Upper GI Tract Pathology Flashcards
What are some examples of pathologies of the upper GI tract?
Oesophageal reflux
Oesophageal cancer
Gastritis
Peptic ulceration
Gastric cancer
What is the upper GI tract formed from?
Oesophagus
Stomach
Duodenum
What is oesophageal reflux?
Reflux of gastric acid into the oesophagus
What is the pathology of oesophageal reflux?
Hiatus hernia
Thickening of squamous epithelium
Ulceration of oesophageal epithelium with severe reflux
What is is called when the oesophagus passes through the diaphram into the stomach?
Hiatus hernia
What does the squamous epithelium of the oesopahgus thicken because of oesophageal reflux?
Try to increase the thickeness to protect itself, but it is rapidly overcame
What are complications of oesophageal reflux?
Healing by fibrosis (after ulceration)
Barrett’s oesophagus
Why is the oesophagus healing by fibrosis after oesophageal reflux a problem?
Stricture (narrowing in oesophagus because muscle has been replaced by fibrous tissue)
Impaired oesophageal motility (food and liquid accumulate in oesophagus)
Oesophageal obstruction
What is stricture?
Narrowing in the oesophagus
What is Barrett’s metaplasia?
Type of metaplasia where transformation from squamous epithelium to glandular epithelium occurs
What is an abnormal change in the nature of a tissue called?
Metaplasia
What is Barrett’s oesophagus associated with?
Increased risk of cancer, it is a pre-malignant condition
What is oesophageal cancer?
Type of cancer affecting the oesophagus
What is the most common cancer of the alimentary tract?
Colorectal cancer
What is the second most common cancer of the alimentary tract?
Stomach cancer
What is the third most common cancer of the alimentary tract?
Oesophageal cancer
Is incidence of oesophageal cancer rising or decreasing?
Rising
What can be said about environmental and genetic components of oesophageal cancer?
Linked with environmental factors, does not seem to have a big genetic component
What are the 2 histological types of oesophageal cancer?
Squamous carcinoma
Adenocarcinoma
Squamous carcinoma is cancer of what type of cell?
Squamous cell
Adenocarcinoma is cancer of what type of cell?
Glandular tissue
How does adenocarcinoma occur in the oesophagus?
If squamous cells of oesophagus have changed to glandular, such as due to Barrett’s oesophagus
What are risk factors for squamous carcinoma oesophageal cancer?
Smoking
Alcohol
Dietary carcinogens
What are risk factors for adenocarcinoma oesophageal cancer?
Barrett’s oesophagus
Obesity
What are some local effects of oesophageal cancer?
Obstruction
Ulceration
Perforation
What are the different methods that oesophageal cancer can use to spread?
Direct (to surrounding tissues)
Lymphatic spead (to regional lymph nodes)
Blood spread (usually to the liver)
Where do most oesophageal tumours develop?
Distal oesophagus
What is the prognosis of oesophageal cancer?
Very poor
5 year survival rate less than 15%
Why is the 5 year survival rate of oesophageal cancer less than 15%?
Patients present with advanced disease at diagnosis, often with liver metastasis
What is gastritis?
Inflammation of the lining of the stomach
What are the different types of gastritis?
Autoimmune (type A)
Bacterial (type B)
Chemical (type C)
What is the commonest kind of gastritis?
Bacterial gastritis
What bacteria is usually responsible for bacterial gastritis?
Helicobacter pyloris
What kind of bacteria is helicobacter pyloris?
Gram negative
Where is helicobacter pyloris found in the stomach?
In gastric mucus on surface of gastric epithelium
In what percentage of the adult population is helicobacter pyloris found in?
50%, but only a small amount generate an inflammatory response
When helicobacter pyloris is pathological, what does it lead to that causes inflammation?
Increased acid production (due to increasing pH in stomach which makes the stomach think it needs to produce more acid)
What are examples of things that can cause chemical injury gastritis?
Drugs such as NSAIDs
Alcohol
Bile reflux
Explain the pathology of autoimmune gastritis?
Atrophy of specialised acid secreting gastric epithelium
Loss of intrinsic factor
What does a loss of intrinsic factor lead to?
Vitamin B12 deficiency (pernicious anaemia)
What is peptic ulceration?
Sores that develop in the lining of the stomach, lower oesophagus or small intestine due to inflammation
Why does peptic ulceration occur?
Due to imbalance between acid secretion and mucosal barrier
Where can peptic ulceration occur?
Anywhere acid and peptic comes into contact and the epithelium is not able to resist the damage
Where does peptic ulceration commonly affect?
Lower oesophagus
Body and antrum of stomach
First and second parts of duodenum
What is peptic ulceration usually associated with?
Helicobacter pyloris or increased gastric acid production leading to imbalance
What is stomach cancer also known as?
Gastric cancer
What are some complications of peptic ulceration?
Bleeding
Perforation
Healing by fibrosis
What are the different kinds of bleeding that can occur due to peptic ulceration?
Acute (haemorrhage), due to large blood loss quickly
Chronic (anaemia), due to slow blood loss over time
What does perforation due to gastric ulceration lead to?
Peritonitis
What is peritonitis?
Infection of the inner lining of the stomach
Why is healing by fibrosis after gastric ulceration a problem?
Causes obstruction (not really an issue in stomach of body due to being wide, but is elsewhere such as pyloric region, oesophagus and duodenum)
What does gastric cancer develop through phases of?
Metaplasia and dysplasia (abnormal growth or development of cells)
What is dysplasia?
Presence of cells of an abnormal type within a tissue, may signify stage precipitating cancer
What infection is gastric cancer associated with?
Helicobacter pyloris infection
What is the histology of gastric cancer?
Adenocarcinoma
What are the methods that gastric cancer uses to spread?
Direct (to surrounding tissues)
Lymphatics (to regional lymph nodes)
Blood (usually to liver)
Transcoelomic spread (within peritoneal cavity)
What is the prognosis of stomach cancer?
Very poor
5 year survival rate less than 20%
