UPPER GI Tract Flashcards
What consists of the UPPER GI tract?
- Esophagus
- Stomach
- Intestines
What’s chronic gastritis?
- It’s ongoing inflammation of the stomach mucosa
- Compared to acute Gastritis, symptoms less severe but more persistent
- Provides environment where dysplasia and carcinoma can arise.
- Causing many symptoms: upper abdo pain, indigestion/ bloating, belching, nausia, loss of apetite.
What’s DYSPLASIA?
It’s the enlargement of an organ or tissue by rapid increase of abnormal cells .
Can be a development disorder or early stage cancer.
What disorder are these factors describing:
- Ongoing inflammation of stomach mucosa
- Compared to the acute variety, symptoms are less severe but more persistent
- Provides an environment in which dysplasia and carcinoma can arise.
This is describing CHRONIC GASTRITIS
What are the symptoms of chronic gastritis
- Upper abdo pain
- Indigestion/ bloating
- Nausea + vomiting
- Belching
- Loss of appetite or weight loss
- CAN BE ASYMPTOMATIC
What disorder do these symptoms represent?
- can be asymptomatic
- belching
- indigestion/ bloating
- upper abdo pain
- nausea / vomiting
- loss of appetite/ weight loss
These symptoms are describing CHRONIC GASTRITIS
What can cause chronic gastritis?
A - autoimmune
B - bacterial (H.Pylori)
C - chemical (alcohol, tobacco, caffeine)
and psychological stress
What disease do these things cause:
A- Autoimmune
B- Bacteria (H.Pylori)
C- Chemical (tobacco, alcohol, caffeine)
Psychological stress
These things all may cause CHRONIC GASTRITIS
What does H.Pylori stand for
It stands for the bacteria:
Helicobacter pylori
(Gram -ve found in stomach particularly the antrum. Infects half the world pop by age 5. Faecal-oral route)
What is the bacterial H.Pylori linked to?
It’s been linked to:
- Chronic gastritis
- Development of duodenal ulcers
- Development of stomach cancer.
- Associated with gastric ulcer
Some clinical presentations of H.Pylori?
- 80% asymptomatics!
- 5-10% peptic ulcer disease
- 10% non-ulcer dyspepsia
- 1-3% gastric adenocarcinoma
- 0.5% gastric MALToma
What are common causes of peptic ulcer disease?
- H.Pylori infection
- NSAIDS
True or false:
Most ulcers come in groups?
FALSE
Most ulcers are solitary
Name some symptoms of peptic ulcer disease?
- Pain (gnawing, burning, aching)
- Worse at night
- Worse after meals
What condition can these complications arise from?
- Bleeding leading to iron deficiency anaemia
- haematemesis (vomiting blood)
- perforation leading to peritonitis
These complications are from peptic ulcer disease.
Can also cause long term cancer at the edge of the ulcer.
Name some complications of peptic ulcer disease…
- Bleeding leading to iron deficiency (anemia)
- Haematemesis (vomiting blood)
- perforation leading to peritoneum inflammation (peritonitis)
- Long term cancer at the edge of ulcer
What’s Barrett’s Oesphagus?
It’s a condition where the normal (stratified squamous) epithelium of the oesophagus is replaced by columnar epithelium with goblet cells (usually in lower GI tract). Thought to be an adaptation to chronic acid reflux.
What is the name of the condition where the cells of the oesophagus are changed from stratified squamous -> colunmar epithelium with goblet cells.
Barrett’s Oesophagus
Thought to be linked with chronic acid reflux.
What condition has a strong association with oesophageal adenocarcinoma (0.5% per patient per year)
Barrett’s oesophagus
Large need for surveillance if people have this condition to prevent cancer.
What are the types of UPPER GI tract cancers?
- Oesophagus (squamous carcinoma, adenocarcinoma (barrett’s)
- Stomach (Adenocarcinoma, GI stromal tumours)
- Small bowel (Lymphoma, GI stromal tumours, Neuroendocrine tumours)
What’s another name for the cancer largely caused by Barrett’s oesophagus
Adenocarcinoma of the oesophagus
What are some risk factors for developing Oesophageal squamous cell carcinoma?
- Adults over 45
- Male (4:1 female)
- Alcohol
- Tobacco
- Caustic injury to oesophagus
- Achalasia (condition where muscles at end of oesophagus don’t relax causing food to stay there)
Name some symptoms of oesophageal squamous cell carcinoma.
- Dysphagia (difficulty swallowing)
- Weight loss
- Haemorrhage
- Sepsis
- Respiratory Fistula (with aspiration)
- Over five year survival 9%
What are the types of Oesophageal cancers?
- Oesophageal squamous cell carcinoma
- Oesophageal Adenocarcinoma (Barrett’s)
How might an oesophageal carcinoma spread?
- Directly (into surrounding tissue)
- Lymphatic (to paraoesophageal, paratracheal and cervical node groups)
- Haematogenous (to liver or lung)
What precursor lesions may put someone at risk of getting stomach adenocarcinoma?
- Pernicious anaemia (atrophic gastritis)
- Intestinal Metaplasia
- Neoplastic polyps
- Helicobacter associated gastritis
True or false:
Stomach adenocarcinoma is quite a rare carcinoma?
FALSE:
It’s 2nd most common carcinoma worldwide
Symptoms of Stomach Adenocarcinoma?
- Early symptoms resemble gastritis
- Advanced (Weight loss, anorexia, anaemia, heamorrhage)
How might adenocarcinoma of the stomach spread?
- Direct (duodenum, pancreas, colon, liver, spleen)
- Lymphatic (local + regional, verchow’s node)
- Haematogenous (liver lungs)
- Transcoelomic
- Omentum
- Mesentery
- Ovary (Krukenberg tumour)
True or false:
Small bowel neoplasia is quite a common GI malignancy
FALSE
It’s quite a rare GI malignancy
What are some of the risk factors for small intestinal cancer?
- Crohn’s disease
- Ceoliac disease
- Radiation exposure
- Hereditary GI cancer syndromes (familial adenomatous polyposis)
What type of cancer does these problems predispose you to?
- Crohn’s disease
- Ceoliac disease
- Radiation exposure
- Hereditary GI cancer syndromes (familial adenomatous polyposis)
These conditions are all risk factors for developing small intestinal cancer.
What causes extensive mucosal disease related to gluten sensitivity?
Coeliac’s disease
What is coeliac’s disease?
Extensive mucosal disease related to sensitivity to gluten. It’s immune mediated.
What do these symptoms characterise?
- pain and discomfort in the digestive tract,
- chronic constipation and diarrhoea,
- failure to thrive (in children),
- anaemia
- fatigue
Coeliac’s disease
Name some possible SE of Coeliac’s disease
- pain and discomfort in the digestive tract,
- chronic constipation and diarrhoea,
- failure to thrive (in children),
- anaemia
- fatigue
All symptoms including intestinal damage begins to heal within weeks of gluten being removed.
If you have coeliac’s disease, what are you more at risk of getting?
Having Coeliac disease can lead to increased risk of:
- Adenocarcinoma
- Lymphoma
of the small bowel!
