Upper GI tract pathology Flashcards

1
Q

what are the 5 types of upper GI tract pathology

A
Oesophageal reflux
Oesophageal cancer
Gastritis
Peptic ulceration
Gastric cancer
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2
Q

what is oesophageal reflux

A

reflux of gastric acid into the oesophagus
- can be from a hiatus hernia

oesophageal sphincter usually prevents acid travelling back up

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3
Q

what happens to the squamous epithelium in oesophageal reflux

A

minor thickening

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4
Q

what happens to the oesophagus when there is sever reflux

A

can ulcerate - acid burns the tissue

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5
Q

what are the 2 complications of oesophagus reflux

A

healing by fibrosis

barretts oesophagus

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6
Q

what happens if the oesophagus heals by fibrosis

A

stricture formation (narrowing at lower end of oesophagus)

Impaired oesophageal motility

Oesophageal obstruction

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7
Q

what is barrettes oesophagus

A

type of metaplasia
- transformation from squamous epithelium to glandular epithelium

*histologically looks like intestinal epithelium

pre malignant condition to eg oesophageal cancer

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8
Q

what are the two histological types of oesophageal cancer

A

Squamous carcinoma

Adenocarcinoma
develops from Barrett’s oesophagus

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9
Q

what are risk factors for squamous carcinoma

A

smoking
alcohol
dietary carcinogens

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10
Q

what are the risk factors for adenocarcinoma

A

barretts metaplasia

obesity - pushes stomach through oesophageal sphincter – hernia

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11
Q

what are the local effects of oesophageal cancer

A

obstruction

ulceration - dark areas (chronic blood loss)

perforation

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12
Q

what are common symptoms of oesophageal cancer

A

dysphagia and weight loss

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13
Q

what are the three types of spread of oesophageal cancer

A

direct - to surrounding structures

lymphatic - to regional lymph nodes

blood spread - liver

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14
Q

what is the prognosis for oesophageal cancer

A

very poor - 5 year survival rate <15%

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15
Q

what is gastritis

A

inflammation of the lining of the stomach

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16
Q

what are the three types of gastritis (think ABC)

A
Autoimmune (type A)
Bacterial (type B)
Chemical injury (type C)
17
Q

what is autoimmune gastritis

A

organ specific autoimmune disease

involves autoantibodies to parietal cells and intrinsic factor

associated with the autoimmune diseases

18
Q

what is the pathology of autoimmune gastritis

A

atrophy of specialised acid secreting gastric epithelium

loss of speckled historic epithelial cells
= decreased acid secretion
= loss of intrinsic factor

can lead to it B12 deficiency (pernicious anaemia)

19
Q

what is bacterial gastritis

A

commonest type of gastritis

H pylori related (gram-ve bacterium found in gastric mucus on surface of gastric epithelium)

produces acute and chronic inflammatory response

20
Q

what is the pathology of bacterial gastritis

A

bacteria produces urinase

  • increases local pH of stomach
  • increases acid production
21
Q

how can bacterial gastritis be treated

A

can be reversed with antibiotics

22
Q

what are the causes of chemical gastritis

A

drugs - NSAIDS
alcohol
bile reflux

23
Q

how do peptic ulcers occur

A

imbalance between acid secretion and mucosal barrier

24
Q

where can peptic ulcers affect

A

Affects oesophagus, stomach, duodenum:

  • Lower oesophagus
  • Body and antrum of stomach
  • First and second parts of duodenum
25
Q

what bacterium is associated with epic ulcers and why

A

h pylori - increased gastric acid

26
Q

what are some complications of peptic ulcers

A

bleeding

  • acute = haemorrhage
  • chronic (usually small capillary blood vessels) = anaemia

perforation
- peritonitis

healing by fibrosis
- obstruction

27
Q

how does gastric cancer develop

A

develops through phases of intestinal metaplasia and dysplasia

associated with previous H pylori infection

28
Q

what does gastric cancer look like histologically

A

adenocarcinoma

29
Q

how can gastric cancer spread

A

Direct - Spread to surrounding structures

Lymphatic - Spread to regional lymph nodes

Blood spread - Liver

Transcoelomic spread - Spread within peritoneal cavity

30
Q

what is the prognosis of gastric cancer

A

very poor - 5 year survival rate <20%