W20 - Upper GI pathology Flashcards
The normal oesophagus has a squamo-columnar junction called a ____
Z line
What do the arrows point to?
NORMAL OESOPHAGUS
Z line/Squamo-columnar junction
Label the areas of the stomach
Name the 3 parts of the normal body of the stomach
- Gastric mucosa (columnar epithelium)
- Specialised glands in the lamina propria
- Muscularis mucosa
In a healthy antrum of the stomach, what are the 3 parts?
- Gastric mucosa (columnar epithelium)
- Lamina propria (non-specialised glands)
- Muscularis mucosa
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?
Glandular epithelium with goblet cells
2 = villi
1 = crypt
villous:crypt ratio of >2:1
In a healthy body of the stomach, which cells are absent?
goblet cells
Name 2 causes of oesophagitis
which is more common?
GORD (MOST COMMON)
Barrett’s oesophagus
Name 4 complications that could arise due to GORD
- Ulceration
- haemorrhage
- Perforation
- Stricture (if it heals with fibrosis)
NB: these 4 coudl arise in every GI inflammatory disease
What is Barrett’s oesophagus?
Replacement of squamous epithelium with metaplastic columbar epithelium
metaplastic means it’s reversible if trigger (i.e. acid) is removed
2 types of Barrett’s oesophagus - name them.
- Without goblet cells = gastric metaplasia
- With goblet cells = intestinal type metaplasia
Barrett’s oesophagus is also known as…
Columnar lined oesophagus (CLO)
Name the steps of changes that occurs starting in a healthy oesophagus, giving rise to cancer
Typically from Sqaumous => metaplasia (Barrett’s) => Low grade dysplasia => high grade dysplasia => adenocarcinoma
This is a endoscopic image of the stomach + respective histology. What does it show?
Gastric ulcer
erosion of the submucosa, can extent into lamina propria, usually NOT through muscular layer
There are 2 types of cancer of the oesophagus - adenocarcinoma and squamous cell carcinoma.
Describe:
- risk factors for each
- where each occurs
Adenocarcinoma of the oesophagus:
- commonest
- RF: GORD
- Location: lower oesophagus
Squamous cell carcinoma of the oesophagus:
- RF: smoking, alcohol, HPV
- Location: mid-lower oesophagus
The commonest cause of oesophageal varices is…
cirrhosis
(NB: portal vein thrombosis is also a cause)
Name chemical and infection causes of acute gastritis
Chemical:
- aspirin/NSAIDs
- alcohol
- corrosives
Infection:
- e.g. Helicobacter pylori
Name causes (3 groups) of chronic gastritis
ABC
Autoimmune - antiparietal antibodies
Bacterial - H pylori, antrum
Chemical - NSAIDs, bile reflux, antrum
Describe how H pylori can cause chronic gastritis and gastric cancer
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
Complications of gastric ulcer
- Bleeding => anaemia, shock (if massive)
- Perforation => peritonitis
Why do we worry about chronic gastritis?
chronic gastritis => intestinl metaplasia => intestinl dysplasia (not through BM) => gastric cancer
Gastric cancer:
- epidemiology
- M:F ratio
- type of cancer
Gastric cancer:
- epidemiology = high incidence in Japan, Chile, Italy
- M:F ratio = 1.8/1
- type of cancer = adenocarcinomas (>95%)
95% of gastric cancers are adenocarcinomas. What are the remaining 5% made up of?
– Squamous cell carcinoma
– Lymphoma (MALToma)
– Gastrointestinal stromal tumour (GIST)
– Neuroendocrine tumours
Overall survival is poor!
Gastric MALToma/lymphoma - treatment?
–If limited to the stomach and H.pylori is present: H.pylori eradication (abx)
NB: these are usually low grde tumours.
