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*GI System - Pathology > Upper GI Tract Pathology > Flashcards

Upper GI Tract Pathology Flashcards

1
Q

What is oesophageal reflux?

A

Reflux of gastric acid into oesophagus

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2
Q

What commonly causes oesophageal reflux?

A

Hiatus hernia

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3
Q

What is a hiatus hernia?

A

Part of stomach protrudes into thorax

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4
Q

What is thickening of oesophageal squamous epithelium a pathological response to?

A

Presence of acid in oesophagus (usually short lived)

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5
Q

What occurs in the oesophagus when reflux is severe?

A

Ulceration

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6
Q

What is present in anatomy of the oesophagus which should prevent reflux?

A

Lower oesophageal sphincter

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7
Q

What are 2 possible complications from oesophageal reflux?

A
  • Healing by fibrosis

- Barretts

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8
Q

Describe oesophageal healing by fibrosis

A

Stricture formation; impaired oesophageal motility; oesophageal obstruction

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9
Q

What is Barrett’s oesophagus?

A

Type of metaplasia; pre-malignant condition for adenocarcinoma oesophageal cancer

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10
Q

What is metaplasia and what occurs in Barretts metaplasia?

A

Metaplasia is transformation from one normal tissue type to another normal tissue type - in Barretts it is squamous to glandular epithelium

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11
Q

What are the 2 histological types of oesophageal cancer?

A

SQUAMOUS CARCINOMA

ADENOCARCINOMA

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12
Q

Give 3 risk factors for squamous carcinoma

A
  • smoking
  • alcohol
  • dietary carcinogens e.g. processed meats
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13
Q

Give 2 risk factors for adenocarcinoma

A
  • Barrett’s

- obesity (increased reflux due to increased intra-abdominal pressure)

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14
Q

Give 3 local effects of oesophageal cancer

A

Obstruction
Perforation
Ulceration

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15
Q

Where does oesophageal cancer directly spread?

A

To surrounding structures i.e. lungs, lymphatic spread to regional lymph nodes

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16
Q

Where can oesophageal cancer spread via blood?

A

Liver

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17
Q

What is the prognosis for oesophageal cancer?

A

VERY POOR (5 year survival rate less than 15%; high percentage have metastatic disease)

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18
Q

What are the 3 types of gastritis?

A

Autoimmune (TYPE A)
Bacterial (TYPE B)
Chemical injury (TYPE C)

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19
Q

What is type A gastritis?

A

Organ-specific autoimmune disease; autoantibodies to parietal cells and therefore intrinsic factor; associated with other autoimmune diseases

20
Q

Describe the pathology of type A gastritis

A

Atrophy of specialised acid secreting gastric epithelium; loss of specialised gastric epithelial cells

21
Q

What does the pathology of type A gastritis result in?

A
  • Decrease acid secretion

- Loss of intrinsic factor (B12 deficiency - pernicious anaemia)

22
Q

What is the role of parietal cells in the stomach?

A

Make stomach acid and intrinsic factor

23
Q

How can a person with type A gastritis present?

A

Tired, pale complexion, heart problems (exercise intolerance, palpitations), pernicious anaemia, person usually has other autoimmune disease

24
Q

What is the most common type of gastritis?

A

Bacterial

25
Q

What bacteria is typically associated with bacterial (type B) gastritis?

A

H. pylori (gram neg)

26
Q

What does H. pylori produce?

A

Enzyme that convert urease to ammonia and carbonate (therefore rising pH associated with infection)

27
Q

How does someone with type B gastritis present?

A

Nausea, bloating, vomiting, indigestion, burning/gnawing feeling in stomach between meals, haematemesis, black tarry stool (acute and chronic inflammatory response)

28
Q

What does the produce produce to try to combat type B gastritis?

A

Inflammatory acid - to try to raise pH - leads to acid reflux (so treatment often includes e.g. PPI or H2-blocker as well as abx)

29
Q

Where is H pylori found?

A

Gastric mucous on surface of gastric epithelium

30
Q

What can cause type C gastritis?

A
  • Drugs (NSAIDs)
  • Alcohol
  • Bile reflux
31
Q

What causes peptic ulceration?

A

Imbalance between acid secretion and mucosal barrier

32
Q

Where can peptic ulcers appear?

A

Lower oesophagus, body + antrum of stomach, 1st + 2nd parts of stomach, 1st + 2nd parts of duodenum

33
Q

What bacteria is peptic ulceration associated with?

A

H. pylori (because causes increased acid secretion)

34
Q

What are 3 potential complications of peptic ulceration?

A
  • Bleeding
  • Perforation
  • Healing by fibrosis
35
Q

What are some further complications from bleeding of peptic ulcer?

A 
Acute = haemhorrage (large blood vessel at base of ulcer)
Chronic = anaemia
36
Q

What is a further complication of perforation?

A

Release of gastric contents into peritoneum - resulting in peritonitis

37
Q

What is peritonitis?

A

Inflammation of the peritoneum; serious condition - IV abx immediately to treat

38
Q

What can healing by fibrosis result in?

A

Obstruction in lumen

39
Q

What is the 2nd commonest cancer of the alimentary tract?

A

Stomach cancer

40
Q

How does stomach cancer develop?

A

Phases of intestinal metaplasia and dysplasia

41
Q

What infection is stomach cancer associated with?

A

H. pylori

42
Q

Histologically, what type of cancer is stomach cancer?

A

Adenocarcinoma - arises in glandular epithelium

43
Q

Where can stomach cancer directly spread?

A

Surrounding structures; lymphatic spread to regional lymph nodes

44
Q

Where can stomach cancer spread via blood?

A

Liver

45
Q

What other type of spread is found in stomach cancer?

A

Trans-coelemic spread - within peritoneal cavity

46
Q

What is the prognosis for stomach cancer?

A

Very poor - 5 yr survival rate under 20%

*GI System - Pathology (8 decks)

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