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Flashcards in GI Tract 1 (Upper GI) Deck (44):
1

What type of epithelium lines most of the oesophagus?

Stratified squamous

2

What are the possible aetiologies of oesophagitis?

- Bacterial, viral (HSV1, CMV), fungal (candida)
- Ingestion of corrosive substances
- Reflux of gastric contents

3

What is the commonest cause of oesophagitis?

Reflux oesophagitis - caused by reflux of gastric acid (gastro-oesophageal reflux) and/or bile (duodeno-gastric reflux)

4

What are the risk factors for reflux oesophagitis?

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

5

What is an hiatus hernia?

- Abnormal bulging of a portion of the stomach through the diaphragm
- Sliding hiatus hernia = reflux symptoms
- Para-oesophageal hernia = strangulation

6

What histological changes are seen in reflux oesophagitis?

- Squamous epithelium
- Basal cell hyperplasia, elongation of papillae, increased cell desquamation
- Lamina propria
- Inflammatory cell infiltration (neutrophils, eosinophils, lymphocytes)

7

What are the possible complications of reflux oesophagitis?

- Ulceration
- Haemorrhage
- Perforation
- Benign stricture (segmental narrowing)
- Barrett’s oesophagus

8

What is the cause of Barett's oesophagus?

Longstanding reflux

9

What are the risk factors for Barrett's oesophagus?

Same as for reflux (male, Caucasian, overweight)

10

What are the macroscopic findings in Barrett's oesophagus?

Proximal extension of the squamo-columnar junction

11

What are the histological features of Barrett's oesophagus?

Squamous mucosa replaced by columnar mucosa > “glandular metaplasia"

12

What are the types of columnar mucosa found in Barrett's oesophagus?

- Gastric cardia type

- Gastric body type

- Intestinal type = “specialised Barrett’s mucosa”

13

What is the relevance of Barrett's oesophagus?

Premalignant condition with an increased risk of developing adenocarcinoma

14

What is the potential disease progression for Barrett's oesophagus?

Barrett's -> low-grade dysplasia -> high grade dysplasia -> adenocarcinoma

15

What are the 2 histological types of oesophageal cancer?

- Squamous cell carcinoma
- Adenocarcinoma

16

What are the risk factors for adenocarcinoma?

Male gender, tobacco, obesity, alcohol, Western populations

17

What are the macroscopic features of oesophageal adenocarcinoma?

Plaque-like, nodular, fungating, ulcerated, depressed, infiltrating

18

What are the risk factors for oesophageal squamous cell carcinoma?

- Tobacco and alcohol
- Nutrition (potential sources of nitrosamines)
- Thermal injury (hot beverages)
- HPV
- Male
- Ethnicity (black)
- More common in Eastern population

19

In what part of the the oesophagus are squamous cell carcinomas usually found?

Middle and lower third

20

In what part of the the oesophagus are adenomas usually found?

Distally

21

What are the features of Helicobacter pylori?

- Gram negative spiral shaped bacterium
- 2.5-5.0 micrometres long
- 4 to 6 flagellae
- Lives on the epithelial surface protected by the overlying mucus barrier

22

What is peptic ulcer disease?

Localised defect extending at least into submucosa

23

What are the major sites of peptic ulcer disease?

- First part of duodenum
- Junction of antral and body mucosa
- Distal oesophagus (GOJ)

24

What are the main aetiological factors in peptic ulcer disease?

- Hyperacidity
- H. pylori infection
- Duodeno-gastric reflux
- Drugs (NSAIDs)
- Smoking

25

What is the histology of an acute gastric ulcer?

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

26

What is the histology of a chronic gastric ulcer?

- Clear-cut edges overhanging the base
- Extensive granulation and scar tissue at ulcer floor
- Scarring often throughout the entire gastric wall with breaching of the muscularis propria
- Bleeding

27

What are the complications of peptic ulcers?

- Haemorrhage (acute and/or chronic  anaemia)
- Perforation -> peritonitis
- Penetration into an adjacent organ (liver, pancreas)
- Stricturing -> hour-glass deformity

28

What is the most common type of gastric cancer?

Adenocarcinoma

29

What are the less common types of gastric cancer?

- Endocrine tumours
- MALT lymphomas
- Stromal tumours (GIST)

30

What is the incidence of gastric adenocarcinoma?

- 5th most common cancer in the World (951,594 new cases/year)
- Wide geographical variation (high rates in Eastern Asia, - Andean regions of South America, Eastern Europe)
- Steady decline over the past decades

31

What is the aetiology of gastric adenocarcinoma?

- Diet (smoked/cured meat or fish, pickled vegetables)
- Helicobacter pylori infection
- Bile reflux (e.g. post Billroth II operation)
- Hypochlorhydria (allows bacterial growth)
- ~1% hereditary

32

What are the features of for carcinomas of GOJ?

- White males
- Association with GO reflux
- No association with H. pylori / diet
- Increased incidence in recent years

33

What are the features of carcinomas of the gastric body/antrum?

- Association with H. pylori
- Association with diet (salt, low fruit
& vegetables)
- No association with GO reflux
- Decreased incidence in recent years

34

A mutation in which protein can predispose a person to gastric cancer?

Cadherin

35

What is coeliac disease?

Immune mediated enteropathy

36

What is the aetiology of coeliac disease?

- Ingestion of gluten containing cereals
- Wheat, rye, or barley

- Genetically predisposed individuals

37

What is gliadin?

- Alcohol soluble component of gluten
- Contains most of the disease-producing components
- Induces epithelial cells to express IL-15

38

What is the role of CD8+ intraepithlial lymphocytes cells in coeliac disease?

- IL15 produced by the epithelial activation/proliferation of CD8+ IELs
- These are cytotoxic and kill enterocytes
- CD8+ IELs do not recognise gliadin directly
- Gliadin-induced IL15 secretion by epithelium is the mechanism 

39

What are the clinical features of Coeliac disease?

Anaemia, chronic diarrhoea, bloating, or chronic fatigue

40

What are the disease associations of Coeliac disease?

- Dermatitis herpetiformis - 10% of patients
- Lymphocytic gastritis and lymphocytic colitis

41

Which cancers are associated with Coeliac disease?

- Enteropathy-associated T-cell lymphoma 
- Small intestinal adenocarcinoma 

42

What is the diagnostic procedure for Coeliac disease?

- Non-invasive serologic tests usually performed before biopsy
- The most sensitive tests
- IgA antibodies to tissue transglutaminase (TTG)
- IgA or IgG antibodies to deamidated gliadin
- Anti-endomysial antibodies - highly specific but less sensitive
- Tissue biopsy is diagnostic (2nd biopsy after GFD)

43

What is the treatment for Coeliac disease?

- Gluten-free diet = symptomatic improvement for most patients
- Reduces risk of long-term complications including anaemia, female infertility, osteoporosis, and cancer

44

How does the TNM staging system work?

Primary tumor (T)
- TX Primary tumor cannot be assessed
- T0 No evidence of primary tumor
- Tis High-grade dysplasia
- T1 Tumor invades lamina propria, muscularis mucosae, or submucosa
- T1a Tumor invades lamina propria or muscularis mucosae
- T1b Tumor invades submucosa
- T2 Tumor invades muscularis propria
- T3 Tumor invades adventitia
- T4 Tumor invades adjacent structures
- T4a Resectable tumor invading pleura, pericardium, or diaphragm
- T4b Unresectable tumor invading other adjacent structures, such as the aorta, vertebral body, and trachea

Regional lymph nodes (N)
- NX Regional lymph node(s) cannot be assessed
- N0 No regional lymph node metastasis
- N1 Metastasis in 1-2 regional lymph nodes
- N2 Metastasis in 3-6 regional lymph nodes
- N3 Metastasis in 7 or more regional lymph nodes

Distant metastasis (M)
- M0 No distant metastasis
- M1 Distant metastasis

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