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Flashcards in GI Pathology Deck (65):
1

How long is the oesophagus?

25cm

2

What type of epithelium lines the oesophagus?

Squamous epithelium

3

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

Cricopharyngeal sphincter
Gastro-oesophageal sphincter

4

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

Glandular (columnar) mucosa

5

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

40cm

6

Reflux of gastric acid

gastro-oesophageal reflux

7

Reflux of gastric acid and/or bile

Duodeno-gastric reflux

8

2 types of hernia

Sliding hiatus hernia
Para-oesophageal hernia

9

What is a serious complication of para-oesophageal hernias?

Strangulation

10

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

Basal cell hyperplasia
Elongation of papillae
Increase in cell desquamation

11

How might a benign stricture in reflux oesophagitis present?

Dysphagia

12

Risk factors for barrett's oesophagus

Male, caucasian, overweight

13

Define barrett's oesophagus in macroscopic terms

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

14

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

Gastric cardia type
Gastric body type
Intestinal type 'specialised barrett's oesophagu'

15

What are the 2 histological types of oesophageal carcinoma?

Squamous cell carcinoma
Adenocarcinoma

16

Risk factors for adenocarcinoma

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

17

What are the 3 types of oesophageal adenocarcinoma

Polypoidal
Stricturing
Ulcerated

18

A tumour that projects into the lumen of the oesophagus

Polypoidal

19

Risk factors for squamous carcinoma

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

20

Location of oesophageal adenocarcinoma

lower oesophagus

21

Location of squamous carcinoma

Middle and lower 1/3rd

22

Tumour invades lamina propria, muscularis mucosae or submucosa

PT1

23

Tumour invades muscularis propria

PT2

24

Tumour invades adventitia

PT3

25

Tumour invades adjacent structures

PT4

26

No lymph node metastasis

PN0

27

Metastasises to 1 or 2 nodes

PN1

28

Metastasises to 3-6 nodes

PN2

29

Metastasises to 7 or more lymph nodes

PN3

30

No distant metastasis

MO

31

Distant metastases

M1

32

4 anatomical regions of the normal stomach

Cardia
Fundus
Body
Antrum

33

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

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

34

Types of chronic gastritis

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

35

How does bile reflux present histologically

Degranulation of mast cells- vasodilation

36

How does overuse of NSAIDs present histologically

Disruption of mucous layer- oedema

37

Describe the shape and type of H.Pylori

Gram -ve spiral shaped bacterium with flagellae

38

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

Antrum

39

Result of H.Pylori infection in the stomach

Glandular atrophy, replacement fibrosis and intestinal metaplasia

40

Complications of H.Pylori

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

41

Major sites for peptic ulcer disease

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

42

Risk factors for peptic ulcer disease

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

43

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

Peptic Ulcer Disease

44

Difference between peptic ulcer disease and chronic gastric ulcer?

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

45

Complications of chronic gastric ulcer

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

46

What is more common- gastric or duodenal ulcer?

Duodenal

47

Which type of ulcer is more common in older patients?

Gastric

48

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

Gastric

49

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

Duodenal

50

What are the different types of gastric cancer?

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

51

Risk factors for gastric adenocarcinoma?

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

52

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

no

53

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

yes

54

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

yes

55

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

no

56

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

Exophytic
Flat/depressed
Excavated

57

Diffuse type gastric carcinoma is a result of what mutation?

E.cadherin loss/mutation

58

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

Signet ring shape cells.

59

Cells infiltrate widely-marked thickening of the wall

Linitis plastica

60

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

Hereditory diffuse type gastric cancer (HDGC)

61

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

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

Positive serology for coealiac disease and villous atrophy but no symptoms

Silent disease

63

Positive serology for coealiac disease, no villous atrophy

Latent disease

64

Clinical features of coeliac disease

Anaemia, chronic diarrhoea, bloating, chronic fatigue

65

Disease associations with coeliac disease

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