Upper GI patho Flashcards
epithelial tumours of salivary gland (acinar, myoepithelial, ductal cells)
- salivary gland tumours
epithelial tumours of oral cavity and oesophagus
(squamous epithelium-lined
mucosa)
- squamous papilloma
- squamous cell carcinoma
epithelial tumour of stomach, small bowel, colon
and rectum (Glandular/ Columnar epithelium-lined mucosa)
- adenoma
- adenocarcinoma
epithelial tumours of anus (squamous epthelium-lined mucosa)
- condyloma acuminatum
- squamous cell carcinoma
what are ulcers
- local defect of surface of an organ/ tissue caused by sloughing of inflamed necrotic tissue
- erodes mucosa & muscularis mucosae (reaches SUBMUCOSA as well) -> vs erosion: usually only disrupts mucosa and not any further
causes of ulcers (3)
- aphthous ulcers
- oral candidiasis
- HSV infection/ herpetic stomatitis
described aphthous ulcers (canker sores)
- common, usually small, painful shallow ulcer
oral candidiasis presentation
- adherent white, curd-like plaque
- scrapped to reveal an underlying granular erythematous inflammatory
base
**infective organism: Candida albicans
what is associated with oral candidiasis
- immunodeficiency - eg AIDS
- diabetes
- glucocorticoid therapy
- antibiotics, chemotherapy
HSV infection presentation
- small vesicles/ blisters containing CLEAR fluid
- most common on/ around lips
complications of HSV infection in immunocompromised
- more severe, multiple vesicles in oral cavity
- lymphadenopathy
- viraemia
mucocutaneous disorders (2)
- lichen planus
- pemphigus vulgaris
lichen planus presentations
- WICKHAM STRIAE -> lacy web like, white threads; commonly on inside of cheek
- ulceration
lichen planus cause
- likely autoimmune
*treat with steroids/ immunosuppressant
pemphigus vulgaris presentation
- autoimmune disorder
- blisters form on mucous membranes (eg mouth)
*treat with steroids, immunosuppressants
types of mucosal change (3)
leukoplakia (WHITE patch)
- Whitish, well-defined mucosal patch caused by epidermal thickening/
hyperkeratosis
- cannot be scraped off
erythroplakia (RED patch)
- Thin, friable atrophic mucosa with a red, granular gross appearance
speckled mucosa (red +
white)
- Combined leuko-erythroplakia mucosal changes
what is leukoplakia associated with
- tobacco, chronic friction, alcohol abuse
- older men
complications of leukoplakia
- mostly benign
- some transform into INVASIVE CARCINOMA
where is erythroplakia commonly found
- thin squamous mucosal sites
complications of erythroplakia
- epithelial dysplasia
- carcinoma in situ
- invasive squamous cell carcinoma
- absence of keratin production, reduced epithelial cell number
tumours of oral cavity - surface squamous epithelium (2)
- benign: squamous cell papilloma
- malignant: squamous cell carcinoma
what is squamous cell papilloma associated with
- HPV
- papilloma on uvula, palate, tongue, gingiva, lower lips, buccal mucosa
*most common benign epithelial neoplasm
squamous cell papilloma morphology
macroscopic:
- cauliflower like lesions
what is the majority (95%) of oral cavity cancers
squamous cell carcinoma
what is oropharyngeal squamous cell carcinoma (SCC) associated with
- smoking, alcohol, HPV (type 16)
- men (90%)
- floor of mouth, tongue, hard palate, base of tongue
what decreases risk of SCC in oral cavity
fruit & veggie consumption
features of SCC in oral cavity
- masses containing NECROSIS, ULCERS, rolled borders
diseases of salivary glands
Salivary gland neoplasm
- pleomorphic adenoma
- warthin tumour
most common tumour of salivary glands
- pleomorphic adenoma
where is pleomorphic adenoma found
- most common in PAROTID salivary glands
- painless, slow-growing mass in front of and below
the ear (parotid)
*pleomorphic adenomas are benign epithelial tumours
2nd most common salivary gland tumour
- warthin tumour
what is warthin tumour associated with (3)
- male
- smoker
- found in PAROTID GLAND
congenital diseases of esophagus (2)
- esophageal atresia, tracheo-esophageal fistula
- diaphragmatic hernia
esophageal atresia/ tracheo-esophageal fistula presentations & complications
presentation
- regurgitation during feeding
complications
- aspiration pneumonia, suffocation
*requires prompt surgical repair
diaphragmatic hernia pathogenesis
- incomplete formation of diaphragm allowing abdominal viscera to herniate into the thoracic cavity
- more common on left side
- can lead to PULMONARY HYPOPLASIA (severe)
motility disorders of esophagus (3)
- nutcracker esophagus
- corkscrew esophagus (diffuse esophageal spasm)
- achalasia
motility disorders presentation
- heartburn, dysphagia, frequent coughing/ choking
nutcracker esophagus pathogenesis
- High amplitude, uncoordinated contractions of inner circular and outer longitudinal smooth muscle
- normal barium swallow, diagnosis by manometry
corkscrew esophagus pathogenesis
- Uncoordinated peristalsis with repetitive, simultaneous contractions (normal amplitude) of the distal oesophageal smooth muscle
achalasia pathogenesis
TRIAD
- incomplete LES (lower esophageal sphincter) relaxation
- increased LES tone
- aperistalsis of esophagus
treatment
- balloon dilation, botox injection
laceration injuries to esophagus (2)
- mallory-weiss tears
- boerhaave syndrome
mallory-weiss tears pathogenesis
- longitudinal superficial mucosal tears near the GEJ
- often associated with severe retching/ vomiting secondary to acute alcohol intoxication
- usually do not require surgical intervention
mallory-weiss tears presentation
- haematemesis (vomit blood)
boerhaave syndrome pathogenesis
- barogenic injury from sharp increase in intraluminal pressure -> transmural tearing and rupture of the distal oesophagus
- cause severe mediastinitis
- require surgery
boerhaave syndrome presentation
- severe chest pain
- tachypnea
- shock
pathogenesis of esophageal varices
- dilated vessels (usually submucosal), within lower esophagus & proximal stomach
- due to PORTAL HYPERTENSION in liver cirrhosis -> form collateral channels at sites where portal & caval system communicate (eg esophagus) -> congestion & dilation
complications of esophageal varices
- variceal rupture -> haematemesis, maelena (upper GI bleeding)
common symptoms of esophageal MUCOSAL injury (eg ulceration, tears, inflammation)
- heartburn, chest pain, haematemesis
types of inflammation in esophagus (5)
- reflux esophagitis
- chemical esophagitis -> alcohol, corrosive acid/alkali
- infectious esophagitis -> HSV, CMV, candida
- eosinophilic esophagitis -> eosinophil dominated
- iatrogenic injury -> radiation, chemotherapy
reflux esophagitis pathogenesis
- most common cause of esophagitis
- reflux of gastric contents into lower esophagus (transient LES relaxations)
what is reflux esophagitis associated with
- abrupt increase in abdominal pressure (cough, bending)
- alcohol
- obesity/ pregnancy
complications of reflux esophagitis
- chronic GORD
presentation of reflux esophagitis
- heartburn, dysphagia, postprandial regurgitation of sour-tasting gastric contents, sore throat/cough
barrett esophagus pathogenesis
- complication of chronic GORD
- intestinal metaplasia within esophageal squamous mucosa
what can barrett esophagus develop into
- increase risk of dysplasia and ADENOCARCINOMA
most common esophageal neoplasia
- squamous cell carcinoma
*men > women
presentations of esophageal SCC & adenocarcinoma(3)
- mass -> dysphagia (difficulty swallowing), odynophagia (pain swallowing), obstruction
- ulceration
- systemic weight loss
where is esophageal SCC usually found
upper 2/3 of esophagus
how does esophageal SCC spread
Circumferential and longitudinal spread
Local invasion into adjacent structures:
- Respiratory tree (tracheo-oesophageal fistula) → aspiration pneumonia
- Aorta → catastrophic exsanguination
- Mediastinum → mediastinitis
Lymph node metastasis
- Upper third → cervical lymph nodes
- Middle third → mediastinal, paratracheal and tracheobronchial nodes
- Lower third → gastric and coeliac nodes
Distant metastasis
what is esophageal adenocarcinoma associated with
- long standing GORD
- men > women
where is esophagus adenocarcinoma found
- lower 1/3 of esophagus
- may invade adjacent gastric cardia
