Upper GI Tract Pathology

Question 1

What are some examples of pathologies of the upper GI tract?

Answer 1

Oesophageal reflux

Oesophageal cancer

Gastritis

Peptic ulceration

Gastric cancer

Question 2

What is the upper GI tract formed from?

Answer 2

Oesophagus

Stomach

Duodenum

Question 3

What is oesophageal reflux?

Answer 3

Reflux of gastric acid into the oesophagus

Question 4

What is the pathology of oesophageal reflux?

Answer 4

Hiatus hernia

Thickening of squamous epithelium

Ulceration of oesophageal epithelium with severe reflux

Question 5

What is is called when the oesophagus passes through the diaphram into the stomach?

Answer 5

Hiatus hernia

Question 6

What does the squamous epithelium of the oesopahgus thicken because of oesophageal reflux?

Answer 6

Try to increase the thickeness to protect itself, but it is rapidly overcame

Question 7

What are complications of oesophageal reflux?

Answer 7

Healing by fibrosis (after ulceration)

Barrett’s oesophagus

Question 8

Why is the oesophagus healing by fibrosis after oesophageal reflux a problem?

Answer 8

Stricture (narrowing in oesophagus because muscle has been replaced by fibrous tissue)

Impaired oesophageal motility (food and liquid accumulate in oesophagus)

Oesophageal obstruction

Question 9

What is stricture?

Answer 9

Narrowing in the oesophagus

Question 10

What is Barrett’s metaplasia?

Answer 10

Type of metaplasia where transformation from squamous epithelium to glandular epithelium occurs

Question 11

What is an abnormal change in the nature of a tissue called?

Answer 11

Metaplasia

Question 12

What is Barrett’s oesophagus associated with?

Answer 12

Increased risk of cancer, it is a pre-malignant condition

Question 13

What is oesophageal cancer?

Answer 13

Type of cancer affecting the oesophagus

Question 14

What is the most common cancer of the alimentary tract?

Answer 14

Colorectal cancer

Question 15

What is the second most common cancer of the alimentary tract?

Answer 15

Stomach cancer

Question 16

What is the third most common cancer of the alimentary tract?

Answer 16

Oesophageal cancer

Question 17

Is incidence of oesophageal cancer rising or decreasing?

Answer 17

Rising

Question 18

What can be said about environmental and genetic components of oesophageal cancer?

Answer 18

Linked with environmental factors, does not seem to have a big genetic component

Question 19

What are the 2 histological types of oesophageal cancer?

Answer 19

Squamous carcinoma

Adenocarcinoma

Question 20

Squamous carcinoma is cancer of what type of cell?

Answer 20

Squamous cell

Question 21

Adenocarcinoma is cancer of what type of cell?

Answer 21

Glandular tissue

Question 22

How does adenocarcinoma occur in the oesophagus?

Answer 22

If squamous cells of oesophagus have changed to glandular, such as due to Barrett’s oesophagus

Question 23

What are risk factors for squamous carcinoma oesophageal cancer?

Answer 23

Smoking

Alcohol

Dietary carcinogens

Question 24

What are risk factors for adenocarcinoma oesophageal cancer?

Answer 24

Barrett’s oesophagus

Obesity

Question 25

What are some local effects of oesophageal cancer?

Answer 25

Obstruction Ulceration Perforation

Question 26

What are the different methods that oesophageal cancer can use to spread?

Answer 26

Direct (to surrounding tissues) Lymphatic spead (to regional lymph nodes) Blood spread (usually to the liver)

Question 27

Where do most oesophageal tumours develop?

Answer 27

Distal oesophagus

Question 28

What is the prognosis of oesophageal cancer?

Answer 28

Very poor 5 year survival rate less than 15%

Question 29

Why is the 5 year survival rate of oesophageal cancer less than 15%?

Answer 29

Patients present with advanced disease at diagnosis, often with liver metastasis

Question 30

What is gastritis?

Answer 30

Inflammation of the lining of the stomach

Question 31

What are the different types of gastritis?

Answer 31

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

Question 32

What is the commonest kind of gastritis?

Answer 32

Bacterial gastritis

Question 33

What bacteria is usually responsible for bacterial gastritis?

Answer 33

Helicobacter pyloris

Question 34

What kind of bacteria is helicobacter pyloris?

Answer 34

Gram negative

Question 35

Where is helicobacter pyloris found in the stomach?

Answer 35

In gastric mucus on surface of gastric epithelium

Question 36

In what percentage of the adult population is helicobacter pyloris found in?

Answer 36

50%, but only a small amount generate an inflammatory response

Question 37

When helicobacter pyloris is pathological, what does it lead to that causes inflammation?

Answer 37

Increased acid production (due to increasing pH in stomach which makes the stomach think it needs to produce more acid)

Question 38

What are examples of things that can cause chemical injury gastritis?

Answer 38

Drugs such as NSAIDs Alcohol Bile reflux

Question 39

Explain the pathology of autoimmune gastritis?

Answer 39

Atrophy of specialised acid secreting gastric epithelium Loss of intrinsic factor

Question 40

What does a loss of intrinsic factor lead to?

Answer 40

Vitamin B₁₂ deficiency (pernicious anaemia)

Question 41

What is peptic ulceration?

Answer 41

Sores that develop in the lining of the stomach, lower oesophagus or small intestine due to inflammation

Question 42

Why does peptic ulceration occur?

Answer 42

Due to imbalance between acid secretion and mucosal barrier

Question 43

Where can peptic ulceration occur?

Answer 43

Anywhere acid and peptic comes into contact and the epithelium is not able to resist the damage

Question 44

Where does peptic ulceration commonly affect?

Answer 44

Lower oesophagus Body and antrum of stomach First and second parts of duodenum

Question 45

What is peptic ulceration usually associated with?

Answer 45

Helicobacter pyloris or increased gastric acid production leading to imbalance

Question 46

What is stomach cancer also known as?

Answer 46

Gastric cancer

Question 47

What are some complications of peptic ulceration?

Answer 47

Bleeding Perforation Healing by fibrosis

Question 48

What are the different kinds of bleeding that can occur due to peptic ulceration?

Answer 48

Acute (haemorrhage), due to large blood loss quickly Chronic (anaemia), due to slow blood loss over time

Question 49

What does perforation due to gastric ulceration lead to?

Answer 49

Peritonitis

Question 50

What is peritonitis?

Answer 50

Infection of the inner lining of the stomach

Question 51

Why is healing by fibrosis after gastric ulceration a problem?

Answer 51

Causes obstruction (not really an issue in stomach of body due to being wide, but is elsewhere such as pyloric region, oesophagus and duodenum)

Question 53

What does gastric cancer develop through phases of?

Answer 53

Metaplasia and dysplasia (abnormal growth or development of cells)

Question 54

What is dysplasia?

Answer 54

Presence of cells of an abnormal type within a tissue, may signify stage precipitating cancer

Question 55

What infection is gastric cancer associated with?

Answer 55

Helicobacter pyloris infection

Question 56

What is the histology of gastric cancer?

Answer 56

Adenocarcinoma

Question 57

What are the methods that gastric cancer uses to spread?

Answer 57

Direct (to surrounding tissues) Lymphatics (to regional lymph nodes) Blood (usually to liver) Transcoelomic spread (within peritoneal cavity)

Question 58

What is the prognosis of stomach cancer?

Answer 58

Very poor 5 year survival rate less than 20%