Upper GI Tract Pathology Flashcards
define oesophageal reflux
reflux of acid into oesophagus
how can oesophageal reflux arise?
if the lower oesophageal sphincter doesn’t work properly a hiatus hernia occurs where the stomach refluxes into the oesophagus.
what is the response of the oesophageal epithelium to gastric acid?
thickening of the squamous epithelium
what can occur in severe reflux?
ulceration of the epithelium creates inflammation
what complications can occur with an oesophageal reflux?
> fibrosis
> barrett’s oesophagus
describe the process of fibrotic healing of an oesophageal reflux
> stricture formation, scar tissue causes narrowing of tube
impaired oesophageal motility
= oesophageal obstruction
what is metaplasia?
one normal tissue transforms into another normal tissue
what metaplasia takes place in barretts oesophagus?
squamous epithelium transforms to glandular epithelium
what can barretts oesophagus predispose?
malignant conditions, cancer
what is the third commonest cancer of the alimentary tract?
oesophageal cancer
what are the two histological types of oesophageal cancer?
squamous carcinoma
adenocarcinoma
what type of oesophageal cancer arises from barretts oesophagus?
adenocarcinoma
what are the risk factors associated with squamous carcinoma oesophageal cancer?
smoking
alcohol
dietary carcinogens
how can obesity lead to (adenocarcinoma) oesophageal cancer?
the large abdomen puts pressure on the stomach, pushing it through the lower oesophageal sphincter creating a hernia
what are the local effects of oesophageal cancer?
> obstruction
ulceration
perforation
how may ulceration from an oesophageal tumour cause anaemia?
ulceration causes cell death so when the vessels on top of the ulcer erode there is blood loss = anaemia
describe perforation of an oesophageal tumour
if cell death is sustained a hole through the tumour may occur. food may then enter the thorax and cause infection.
how may oesophageal cancer spread?
> directly to surrounding structures
through the lymphatics to regional lymph nodes
through the blood to the liver
what is the prognosis for oesophageal cancer?
very poor as the 5 year survival rate is less than 15%
what are the three types of gastritis?
> autoimmune
bacterial
chemical injury
what is the most common type of gastritis?
bacterial
what do antibodies in autoimmune gastritis target?
parietal cells and intrinsic factor
what is autoimmune gastritis associated with?
other autoimmune diseases
what is the pathology of autoimmune gastritis?
> atrophy of specialised acid secreting gastric epithelium
loss of specialised gastric epithelial cells: decreased secretion factor and loss of intrinsic factor (pernicious anaemia)
describe the bacteria that causes bacterial gastritis
> helicobacter pylori related
gram negative
found in gastric mucous of surface epithelium
what is the effect of bacterial in bacterial gastritis?
> increase in acid production
> acute and chronic inflammatory response
is bacterial gastritis treatable?
yes and reversible
what can cause chemical gastritis?
> Drugs (NSAIDs)
alcohol
bile reflux
an imbalance in what causes peptic ulceration?
between the acid secretion and mucosal barrier
what parts of the alimentary system are effected by peptic ulceration?
> lower oesophagus
body and antrum of the stomach
first and second parts of the duodenum
what is peptic ulceration often associated with?
H. pylori (increased gastric acid)
what are the complications associated with peptic ulceration?
> bleeding (acute/chronic)
perforation (peritonitis)
Fibrosis (obstruction)
what is the second commonest cancer of the alimentary tract?
gastric cancer
what phase does gastric cancer develop?
through phases of intestinal metaplasia and dysplasia
what infection gastric cancer often associated with?
previous h. pylori infection
what is the histology of gastric cancer?
adenocarcinoma
how does stomach cancer spread?
> directly
through lymphatics
through the blood
transcoelomic
describe transcoelomic spread of stomach cancer
the tumour penetrates all layers of the stomach wall and tumour cells are released in the peritoneal cavity
what is the prognosis of stomach cancer?
very poor, 5 year survival rate is less than 20%
