crypt hyperplasia increased intraepithelial lymphocytes

Question 45

why is it bad that villous atropby occurs

Answer 45

villi flatten > less area for absortpion > malabsorption

Question 46

What is lymhocytic duodenitis

Answer 46

PRECURSOR TO COELIAC there are inflammatory changes (increased intraepithelial lymphocytes ) without architectural changes

Question 47

what antibodies are used to diagnose coeliac disease

Answer 47

Endomysial antibodies | Tissue transglutaminase antibodies (IgA)

Question 48

what must you also measure when measuring TTA

Answer 48

total serum IgA > because if they have selective IgA deficienncy they will not have TTAs

Question 49

What is the gold standard for coeliac dx

Answer 49

duodenal biopsy - on gluten rich diet

Question 50

what is tropical sprue

Answer 50

another cause of malabsorption similar histology to coeliacs but occurs in tropical countries, where there are different bacterial types