Week 2.4 - Pathology of Upper Gastro-Intestinal Tract

Question 1

What is the most common cause of GI issues?

Answer 1

weak/damaged lower oesophageal sphincter allowing acid reflux

Question 2

How can obesity lead to acid reflux and which other disorders may have the same effect?

Answer 2

obesity - pressure causes herniation of sphyncter. collagen disorder may cause same issue

Question 3

What are 5 pathologies of the upper GI tract?

Answer 3

• gastric cancer
• oesophageal cancer
• gastritis
• oesophageal reflux
• peptic ulceration

Question 4

What may cause oesophageal reflux?

Answer 4

hiatus hernia for example

Question 5

How does oesophageal reflux lead to ulceration?

Answer 5

keratin destroyed by acid. hyperplasia of epithelium to counteract. thick epithelium. if fails then ulceration - no epithelium. oesophagus is NON-KERITINISING

Question 6

What is the lining of the oesophagus? Its benefit?

Answer 6

stratified squamous with keratin - strong and flexible with structural integrity and allows food bolluses in

Question 7

How does oesophageal reflux lead to barretts oesophagus?

Answer 7

metaplasia in oesophagus from squamous to glandular mucous secreting cells. these aren’t resistant to sharp foods, so cuts happen and fibrosis to repair. this is barretts.

Question 8

What are the forms and causes of oesophageal cancer?

Answer 8

• squamous carcinoma due to smoking, alcohol or dietary carcinogens like smoked fish/meat
• adenocarcinoma due to barretts metaplasia or obesity, starting with acid reflux

Question 9

Which food is known for causing acid reflux?

Answer 9

high potassium foods as potassium triggers HCl production and release

Question 10

What are the 3 things cancer in the GIT does to cause symptoms?

Answer 10

obstruction, ulceration, perforation

Question 11

How can oesophageal cancer spread?

Answer 11

local invasion, lymph or liver by blood

Question 12

What is the 5YSR of oesophageal cancer and gastric cancer?

Answer 12

oesophageal is 15% and gastric is 20%

Question 13

What is gastritis and causes?

Answer 13

stomach inflammation from ABC - A (autoimmune), B (bacterial) or C (chemical) damage

Question 14

What are commonest causes of ABC?

Answer 14

A - body fights own cells so atrophic, less parietal cells, less acid and less intrinsic factor
B - H-pylori produces potassium - acid produced
C - commonly NSAID’s, bile reflux and alcohol

Question 15

How do you treat gastritis of each cause?

Answer 15

• if autoimmune give b12 injections and iron.
• if bacterial, give antibiotics and proton inhibitor.
• if chemical, stop taking NSAID’s and take antacids or proton inhibitors

Question 16

What is peptic ulceration?

Answer 16

imbalance of mucus and HCl. bleeding in GI tract, ulceration, fibrosis

Question 17

What are 5 risks associated with peptic ulceration?

Answer 17

• melena
• perforation of wall - peritonitis
• obstruction due to fibrosis of healing ulcers
• anaemia if chronic
• vomiting if acute.

Question 18

Who is at risk of developing peptic ulceration?

Answer 18

people with H.Pylori and people taking NSAID’s

Question 19

What is the pathology of gastric cancer?

Answer 19

stomach lining changes to intestinal - metaplasia - has goblet cells. becomes dysplastic, then neoplastic

Question 20

What type of cancer is gastric cancer?

Answer 20

adenocarcinoma because it involves glandular epithelial cells

Question 21

What is a common cause of gastric cancer?

Answer 21

H. pylori

Question 22

What is the spread of gastric cancer?

Answer 22

local, lymph, blood to liver or transcoelemic (into peritoneal cavity lining)