Upper GI Pathology

Question 1

List the main types of pathology which affect the oesophagus. (6)

Answer 1

Infections
Inflammation
Diverticular disease
Cancer
Ulceration
Varices

Question 2

List the 2 main infections in the oesophagus.

Answer 2

Candida

Herpes simplex virus

Question 3

List the 4 main types of inflammation in the oesophagus.

Answer 3

Peptic oesophagitis/GORD
Caustic substances (e.g. NaOH, caustic soda)
Pills getting stuck (e.g. iron)
Eosinophilic oesophagitis

Question 4

List the 4 types of cancer which affect the oesophagus.

Answer 4

Barrett’s oesophagus
Sqaumous carcinoma
Adenocarcinoma
Metastatic gastric cancer

Question 5

List the main cause of oesophageal varices.

Answer 5

Liver cirrhosis and portal hypertension

Question 6

How would you treat eosinophilic oesophagitis? (2)

Answer 6

Avoid dietary triggers

Steroids (fluticasone)

Question 7

List 3 histological features of metastatic gastric cancer in the opesphagus.

Answer 7

Inflammatory cells and exudate
Ulceration
Atypical squamous cells

Question 8

Describe the pathophysiology of Barrett’s oesophagus. (4)

Answer 8

1. Mucosal injury causes metaplasia, which may have 4 different forms:
   a. Gastric cardia cells
   b. Gastric body cells (including gastric glands and parietal cells)
   c. Intestinal cells (with goblet cells)
   d. Mosaic (all of above)

Question 9

List 2 conditions associated with Barrett’s oesophagus.

Answer 9

Benign strictures

Adenocarcinoma

Question 10

What are the 2 types of cancer in the oesophagus? What are they associated with?

Answer 10

Squamous carcinoma

• Smoking
• Drinking

Adenocarcinoma

• Obesity
• GORD

Question 11

Which investigations would you do for oesophageal cancer? (2)

Answer 11

Endoscopy
Biopsy (Seattle protocol)

Question 12

How would you treat oesophageal cancer? (2)

Answer 12

Radiofrequency ablation

Surgery

Question 13

List the 2 main types of gastritis.

Answer 13

Acute gastritis

Chronic gastritis

Question 14

List 3 causes of acute gastritis.

Answer 14

Alcohol
NSAIDs
Severe trauma (e.g. burns, surgery)

Question 15

List 3 causes of chronic gastritis.

Give examples of each.

Answer 15

Autoimmune gastritis, e.g.

• Atrophic gastritis
• Pernicious anaemia

Bacterial gastritis, e.g.
-H. pylori

Chemical gastritis

Question 16

What is Zollinger-Ellison syndrome?

Answer 16

Neuroendocrine tumours (in pancreas/duodenum) producing gastrin, which stimulates increased gastric acid production and therefore severe peptic ulceration

Question 17

List 4 causes of chronic chemical gastritis.

Answer 17

Bile reflux
NSAIDs
Alcohol
Oral iron tablets

Question 18

List 7 risk factors for gastric cancer.

Answer 18

Chronic gastritis, esp.
-H. pylori
-Autoimmune gastritis
Blood group A
Adnomatous polyps
Lower socioeconomic status
Smoking
High salt diet
Nitrosamine exposure

Question 19

What are the 2 types of gastric cancer?

Answer 19

Intestinal type

Diffuse type

Question 20

Where does gastric cancer commonly metastasise to? (3)

Answer 20

Ovaries (Krukenberg tumour)
Supraclavicular lymph node (Virchow’s node)
Umbilicus (Sister Mary Joseph’s nodule)

Question 21

What gene is associated with familial gastric cancer?

Answer 21

CDH1 (E-cadherin) mutation