Upper GI Pathology

Question 1

Describe the oesophageal epithelium

Answer 1

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

Question 2

What is the most common cause of oesophagitis?

Answer 2

Reflux oesophagitis/ gastro-oesophageal reflux disease (GORD)

Question 3

State some complications of GORD

Answer 3

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

Question 4

How is GORD managed?

Answer 4

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

Question 5

Name a proton pump inhibitor

Answer 5

Omeprazole

Question 6

Name a H2 receptor antagonist

Answer 6

Ranitidine

Question 7

What is Barrett’s oesophagus?

Answer 7

Intestinal metaplasia of squamous epithelium into columnar epithelium following chronic GORD

Question 8

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

Answer 8

10%

Question 9

What is the main risk of Barrett’s oesophagus?

Answer 9

Progression into cancer

Question 10

State at least 3 risk factors for oesophageal adenocarcinoma

Answer 10

Barrett’s oesophagus, smoking, obesity, prior radiotherapy

Question 11

Which group is oesophageal adenocarcinoma most common in?

Answer 11

Caucasian men

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

Describe the clinical features of oesophageal squamous cell carcinoma

Answer 14

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

Question 15

Where does oesophageal squamous cell carcinoma metastasise to?

Answer 15

Lymph nodes, liver, proximal structures

Question 16

What are oesophageal varices?

Answer 16

Engorged dilated veins, usually due to portal hypertension

Question 17

How are bleeding oesophageal varices managed?

Answer 17

Emergency endoscopy for sclerotherapy or banding

Question 18

State at least 3 causes of acute gastritis

Answer 18

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

Question 19

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

Answer 19

Antrum

Question 20

State at least 3 causes of chronic gastritis

Answer 20

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

Question 21

Describe the histology of chemical gastritis

Answer 21

Foveolar hyperplasia, chronic inflammation

Question 22

State 2 complications of chronic gastritis

Answer 22

Gastric ulcers, cancer

Question 23

What is a gastric ulcer?

Answer 23

Breach through the muscularis mucosa into the submucosa

Question 24

Describe the clinical features of gastric ulcers

Answer 24

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

Question 25

How are gastric ulcers diagnosed?

Answer 25

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

Question 26

State 3 complications of gastric ulcers

Answer 26

Iron deficiency anaemia, perforation, cancer

Question 27

Which malignancy is associated with H pylori infection?

Answer 27

Gastric lymphoma

Question 28

How is gastric lymphoma managed?

Answer 28

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

Question 29

State the ratio of gastric to duodenal ulcers

Answer 29

1:4

Question 30

Describe the clinical features of duodenal ulcers

Answer 30

Epigastric pain worse at night and relieved by food and milk

Question 31

Which groups are gastric and duodenal ulcers most common in?

Answer 31

Gastric: elderly Duodenal: young adults

Question 32

Which HLAs are associated with coeliac disease?

Answer 32

HLA-DQ2, HLA-DQ8

Question 33

What is coeliac disease?

Answer 33

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

Question 34

Which group is mainly affected by coeliac disease?

Answer 34

Females of Irish descent

Question 35

Describe the clinical presentation of coeliac disease

Answer 35

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

Question 36

State the diagnostic tests for coeliac disease

Answer 36

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

Question 37

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

Answer 37

10%