Upper GI disease

Question 1

What is chronic gastritis?

Answer 1

ongoing inflammation of the stomach mucosa
symptoms are less severe but more persistent compared to acute gastritis
can provide an environment in which dysplasia and carcinomas can arise

Question 2

What is dysplasia?

Answer 2

the enlargement of an organ or tissue by the proliferation of cells of an abnormal type, as a developmental disorder or an early stage in the development of cancer.

Question 3

Symptoms of chronic gastritis

Answer 3

upper abdo pain, indigestion/bloating, nausea and vomiting, belching, loss of appetite and weight loss
can be asymptomatic

Question 4

Causes of chronic gastritis

Answer 4

H.pylori infection, alcohol, tobacco, psychological stress, caffeine, autoimmune - can lead to pernicious anaemia as cannot produce vit. B12 = decrease RBC production

Question 5

H pylori

Answer 5

gram negative bacterium found in stomach
acquired via faecal-oral route
untreated = infection persists through life
80% = asymptomatic
5-15% = peptic ulcer disease
10% = non-ulcer dyspepsia
1-3% = gastric adenocarcinoma

Question 6

Peptic ulcer disease

Answer 6

damage of surface epithelium, can be caused be NSAIDS
symptoms: pain (burning, aching), worse at night and after meals
complications:
- bleeding = iron deficiency anaemia
- massive hematemesis (vomiting of blood)
- perforation = peritonitis

Question 7

Barrett’s oesophagus

Answer 7

normal lining of the oesophagus is stratified squamous epithelium down to stomach where it turns to columnar epithelial to the anus
in Barrett’s, columnar epithelium extends up into the oesophagus and replaces squamous, along with goblet cells- eg. of metaplasia
thought to be an adaption to chronic acid exposure from GERD (reflux)
process of dysplasia = low grade to high grade invasive carcinoma
strong association with oesophageal adenocarcinoma

Question 8

Oesophagus malignancies

Answer 8

Squamous cell carcinoma:
-adults (males) over 45
- risk factors - alcohol, smoking
- late symptoms - dysphagia(difficulty swallowing), weight loss, haemorrhage
- 5 year survival rate of 9%
Adenocarcinoma:
- largely from Barrett's oesophagus 
- symptoms - dysphagia, weight loss, vomiting 
- 5 year survival rate of 25%
Spreads:
> direct, into surrounding tissue
> lymphatic, paraoesophageal, paratracheal, cervical nodes
> haematogenous, to liver/lung

Question 9

Stomach malignancies

Answer 9

Adenocarcinoma: Precursor lesions -
Pernicious anaemia, Intestinal metaplasia, Neoplastic polyps, Helicobacter associated gastritis
second most common carcinoma worldwide
early symptoms resemble gastritis
advanced symptoms: weight loss, anorexia, anaemia, haemorrhage
prognosis depends on depth of invasion
5 year survival rate after surgery of 90%
Spreads:
> direct, into duodenum, pancreas, liver, colon, spleen
> lymphatic, local & regional nodes, Virchow’s nodes
> haematogenous, liver and lung
> ovary, mesentery, omentum

Question 10

Small bowel malignancies

Answer 10

Small bowel neoplasia:
- relatively rare
- subtypes: adenocarcinoma, GI stromal tumour, lymphoma, carcinoid tumour
Risk factors for small intestine cancer include:
- Crohn's disease
- Coeliac disease
- radiation
- hereditary GI cancer syndromes

Question 11

What is Coeliac disease?

Answer 11

extensive mucosal disease related to sensitivity of gluten
immune mediated villous atrophy and malabsorption
can be diagnosed via serological blood test and biopsy
intestinal damage healed by removal of gluten from diet
increased risk of adenocarcinoma and lymphoma of small bowel

Question 12

Symptoms of coeliac disease?

Answer 12

pain and discomfort in digestive tract, chronic constipation and diarrhoea, failure to thrive in children, anaemia, fatigue