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Pathology > Upper GI histopath > Flashcards

Upper GI histopath Flashcards

1
Q

The oesophagus is made up of 2 types of epithelial cells, what are they? and how much of the oesophagus does each occupy?

A

Squamous upper 2/3
Simple columnar lower 1/3
(they are joined by the sqamou-columnar junction = Z line)

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2
Q

What are the complications of GORD? (5)

A 
Ulceration
Haemorrhage - can present as malena or haematemesis
Barrett's oesophagus
Stricture
Perforation
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3
Q

What is the commonest cause of oesophagitis?

A

GORD

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4
Q

Treatment for GORD (3)

A

Lifestyle changes - smoking cessation, weight loss
PPI
H2 receptor antagonists

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5
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia of squamous mucosa > columnar epithelium following chronic GORD (because they have more goblet cells) > upwards migration of SCJ

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6
Q

What percentage of those with symptomatic GORD have Barrett’s?

A

10%

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7
Q

Where is oesophageal adenocarcinoma most commonly seen?

A

Distal 1/3 of oesophagus - because associated with Barrett’s

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8
Q

Other risk factors for oesophageal adenocarcinoma (3)

A

smoking
obesity
prior radiation therapy

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9
Q

Oesophageal adenocarcinoma most common in which ethnicity? & gender?

A

Caucasians

M&raquo_space; F

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10
Q

What are some risk factors for squamous cell carcinomas of oesophagus? (5)

A 
Main is ETOH & smoking
achalasia
Plummer-vinson syndrome
nutritional deficiencies
nitrosamines
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11
Q

In which ethnicity & gender is squamous cell carcinomas of oesophagus more common?

A

Afro-carribeans

M > F

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12
Q

Presentation of squamous cell carcinomas of oesophagus? (4)

A

progressive dysphagia (solids then liquids)
odynophagia
severe weight loss
anorexia

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13
Q

squamous cell carcinomas of oesophagus treatment?

A

Mainly palliative as it has rapid growth & early metastasis

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14
Q

What are oesophageal varices?

A

Dilated & engorged veins - most commonly due to portal HTN (back pressure)

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15
Q

Presentation of oesophageal varices? (1)

A

Severe haematemesis

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16
Q

Management of Varices? (2)

A

Emergency endoscopy

Sclerotherapy/ banding

17
Q

Causes of acute gastritis (5)

A

Acute - neutrophils main wbc, causes:

NSAIDS, aspirin, acute H. Pylori, severe stress e.g. burn

18
Q

Causes of Chronic gastritis (4)

A

Chronic - lymphocytes, plasma cells. Causes:

Chronic H. Pylori, pernicious anemia, alcohol, smoking

19
Q

Special types of gastritis: infectious, chemical, IBD

A

Infectious - HSV, CMV
Chemical - foveolar hyperplasia
IBD

20
Q

Complications of Gastritis (2)

A

Ulcer

Cancer (metaplasia > dysplasia > cancer)

21
Q

What is a gastric ulcer?

A

A breach through muscularis mucosa, into the submucosa

22
Q

Presentation of gastric ulcer (3)

A

Epigastric pain - relieved by antacids
worse with food
weight loss possible

23
Q

Risk factors for gastric ulcer (4)

A

Smoking, H. Pylori, NSAIDs, delayed gastric emptying

mostly occurs in elderly

24
Q

Investigations for gastric ulcer

A

Biopsy for H. Pylori status - PUNCHED OUT LESION with ROLLED margins

25
Q

Complications of gastric ulcer (3)

A

Malignancy
IDA
Perforation (perform erect chest x-ray)

26
Q

Gastric lymphoma cause

A

Due to chronic H-pylori - chronic ag stimulation > lymphoma

27
Q

Treatment of Gastric lymphoma (1)

A

remove cause - H. Pylori triple therapy: PPI + clarithro + amox/ metro

28
Q

Presentation of duodenal ulcer (3)

A 
(4 times more common than GU)
Epigastric pain 
relieved by food & milk
worse at night 
(occurs in young adults)
29
Q

Risk factors for duodenal ulcers (5)

A

drugs, H. pylori, NSAIDs, steroids, smoking

30
Q

Complications of duodenal ulcer (2)

A

IDA, Perforation

31
Q

Coeliac disease HLA assocations (2)

A

HLA DQ2 & DQ8
(t-cell mediated disease)
gluten intolerance results in villous atrophy + malabsorption

32
Q

Presentation of Coeliacs (7)

A

young children or Irish women
Symptoms of malabsorption - bloating, N&v, abdo pain, steatorrhea, weight loss
IDA
Rash - dermatitis herpetiformis

33
Q

Serological tests in coeliacs (3) (abs)

A 
Anti-endomysial (best sen & spec)
Anti TTG
Anti gliadin (poor marker for disease control)
34
Q

Gold standard investigation for Coeliacs

A

Upper GI endoscopy & duodenal biopsy - villous atrophy, crypt hyperplasia, lymphocyte infiltrate

35
Q

Risk of Duodenal T-cell lymphoma in coeliacs not treated properly ?

A

10% if not treated properly

Pathology (20 decks)

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