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GI > Oral and Oesophageal Pathology > Flashcards

Oral and Oesophageal Pathology Flashcards

1
Q

what is the anatomical relations of the oesophagus

A

passes under the bronchus and arch of the aorta and passes through the diaphragm in from of the descending aorta

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2
Q

what is the Z line

A

the gastro oesophageal junction that joints the stomach to the oesophagus

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3
Q

what cells make up a normal oesophagus

A

lined by stratified sqaumous epithelium with basal layer and submucosal glands

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4
Q

what is acute oesophagitis

A

inflammation of the oesophagus due corrosion following chemical ingestion or infection in immunocompromised patients (candidiasis, herpes, CMV- ctyomegaly virus)

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5
Q

what is chronic oesophagitis

A

reflux disease (reflux oesophagitis)

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6
Q

what is refluc oesophagitis

A

inflammation of the oesophagus due to refluxed low pH gastric content moving through the GOJ

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7
Q

what can cause reflux oesophagus

A

defective sphincter mechanism +/- hiatus hernia
abnormal oesophageal motility
increased intra- abdominal pressure (pregnancy, obesity)

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8
Q

what is a hiatus hernia

A

when the stomach goes through the hiatus in the diaphragm

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9
Q

what is seen microscopically in an reflux oesophagus

A

basal zone epithelial expansion (basal zone hyperplasia as it tries to regenerate) and accumulation of immune cells- intraepithelial neutrophils, lymphocytes and eosinophils

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10
Q

why are you more likely to develop malignancy in reflux oesophagus

A

as regeneration of epithelium means cells are mitosing at a higher rate

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11
Q

what are the complications of relfux

A

ulceration (bleeding) painful and may lead to anaemia

stricture- fibrosis, dysphagia

barretts oesophagus

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12
Q

what is barretts oesophagus

A

replacement of stratified squamous epithelium by columnar epithelium- metaplasia due to persistent reflux of acid or bile

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13
Q

what is metaplasia

A

replacement of one cell type with another

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14
Q

what does barretts oesophagus look macroscopically

A

red velvety mucosa replacing normal mucosa in lower oesophagus extending upwards in irregular fashion

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15
Q

what does barretts oesophagus look like microscopically

A

normal squamous epithelium replaced by columnar epithelium (which i glandular, has goblet cells that secrete mucous so are more resistant to acid)

columnar lined mucosa with interstitial metaplasia

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16
Q

why is barretts oesophagus unstable

A

as there is continuing damage- increased risk of developing dysplasia and carcinoma of the oesophagus

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17
Q

what is dysplasia

A

the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.

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18
Q

what is a more likely cause of squamous cell carcinoma

A

drinking and smoking

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19
Q

what is allergic oesophagitis

A

eosinophillic oesophagus- history of allergy/ asthma, pH probe negative for reflux, increased eosinophils in the blood

20
Q

what does allergic oesophagitis look like macroscopically

A

corrugated (feline)- looks like a trachea, ridged- or spotty

21
Q

what does allergic oesophagitis look like microscopically

A

large numbers of intraepithelial eosinophils

22
Q

what are the treatments for allergic oesophagitis

A

steroids, chromoglycate, montelukast

23
Q

what is a papilloma

A

a small wart-like growth on the skin or on a mucous membrane, derived from the epidermis and usually benign

24
Q

what papilloma is associated with the oesophagus

A

squamous papilloma- assymptomatic, HPV related

25
Q

what benign are found in the oesophagus

A

squamous papilloma, leiomyomas, lipomas , fibrovascular polyps, granular cell tumours

26
Q

what malignant tumours are found in the oesophagus

A

squamous cell carcinoma, adenocarcinoma (from transformed barretts oesophagus)

27
Q

what causes squamous cell carcinoma in the oesophagus

A

vit A, zinc deficiency

tannic acid/ strong tea

SMOKING AND ALCOHOL

HPV

oesophagitis

genetic

28
Q

what is GORD

A

gastro-oesophageal reflux disease

29
Q

why does barretts oesophagus result in metaplasia

A

is a protective response as allows faster generation

30
Q

what are the two types of dysplasia

A

low and high grade

31
Q

what can adenocarcinomas cause

A

obstruction and dysphagia (difficulty swallowing)

32
Q

what can be seen microscopically in tumours

A

clusters and glands

33
Q

what are the mechanisms of metastases of oesophagus

A

direct invasion, lymphatic permeation, vascular invasion (spread via bloodstream)

34
Q

what can happen in oesophageal carcinomas directly invading surrounding structures

A

can create fistulas (aspiration pneumonia), septicaemia, haemorrhage

35
Q

what are the general symptoms of malignancy

A

anaemia, weight loss, malaise

36
Q

what does carcinoma of the oesophagus present with

A

dysphagia

37
Q

what is a mallory weiss tear

A

tear or laceration of the right border or near the GOJ

38
Q

can you get oesophageal varices

A

yes

39
Q

what are 90% of oral cancers

A

squamous cell carcinomas

40
Q

how do oral cancers present

A

very variable- white, red, speckled, ulcer, lump

41
Q

where are the high risk sites of oral cancer

A

floor of mouth, lateral border/ ventral tongue, soft palate, retromolar pad/ tonsillar pillars

42
Q

where are oral cancers rare

A

hard palate, dorsum of tongue

43
Q

what causes oral cancer

A

tobacco, alcohol, diet, viral, HPV, infections, nutritional deficiencies, genetics, post transplant

44
Q

how is oral SSC graded

A

degree of differentiation:
-well differentiated: very obviously squamous with prickles and keratinistion

-poorly differentiated: may be hard to identify as epithelial

45
Q

what is the TNM criteria for oral cancer

A

T- diameter, structures invaded
N- lymph node status
M-metastasis

46
Q

what is the treatment for oral cancer

A

surgery, +/- adjuvant therapy (chemotherapy/ radiotherapy)

47
Q

what is the 5 year survival of oral cancer

A

40-50%

GI (64 decks)

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