Upper GI Pathology Flashcards
What is Barrett’s Oesophagus?
- metaplasia of oesophageal stratified squamous epithelium
- forms gastric columnar epithelium
- caused by prolonged gastro-oesophageal reflux
- more men
Types of Barrett’s Oesophagus?
Classic >3cm
Short <3cm
Risk of cancer with Barrett’s oesophagus?
30x increased risk of epithelial dysplasia and adenocarcinoma
Even after successful reflux treatment
Predisposing factors to oesophageal carcinoma
Diet
Esophageal disorders
Smoking and alcohol
Presenting features of oesophageal carcinoma
Progressive dysplasia
Anorexia/weight loss
Aspiration pneumonia
Fistula
Sites of oesophageal carcinoma
Upper 1/3 = 20%
Middle 1/3 = 50%
Lower 1/3 = 30%
Macroscopic appearance
Polypoid fungating
Ulcerating
Annular constricting
Diffuse infiltrating
Microscopic features
- squamous cell carcinoma!
- adenocarcinoma
- undifferentiated
Adenocarcinoma
Elderly
More males
Arises in Barrett’s metaplasia
Chronic Gastritis
Chronic inflammation of gastric mucosa
Common
Often asymptomatic
Causes of chronic gastritis
- bacterial infection = H pylori
- chemical = NSAIDs, bile reflux, alcohol
- autoimmune = anti-parietal cell AB
Outcomes of H. pylori infection
- peptic ulcer
- gastric carcinoma
- primary gastric lymphoma
- asymptomatic (majority of the time)
Peptic ulcer sites
Duodenum
Stomach
oesophagus
Meckel’s diverticulum
Factors predisposing a peptic ulcer
H pylori gastritis
Zollinger Ellison syndrome (gastinoma)
NSAIDs, alcohol
Who is more likely to get which peptic ulcers?
Duodenum = males much more
Gastric ulcer males slightly more
Incidence of peptic and gastric ulcers
Duodenum decreasing
Gastric staying the same
Peptic ulcer macroscopic appearance
Most of the time just single <3cm diameter punched out edges Deeply penetrating Fibrosis at base
Complications of gastric ulcers
- haemorrhage
- obstruction = due to oedema and scarring
- perforation = peritonitis
Presenting features of gastric carcinoma
- anorexia
- weight loss
- dyspepsia
- adbo pain
- haemorrhage
- anaemia
- metastases
Predisposing factors to gastric carcinoma
H pylori gastritis
Genetics
Evnvironmental
Stages of gastric carcinoma
Normal mucosa -> H. pylori infection forms chronic gastritis -> intestinal metaplasia -> dysplasia -> carcinoma
Sites of gastric carcinoma
- antrum = 50%
- body = 25%
- GOJ = 25%
Macroscopic appearance of gastric carcinoma
- polypoid fungating
- polypoid with ulceration
- ulcerating
- diffuse infiltrating
Microscopic features of gastric carcinoma
Adenocarcinoma = 95%
Undifferentiated
Intestinal and diffuse adenocarcinoma
Intestinal more common than diffuse
- intestinal from intestinal metaplasia
- diffuse from mucous neck cells in gastric pits
- intestinal = polypoid/ulcerating mass
- diffuse = linitis plastic
- diffuse spreads widely
Stages of gastric carcinoma
- early = confined to mucosa/sub
- spread = direct/lymph/haem/transcoelomic
Ix for gastric cancer
Endoscopy with biopsy
Then stage with CT or endoscopic US
Classification of tumours of gastro-oesophageal junction
1 = true oesophageal, may be associated with Barrett's 2 = carcinoma of cardia 3 = sub cardial cancers spread across junction
Treatment of gastric cancers
- subtotal gastrectomy if >5-10cm from OG junction and proximal
- total if <5cm from OG junction
- type 2 (extending to oesophagus) = oesophagogastrostomy
- lymphadenopathy = nodal dissection
- chemo pre or post op
