Upper GI tract pathology

Question 1

Explain the mechanisms associated with oesophageal reflux

Answer 1

• Hiatus hernias
  
  • Acid gets into oesophagus and burns
  • Healing by fibrosis results in: stricture formation, impaired mobility, obstruction
  • Barrett’s oesophagus (squamous -> glandular) is pre-malignant

Question 2

Explain the mechanisms associated with oesophageal cancer

Answer 2

• Adenocarcinoma and squamous
  
  • Direct spread: surrounding structures
  • Lymph: regional lymph nodes
  • Blood: liver
  • Causes of adenocarcinoma: Barrett’s oesophagus, obesity
  • Causes of squamous cell: alcohol, smoking, bile reflux
    
    • Effects: obstruction, ulceration, perforation

Question 3

Explain the mechanisms associated with gastritis

Answer 3

• Autoimmune: targets parietal and intrinsic cells which decreases the acid
  
  • Bacterial: H. Pylori
  • Chemicals: NSAIDs, alcohol, bile reflux

Question 4

Explain the mechanisms associated with peptic ulcers

Answer 4

• Effects: stomach, oesophagus and duodenum

- Complications: bleeding (acute, chronic), perforation

Question 5

Explain the mechanisms associated with gastric cancer

Answer 5

• Adenocarcinoma
  
  • Associated with previous H. pylori infection
  • Direct: surrounding structures
  • Lymph: regional lymph nodes
  • Blood: liver
  • Trans coelomic: Due to peritoneal

Question 6

Define the role of H. pylori in gastric disease

Answer 6

• Gastritis
	- H. Pylori is the bacterial cause 
	- Lives in mucous of stomach
	- Makes ammonia so more acid is produced
	- Gram negative
	• Peptic ulcer
	- One of the main causes
	• Gastric cancer
        - Associated with previous infection

Question 7

Explain the presentation of Oesophageal reflux

Answer 7

• Burning

- Tiredness due to anaemia

Question 8

Explain the presentation of oesophageal cancer and the pathology of the underlying cause

Answer 8

• Weight loss and dyspepsia (due to obstruction)
  
  • Cell death (from ulceration) leads to burst blood vessels, which results in blood loss (anaemia) and making the patient tired

Question 9

Explain the presentation of gastritis and the pathology of the underlying cause

Answer 9

• Autoimmune: pernicious anaemia due to loss of intrinsic factor and also decreased acid secretion
  
  • Bacterial: increased acid secretion leads to ulceration which then causes anaemia

Question 10

Explain the presentation of peptic ulcers and the pathology of the underlying cause

Answer 10

• Acute bleeding (haemorrhage)
  
  • Chronic bleeding (anaemia)
  • Perforation

Question 11

Explain the presentation of Gastric cancer and the pathology of the underlying cause

Answer 11

• Tiredness (ulceration)

- Weight loss (obstruction)