Upper GI tract pathology Flashcards
What s found in the upper GI tract?
Oesophagus
Stomach
Upper duodenum
What are the 5 main pathologies of the upper GI tract?
- Oesophageal reflux
- Oesophageal cancer
- Gastritis
- Peptic ulceration
- Gastric cancer
What are some complications associated with oesophageal reflux?
Fibrosis - strictures and obstruction
Barretts oesophagus - increased risk of cancer
What is Barretts oesophagus?
Type of metaplasia - transformation from squamous epithelium to premalignant glandular epithelium typical of stomach
What type of cancer is linked to GORD?
Oesophageal adenocarcinoma
What risk factors are associated with different types of oesophageal cancer?
Squamous carcinoma – Smoking – Alcohol – Dietary carcinogens Adenocarcinoma – Barrett’s metaplasia – Obesity
What are the local effects of oesophageal cancer?
- Obstruction – difficulty eating/swallowing (dysphagia), weight loss
- Ulceration - heartburn
- Perforation – haematemesis, anaemia, tiredness, abscess
What are the 3 types of gastritis?
- Autoimmune (type A)
- Bacterial (type B)
- Chemical injury (type C)
Describe the pathophysiology of autoimmune gastritis
Organ-specific autoimmune disease
Autoantibodies to parietal cells and intrinsic factor of the stomach
Associated with other autoimmune diseases, and tends to be more common in females (as with most autoimmune diseases)
Atrophy of specialised acid secreting gastric epithelium
Loss of specialised gastric epithelial cells
– Decreased acid secretion
– Loss of intrinsic factor
Whats the most common type of gastritis?
Bacterial gastritis
What organism is most commonly linked to bacterial gastritis?
Helicobacter pylori
What causes chemical gastritis?
- Drugs e.g. Non-steroidal anti-inflammatory drugs
- Alcohol
- Bile reflux
Where can peptic ulceration be found?
– Lower oesophagus
– Body and antrum of stomach
– First and second parts of duodenum
Describe the pathophysiology of bacterial gastritis by H. pylori
– To avoid the acidic environment of the stomach H. pylori burrows into the mucus lining of the stomach to the epithelial cells via chemotaxis. They adhere to the epithelium and produce urease, which breaks down urea in the stomach into carbon dioxide and ammonia to form protective bubble. These react with the gastric acid to produce a neutralised area around the H. pylori
– Stomach recognises the higher pH and causes increased gastric acid production, which can enter the breaches in mucus wall to cause ulcers
What are some complications of peptic ulceration?
- Bleeding - haemorrhage, anaemia
- Perforation - Peritonitis
- Healing by fibrosis - Obstruction of oesophagus, stomach or duodenum
