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Histopathology > Upper GI Pathology > Flashcards

Upper GI Pathology Flashcards

1
Q

Describe the oesophageal epithelium

A

Upper 2/3 squamous epithelium, lower 1/3 columnar epithelium, joined by the squamo-columnar junction/ Z-line

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2
Q

What is the most common cause of oesophagitis?

A

Reflux oesophagitis/ gastro-oesophageal reflux disease (GORD)

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3
Q

State some complications of GORD

A

Ulceration, haemorrhage, Barrett’s oesophagus, stricture, perforation

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4
Q

How is GORD managed?

A

Lifestyle changes (weight loss, smoking cessation), proton pump inhibitors (PPIs), H2 receptor antagonists

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5
Q

Name a proton pump inhibitor

A

Omeprazole

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6
Q

Name a H2 receptor antagonist

A

Ranitidine

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7
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia of squamous epithelium into columnar epithelium following chronic GORD

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8
Q

What % of patients with symptomatic GORD develop Barrett’s oesophagus?

A

10%

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9
Q

What is the main risk of Barrett’s oesophagus?

A

Progression into cancer

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10
Q

State at least 3 risk factors for oesophageal adenocarcinoma

A

Barrett’s oesophagus, smoking, obesity, prior radiotherapy

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11
Q

Which group is oesophageal adenocarcinoma most common in?

A

Caucasian men

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12
Q

State the 2 main and at least 2 other risk factors for oesophageal squamous cell carcinoma

A

Main: Alcohol, smoking
Others: achalasia of cardia, Plummer-Vinson syndrome, nutritional deficiencies, nitrosamines, HPV, Afro-Caribbean ethnicity, male gender

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13
Q

What percentage of squamous cell carcinoma is found in each third of the oesophagus?

A

Proximal: 20%
Middle: 50%
Distal: 30%

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14
Q

Describe the clinical features of oesophageal squamous cell carcinoma

A

Progressive dysphagia (solids then fluids), odynophagia, anorexia, severe weight loss

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15
Q

Where does oesophageal squamous cell carcinoma metastasise to?

A

Lymph nodes, liver, proximal structures

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16
Q

What are oesophageal varices?

A

Engorged dilated veins, usually due to portal hypertension

17
Q

How are bleeding oesophageal varices managed?

A

Emergency endoscopy for sclerotherapy or banding

18
Q

State at least 3 causes of acute gastritis

A

Aspirin and other NSAIDs, bleach, acute H pylori, severe stress

19
Q

Which section of the stomach is chronic H pylori gastritis usually found in?

A

Antrum

20
Q

State at least 3 causes of chronic gastritis

A

H pylori, pernicious anaemia, alcohol, smoking, IBD, strongyloides

21
Q

Describe the histology of chemical gastritis

A

Foveolar hyperplasia, chronic inflammation

22
Q

State 2 complications of chronic gastritis

A

Gastric ulcers, cancer

23
Q

What is a gastric ulcer?

A

Breach through the muscularis mucosa into the submucosa

24
Q

Describe the clinical features of gastric ulcers

A

Epigastric pain worse when eating and relieved by antacids, weight loss

25
Q

How are gastric ulcers diagnosed?

A

Endoscopy showing punched out lesion with rolled margins. Biopsy for H pylori histology status

26
Q

State 3 complications of gastric ulcers

A

Iron deficiency anaemia, perforation, cancer

27
Q

Which malignancy is associated with H pylori infection?

A

Gastric lymphoma

28
Q

How is gastric lymphoma managed?

A

Eradication of H pylori with triple therapy - proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole

29
Q

State the ratio of gastric to duodenal ulcers

A

1:4

30
Q

Describe the clinical features of duodenal ulcers

A

Epigastric pain worse at night and relieved by food and milk

31
Q

Which groups are gastric and duodenal ulcers most common in?

A

Gastric: elderly
Duodenal: young adults

32
Q

Which HLAs are associated with coeliac disease?

A

HLA-DQ2, HLA-DQ8

33
Q

What is coeliac disease?

A

T-cell mediated autoimmune disease causing gluten intolerance - gluten intake leads to villous atrophy and malabsorption

34
Q

Which group is mainly affected by coeliac disease?

A

Females of Irish descent

35
Q

Describe the clinical presentation of coeliac disease

A

Presents in childhood: Steatorrhoea, failure to thrive, abdominal pain, bloating, nausea, vomiting, fatigue, iron deficiency anaemia, dermatitis herpetiformis

36
Q

State the diagnostic tests for coeliac disease

A

Anti-endomysial antibodies, anti-tissue transglutaminase IgA antibodies, anti-gliadin antibodies, upper GI endoscopy and duodenal biopsy

37
Q

What % of patients with poorly controlled coeliac disease progress to duodenal T cell lymphoma?

A

10%

Histopathology (30 decks)

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