Upper GI Tract Pathology

Question 1

In this lecture we were told about 5 of the commonest upper GI conditions:

Answer 1

• Oesophageal Reflux
• Oesophageal Cancer
• Gastritis
• Peptic Ulceration
• Gastric Cancer

Question 2

What is oesophageal reflux?

Answer 2

Reflux of gastric acid into the oesophagus

Question 3

What causes oesophageal reflux?

Answer 3

Often caused by a hiatus hernia

Question 4

What are the consequences of oesophageal reflux?

Answer 4

• Thickening of squamous epithelium
• Ulceration of the oesophagus
• Fibrosis -> Stricture formation
• Barrett’s Oesophagus

Question 5

Define Barrett’s Oesophagus?

Answer 5

A Type of metaplasia where the squamous epithelium transforms into glandular epithelium
It predisposes one to oesophageal cancer (i.e. pre-malignant)

Question 6

How common is oesophageal cancer?

Answer 6

The 3rd commonest form of alimentary tract cancer

Question 7

What are the types of oesophageal cancer?

Answer 7

Two histological types:
- Squamous Carcinoma
- Adenocarcinoma

Question 8

Which type of oesophageal cancer does Barrett’s oesophagus predispose you to>

Answer 8

Adenocarcinoma

Question 9

What are the risk factors for oesophageal cancer?

Answer 9

Squamous:
- Alcohol
- Smoking
- Dietary Carcinogens

Adenocarcinoma:
- Barrett’s Metaplasia
- Obesity

Question 10

What are the local effects of oesophageal cancer?

Answer 10

Obstruction
Ulceration
Perforation -> food in thoracic cavity -> infection -> abscess

Question 11

How does oesophageal cancer spread/

Answer 11

Direct to surrounding structures
Through lymphatics to regional lymph nodes
Through blood, most often to the liver

Question 12

Whats the prognosis on oesophageal cancer?

Answer 12

Pretty fucking dire mate
5yr survival is <15%

Question 13

What is gastritis?

Answer 13

Inflammation of the stomach mucosa

Question 14

What types of gastritis are there?

Answer 14

Type A - Autoimmune
Type B - Bacterial
Type C - Chemical Injury

Question 15

What happens in type A gastritis?

Answer 15

Autoantibodies attack parietal cells and intrinsic factor.

Causes atrophy of the specialised gastric epithelium that secrete gastric acid (parietal cells)
–> Decrease Acid Secretion & Loss of intrinsic factor

Question 16

Which type of gastritis is commonest?

Answer 16

Type B (bacterial)

Question 17

What bacteria is involved in type B gastritis?

Answer 17

Heliobactor Pylori (A gram -ve bacterium)

Question 18

How does type B gastritis work?

Answer 18

Heliobacter pylori releases ammonia –> stomach detects pH rise –> Parietal cells release more acid –> Inflames itself

Question 19

How is type B gastritis treated?

Answer 19

Antibiotics

Question 20

What causes Type C gastritis?

Answer 20

Drugs e.g. NSAIDS
Alcohol
Bile Reflux from Duodenum

Question 21

What is peptic ulceration?

Answer 21

An imbalance of acid secretion and the mucosal barrier
Can be related to too much acid or acid where it shouldn’t be
(Usually associated with H pylori causing an increase in HCl secretion)

Question 22

Where does peptic ulceration take place?

Answer 22

Lower oesophagus
Body + antrum of stomach
1st & 2nd sections of duodenum

Question 23

What are hte complications of peptic ulceration?

Answer 23

Bleeding:
- Acute haemorrhage
- Chronic (more common, due to capillaries breaking) can lead to anaemia

Perforation:
- Digestive contents enter peritoneal cavity
- Causes Peritonitis

Fibrosis:
- Can heal to form obstruction of the GI tract

Question 24

How common is gastric cancer?

Answer 24

The 2nd commonest alimentary tract cancer

Question 25

How does gastric cancer develop?

Answer 25

Through phases of metaplasia and dysplasia of the stomach epithelium

Question 26

What conditions are heliobactor pylori associated with?

Answer 26

Peptic Ulceration
Type B gastritis
Past infection is highly associated with gastric cancer

Question 27

What type of cancer is gastric cancer?

Answer 27

Adenocarcinoma, as it effects the stomach lining which is glandular epithelium

Question 28

How does gastric cancer spread?

Answer 28

Direct - to surrounding structures
Lymphatics
Blood - Mostly often to liver
Transcoelomic - Through peritoneal cavity

Question 29

Whats the prognosis for gastric cancer?

Answer 29

Almost as bad as oesophageal
Bet you didnt see that coming did ya
5 yr survival <20%