Upper GI pathology Flashcards
what type of epithelium found Lining the BODY and ANTRUM of the stomach?
columnar epithelium (foveolar)
what does the epithelium found in the BODY and ANTRUM of the stomach secrete?
mucin
which part of the stomach contains specialised glands in the lamina propria ?
Body
which part of the stomach does NOT contain specialised glands in the lamina propria ?
ANTRUM
what is the difference between a stomach ulcer and erosion?
Ulcer goes through muscularis, and erosion does NOT
what type of epithelium found in duodenum?
what cells too?
Glandular epithelium
with goblet cells
can we find goblet cells in the stomach?
NO
which cells infiltrate of histopath films in acute oesophagitis
neutrophils
a normal oesophagus has which type of glands?
submucosal glands
what is the z line?
• The Z-line is the point at which the epithelium transitions from being squamous TO columnar
where do you tend to see H. pylori-associated gastritis ?
• In the pyloric antrum and pyloric canal,
what is the usual cause of acute oesophagitis?
GORD
Gastro-Oesophageal Reflux Disease
complications of GORD/ reflux oesophagitis?
ulceration haemorrhage perforation stricture Barrett’s oesophagus
what is the underlying process in Barretts oesophagus?
metaplastic process
normal squamous epithelium of the lower oesophagus gets replaced by columnar epithelium
• This is also known as columnar-lined oesophagus (CLO)
when goblet cells become visible in oesophagus this is called?
intestinal metaplasia
hanges showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane is known as??
dysplasia
what comes next?
Metaplasia –> Dysplasia –> _____
cancer/adenocarcinoma (BM invasion)
which oesophageal carcinoma is associated with reflux?
which type of countries is this found?
adenocarcinoma
in Developed Countries
where does oesophageal adenocarcinoma typically present?
lower oesophagus
which is the commonest oesophageal cancer in Developing Countries?
which region of oesophagus
Squamous Cell Carcinomaof the oesophagus
mid/lower
difference between Adeno and SCC of oesophagus?
Squamous cell cancers make keratin
and intercellular bridges
on histology
cause of ACUTE Gastritis?
Infection; h.pylori
Chemical; NSAIDs, alcohol, aspirin etc
what is the ABC of chronic gastritis?
Autoimmune, Bacteria, Chemical
Autoimmune (antiparietal antibodies etc. BODY)
Bacterial (H. pylori; Antrum )
Chemical (NSAIDs, bile reflux; antrum )
Metabolic disease is NOT a cause of chronic gastritis (so not alcohol)
which part of the stomach does h. pylori attack?
antrum
which part of the stomach does bile reflux affect ?
antrum
what does it mean If you see lymphoid follicles in a stomach biopsy?
the patient has had an H. pylori infection (i.e. the presence of lymphoid follicles is NOT part of the normal stomach mucosa)
Mucosa Associated Lymphoid Tissue (MALT) is found in which condition?
chronic gastritis
MALT increases the risk of?
lymphoma
Consequences of H. pylori associated gastritis?
CLO –> IM –> Dysplasia
Adenocarcinoma (8 x increased risk)
Lymphoma (MALToma)
which strain o bacteria is associated with more chronic inflammation?
cag-A-positive H.pylori
the Metaplasia-Dysplasia Pathway leads to cancer where?
§ E.g. oesophageal cancer
the Adenoma-Carcinoma pathway leads to cancer where?
colon cancer
hronic ulcers are accompanied by ??
scarring and fibrosis
is Gastric Epithelial Dysplasia malignant?
• Some of the cytological and histological features of malignancy are present, but there is no invasion through the basement membrane
> 95% of all malignant tumours in the stomach are ?
ADENOCARCINOMAS
gastric cancers are present in which 2 forms?
intestinal
diffuse - poor differentiatoin
overall survival rate of gastric cancers is?
15%
name a LOW GRADE B CELL LYMPHOMA in stomach?
Gastric MALToma / Lymphoma
how to treat a gastric maltoma?
If limited to the stomach and H.pylori is present: H.pylori eradication
what is duodenitis?
Increased acid production in the stomach which spills over into duodenum causing
Chronic inflammation
consequences of duodenitis?
- gastric metaplasia ;
Duodenum changes to gastric type tissue making it vulnerable to helicobacter (2)
- hence ulcer
duodenal ulcers are benign/malignant?
what inflame cells seen?
benign
neutrohphils
Name 2 IMPORTANT pathogens affecting the duodenum?
Giardiasis
Whipple’s disease (Tropheryma whippelii)
○ CMV - like stomach
○ Cryptosporidium - like stomach
what histological features seen in coealics?
○ Villous atrophy - also flattening!
○ Crypt hyperplasia
○ Increased intraepithelial lymphocytes
§ Normal Range: < 20 per 100 enterocytes
2 antibody present in coeliacs?
endomysial antibodies and
tissue transglutaminase antibodies (TTG)
when would a coeliac patient villi look normal?
*stopped gluten due to side effects so their villi may look normal.
Patients with coeliac disease have an increased risk of which cancers?
MALToma
• These are T cell lymphomas
EATL:
Enteropathy Associated T-cell Lymphoma
○ NOTE: lymphomas in the stomach due to H. pylori are B cell lymphomas
in the stomach, there are NO crypts of Leiberkhun or just crypts as such. what is the gastric equivalent and where are they found?
gastric pits
found just underneath the villi -> in the lamina propria
which either conatain specialised/Non-specialised glands
signet ring cells are found in?
Gastric cancers (adenocarcinoma)
particularly the diffuse poorly differentiated ones
