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Gastroenterology > Pathology Of Upper GI Tract > Flashcards

Pathology Of Upper GI Tract Flashcards

1
Q

Epithelial of Esopahgus vs. Stomach

A

Esophagus - stratified squamous non-keratinized epithelia
Stomach - columnar mucosa

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2
Q

What is a hernia?

A

An abnormal protrusion of tissue/organ through the wall of the cavity in which it resides

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3
Q

Hiatal Hernia

A

Abnormal protrusion of a segment of the stomach above the diaphragm (hiatus is the opening of the diaphragm through which the esophagus passes)

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4
Q

What are the two types of Hiatal Hernias?
% of each and description

A

Sliding Hiatal hernia
- 95% of hiatal hernias, has a bell shaped dilation

Nonaxial (paraesophageal) Hiatal hernia
5% of Hiatal Hernias, usually along the greater curvature

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5
Q

What is the significance of Hiatal Hernias?
- commonality
- symptoms
- complications

A

Common - 1-20% of adults have them (children as well)

Usually asymptomatic - only 9% with sliding hernias have heartburn or regurgitation of gastric juice into mouth

Complications
- ulceration
- bleeding
- perforation
- strangulation of paraesophageal hernias

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6
Q

Achalasia of the Esophagus
Description
Causes

A

Function disorder of the esophagus characterized by increased resting tone and incomplete relaxation of the lower esophageal sphincter preventing food from entering the stomach

Primary (unknown cause)
Secondary
- Chana’s disease (trypanosoma Cruzi)
- malignancy
- sarcoidosis

Radiologically - bird beak design

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7
Q

Esophagitis
Definition
Causes

A

Inflammation and epithelial damage of the esophagus
Inflammation can be caused by:
- infection, irritant or autoimmune

Causes of esophagitis:
- gastroesophageal reflux
- infection (uncommon unless immunocompromised)
- eosinophilic esophagitis (males 20-40)
- other

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8
Q

Eosinophilic Esophagitis
Definition
How does it present?

A
  • type of esophagitis characterized by numerous eosinophils within the squamous mucosa associated with dysphagia
  • presents as:
    1) dysphagia (difficulty swallowing, food impact ion, heartburn)
    2) more common in males; affects both children and adults
    3) endoscopy: ring appearance (like trachea)
    4) Biopsy required to confirm presence of eosinophils
    5) Need to exclude GERD
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9
Q

GERD
Definition
Symptoms

A

Gastric contents leak backwards into esophagus causing irritation/inflammation of esophagus

Symptoms
- variable heartburn
- water brash
- frequent belching

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10
Q

Factors contributing to GERD

A
  • low resting tone in LES
  • delayed esophageal clearance
  • delayed gastric emptying
  • increased abdominal pressure
  • increased acid production
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11
Q

How is GERD Diagnosed?

A

Clinical - history and relief with medication (PPI)
Endoscopy if:
- heartburn with alarm features (bleeding, weight loss)
- persistent reflux or previous severe erosive esophagitis
- Hx of esophageal stricture with persistent dysphagia

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12
Q

Complications associated with GERD

A

Stricture (scarring)

Ulceration

Bleeding

Barrett Esophagus

Adenocarcinoma

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13
Q

What does a biopsy of GERD show?

A

1) increasing inflammatory cells in epithelial layer (eosinophils, neutrophils, excess T cells)

2) basal cell hyperplasia exceeding 15-20% of epithelial thickness

3) elongation of lamina propria papillae extending into upper 1/3 of epithelium

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14
Q

How is GERD treated?

A

PPI
Antacids
Diet modification
Weight loss

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15
Q

Barrett Esophagus
Definition
Significance
How is it diagnosed?

A

Distal squamous mucosa of esophagus replaced by meta plastic columnar epithelium in response to prolonged injury (columnar epithelium may be more resistant to acid)

  • risk for dysplasia and subsequent esophageal adenocarcinoma
  • diagnosed via endoscopic and histologic features (biopsy)
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16
Q

Endoscopic features of BE

A

Red velvety GI type mucosa b/w pale squamous mucosa
- tongues extending up from GEJ or broad band displacing the GE junction proximally

17
Q

Histologic features of BE

A
  • squamous epithelium replaced by columnar epithelium of intestinal type (small bowel or colon)
  • other types of glandular epithelium
    - cardiac type epithelium with mucosal distortion, glandular atrophy, mild inflammation
18
Q

Assessment of BE
-two segment types of BE

A

Long-segment - Barrett mucosa extending 3cm or more from GE jxn

Short-segment - Barrett mucosa extends <3cm from GE jxn

19
Q

How is BE treated?

A

Anti-reflux therapy
Endoscopy every 1-2 years to detect dysplasia, carcinoma (4 quadrant biopsies at intervals of 2cm or less throughout the length of the Barrett’s segment plus any suspicious lesions

20
Q

Postulated pathway of Dysplasia from BE

A

Esophagitis —> BE without dysplasia —> low grade dysplasia —> high grade dysplasia —> invasive adenocarcinoma

21
Q

What is dysplasia arising in BE?

A

Dysplasia epithelium that does not invade lamina propria (premalignant)

Usually patchy or irregular and may appear endoscopically as thickened, or a polyploid mass

Dysplasia is assessed as low or high grade based on histologic assessment of biopsies

22
Q

Esophageal carcinoma

A

A malignant neoplasm of the esophagus

Two types:
1) squamous cell carcinoma (upper 2/3 of esophagus)
2) adenocarcinoma (distal 1/3 of esophagus)

23
Q

Squamous cell carcinoma

A

In upper 2/3 of esophagus
Most common world wide
Risk factors are tobacco and alcohol

24
Q

Adenocarcinoma of esophagus

A

Distal 1/3 of esophagus
Common in western countries
Risk factor - Barrett esophagus

25
Q

Gastritis

A

Inflammation/irritation of the gastric mucosa
Has many causes

26
Q

How is gastritis classified

A

Several different classification schemes
Most take into account the acuity of the presentation and histologic features

27
Q

Acute Gastritis
Definition
Causes

A

Sudden onset of inflammation and related symptoms often with erosions or ulcer - rarely biopsied

Causes:
- NSAIDs, alcohol, acid, cocaine
- stress, trauma, burns, critically ill, shock, sepsis
- severely debilitated patients

28
Q

Chronic gastritis
- definition
- types

A

Ongoing irritation/inflammation of the stomach due to several causes - some have acute inflammation as well

Chronic active gastritis (helicobacter)
Chronic autoimmune gastritis
Reactive gastropathy
Specific forms of gastritis

29
Q

Chronic Active Gastritis
- defitinition
- significance

A

Persistent inflammation of the gastric mucosa with varying degrees of acute inflammation

  • related to helicobacter infection
  • typically affects antrum - may extend to the body
  • increased risk of gastric carcinoma and gastric lymphoma
30
Q

Tests for Helicobacter

A

Non-invasive:
- Serology
- Urea breath test
- Stool antigen test

Invasive (require endoscopy)
- Histology
- rapid urease test (on biopsy)
- microbiology culture

31
Q

Chronic reactive gastropathy
Defitinion
Causes

A

Chronic irritation (usually with minimal inflammation) of the gastric mucosa due to irritant

Causes:
NSAIDs
Bile reflux (prior surgery)
Chronic EtOH

32
Q

Peptic ulcer disease
What is it
Complications associated with

A

Acid induced ulceration of the mucosa and wall of the stomach and/or duodenum often associated with H pylori

Complications
- perforation
- hemorrhage
- obstruction (stenosis)
- penetration

33
Q

Difference between ulcers and erosion

A

Ulcers extend through full thickness of mucosa
Erosion is limited to the superficial mucosa

34
Q

Gastric Polyps
- definition
- types

A

A polyp is an abnormal growth of tissue projecting from a mucous membrane (gastric polyps in stomach)

Neoplastic (benign (adenoma) or malignant)
Non-neoplastic
- hyperplastic polyp
- Fundic gland polyp

35
Q

Gastric neoplasms
- what are they
- types of malignant neoplasms

A

An abnormal growth of tissue in the stomach caused by rapid division of cells that have undergone some form of mutation
- may be benign, pre-malignant or malignant

  • carcinoma (adenocarcinoma) or lymphomas
36
Q

Gastric carcinoma

A

A malignant neoplasm of the gastric epithelium
- more common in certain countries (Japan) - smoked fish
Decreased incidence in North America
Are Adenocarcinomas

Have a poor prognosis

37
Q

Pre-disposing conditions of Gastric adenocarcinoma

A

H. Pylori infection
Chronic strophic gastritis with intestinal metaplasia
Post gastectomy
Gastric adenomatous polyps

38
Q

Endoscopic and histologic appearance of gastric carcinomas

A

Different endoscopic appearance:
- exophytic, ulcerating, diffuse infiltrating

Histologic:
- intestinal type, and diffuse type (signet ring cell type)

39
Q

Lymphoma of stomach

A

In the setting of chronic H. Pylori (MALT lymphoma)
- GI tract is most common site of extranodal lymphoma
- stomach is a relatively common site
- primary
- secondary

Gastroenterology (7 decks)

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