Upper GI Pathology Flashcards
What are the layers of the gut?
What is the Z line?
Transitional line from squamous to columnar
What are the parts of a normal stomach?
What are the layers of the stomach in the body?
What are the layers of the stomach in the antrum?
What is normal duodenal epithelium?
What is this?
Acute oesophagitis
What is the presentation and complications of GORD?
- Gastro-oesophageal reflux disease
- Commonest cause of oesophagitis
- Reflux of acidic gastric contents
Ulceration
–necrotic slough
–inflammatory exudate
–granulation tissue
•Fibrosis
Complications
- haemorrhage
- perforation
- stricture
- Barrett’s oesophagus
What is this?
BARRETT’S OESOPHAGUS
•Re-epithelialisation by metaplastic columnar epithelium usually with goblet cells
(intestinal type epithelium)
•AKA columnar lined oesophagus (CLO)
What is 1,2 and 3?
- Normal
- CLO
- CLO with IM
What changes lead to cancer?
Metaplastic glandular epithelium (intestinal type)
Dysplasia changes showing some of the cytological and histological features of malignancy but no invasion through the basement membrane
Adenocarcinoma invasion through the basement membrane
What is the most common type of oesophageal cancer?
Adenocarcinoma of the oesophagus (lower- associated with reflux)
What is this?
- Associated with alcohol and smoking
- Mid/lower oesophagus
- Invasion into the submucosa
What is this?
SCC of oesophagus
What is the prognosis of an oesophageal carcinoma?
- Prognosis poor
- Diagnosis of pre-invasive stage important
What is the oesophageal varices?
caused by: cirrhosis, Budd Chiari/ PV thrombosis
What is gastritis?
- inflammation of the gastric mucosa
- Acute gastritis - acute insult
- Chronic gastritis - chronic / persistent insult
What might cause acute gastritis?
Chemical
- aspirin/NSAIDs
- alcohol
- corrosives
Infection
e.g. Helicobacter pylori
What causes chronic gastritis?
- H. pylori associated
- Chemical (NSAIDs, bile reflux; antrum )
- Autoimmune (body, auto-antibodies e.g. antiparietal)
- Lymphocytes +/- Neutrophils
Mucosal Associated Lymphoid Tissue (MALT)induction
What is H Pylori associated gastritis?
•Cause
H. pylori
•Pattern
chronic gastritis +/- activity
•Outcome
CLO-IM-Dysplasia,
Adenocarcinoma
Lymphoma (MALToma)
How is Helicobacter a carcinogen?
- Helicobacter infection is associated with an 8x increased risk of (non-cardia) gastric cancer
- cag-A-positive H.pylori have a needle like appendage that injects toxin into intercellular junctions allowing the bacteria to attach more easily.
- This strain is associated with more chronic inflammation.
- Treatment of the infection with antibiotics drastically reduces the risk of cancer.
What else causes gastritis?
•Infection
e.g. CMV, strongyloides
(immunosuppression)
•Inflammatory bowel disease
Crohn’s Disease
What is this?
Gastric ulcers
All ulcers should be biopsied to exclude malignancy
What are the complications of ulcers?
•Bleeding
Anaemia
Shock (massive haemorrhage)
•Perforation
Peritonitis
What is intestinal metaplasia?
- As in the oesophagus:
- intestinal metaplasia in gastric mucosa in response to long term damage
- Increased cancer risk
What is gastric epithelial dysplasia?
- Abnormal epithelial pattern of growth
- Some of the cytological and histological features of malignancy are present, but no invasive through the basement membrane
What are factors contributing to gastric cancer?
Who gets gastric cancer?
- High incidence in Japan, Chile, Italy, China, Portugal, Russia
- More common in men (1.8:1 ♂:♀)
- >95% of all malignant tumors in stomach are adenocarcinomas
What type of cancers are gastric cancers?
95% of stomach cancers are adenocarcinoma
These are split morphologically into:
- Intestinal – well differentiated
- Diffuse – poorly differentiated (Linitis plastica), includes signet ring cell carcinoma
- The remaining 5% is made up of:
–Squamous cell carcinoma
–Lymphoma (MALToma) [Haematology]
–Gastrointestinal stromal tumour (GIST) [Endocrinology]
–Neuroendocrine tumours [Endocrinology]
•Overall survival rate is 15%
What is gastric lymphoma?
•Chronic inflammation
–Chronic immune stimulation
- B cell (marginal zone) lymphocytes
- Treatment
–If limited to the stomach and H.pylori is present: H.pylori eradication
What is duodenitis?
- Increased acid production in the stomach which spills over into duodenum
- Chronic inflammation and gastric metaplasia with helicobacter infection
What is a duodenal ulcer?
Duodenitis and DU
good correlation between endoscopy and biopsy pathology
Endoscopy “itis”:
73.5% progress to ulcer, mainly erosive duodenitis (biopsy – neutrophils)
What other pathogens can cause a duodenal ulcer?
- Immunosuppressed
- CMV
- Cryptosporidiosis
- Giardia lamblia infection
- Whipple’s disease -Tropheryma whippelii.
What causes malabsorption in partial villous atrophy?
- Histology
- Villous atrophy
- Crypt hyperplasia
- Increased Intraepithelial lymphocytes
(normal range less than 20 lymphocytes /100 enterocytes)
What does the second half of this image show?
Flattening in villous atrophy
What is required for the diagnosis of coeliac disease?
•Diagnosis requires:
endomysial antibodies and tissue transglutaminase antibodies
Duodenal biopsies:
On gluten rich diet showing villous atrophy
Off gluten showing normal villi
There are other causes of malabsorption with similar histology e.g. tropical sprue
What is a duodenal MALToma?
Patients with coeliac disease have an increased risk of GIT cancers
- MALToma associated with Coeliac is
- in the duodenum
- T-cell origin
- (Enteropathy Associated T-cell Lymphoma)
What is this?
Duodenal maltoma
What are the 2 types of Barretts?
Without gobelt cells (gastric metaplasia)
With goblets cells (intestinal metaplasia)
What is CLO?
Barrett’s oesophagus (metaplastic change in oesophagus)
What is associated with SCC of the oesophagus?
Commonest in developing countries
Associated with alcohol and smoking
Mid/ lower oesophagus
Do cancers arise from pre existing adenomas in the oesophagus and stomach?
No (but this is not true in colon)
In a patient with coeliac disease on a diet containing gluten, which is the most likely histological change in the duodenum?
Villous atrophy, increased intra-epithelial lymphocytes
