Histo: Upper GI Disease Pt.1

Question 1

What is a key histological feature of the oesophageal mucosa?

Answer 1

Presence of submucosal glands

Question 2

what is the Z-line?

Answer 2

The point in the oesophagus at which the epithelium transitions from being squamous to being columnar

Question 3

What does the cell types does the body and fundus of the stomach have in abundance?

Answer 3

Specialised glands responsible for producing acid and enzymes

• Parietal cells - produce HCL and IF
• Chief cells - produce pepsinogen and gastric lipase

Question 4

Which part of the stomach tends to be affected by H. pylori-associated gastritis?

Answer 4

Pylorus and antrum

Question 5

What are the three layers of the gastric mucosa?

Answer 5

• Columnar epithelium
• Lamina propria
• Muscularis mucosa

Question 6

Describe the structure of the duodenal mucosa

Answer 6

Intestinal type epithelium - glandular epithelium with goblet cells
Villous architecture

Question 7

What is the normal villous: crypt ratio?

Answer 7

2:1

Question 8

What does the presence of goblet cells in the stomach signify?

Answer 8

Intestinal metaplasia

NOTE: goblet cells are NOT normally seen in the stomach

Question 9

What is the most common cause of oesophagitis

Answer 9

Reflux oesophagitis/GORD

Question 10

What is the characteristic histological feature of acute oesophagitis?

Answer 10

Presence of lots of neutrophils

Question 11

What can acute oesophagitis result in?

Answer 11

• Ulceration
• Fibrosis
• Haemorrhage
• Perforation
• Stricture
• Barrett’s oesophagus

Question 12

Define Barrett’s oesophagus.

Answer 12

Metaplastic process by which the normal sqaumous epithelium of the lower oesophagus is replaced by columnar epithlieum

NOTE: this is also known as columnar-lined epithelium (CLO)

Question 13

What are the 2 types of oesopahgeal metaplasia in Barrett’s

Answer 13

• Gastic metaplasia: no goblet cells
• Intestinal metaplasia: with goblet cells (associated with increased risk of cancer)

NOTE: metaplasia is reversible

Question 14

Define dysplasia.

Answer 14

Changes showing some of the cytological and histological features of malignancy but with no invasion through the basement membrane.

Question 15

What is adenocarcinoma of the oesophagus associated with and which part does it affect?

Answer 15

• Associated with reflux
• Affects lower 1/3 of oesophagus
• Most common type of oesophageal cancer in developed countries

Question 16

Describe the main histological feature of oesophageal adenocarcinoma

Answer 16

Moderate to well-differentiated, mucin producing glands (intestinal type mucosa)
Usually adjacent regions of Barrett’s present

Question 17

What is squamous carcinoma of the oesophagus associated with and which part does it affect?

Answer 17

• Smoking and alcohol
• It tends to affect the upper 2/3 of oesophagus
• It is the most common type of oesophageal cancer in developing countries

Question 18

What are the main histological features of squamous cell carcinoma of the oesophagus?

Answer 18

Cells produce keratin (normal oesophageal squamous epithelium is non-keratinised)

Intercellular bridges

Question 19

How is eosinophilis oesophagitis treated?

Answer 19

• Steroids
• Allergen removal

NOTE: this is associated with an allergic reaction (asthma of the oesophagus). It is due to allergy to food causing muscle spasm and dysphagia.

Question 20

What is the commonest cause of oesophageal varices?

Answer 20

1. Cirrhosis of the liver (Most common)
2. Portal vein thrombosis