Upper_GI_Diseases_Flashcards
Topic
Details
Introduction
Speaker: Prof. Rob Goldin
Focus: Upper gastrointestinal (GI) diseases, covering the oesophagus, stomach, and duodenum.
Importance: Emphasized the significance of histopathology in diagnosing and understanding GI diseases.
General Concepts
Disease Types:
- Inflammatory
- Neoplastic
- Metabolic
Pathway: Diseases often follow a progression from normal tissue to inflammation, to dysplasia, and finally to neoplasia.
Oesophagus - Normal Histology
Lined by stratified squamous epithelium.
Key layers: epithelium, submucosa, and muscularis externa.
Oesophagus - Acute Esophagitis
Causes: alcohol, drugs, acid reflux, bile reflux.
Histological Features: oedema, neutrophils, redness, and swelling.
Complications: ulceration, haemorrhage, perforation, stricture, Barrett’s oesophagus, cancer.
Oesophagus - Ulcers
Definition: deeper defect in the epithelium extending into the muscularis mucosa.
Difference from Erosion: Erosion is more superficial and does not penetrate the muscularis mucosa.
Chronic Ulcers: Show fibrosis and scarring.
Oesophagus - Barrett’s Oesophagus
Definition: Replacement of squamous epithelium with columnar epithelium.
Types:
- Gastric metaplasia (no goblet cells).
- Intestinal metaplasia (with goblet cells).
Risk Progression: Normal -> Metaplasia -> Low-grade dysplasia -> High-grade dysplasia -> Adenocarcinoma.
Diagnosis: Endoscopy shows red, velvety mucosa extending from the gastroesophageal junction.
Oesophagus - Adenocarcinoma of the Oesophagus
Prevalence: Common in developed countries.
Risk Factors: Chronic gastroesophageal reflux disease (GERD).
Location: Typically in the lower oesophagus near the gastroesophageal junction.
Histological Features: Formation of glands, mucus secretion.
Oesophagus - Squamous Cell Carcinoma
Prevalence: Common in developing countries.
Risk Factors: Smoking, alcohol, human papillomavirus (HPV).
Location: Middle third of the oesophagus.
Histological Features: Formation of keratin pearls, intercellular bridges.
Oesophagus - Oesophageal Varices
Definition: Dilated veins in the lower oesophagus due to portal hypertension.
Association: Common in patients with liver cirrhosis.
Complications: Risk of rupture leading to severe bleeding.
Stomach - Anatomy
Regions: Fundus, body, and antrum.
Body: Contains specialised glands secreting intrinsic factor, acid, and pepsin.
Antrum: Contains less specialised glands.
Stomach - Gastritis
Acute Gastritis:
- Causes: NSAIDs, alcohol, corrosive substances, infections.
- Features: Inflammation, erosion, potential ulceration.
Chronic Gastritis:
- Types:
- Autoimmune (anti-parietal cell antibodies, typically in the body).
- Bacterial (Helicobacter pylori, typically in the antrum).
- Chemical (NSAIDs, bile reflux, typically in the antrum).
- Other Causes: CMV, Strongyloides, Crohn’s disease.
Stomach - Helicobacter Pylori
Characteristics: Flagellated bacterium causing chronic gastritis.
Complications: Peptic ulcer disease, gastric adenocarcinoma, MALT lymphoma.
Treatment: Antibiotics can eradicate the infection and potentially reverse associated lymphomas.
Stomach - Peptic Ulcers
Definition: Ulcers in the stomach or duodenum.
Complications: Bleeding, perforation, obstruction.
Associations: H. pylori, NSAIDs.
Risk of Malignancy: Most gastric ulcers are benign; however, some may be malignant.
Stomach - Gastric Cancer
Types:
- Intestinal type: Forms well-defined glands, related to chronic gastritis.
- Diffuse type: Poorly differentiated, signet ring cells, widespread infiltration.
Epidemiology: Higher prevalence in Japan, South Korea, and other East Asian countries.
Prognosis: Diffuse type has a worse prognosis due to its aggressive nature.
