Upper GI Tract Pathology Flashcards
Describe Indigestion
Upper (retrosternal discomfort/burning) Abdominal Pain
Define oesophageal Reflux
Reflux of gastric acid into the oesophagus
What causes or worsens oesophageal reflux?
Hiatus Hernia, bulging of the stomach through the diaphragm. Thought to cause weakening of the lower esophageal sphincter.
What causes a hiatus herina?
Increase in abdominal pressure. (heavy lifting, coughing, defecation/urination)
Obesity
Pregnancy
Pathologies of Oesophageal Reflux
- Esophagitis
- Cameron Ulcers (bleeding from erosion of the oesophagus.)
- Barrett’s Oesophagus
- Severe Reflux = ulceration
What is Barretts Oesophagus?
Healthy squamous epithelial is replaced with premalignant meta plastic glandular. columnar cells. Occurs as a result of prolonged oesophageal reflux damage.
Consequences of Esophagitis
Inflammation of the oesophagus caused by corrosion leads to healing by fibrosis.
This replaces mobile squamous tissue with fibrous scarf tissue. Stricture formation.
Consequences of stricture formation
Narrowing of the oesophagus = loss of mobility and obstruction.
Variations of Oesophageal Cancer
Both linked to enviomental factors > genetic
Squamous Carcinoma. Rises from squamous epithelial.
Adenocarcioma - arises from glandular structures in the epithelia.
Factors influencing squamous carcinoma of the oesophagus
Smoking
Alcohol
Dietary carcinogens
Factors influencing adenocarcinoma of the oesophagus
Barrett’s Metaplasia
Obesity
Ranked Three most common GI cancers
- Colo-rectal
- Gastric
- Oesophageal
Name the Local Effects of Oesophageal Cancer
Obstruction
Ulceration
Perforation
How does oesophageal cancer spread?
Direclty to local tissue
Via Lymphatics
Via Blood to the liver.
Over poor prognosis <15% after 5 years
Define Gastritis
Inflammation of the inner lining of the stomach
Types of Gastritis
ABC
A - Autoimmune
B - Bacterial
C- Chemical
Define Autoimmune gastritis
Chronic inflammation of the gastric mucosa. Resulting in Gastric Atropy and
Replacement with fibrous tissue, intestinal metaplasia
Mechanism of Autoimmune Gastritis
Auto-antibodies attack parietal cells and intrinsic factor causing atrophy and replacement of these cells.
Define autoantibodies
Proteins produced by the immune tissue which attack self-tissue
Define atropy
Parital/complete wasting away
Define intestinal metaplasia
Gastric epithelial is changed and replaced with epithelial similar to that of the intestines. Pre-malignant condition
Define Metaplasia
Change in fully differentiated cells to another cell type.
Define Bacterial Gastritis
H. Pyrloi involvement.
Produces both acute and chronic inflammatory response.
Increases Acid Production
Definition and causes of Chemical Gastritis
Injury caused to the gastric mucousa by chemical factors.
Drugs (NSAIDS)
Bile Reflux
Alcohol
Cause of Peptic Ulceration
In-balance between acid secretion and the mucous barrier.
Associated with H.pylori due to increased acid secretion.
Complications of Peptic Ulceration
Bleeding (acute/haermorrage)(chronic/anaemia)
Perforation - Periotonitis
Healing by Fibrosis - Obstruction
Stomach Carcinoma - Type
- Mechanism
- Cause
Adenocarcinoma - associated with previous H.pylori damage
Develops througb phases of intestinal metaplasia and dyplasia.
Describe Spread of Stomach Cancer
Direct
Lymphatic
Blood (lover)
Transcoelomic (within the abdominal cavity)
Define Dysplasia
Abnormal development of cells within tissues. I.e abnormal cell growth/anatomical structure/organisation.
Abnormal, not yet cancer.
