Upper GI Tract Pathology Flashcards
Describe the pathology of oesophageal reflux.
- Reflux of gastric acid into oesophagus
- Caused by loss of lower oesophageal sphincter e.g. hiatus hernia
- Thickening of squamous epithelium
- Ulceration of oesophageal epithelium when severe reflux
Describe the complications of oesophageal reflux (ulceration).
Healing by fibrosis;
- Stricture formation
- Impaired oesophageal motility
- Oesophageal obstruction
- Barrett’s oesophagus
Describe Barrett’s oesophagus.
- Type of metaplasia: squamous –> glandular columnar epithelium
- Response in some patients to oesophageal reflux
- Pre-malignant condition (0.1-4% increased risk of adenocarcinoma)
Name the two histological types of oesophageal carcinoma.
- Squamous carcinoma: occurs in proximal and middle 1/3 of oesophagus
- Adenocarcinoma: occurs in distal oesophagus (develops from Barrett’s oesophagus)
Describe the risk factors of oesophageal cancer.
Squamous carcinoma;
- Smoking
- Alcohol
- Dietary carcinogens
Adenocarcinoma;
- Barrett’s oesophagus
- Obesity
Describe the local effects oesophageal cancer can have.
- Obstruction
- Ulceration
- Perforation (presents as anaemia)
Describe how oesophageal cancer can spread/metastasise.
- Direct: to surrounding tissues
- Lymphatic: to regional lymph nodes
- Blood: liver
Describe the prognosis of oesophageal cancer.
Very poor - 5YS <15%.
Name the three pathologies of gastritis.
Remember ABC.
- Autoimmune (type A)
- Bacterial (type B)
- Chemical injury (type C)
Describe autoimmune gastritis.
- Organ-specific autoimmune disease
- Autoantibodies to parietal cells and thus, intrinsic factor
- Atrophy of specialised acid secreting gastric epithelium
Loss of specialised gastric epithelial cells;
- Decreased acid secretion
- Loss of intrinsic factor –> vitamin B12 deficiency (pernicious anaemia)
Describe bacterial gastritis.
- Most common type
- H. pylori related
Describe Helicobacter pylori.
- Gram-negative bacterium
- Found in gastric mucus on surface of gastric epithelium
- Produces acute and chronic inflammatory response
- Increases acid production: bacteria breaks down urea causing pH to rise, so more gastric acid produced in response
Describe chemical gastritis.
- Drugs e.g. NSAIDs
- Alcohol
- Bile reflux
Describe peptic ulceration.
- Imbalance between acid secretion and mucosal barrier
- Affects lower oesophagus, body and antrum of stomach, and first and second parts of duodenum
- Usually H. pylori related
Describe the complications of peptic ulceration.
- Bleeding (chronic, i.e. anaemia, more likely)
- Perforation (–> peritonitis)
- Healing by fibrosis (–> obstruction)
