Upper GI tract pathology

Question 1

What is oesophageal reflux?

Answer 1

Reflux of gastric acid into the oesophagus

Question 2

What problems does oesophageal reflux cause?

Answer 2

Thickening of squamous epithelium

Severe reflux can cause Ulceration of the oesophageal epithelium

Question 3

Oesophageal reflux is commonly caused by, and is thus an indicator of a specific anatomy-ish problem in le body…

What is this?

Answer 3

Hiatus hernia

When your stomach slips oot eh

Question 4

What are the complications of oesophageal reflux?

Answer 4

1) Repeated insult to epithelium will lead to healing by fibrosis
2) Barrett’s oesophagus

Question 5

What are the specific problems caused by fibrosis in the oesophagus?

Answer 5

Stricture formation

Impaired oesophageal motility

Oesophageal obstruction

Question 6

What is Barrett’s oesophagus?

Answer 6

Pre malignant Condition in which the bottom end of the oesophagus’ lining becomes thin/weak

A Transformation from squamous epithelium to columnar epithelium in the lower oesophagus is seen

Oesophageal reflux can cause it to develop

Question 7

What histological types of cancer are there of oesophageal cancer ?

Answer 7

Squamous carcinoma (proximal 2/3rds) & Adenocarcinoma (distal 1/3rd)

Question 8

Adenocarcinoma develops from what oesophageal condition>

Answer 8

Barrett’s oesophagus

barrett’s metaplasia

Question 9

What are the risk factors for squamous carcinoma in the oesophagus?

Answer 9

Smoking

Alcohol

Dietary carcinogens

Question 10

What risk factors are there for the development of adenocarcinoma of the oesophagus

Answer 10

Barrett’s oesophagus / GORD

Being phat

Question 11

What are the potential local effects of Oesophageal cancer?

Answer 11

Obstruction
Ulceration
Perforation

Question 12

Like with many cancers, oesophageal cancer can spread directly, via the lymphatic system and through the blood

What organ is at risk of metastasis to through the blood?

Answer 12

Liver

bc distal oesophagus involved in portal circulation

Question 13

Whats the prognosis for oesophageal cancer?

Answer 13

5 year survival rate < 15%

Question 14

There are 3 type of gastritis. What are they?

Answer 14

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

(think ABC)

Question 15

WHat is autoimmune gastritis?

Answer 15

Chronic inflammatory disease involving auto-destruction of parietal cells in the stomach

This is caused by autoantibodies attacking parietal cells and intrinsic factor

Question 16

What is the histological effect of autoimmune gastritis?

Answer 16

Parietal cells normally chuck out HCl and intrinsic factor

Damage/loss of this gastric epithelium leads to decreased acid secretion and vitamin B12 deficiency

Vitamin B12 deficiency causes pernicious anaemia

Question 17

Which type of gastritis is most common?

Answer 17

Bacterial

Question 18

What bacterium is related to bacterial gastritis?

Answer 18

Helicobacter pylori

Question 19

What is H pylori?

Answer 19

Gram negative bacterium which is found in gastric mucus on the surface of the gastric epithelium

Produces acute and chronic inflammatory response in gastritis and also causes an increased acid production

Question 20

What are the main causes of chemical gastritis?

Answer 20

Drugs such as NSAIDs (aspirin etc)
Alcohol
Bile reflux

Question 21

What are peptic ulcers?

Answer 21

Ulcers/sores that form in the lining of the stomach, oesophagus and/or duodenum

Question 22

What bacterium is strongly associated with the formation of peptic ulcers?

Answer 22

Helicobacter pylori

Question 23

What parts of the stomach can be affected by peptic ulcers?

Answer 23

Body and antrum

Question 24

What are the complications of peptic ulcers?

Answer 24

1) Bleeding
- Can be acute (haemorrhage)
- Chronic bleeding leads to anaemia

2) Perforation (leading to peritonitis)
3) Obstruction due to healing by fibrosis

Question 25

What histological type of cancer is stomach cancer?

Answer 25

Adenocarcinoma

Question 26

What is the link between an infection and stomach cancer?

Answer 26

Stomach cancer associated with previous infection with H. pylori

Question 27

In what ways can stomach cancer spread?

Answer 27

Blood (liver)

Lymph

Direct invasion

Transcoelomic spread
(Spread within peritoneal cavity)

Question 28

What is the prognosis for a patient with stomach cancer?

Answer 28

Very poor

5 year survival rate less than 20%