Upper GI Tract Pathology

Question 1

What is oesophageal reflux?

Answer 1

Reflux of gastric acid into the oesophagus

Question 2

What is a hiatus hernia?

Answer 2

Protrusion of part of the stomach into the thorax

Question 3

Pathology of oesophageal reflux

Answer 3

Reflux of gastric acid into the oesophagus
Thickening of squamous epithelium
Ulceration of oesophagus when severe
Sets up an inflammatory process

Question 4

Complications of oesophageal reflux

Answer 4

Healing by fibrosis
- stricture formation 
- impaired oesophageal motility
- oesophageal obstruction 
Barrett's oesophagus

Question 5

Causes / types of gastritis (ABC)

Answer 5

Autoimmune
Bacterial
Chemical injury

Question 6

What is the most common type of gastritis?

Answer 6

Bacterial

Question 7

Pathology of autoimmune gastritis

Answer 7

Targets stomach
Autoantibodies to parietal cells and intrinsic factor
Atrophy of specialised acid secreting gastric epithelium
Also loss of specialised gastric epithelial cells leading to
- decreased acid secretion
- loss of intrinsic factor leading to vit B 12 deficiency - pernicious anaemia

Question 8

What is bacterial gastritis related to?

Answer 8

Helicobacter pylori

Question 9

Causes of chemical gastritis

Answer 9

Drugs (NSAIDs)
Alcohol
Bile reflux

Question 10

Pathology of peptic ulceration

Answer 10

Stomach has well established mucosal barrier so that it does not destroy itself, however the oesophagus and duodenum do not have this same mucosal barrier.
Imbalance between acid secretion and mucosal barrier
When barrier breaks down, there will be damage to the epithelium due to the acid

Question 11

What does H pylori increase?

Answer 11

Gastric acid

Question 12

Complications of peptic ulceration

Answer 12

Bleeding - haemorrhage or anaemia
Perforation
- > peritonitis

Question 13

What is gastric cancer?

Answer 13

Stomach cancer

Question 14

Pathology of gastric cancer

Answer 14

Develops through phases of intestinal metasplasia and dysplasia

Question 15

What is gastric cancer associated with?

Answer 15

Previous H pylori infection

Question 16

Histology of gastric cancer

Answer 16

Adenocarcinoma

Question 17

How does gastric cancer spread?

Answer 17

Direct to surrounding areas
Lymphatic
Blood spread to liver
Transcolemic spread within peritoneal cavity

Question 18

Prognosis of gastric cancer

Answer 18

Very poor - 5 year survival rate less than 20%

Question 19

Pathology of Barrett’s Oesophagus

Answer 19

Metaplasia

- transformation from squamous epithelium to glandular epithelium

Question 20

What is metaplasia?

Answer 20

The transformation of one normal tissue to another normal tissue

Question 21

What does barretts oesophagus happen in response to?

Answer 21

Oesophageal reflux

Question 22

What is barrets oesophagus a pre malignant condition for?

Answer 22

Oesophageal cancer

Question 23

Two types of oesophageal cancer

Answer 23

Squamous cancer

Adenocarcinoma

Question 24

Which type of oesophageal cancer develops from barretts oesophagus?

Answer 24

Adenocarcinoma

Question 25

Risk factors for squamous carcinoma of the oesophagus

Answer 25

Smoking Alcohol Dietary carcinogens

Question 26

Risk factors for adenocarcinoma of the oesophagus

Answer 26

Barrett's metaplasia | Obesity

Question 27

How can obesity increase the risk of developing an adenocarcinoma of the oesophagus?

Answer 27

Abdominal obesity pushes the stomach through the lower sphincter leading to herniation This creates a proinflammatory environment which increases the chance of cancer

Question 28

Local effects of oesophageal cancer

Answer 28

``` Obstruction - dysphagia - weight loss Ulceration - blood loss - anaemia Perforation - infection - inflammatory response ```

Question 29

How does oesophageal cancer spread?

Answer 29

Direct to surrounding structures Lymphatic Blood spread to lier

Question 30

Prognosis of oesophageal cancer

Answer 30

5 year survival rate < 15%

Question 31

What is helicobacter pylori?

Answer 31

Gram -ve bacterium

Question 32

Where is H pylori found?

Answer 32

Gastric mucus on the surface of gastric epithelium

Question 33

Effects of H pylori

Answer 33

Produces acute and chronic inflammatory response Increases acid production Produces urease which splits urea into ammonia and carbonate which increases the local pH The stomach senses the rising pH and this stimulates acid production

Question 34

What is the most appropriate tool to screen for malnutrition?

Answer 34

MUST

Question 35

What is the waterloo score for?

Answer 35

The risk of a patient developing a pressure sore