Upper GI Pathology

Question 1

What is Barrett’s Oesophagus?

Answer 1

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

Question 2

Types of Barrett’s Oesophagus?

Answer 2

Classic >3cm

Short <3cm

Question 3

Risk of cancer with Barrett’s oesophagus?

Answer 3

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

Question 4

Predisposing factors to oesophageal carcinoma

Answer 4

Diet
Esophageal disorders
Smoking and alcohol

Question 5

Presenting features of oesophageal carcinoma

Answer 5

Progressive dysplasia
Anorexia/weight loss
Aspiration pneumonia
Fistula

Question 6

Sites of oesophageal carcinoma

Answer 6

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

Question 7

Macroscopic appearance

Answer 7

Polypoid fungating
Ulcerating
Annular constricting
Diffuse infiltrating

Question 8

Microscopic features

Answer 8

• squamous cell carcinoma!
• adenocarcinoma
• undifferentiated

Question 9

Adenocarcinoma

Answer 9

Elderly
More males
Arises in Barrett’s metaplasia

Question 10

Chronic Gastritis

Answer 10

Chronic inflammation of gastric mucosa
Common
Often asymptomatic

Question 11

Causes of chronic gastritis

Answer 11

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

Question 12

Outcomes of H. pylori infection

Answer 12

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

Question 13

Peptic ulcer sites

Answer 13

Duodenum
Stomach
oesophagus
Meckel’s diverticulum

Question 14

Factors predisposing a peptic ulcer

Answer 14

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

Question 15

Who is more likely to get which peptic ulcers?

Answer 15

Duodenum = males much more

Gastric ulcer males slightly more

Question 16

Incidence of peptic and gastric ulcers

Answer 16

Duodenum decreasing

Gastric staying the same

Question 17

Peptic ulcer macroscopic appearance

Answer 17

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

Question 18

Complications of gastric ulcers

Answer 18

• haemorrhage
• obstruction = due to oedema and scarring
• perforation = peritonitis

Question 19

Presenting features of gastric carcinoma

Answer 19

• anorexia
• weight loss
• dyspepsia
• adbo pain
• haemorrhage
• anaemia
• metastases

Question 20

Predisposing factors to gastric carcinoma

Answer 20

H pylori gastritis
Genetics
Evnvironmental

Question 21

Stages of gastric carcinoma

Answer 21

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

Question 22

Sites of gastric carcinoma

Answer 22

• antrum = 50%
• body = 25%
• GOJ = 25%

Question 23

Macroscopic appearance of gastric carcinoma

Answer 23

• polypoid fungating
• polypoid with ulceration
• ulcerating
• diffuse infiltrating

Question 24

Microscopic features of gastric carcinoma

Answer 24

Adenocarcinoma = 95%

Undifferentiated

Question 25

Intestinal and diffuse adenocarcinoma

Answer 25

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

Question 26

Stages of gastric carcinoma

Answer 26

- early = confined to mucosa/sub | - spread = direct/lymph/haem/transcoelomic

Question 27

Ix for gastric cancer

Answer 27

Endoscopy with biopsy | Then stage with CT or endoscopic US

Question 28

Classification of tumours of gastro-oesophageal junction

Answer 28

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

Question 29

Treatment of gastric cancers

Answer 29

- 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