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Clinical Pathology > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

How long is the oesophagus?

A

25cm

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2
Q

What type of epithelium lines the oesophagus?

A

Squamous epithelium

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3
Q

What is the name of the spinchter at the upper and lower end of the oesophagus?

A

Cricopharyngeal sphincter

Gastro-oesophageal sphincter

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4
Q

What type of epithelium lines the distal 2cm below the diaphragm?

A

Glandular (columnar) mucosa

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5
Q

The squamo-columnar junction is usually located at ___cm frm the incisor teeth

A

40cm

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6
Q

Reflux of gastric acid

A

gastro-oesophageal reflux

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7
Q

Reflux of gastric acid and/or bile

A

Duodeno-gastric reflux

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8
Q

2 types of hernia

A

Sliding hiatus hernia

Para-oesophageal hernia

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9
Q

What is a serious complication of para-oesophageal hernias?

A

Strangulation

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10
Q

What 3 histological changes occur in the squamous epithlium during reflex oesophagitis?

A

Basal cell hyperplasia
Elongation of papillae
Increase in cell desquamation

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11
Q

How might a benign stricture in reflux oesophagitis present?

A

Dysphagia

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12
Q

Risk factors for barrett’s oesophagus

A

Male, caucasian, overweight

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13
Q

Define barrett’s oesophagus in macroscopic terms

A

Proximal extention of squamo-columnar junction- squamous mucosa replaced by columnar mucosa (glandular metaplasia)

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14
Q

What are the 3 types of columnar mucosa in the GI tract

A

Gastric cardia type
Gastric body type
Intestinal type ‘specialised barrett’s oesophagu’

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15
Q

What are the 2 histological types of oesophageal carcinoma?

A

Squamous cell carcinoma

Adenocarcinoma

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16
Q

Risk factors for adenocarcinoma

A

Mle, caucasian, obestiy, Barrett’s oesophagus, tobacco

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17
Q

What are the 3 types of oesophageal adenocarcinoma

A

Polypoidal
Stricturing
Ulcerated

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18
Q

A tumour that projects into the lumen of the oesophagus

A

Polypoidal

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19
Q

Risk factors for squamous carcinoma

A

Tobacco, alcohol, nutrition, thermal injury, HPV, male, black ethnicity

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20
Q

Location of oesophageal adenocarcinoma

A

lower oesophagus

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21
Q

Location of squamous carcinoma

A

Middle and lower 1/3rd

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22
Q

Tumour invades lamina propria, muscularis mucosae or submucosa

A

PT1

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23
Q

Tumour invades muscularis propria

A

PT2

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24
Q

Tumour invades adventitia

A

PT3

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25
Q

Tumour invades adjacent structures

A

PT4

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26
Q

No lymph node metastasis

A

PN0

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27
Q

Metastasises to 1 or 2 nodes

A

PN1

28
Q

Metastasises to 3-6 nodes

A

PN2

29
Q

Metastasises to 7 or more lymph nodes

A

PN3

30
Q

No distant metastasis

A

MO

31
Q

Distant metastases

A

M1

32
Q

4 anatomical regions of the normal stomach

A

Cardia
Fundus
Body
Antrum

33
Q

3 histological regions of the stomach and the type of glands found in each

A

Cardia-mucinous glands
Body-specialised glands
Antrum-mucinous glands

34
Q

Types of chronic gastritis

A 
ABC
Autoimmune (glandular atrophy)
Bacterial infection e.g. H.Pylori
Chemical injury (foveolar hyperplasia)
(NSAIDs, Bile reflux, alcohol)
35
Q

How does bile reflux present histologically

A

Degranulation of mast cells- vasodilation

36
Q

How does overuse of NSAIDs present histologically

A

Disruption of mucous layer- oedema

37
Q

Describe the shape and type of H.Pylori

A

Gram -ve spiral shaped bacterium with flagellae

38
Q

Which part of the stomach is H.Pylori more common?

A

Antrum

39
Q

Result of H.Pylori infection in the stomach

A

Glandular atrophy, replacement fibrosis and intestinal metaplasia

40
Q

Complications of H.Pylori

A

85% no symptoms
Gastric or duodenal (more common) ulcer
Gastric cancer (usually adenocarcinoma)
MALT lymphoma (mucosa associated lymphoid tissue)

41
Q

Major sites for peptic ulcer disease

A

Junction of antral and body mucosa
First part of duodenum
Distal oesophagus

42
Q

Risk factors for peptic ulcer disease

A 
Hyperacidity
H.Pylori infection
duodeno-gastric reflux
Drugs (NSAIDS)
Smoking
43
Q

Full thickness coagulative necrosis of mucosa (or deeper layers) covered with ulcer slough (necrotic debris and fibrin and neutrophils) Granulation tissue at ulcer floor

A

Peptic Ulcer Disease

44
Q

Difference between peptic ulcer disease and chronic gastric ulcer?

A

Chronic gastric ulcer- clear cut edges overhanging the base. Extensive graulation and scar tissue at ulcer floor.

45
Q

Complications of chronic gastric ulcer

A

Haemorrhage (–>anaemia)
Perforation (–>peritonitis)
Stricturing

46
Q

What is more common- gastric or duodenal ulcer?

A

Duodenal

47
Q

Which type of ulcer is more common in older patients?

A

Gastric

48
Q

Which type of ulcer is more common in people with blood group A?

A

Gastric

49
Q

Which type of ulcer is more common in people with blood group O?

A

Duodenal

50
Q

What are the different types of gastric cancer?

A

Adenocarcinoma (most common)
Endocrine tumours
MALT lymphomas
Stromal tumours (GIST)

51
Q

Risk factors for gastric adenocarcinoma?

A 
Diet (smoked/cured meats)
H.Pylori
Bile Reflux
Hypochlorhydria (low HCl concentration- allows bacterial growth)
Mutation in E.cadherin gene
52
Q

Is there an asoociation between H. pylori/diet and carcinoma of gastro-oesophageal junction?

A

no

53
Q

Is there an asoociation between H. pylori/diet and carcinoma of gastric body/antrum?

A

yes

54
Q

Is there an asoociation between GO reflux and carcinoma of gastro-oesophageal junction?

A

yes

55
Q

Is there an asoociation between GO reflux and carcinoma of gastric body/antrum?

A

no

56
Q

A gastric carcinoma that

a) bulges out of the epithlium
b) Neither bulges out or is depressed within
c) Depressed within epithelium

A

Exophytic
Flat/depressed
Excavated

57
Q

Diffuse type gastric carcinoma is a result of what mutation?

A

E.cadherin loss/mutation

58
Q

What type of cells is characteristic of diffuse type gastric cancer?

A

Signet ring shape cells.

59
Q

Cells infiltrate widely-marked thickening of the wall

A

Linitis plastica

60
Q

What type of gastric cancer arises from a germline CDH1/E.Cadherin mutation?

A

Hereditory diffuse type gastric cancer (HDGC)

61
Q

What is the coeliac disease producing component and what effect does it have on the epithelial cells of the intestines?

A

Gliadin, induces epithelial cells to express IL-15 which activates CD8 and intraepithelial lymphocytes (IELs) which are cytotoxic and kill enterocytes. Net results is atrophy of villi, mucosa flattens and malabsorption sundrome

62
Q

Positive serology for coealiac disease and villous atrophy but no symptoms

A

Silent disease

63
Q

Positive serology for coealiac disease, no villous atrophy

A

Latent disease

64
Q

Clinical features of coeliac disease

A

Anaemia, chronic diarrhoea, bloating, chronic fatigue

65
Q

Disease associations with coeliac disease

A

Dermatitis herpetiformis
Lymphocytic gastritis and colitis
Enteropathy-associated T cell lymphoma

Clinical Pathology (53 decks)

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