Upper GI Tract - Pathology

Question 1

What is oesophageal reflux?

Answer 1

Reflux of gastric acid into oesophagus

Question 2

What is a hiatus hernia?

Answer 2

Part of the stomach going through the diaphragm into the chest

Question 3

What is the result of oesophageal reflux?

Answer 3

Acid causes damages to the epithelium of the oesophagus causing inflammation of the squamous epithelium
May also cause ulcers (severe)

Question 4

What are the complications of oesophageal reflux?

Answer 4

Healing by fibrosis - reduces motility, stricture formation and may cause obstruction
Barretts oesophagus

Question 5

What is Barrett’s oesophagus?

Answer 5

Transformation from squamous epithelium to glandular epithelium
Pre-malignant condition

Question 6

What are the 2 histological types of oesophageal cancer?

Answer 6

Squamous carcinoma

Adenocarcinoma

Question 7

What are the risk factors of squamous carcinoma?

Answer 7

Smoking
Alcohol
Dietary carcinogens

Question 8

What are the risk factors of adenocarcinoma?

Answer 8

Barrett’s metaplasia

Obesity

Question 9

What are the 3 local effects of oesophageal cancer?

Answer 9

Obstruction
Ulceration
Perforation

Question 10

What are different ways of oesophageal cancer spread?

Answer 10

Direct -> surrounding tissues
Lymphatic -> regional lymph nodes
Blood -> liver

Question 11

What is the prognosis of oesophageal cancer?

Answer 11

Very poor (5 year survival rate less than 15%)
Mostly diagnosed after metastases

Question 12

What are the 3 types of gastritis?

Answer 12

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

Question 13

What is autoimmune gastritis?

Answer 13

Autoantibodies to parietal cells and intrinsic factor (organ-specific)
Associated with other autoimmune diseases

Question 14

What happens in autoimmune gastritis?

Answer 14

Atrophy of specialised acid secreting gastric epithelium
Loss of specialised gastric epithelial cells causes decreased acid secretion and loss of intrinsic factor (B12 deficiency)

Question 15

What is bacterial gastritis?

Answer 15

Helicobacter pylori related
Gram negative bacterium found in gastric mucus on surface of gastric epithelium that produces acute/chronic inflammatory response
Results in increased acid production

Question 16

What is chemical gastritis?

Answer 16

Result of drugs (NSAIDS), alcohol or bile reflux from duodenum

Question 17

What is peptic ulceration?

Answer 17

Imbalance between acid secretion and mucosal barrier

Usually H. pyloric associated (increased gastric acid)

Question 18

What structures are affected by peptic ulceration?

Answer 18

Lower oesophagus
Body and antrum of stomach
1st and 2nd parts of duodenum

Question 19

What are the 3 main complications of peptic ulceration?

Answer 19

BLEEDING: acute (haemorrhage), chronic (slow blood loss = anaemia)
PERFORATION: hole in stomach = release of stomach contents into abdominal cavity
FIBROSIS: reduces motility = narrows tube = obstruction = build up of food contents in stomach

Question 20

How does gastric cancer develop?

Answer 20

Through phases of intestinal metaplasia and dysplasia
Associated with previous H.pylori infection
Adenocarcinoma

Question 21

What are the 4 types of spread in stomach cancer?

Answer 21

DIRECT: surrounding tissues
LYMPHATIC: regional lymph nodes
BLOOD: liver
TRANSCOELOMIC: within peritoneal cavity

Question 22

What is the prognosis of stomach cancer?

Answer 22

Very poor: 5 year survival rate less than 20%