Week 6 - Upper Gastrointestinal Disease Flashcards
What is chronic gastritis?
- ongoing inflammation of the stomach mucosa
- can provide an environment in which dysplasia and carcinoma can arise
How does chronic gastritis compare to acute gastritis?
Symptoms less severe but more persistent
What are the symptoms of chronic gastritis?
- upper abdominal pain
- indigestion or bloating
- N&V
- belching
- loss of appetite or weight loss
-may be asymptomatic
What are the causes for chronic gastritis?
Bacterial - helicobacter pylori infection
Chemical - alcohol, tobacco, caffeine
Autoimmune - can lead to pernicious anaemia
Psychological stress
What is helicobacter pylori?
- gram -ve bacterium found in the stomach, particularly antrum
- infects over half the worlds population by age 5
- infection probably acquired via faecal-oral route
- if untreated, infection persists throughout life
What is the clinical presentation of H.pylori?
- 80% asymptomatic
- 5-15% peptic ulcer disease
- 10% non-ulcer dyspepsia
- 1-3% gastric adenocarcinoma
- 0.5% gastric MALToma
What is the importance of H.pylori?
- strongly associated with chronic gastritis
- strongly associated with duodenal ulcer
- fairly strongly associated with gastric ulcer
- associated with gastric carcinoma
- associated with gastric MALT lymphoma
What are the effects of H.pylori infection?
- mild pan gastritis - no significant disease
- body-predominant (hypochlorhydria, gastric atrophy, intestinal metaplasia) - gastric cancer phenotype
- antrum-predominant (hyperchlorhydria) - DU phenotype
What is peptic ulcer disease?
Painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum
-most ulcers are solitary
Where does peptic ulcer disease usually occur?
-D1 or antrum (4:1)
What are common causes of peptic ulcer disease?
- H.pylori (80-100% DU, 65% gastric)
- NSAIDs
What are the symptoms of peptic ulcer disease?
- pain (gnawing, burning, aching)
- worse at night
- worse after meals
What are the complications of peptic ulcer disease?
- bleeding leading to iron deficiency anaemia
- massive haematemesis - vomiting of blood
- perforation leading to peritonitis
- long term cancer at edge of ulcer
What is Barrett’s oesophagus?
Normal lining of the oesophagus = stratified squamous epithelium
- in Barrett’s oesophagus - squamous epithelium is replaced by columnar epithelium with goblet cells (usually found lower in the GI tract)
- thought to be an adaptation to chronic acid exposure from reflux oesophagitis
What is the process of dysplasia in Barrett’s oesophagus?
- low grade to high grade to invasive carcinoma
- strong association 0.5% per patient per year) with oesophageal adenocarcinoma - need for surveillance
Name the upper GI malignancies
Oesophagus
- squamous carcinoma
- adenocarcinoma (Barrett’s)
Stomach
- adenocarcinoma
- GI stromal tumours (GIST)
Small bowel
- lymphoma
- GI stromal tumours (GIST)
- neuroendocrine tumours
What is oesophageal carcinoma and who does it affect?
- squamous cell carcinoma
- adults over 45
- M:F = 4:1
What are the risk factors for oesophageal cancer?
-alcohol, tobacco, caustic/corrosive injury, achalasia (muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach)
What are the symptoms of oesophageal cancer?
- insidious onset with late symptoms
- dysphagia, weight loss, haemorrhage, sepsis, respiratory fistula with aspiration
- overall 5 year survival of 9%
Describe oesophageal adenocarcinoma
-now more common
-largely from dysplastic change in Barrett’s oesophagus
Present with dysphagia, weight loss, haematemesis, chest pain, vomiting
-5 year survival
What are the similarities between oesophageal carcinoma and adenocarcinoma?
Both are:
Direct -into surrounding tissues
Lymphatic -to paraoesophageal, paratracheal and cervical node groups
Haematogenous - to liver or lung
How common is stomach adenocarcinoma?
- adenocarcinoma- 90% of gastric malignancies
- 2nd most common carcinoma worldwide
- east Asia, South America (Andes), Eastern Europe
- declining incidence
What are the precursor lesions of stomach -adenocarcinoma?
- pernicious anaemia (atrophied gastritis)
- intestinal metaplasia
- neoplastic polyps
- h.pylori associated gastritis
What are the early symptoms of stomach adenocarcinoma?
Resemble gastritis
What are the advanced symptoms of stomach adenocarcinoma?
- weight loss, anorexia, anaemia, haemorrhage
- fungating exophytic growth
- prognosis depends on depth of invasion
- 5 year survival (early) after surgery (90%)
- overall 5 year survival 30%
How does stomach adenocarcinoma spread?
Direct infiltration
-duodenum, pancreas, colon, liver, spleen
Lymphatic spread
- local and regional nodes
- Virchow’s node
Haematogenous
-liver/lungs
Transcoelomic (via pleura, peritoneum etc)
Omentum (a fold of peritoneum connecting the stomach with other abdominal organs)
Mesentary (fold of the peritoneum which attaches the stomach, small intestine, pancreas, spleen, and other organs to the posterior wall of the abdomen)
Ovary (Krukenberg tumour)
What are the subtypes of small bowel neoplasia?
Different subtypes include:
- adenocarcinoma (rare)
- GI stromal tumour
- lymphoma
- carcinoid (neuroendocrine) tumour
How common is small bowel neoplasia?
-relatively rare compared to other GI malignancies
What are the risk factors for small bowel neoplasia?
- crohn’s disease
- coeliac disease
- radiation exposure
- hereditary GI cancer syndromes e.g. familial adenomatous polyposis
What is coeliac disease?
- extensive mucosal disease related to sensitivity to gluten
- immune mediated villous atrophy and malabsorption
- prevalence in white Europeans of 0.5-1%
How can coeliac disease be diagnosed?
Via serological blood test (TTG) and biopsy
What are the symptoms of coeliac disease?
- pain and discomfort in digestive tract
- chronic constipation and diarrhoea
- failure to thrive - in children
- anaemia
- fatigue
-intestinal damage begins to heal within weeks of gluten being removed from diet
What does coeliac disease increase the risk of?
- adenocarcinoma
- lymphoma of the small bowel
What does the upper GI tract consist of?
Oesophagus
Stomach
Intestines
