Upper GI tract pathology

Question 1

diseases of upper GI tract have the potential to cause what type of symptoms

Answer 1

upper abdominal or retrosternal discomfort/pain

or indigestion

Question 2

5 common pathologies of upper GI tract?

Answer 2

Oesophageal reflux
Oesophageal cancer
Gastritis
Peptic ulceration
Gastric cancer

Question 3

What is oesophageal reflux and what is the outcome of this?

Answer 3

Reflux of gastric acid into oesophagus

this can cause thickening of squamous epithelium or ulceration of the oesophageal epithelium if severe reflux

Question 4

what are some complications of oesophageal reflux (2)

Answer 4

1. healing by fibrosis - may obstruct the oesophagus, impair the motility (prevent peristalsis - food accumulates in oesophagus) within the oesophagus or narrow it
2. Barrett’s oesophagus - the lining of the lower part of the oesophagus changes. It changes from stratified squamous to simple columnar with interspersed goblet cells (like that of the small and large intestines)

Question 5

what is Barrett’s oesophagus

Answer 5

serious but uncommon type of metaplasia (change of tissue from one normal type to another normal type)

the tissue lining the oesophagus changes to resemble that of the intestine - stratified squamous to simple columnar + glandular

however this is important as it is a pre-malignant condition

Question 6

oesophageal cancer prevalence and prognosis

Answer 6

3rd commonest cancer of GI tract

very poor survival rate

Question 7

what are the 2 histological types related to oesophageal cancer

Answer 7

squamous carcinoma

adenocarcinoma - develops from Barrett’s oesophagus

Question 8

Risk factors for oesophageal cancer:- squamous carcinoma and adenocarcinoma

Answer 8

squamous carcinoma - smoking, alcohol, dietary carcinogens

adenocarcinoma - Barrett’s, obesity

Question 9

what are the local effects of oesophageal cancer? (3)

Answer 9

obstruction
ulceration
perforation - release oesophageal contents into thorax

Question 10

how does oesophageal cancer commonly spread in the body?

Answer 10

direct - to surrounding tissues
blood - to the liver
lymphatic - to regional lymph nodes

Question 11

what are the 3 types of gastritis

Answer 11

Types ABC
Autoimmune
Bacterial
Chemical injury

Question 12

how does autoimmune gastritis come about

Answer 12

Atrophy of specialised acid secreting gastric epithelium

loss of specialised gastric epithelial cells so decreased acid secretion or loss of intrinsic factor - vit B12 deficiency

tends to be more than 2 disease in other tissues. multifactorial

Question 13

bacterial gastritis: most common bacterium

Answer 13

most common

helicobacter pylori - gram negative found in gastric mucus

Question 14

what types of things can cause chemical gastritis?

Answer 14

alcohol
drugs like NSAIDs
bile reflux from duodenum

Question 15

complications of peptic ulceration (3)

Answer 15

Bleeding
Acute = haemorrhage
Chronic = anaemia

Perforation - Peritonitis

Healing by fibrosis - Obstruction

Question 16

Stomach cancer: prevalence and histology?

Answer 16

2nd commonest cancer of GI tract

adenocarcinoma

Question 17

spread of stomach cancer within the body

Answer 17

direct to surrounding tissues
lymphatic - regional lymph nodes
blood - liver
transcoelomic - within peritoneal cavity

Question 18

What happens if you lose the lower oesophageal sphincter

Answer 18

a hiatus hernia (part of your stomach moves into oesophagus)
Gastric acid leaks into the oesophagus from the stomach

Question 19

What happens that means gastric acid can leak into the oesophagus from the stomach?

Answer 19

loss of the lower oesophageal sphincter

Question 20

what is peptic ulceration

Answer 20

imbalance between acid secretion and mucosal barrier

ulcers that are often caused by H. pylori bacteria as well as stomach acid erosion

the duodenum and oesophagus don’t have a mucosal barrier that can resist acid - so if gastric acid gets into this area it can cause ulceration