GI, hepatobiliary and pancreatic pathology

Question 1

How long is the normal oesophagus?

Answer 1

25cm

Question 2

What is the oesophagus lined with?

Answer 2

Stratified squamous epithelium

Question 3

At which point does the stratified squamous epithelium lining change and to what?

Answer 3

Squamo-columnar junction to columnar epithelium - this is 40cm away from the incisor teeth

Question 4

What sphincters do you have in the oesophagus?

Answer 4

Cricopharyngeal and gastro-oesophageal junction

Question 5

What is the distal 1.5-2cm of the oesophagus lined with and what structure is it found below?

Answer 5

Glandular/columnar mucosa - below the diaphragm

Question 6

What is normal oesophageal histology?

Answer 6

Top - mucosal layer
Surfaced by layer of squamous epithelium - darker at bottom where basal cells are - all cells proliferate from this
Oesophagus is non-keratinised
Beneath = lamina propria - thin layer of connective tissue containing blood vessels/lymphatics supplying epithelial layer
Dark pink layer = muscularis mucosi = thin layer muscle separating mucosa and submucosa
Beneath sub-mucosa = main muscle of oesophageal wall - MUSCULARIS PROPRIA - 2/3 layers depending of oesophagus

Question 7

What is oesophagitis

Answer 7

Inflammation of the oesophagus

Question 8

What can cause oesophagitis

Answer 8

Infectious, viral (HSV1, CMV), fungal - candida

Chemical: ingestion of corrosive liquid or reflux of gastric contents: most common form of oesophagitis caused by reflux of gastric acid and/or bile (more acidic caused by duodenal-gastric reflux)

Question 9

What is the histology of reflux oesophagitis?

Answer 9

Squamous epithelium - basal cell hyperplasia, darkened and rounded, elongated papillae, increased cell desquamation, inflammation

Lamina propria: infiltration of NEL - neutrophils, eosinophils and lymphocytes

Ulcer and haemorrhaging: bleeding granulation tissue at the base of ulcers

Question 10

What are the complications reflux oesophagitis?

Answer 10

B P H U BAR

Benign stricture
Perforation
Haemorrhage
Ulceration
Barrets Oesophagus

Question 11

Risk Factors

Answer 11

Defective lower oesophageal sphincter
Hiatus hernia
Increased intra-abdominal pressure
Increased gastric fluid due to gastric outflow stenosis

Question 12

What are the clinical symptoms of reflux oesophagitis?

Answer 12

Heartburn - upper chest pain, may be mistaken for cardiac event

Question 13

What is a hiatus hernia?

Answer 13

Part of gastric content bulges through diaphragm to lie alongside the oesophagus > reflux symptoms

Question 14

What is a Para-oesophageal hernia?

Answer 14

Part of the stomach pouches > strangulation > necrosis