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Pathology by week > W20 - Upper GI pathology > Flashcards

W20 - Upper GI pathology Flashcards

1
Q

The normal oesophagus has a squamo-columnar junction called a ____

A

Z line

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2
Q

What do the arrows point to?

A

NORMAL OESOPHAGUS
Z line/Squamo-columnar junction

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3
Q

Label the areas of the stomach

A
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4
Q

Name the 3 parts of the normal body of the stomach

A
  1. Gastric mucosa (columnar epithelium)
  2. Specialised glands in the lamina propria
  3. Muscularis mucosa
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6
Q

In a healthy antrum of the stomach, what are the 3 parts?

A
  1. Gastric mucosa (columnar epithelium)
  2. Lamina propria (non-specialised glands)
  3. Muscularis mucosa
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7
Q

This is. normal duodenum.

What type of epithelium does a normal duodenum have?

The 2 labels the ____

The 1 labels the ____

What is a normal ratio of these 2 parts?

A

Glandular epithelium with goblet cells

2 = villi

1 = crypt

villous:crypt ratio of >2:1

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10
Q

In a healthy body of the stomach, which cells are absent?

A

goblet cells

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13
Q

Name 2 causes of oesophagitis

which is more common?

A

GORD (MOST COMMON)

Barrett’s oesophagus

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14
Q

Name 4 complications that could arise due to GORD

A
  1. Ulceration
  2. haemorrhage
  3. Perforation
  4. Stricture (if it heals with fibrosis)

NB: these 4 coudl arise in every GI inflammatory disease

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15
Q

What is Barrett’s oesophagus?

A

Replacement of squamous epithelium with metaplastic columbar epithelium

metaplastic means it’s reversible if trigger (i.e. acid) is removed

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16
Q

2 types of Barrett’s oesophagus - name them.

A
  1. Without goblet cells = gastric metaplasia
  2. With goblet cells = intestinal type metaplasia
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17
Q

Barrett’s oesophagus is also known as…

A

Columnar lined oesophagus (CLO)

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18
Q

Name the steps of changes that occurs starting in a healthy oesophagus, giving rise to cancer

A

Typically from Sqaumous => metaplasia (Barrett’s) => Low grade dysplasia => high grade dysplasia => adenocarcinoma

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19
Q

This is a endoscopic image of the stomach + respective histology. What does it show?

A

Gastric ulcer

erosion of the submucosa, can extent into lamina propria, usually NOT through muscular layer

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20
Q

There are 2 types of cancer of the oesophagus - adenocarcinoma and squamous cell carcinoma.

Describe:

  • risk factors for each
  • where each occurs
A

Adenocarcinoma of the oesophagus:

  • commonest
  • RF: GORD
  • Location: lower oesophagus

Squamous cell carcinoma of the oesophagus:

  • RF: smoking, alcohol, HPV
  • Location: mid-lower oesophagus
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21
Q

The commonest cause of oesophageal varices is…

A

cirrhosis

(NB: portal vein thrombosis is also a cause)

22
Q

Name chemical and infection causes of acute gastritis

A

Chemical:

  • aspirin/NSAIDs
  • alcohol
  • corrosives

Infection:

  • e.g. Helicobacter pylori
23
Q

Name causes (3 groups) of chronic gastritis

A

ABC

Autoimmune - antiparietal antibodies

Bacterial - H pylori, antrum

Chemical - NSAIDs, bile reflux, antrum

24
Q

Describe how H pylori can cause chronic gastritis and gastric cancer

A

Cag-A-positive H pylori => needle-like appendage that can inject toxin into intercellular junctions => bacteria attach more easily => chronic inflammation => x8 risk of non-cardial gastric cancer

26
Q

Complications of gastric ulcer

A
  1. Bleeding => anaemia, shock (if massive)
  2. Perforation => peritonitis
27
Q

Why do we worry about chronic gastritis?

A

chronic gastritis => intestinl metaplasia => intestinl dysplasia (not through BM) => gastric cancer

28
Q

Gastric cancer:

  • epidemiology
  • M:F ratio
  • type of cancer
A

Gastric cancer:

  • epidemiology = high incidence in Japan, Chile, Italy
  • M:F ratio = 1.8/1
  • type of cancer = adenocarcinomas (>95%)
29
Q

95% of gastric cancers are adenocarcinomas. What are the remaining 5% made up of?

A

– Squamous cell carcinoma

– Lymphoma (MALToma)

– Gastrointestinal stromal tumour (GIST)

– Neuroendocrine tumours

Overall survival is poor!

30
Q

Gastric MALToma/lymphoma - treatment?

A

–If limited to the stomach and H.pylori is present: H.pylori eradication (abx)

NB: these are usually low grde tumours.

31
Q

Duodenitis is usually due to…

A
  • Increased acid production in the stomach (gastritis) which spills over into duodenum
  • Chronic inflammation and gastric metaplasia with helicobacter infection
32
Q

Most cases of duodenitis progress to become…

A

Duodenl ulcer

33
Q

3 histological features of villious atrophy

A
  1. Villous atrophy
  2. Crypt hyperplasia
  3. Increased Intraepithelial lymphocytes
34
Q

Malabsorption is due to what change in the duodenum?

A

Villious atrophy

35
Q

Coeliac disese - duodenal biopsies:

on gluten rich diet shows…

off gluten shows…

A

Coeliac disese - duodenal biopsies:

on gluten rich diet shows villious atrophy

off gluten shows normal villi

36
Q

Patients with coeliac disease without strict diet adherence have incresed risk of… (2 cancers)

A
  1. MALToma in the duodenum
  2. T cell origin (EATL)
37
Q

Most oesophagel and gastric cancers arise from pre-existing adenomas - True or False

A

False - most gastric and oesophageal cancers arise from metaplastic pathways!

38
Q

In a patient with coeliac disease on a diet containing gluten, the following is the most likely histological change in the duodenum:

A - Normal villious architecture, no increase in intraepithelial lymphocytes

B - Villious atrophy, no increase in intraepithelial lymphocytes

C - Villious atrophy, increased intraepithelial lymphocytes

D - Normal villious architecture, increased intra-epithelal lymphocytes

A

C - Villious atrophy, increased intraepithelial lymphocytes

39
Q

Which of the following is not a cause of chronic gastritis?

A) auto-antibody

B) Infection

C) Drugs

D) Metabolic disease

A

D) Metabolic disease

remember, it’s the ABC causes (Autoimmune, Bacterial, Chemicals/drugs)

Pathology by week (70 decks)

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