Upper GI tract pathology Flashcards
what are the 5 types of upper GI tract pathology
Oesophageal reflux Oesophageal cancer Gastritis Peptic ulceration Gastric cancer
what is oesophageal reflux
reflux of gastric acid into the oesophagus
- can be from a hiatus hernia
oesophageal sphincter usually prevents acid travelling back up
what happens to the squamous epithelium in oesophageal reflux
minor thickening
what happens to the oesophagus when there is sever reflux
can ulcerate - acid burns the tissue
what are the 2 complications of oesophagus reflux
healing by fibrosis
barretts oesophagus
what happens if the oesophagus heals by fibrosis
stricture formation (narrowing at lower end of oesophagus)
Impaired oesophageal motility
Oesophageal obstruction
what is barrettes oesophagus
type of metaplasia
- transformation from squamous epithelium to glandular epithelium
*histologically looks like intestinal epithelium
pre malignant condition to eg oesophageal cancer
what are the two histological types of oesophageal cancer
Squamous carcinoma
Adenocarcinoma
develops from Barrett’s oesophagus
what are risk factors for squamous carcinoma
smoking
alcohol
dietary carcinogens
what are the risk factors for adenocarcinoma
barretts metaplasia
obesity - pushes stomach through oesophageal sphincter – hernia
what are the local effects of oesophageal cancer
obstruction
ulceration - dark areas (chronic blood loss)
perforation
what are common symptoms of oesophageal cancer
dysphagia and weight loss
what are the three types of spread of oesophageal cancer
direct - to surrounding structures
lymphatic - to regional lymph nodes
blood spread - liver
what is the prognosis for oesophageal cancer
very poor - 5 year survival rate <15%
what is gastritis
inflammation of the lining of the stomach
what are the three types of gastritis (think ABC)
Autoimmune (type A) Bacterial (type B) Chemical injury (type C)
what is autoimmune gastritis
organ specific autoimmune disease
involves autoantibodies to parietal cells and intrinsic factor
associated with the autoimmune diseases
what is the pathology of autoimmune gastritis
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)
what is bacterial gastritis
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
what is the pathology of bacterial gastritis
bacteria produces urinase
- increases local pH of stomach
- increases acid production
how can bacterial gastritis be treated
can be reversed with antibiotics
what are the causes of chemical gastritis
drugs - NSAIDS
alcohol
bile reflux
how do peptic ulcers occur
imbalance between acid secretion and mucosal barrier
where can peptic ulcers affect
Affects oesophagus, stomach, duodenum:
- Lower oesophagus
- Body and antrum of stomach
- First and second parts of duodenum
