Upper GI Tract Pathology Flashcards
What is oesophageal reflux?
Reflux of gastric acid into oesophagus
What commonly causes oesophageal reflux?
Hiatus hernia
What is a hiatus hernia?
Part of stomach protrudes into thorax
What is thickening of oesophageal squamous epithelium a pathological response to?
Presence of acid in oesophagus (usually short lived)
What occurs in the oesophagus when reflux is severe?
Ulceration
What is present in anatomy of the oesophagus which should prevent reflux?
Lower oesophageal sphincter
What are 2 possible complications from oesophageal reflux?
- Healing by fibrosis
- Barretts
Describe oesophageal healing by fibrosis
Stricture formation; impaired oesophageal motility; oesophageal obstruction
What is Barrett’s oesophagus?
Type of metaplasia; pre-malignant condition for adenocarcinoma oesophageal cancer
What is metaplasia and what occurs in Barretts metaplasia?
Metaplasia is transformation from one normal tissue type to another normal tissue type - in Barretts it is squamous to glandular epithelium
What are the 2 histological types of oesophageal cancer?
SQUAMOUS CARCINOMA
ADENOCARCINOMA
Give 3 risk factors for squamous carcinoma
- smoking
- alcohol
- dietary carcinogens e.g. processed meats
Give 2 risk factors for adenocarcinoma
- Barrett’s
- obesity (increased reflux due to increased intra-abdominal pressure)
Give 3 local effects of oesophageal cancer
Obstruction
Perforation
Ulceration
Where does oesophageal cancer directly spread?
To surrounding structures i.e. lungs, lymphatic spread to regional lymph nodes
Where can oesophageal cancer spread via blood?
Liver
What is the prognosis for oesophageal cancer?
VERY POOR (5 year survival rate less than 15%; high percentage have metastatic disease)
What are the 3 types of gastritis?
Autoimmune (TYPE A)
Bacterial (TYPE B)
Chemical injury (TYPE C)
What is type A gastritis?
Organ-specific autoimmune disease; autoantibodies to parietal cells and therefore intrinsic factor; associated with other autoimmune diseases
Describe the pathology of type A gastritis
Atrophy of specialised acid secreting gastric epithelium; loss of specialised gastric epithelial cells
What does the pathology of type A gastritis result in?
- Decrease acid secretion
- Loss of intrinsic factor (B12 deficiency - pernicious anaemia)
What is the role of parietal cells in the stomach?
Make stomach acid and intrinsic factor
How can a person with type A gastritis present?
Tired, pale complexion, heart problems (exercise intolerance, palpitations), pernicious anaemia, person usually has other autoimmune disease
What is the most common type of gastritis?
Bacterial
What bacteria is typically associated with bacterial (type B) gastritis?
H. pylori (gram neg)
What does H. pylori produce?
Enzyme that convert urease to ammonia and carbonate (therefore rising pH associated with infection)
How does someone with type B gastritis present?
Nausea, bloating, vomiting, indigestion, burning/gnawing feeling in stomach between meals, haematemesis, black tarry stool (acute and chronic inflammatory response)
What does the produce produce to try to combat type B gastritis?
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)
Where is H pylori found?
Gastric mucous on surface of gastric epithelium
What can cause type C gastritis?
- Drugs (NSAIDs)
- Alcohol
- Bile reflux
What causes peptic ulceration?
Imbalance between acid secretion and mucosal barrier
Where can peptic ulcers appear?
Lower oesophagus, body + antrum of stomach, 1st + 2nd parts of stomach, 1st + 2nd parts of duodenum
What bacteria is peptic ulceration associated with?
H. pylori (because causes increased acid secretion)
What are 3 potential complications of peptic ulceration?
- Bleeding
- Perforation
- Healing by fibrosis
What are some further complications from bleeding of peptic ulcer?
Acute = haemhorrage (large blood vessel at base of ulcer) Chronic = anaemia
What is a further complication of perforation?
Release of gastric contents into peritoneum - resulting in peritonitis
What is peritonitis?
Inflammation of the peritoneum; serious condition - IV abx immediately to treat
What can healing by fibrosis result in?
Obstruction in lumen
What is the 2nd commonest cancer of the alimentary tract?
Stomach cancer
How does stomach cancer develop?
Phases of intestinal metaplasia and dysplasia
What infection is stomach cancer associated with?
H. pylori
Histologically, what type of cancer is stomach cancer?
Adenocarcinoma - arises in glandular epithelium
Where can stomach cancer directly spread?
Surrounding structures; lymphatic spread to regional lymph nodes
Where can stomach cancer spread via blood?
Liver
What other type of spread is found in stomach cancer?
Trans-coelemic spread - within peritoneal cavity
What is the prognosis for stomach cancer?
Very poor - 5 yr survival rate under 20%
