gastrooesophageal ulcers

Question 1

what can cause acute oesophagitis

Answer 1

infection in immunocompromised patients: herpes simplex, candida, cytomegalovirus
corrosives

Question 2

what can cause chronic oesophagitis

Answer 2

• Tuberculosis
• Bullous pemphigoid and Epidermolysis bullosa
• Crohn’s disease

reflux oesophagitis

Question 3

what can cause gastro-oesophageal reflux disease

Answer 3

alchohol and tobacco 
obesity
caffeine 
hiatus hernia
motility disorder

Question 4

what are the features of reflux oesophagitis

Answer 4

Squamous epithelium damaged
– Eosinophils epithelial infiltration
– Basal cell hyperplasia
– Chronic inflammation
increased desquamation
ulceration, fibrosis, stricture, obstruction

Question 5

what is barret’s oesophagus

Answer 5

lower oesophagus becomes lined with columnar epithelium

– Intestinal METAPLASIA
– ?Role of gastric/biliary reflux
– ?Role of Helicobacter pylori
• Premalignant - risk of adenocarcinoma of
distal oesophagus 100x general population

metaplasia due to chronic acid reflux

Question 6

what is acute gastritis

Answer 6

inflammation of the stomach lining

due to chemical injury (NSAIDs or alcohol) or H. pylori

Question 7

what can cause chronic gastritis

Answer 7

H. pylori
autoimmune
chemical

Question 8

what do H. pylori look like

Answer 8

Gram negative spiral-shaped or curved bacilli

Question 9

how is H. pylori treated

Answer 9

double antibiotics and proton pump inhibitors

Question 10

what are the histological features of H.pylori infection

Answer 10

neutrophil infiltration
lymphoid aggregates with plasma cells infiltrate lamina propria

atrophy, fibrosis, metaplasia, gastric ulcer and gastric cancer

increased gastric acid secretion
duodenal ulcers

Question 11

what are the two distribution patterns

Answer 11

involvement of antrum and body

or just antrum

Question 12

how can H. pylori gastritis be detected

Answer 12

faecal bacteria, urea breath test, biopsy, urease test

Question 13

what is reflux gastritis

Answer 13

regurgitation of bile and alkaline duodenal secretion
loss of epithelial cells with compensatory hyperplasia of foveolae
defective pylorus and motility disorders

Question 14

what is Autoimmune Chronic Gastritis

Answer 14

Autoimmune reaction to gastric parietal cells
– Loss of acid secretion (hypochlorhydria / achlorhydria)
– Loss of intrinsic factor
• Vitamin B12 deficiency
• Macrocytic anaemia (Pernicious anaemia)
• Associated with marked gastric atrophy and intestinal
metaplasia
• Increased risk of gastric cancer
• Serum antibodies to gastric parietal cells and intrinsic
factor

Question 15

what can cause peptic ulceration

Answer 15

hyperacidity 
– H pylori gastritis
– Duodenal reflux
– NSAIDs
– Smoking
– Genetic factors
– Zollinger-Ellison syndrome

leads to a breach in the mucosal lining of the alimentary tract as a result of acid and pepsin attack

Question 16

what are the complication of peptic ulcers

Answer 16

– Haemorrhage
– Penetration of adjacent organs e.g. pancreas
– Perforation
– Anaemia
– Obstruction
– Malignancy

Question 17

what is duodenal ulcer almost always caused by

Answer 17

helicobacter gastritis

Question 18

what can lead to acute peptic ulceration

Answer 18

acute gastritis
stress response e.g. after severe burns
a result of extreme hyperacidity

Question 19

where do chronic peptic ulcers tend to occur

Answer 19

at mucosal junctions

Question 20

what leads to chronic peptic ulcers

Answer 20

hyperacidity

mucosal defence defects

Question 21

what are the normal mucosal defences

Answer 21

mucus bicarbonate barrier

surface epithelium

Question 22

what damages the mucus bicarbonate barrier

Answer 22

biliary reflux where bile refluxes into the stomach

Question 23

what damages the surface epithelium

Answer 23

NSAIDS

H. pylori

Question 24

what are the effects of gastric injury

Answer 24

necrotic debris
inflammation
granulation tissue
fibrosis

Question 25

what causes duodenal ulcers

Answer 25

``` • Increased acid production – More important than for gastric ulcer – Can be induced by H pylori • Reduced mucosal resistance – Gastric metaplasia occurs in response to hyperacidity – Then colonised by H pylori ```

Question 26

what is the histologica appearance of gastric ulcers

Answer 26

• Usually small, sharply demarcated (punched out), defined structure, granulation tissue,

Question 27

what are the complications of duodenal ulcers

Answer 27

• ‘Bleed, burst or block’ • Penetration of adjacent organs e.g. pancreas • Malignant change: rare in gastric ulcer and ‘never’ in duodenal ulcer

Question 28

what immune cells are involved in reflux oesophagitis

Answer 28

eosinophils

Question 29

what type of epithelia is found in barret's oesophagus

Answer 29

columnar

Question 30

is H. pylori gram neg or pos

Answer 30

negative bacilli

Question 31

how is H. pylori spread

Answer 31

oral- oral, faecal-oral or environment

Question 32

what are the features of antrum only H.pylori infection

Answer 32

increased gastric acid secretion | duodenal ulcer

Question 33

what are the features of antrum and body H. pylori

Answer 33

Atrophy, fibrosis, intestinal metaplasia | • Associated with gastric ulcer and gastric cancer

Question 34

what is the histological appearance of chemical gastritis

Answer 34

loss of epithelia with crypt hypertrophy

Question 35

what disease involves an autoimmune reaction to gastric parietal cells

Answer 35

autoimmune chronic gastritis

Question 36

what are the two features of autoimmune chronic gastritis

Answer 36

loss of acid secretion | loss of intrinsic factor

Question 37

what are the features of pernicious anaemia

Answer 37

macrocytic anaemia | B12 is needed in order to make RBCs

Question 38

what is the histological appearance of chronic autoimmune gastritis

Answer 38

gastric atrophy and intestinal metaplasia increased risk of stomach cancer antiparietal and intrinsic factor antibodies

Question 39

what blood group is more likely to get a gastric ulcer

Answer 39

A

Question 40

what blood group is more likely to get a duodenal ulcer

Answer 40

O

Question 41

what social group is most likely to get a duodenal ulcer

Answer 41

even distribution

Question 42

what social group is most likely to get a stomach ulcer

Answer 42

5

Question 43

which are more common out of stomach and duodenal ulcers

Answer 43

duodenal ulcers are 3 times more common

Question 44

what acid levels predispose to a stomach ulcer

Answer 44

normal or low

Question 45

what acid levels predispose to a duodenal ulcer

Answer 45

normal or high

Question 46

how often is H. pylori found in gastric ulcers

Answer 46

about 70% in duodenal ulcers almost always

Question 47

What is Curling's ulcer

Answer 47

complication of severe burns due to ischaemia and necrosis

Question 48

what can cause acute gastric ulcers

Answer 48

acute gastritis burns hyperacidity e.g. gastrin secreting tumour

Question 49

what pathology destroys the mucus bicarbonate barrier

Answer 49

biliary reflux

Question 50

what are the histological features of ulcers

Answer 50

fibrosis inflammation granulation tissue necrosis

Question 51

how common is cancer after having an ulcer

Answer 51

rare - stomach | 'never'- duodenum

Question 52

what could cause pernicious anaemia

Answer 52

autoimmune gastritis due to anti parietal cell and anti intrinsic factor antibodies glandular atrophy and intestinal metaplasia

Question 53

what is the histology of an H.pylori infection

Answer 53

``` cytotoxins immune response atrophy intestinal metaplasia peptic ulceration ```

Question 54

what is biliary reflux

Answer 54

bile goes into your stomach