Hi - Upper GI

Question 1

3 layers of SI

Answer 1

epithelium
Submucosa
Muscularis propria

Question 2

what is the Z line of the oesophagus?

Answer 2

Squamocolumnar junction

Question 3

3 layers of the normal stomach?
in layer 1, what shape are the cells?

Answer 3

1) Columnar epithelium
2) Lamina Propria
3) Muscularis mucosa

Question 4

Which cell type should NOT be present in the normal stomach? (It’s presence is indicative of metaplastic change)

Answer 4

Goblet cells

Question 5

normal ratio of villous architecture?

Answer 5

2:1 (villi:crypt)

Question 6

5 complications of GORD?

Answer 6

1) Haemorrhage
2) Perforation
3) Stricture
4) Barret’s
5) Ulceration

Question 7

Which particular complication may arise if GORD –> fibrotic change?

Answer 7

Stricture

Question 8

Define Barrett’s oesophagus

Answer 8

metaplastic columnar epithelium in the oesophagus

Question 9

Lymphoid follicles in the stomach. What is the cause?

Answer 9

H. Pylori infection

Question 10

Which strain of H-pylori is most worrying?

Answer 10

Cag-A positive: has a needle like appendage which injects toxin into intracellular junctions

Question 11

Complications of gastric ulcers

Answer 11

Haemorrhage
Anaemia
Perforation –> peritonitis

Question 12

Steps to gastric cancer

Answer 12

H. pylori –> intestinal metaplasia –> dysplasia –> invasive cancer

Question 13

Which type of gastric carcinoma is most common?

Answer 13

adenocarcinoma (95%)

Question 14

which cell is high in gastric maltoma?

Answer 14

B cell (marginal zone) lymphocytes

Question 15

How can H. Pylori affect the duodenum?

Answer 15

Increases gastric acid secretion in stomach, which spills in to duodenum –> Chronic inflammation –> gastric metaplasia –> H.Pylori colonise duodenum –> ulcers / duodenitis

Question 16

common parasite in children which causes duodenitis?

Answer 16

Cryptosporidium

Question 17

which cell type populates the duodenum in malabsorption?

Answer 17

Lymphocytes

Question 18

Coeliac disease increases the risk of which cancer? Which cells are important in this cancer?

Answer 18

Duodenal MALToma/lymphoma

T-cell mediated!!!

Question 19

2 types of oesophageal cancer - state their differences in:
- Aetiology?
- Location?

Answer 19

ADENOCARCINOMA
- Barrett’s oesophagus
- Lower 1/3 of oesophagus
vs

SqCC
- EtOH, smoking, nutritional deficiencies
- Middle 1/3 of oesophagus

Question 20

Which antibody is important in pernicious anaemia

Answer 20

Anti-Intrinsic factor

Question 21

Cancer associated with Coeliac disease

Answer 21

Duodenal MALToma aka
Enteropathy associated T cell Lymphoma

Question 22

Cancer associated with chronic immune stimulation by H. Pylori

Answer 22

Gastric MALToma

Question 23

What is the flat pathway?

Answer 23

Squamous epithelium –> metaplasia –> low grade dysplasia –> high grade dysplasia –> adenocarcinoma

Question 24

2 types of Baretts?

Answer 24

With or without goblet cells

Question 25

Apperance of acute oesophagitis

Answer 25

red, pain, hot, decreased function, swollen increased neutrophils in epithelium

Question 26

2 features of adenocarcioma of oesophagus

Answer 26

makes glands, secretes mucin

Question 27

2 features of SCC of oesophagus

Answer 27

produces keratin strong intracellular bridges

Question 28

where do oesophageal varices occur

Answer 28

anastomoses of artery and vein

Question 29

causes of acute gastritis

Answer 29

NSAIDs alcohol corrosives H.Pylori / infection

Question 30

causes of chronic gastritis

Answer 30

ABC Autoimmune - antiparietal ABs bacterial - H.Pylori chemical - NSAIDs

Question 31

complications of H.Pylori

Answer 31

CLO - IM - Dysplasia / adnenocarcinoma / MALT lymphoma 8x risk of gastric cancer

Question 32

ulcer vs erosion

Answer 32

ulcer goes through muscularis mucosae into submucosa but erosion more superficial

Question 33

% survival from gastric cancer

Answer 33

15%

Question 34

what are the other 5% of causes of gastric cancer

Answer 34

SCC MALT lymphoma GI stromal tumour (GIST) neuroendocrine tumours

Question 35

2 types of gastric adenocarcinoma and features

Answer 35

Intestinal = well differentiated Diffuse = poorly differentiated

Question 36

Histology of diffuse adenocarcinoma of stomach

Answer 36

Linitis plastica Signet ring cells - mucin inside cell

Question 37

Most common cause of duodenal ulcers

Answer 37

H.Pylori Giardia lamblia

Question 38

Histology of villous atrophy

Answer 38

Crypt hyperplasia Villous atrophy Raised intraepithelial lymphocytes

Question 39

Dx of coeliac?

Answer 39

Endomysial ABs and anti TTG (tissue transglutaminase)

Question 40

Biopsy results of coeliac?

Answer 40

If on diet WITH gluten --> vilous atrophy If on diet WITHOUT gluten --> normal vili

Question 41

Name a disease which can present similarly to coealic

Answer 41

Tropical sprue