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MET3a > Upper GI Pathology > Flashcards

Upper GI Pathology Flashcards

1
Q

What is Barrett’s Oesophagus?

A
  • metaplasia of oesophageal stratified squamous epithelium
  • forms gastric columnar epithelium
  • caused by prolonged gastro-oesophageal reflux
  • more men
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2
Q

Types of Barrett’s Oesophagus?

A

Classic >3cm

Short <3cm

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3
Q

Risk of cancer with Barrett’s oesophagus?

A

30x increased risk of epithelial dysplasia and adenocarcinoma
Even after successful reflux treatment

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4
Q

Predisposing factors to oesophageal carcinoma

A

Diet
Esophageal disorders
Smoking and alcohol

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5
Q

Presenting features of oesophageal carcinoma

A

Progressive dysplasia
Anorexia/weight loss
Aspiration pneumonia
Fistula

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6
Q

Sites of oesophageal carcinoma

A

Upper 1/3 = 20%
Middle 1/3 = 50%
Lower 1/3 = 30%

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7
Q

Macroscopic appearance

A

Polypoid fungating
Ulcerating
Annular constricting
Diffuse infiltrating

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8
Q

Microscopic features

A
  • squamous cell carcinoma!
  • adenocarcinoma
  • undifferentiated
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9
Q

Adenocarcinoma

A

Elderly
More males
Arises in Barrett’s metaplasia

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10
Q

Chronic Gastritis

A

Chronic inflammation of gastric mucosa
Common
Often asymptomatic

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11
Q

Causes of chronic gastritis

A
  • bacterial infection = H pylori
  • chemical = NSAIDs, bile reflux, alcohol
  • autoimmune = anti-parietal cell AB
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12
Q

Outcomes of H. pylori infection

A
  • peptic ulcer
  • gastric carcinoma
  • primary gastric lymphoma
  • asymptomatic (majority of the time)
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13
Q

Peptic ulcer sites

A

Duodenum
Stomach
oesophagus
Meckel’s diverticulum

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14
Q

Factors predisposing a peptic ulcer

A

H pylori gastritis
Zollinger Ellison syndrome (gastinoma)
NSAIDs, alcohol

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15
Q

Who is more likely to get which peptic ulcers?

A

Duodenum = males much more

Gastric ulcer males slightly more

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16
Q

Incidence of peptic and gastric ulcers

A

Duodenum decreasing

Gastric staying the same

17
Q

Peptic ulcer macroscopic appearance

A 
Most of the time just single
<3cm diameter 
punched out edges
Deeply penetrating
Fibrosis at base
18
Q

Complications of gastric ulcers

A
  • haemorrhage
  • obstruction = due to oedema and scarring
  • perforation = peritonitis
19
Q

Presenting features of gastric carcinoma

A
  • anorexia
  • weight loss
  • dyspepsia
  • adbo pain
  • haemorrhage
  • anaemia
  • metastases
20
Q

Predisposing factors to gastric carcinoma

A

H pylori gastritis
Genetics
Evnvironmental

21
Q

Stages of gastric carcinoma

A

Normal mucosa -> H. pylori infection forms chronic gastritis -> intestinal metaplasia -> dysplasia -> carcinoma

22
Q

Sites of gastric carcinoma

A
  • antrum = 50%
  • body = 25%
  • GOJ = 25%
23
Q

Macroscopic appearance of gastric carcinoma

A
  • polypoid fungating
  • polypoid with ulceration
  • ulcerating
  • diffuse infiltrating
24
Q

Microscopic features of gastric carcinoma

A

Adenocarcinoma = 95%

Undifferentiated

25
Q

Intestinal and diffuse adenocarcinoma

A

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
26
Q

Stages of gastric carcinoma

A
  • early = confined to mucosa/sub

- spread = direct/lymph/haem/transcoelomic

27
Q

Ix for gastric cancer

A

Endoscopy with biopsy

Then stage with CT or endoscopic US

28
Q

Classification of tumours of gastro-oesophageal junction

A 
1 = true oesophageal, may be associated with Barrett's
2 = carcinoma of cardia
3 = sub cardial cancers spread across junction
29
Q

Treatment of gastric cancers

A
  • 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

MET3a (38 decks)

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