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HistoPath > Histopathology 11: Upper G.I pathology > Flashcards

Histopathology 11: Upper G.I pathology Flashcards

1
Q

In which part of the stomach does H.Pylori tend to reside ?

A

Pyloric antrum and pyloric canal

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2
Q

List the 3 layers of tissue seen on histology of the antrum and body of the stomach ?

A
  • gastric mucos collomnar epithelium at the top
  • Lamina propria in the middle (with specialised acid secreting glands)
  • Muscularis mucosa at the bottom
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3
Q

What is the normal villous: Crypt ratio in the duodenum ?

A

villous: crypt > 2:1

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4
Q

What do goblet cells in the stomach suggest ?

A

Metaplasia - should not be any goblet cells in the stomach

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5
Q

Which risk factors are associated with squamous cell carcinoma of the oesophagus ?

A
  • -Smoking and alcohol
  • -More common in afro-carribeans
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6
Q

Which risk factors are associated with adenocarcinoma of the oesophagus ?

A
  • Barret’s oesophagus
  • GORD
  • smoking
  • obesity
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7
Q

Which cancer is more common in the distal 1/3 of the oesophagus ?

A

Adenocarcinoma

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8
Q

Which cancer is more common in the middle 1/3 of the oesophagus ?

A

Squamous cell carcinoma

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9
Q

List 3 causes of acute gastritis (inflammation of gastric mucosa)?

A
  • NSAIDS
  • Alcohol
  • H.Pylori
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10
Q

List 3 causes of chronic gastritis ?

A

ABC of gastritis:

  • Autoimmune: anti-parietal autoantibodies
  • Bacterial: H. pylori
  • Chemical: NSAIDs, bile reflux

Key cells in chronic = lymphocytes

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11
Q

What does the presence of lymphoid follicles (MALT) in the stomach suggest ?

A
  • H.Pylori infection
  • Increased risk of lymphoma (gastric MALToma)
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12
Q

Which type of cancer is most common in the stomach ?

A

Adenocarcinoma

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13
Q

what is the z-line in the oesophagus

A

point at which epithelium transitions from squamous to columnar (squamo-columnar junction)

Oesophagus = squamous, stomach = columnar

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14
Q

important feature of the oesophageal mucosa

A

submucosal glands

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15
Q

marker for intestinal type epithelium

A

glandular epithelium with goblet cells

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16
Q

hallmark of acute inflammation in general

A

Neutrophil polymorphs

17
Q

Commonest cause of oesophagitis

A

Reflux Oesophagitis/ GORD

18
Q

Aetiology of Barrett’s oesophagus

Two types

A
  • NORMAL squamous epithelium of the lower oesophagus is REPLACED by metaplastic columnar epithelium (usually with goblet cells)
  • Due to GORD/reflux
  1. WITHOUT goblet cells - gastric metaplasia
  2. WITH goblet cells – intestinal type metaplasia (NB since no goblet cells in gastric/stomach, but there are in intestine)
19
Q

Is cancer more likely in gastric metaplasia (without goblet cells) or intestinal metaplasia (with goblet cells) in Barrett’s oesophagus?

A

MUCH HIGHER in intestinal metaplasia

20
Q

Premalignant stages before cancer

A

Metaplasia (reversible) > dysplasia > cancer

21
Q

How do cells in Barrett’s look during screening for the disease?

A

hyperchromatic

22
Q

Most common type of oesophageal cancer in developed countries

Most common WW

A
  • Adenocarcinoma of the Oesophagus (associated with reflux)
  • Adenocarcinomas form glands and secrete mucus
  • Found in lower oesophagus

WW: Squamous Cell Carcinoma (mid-lower oesophagus)

23
Q

Most damaging form of H pylori

A
  • Cag-A +ve H. pylori
  • Cag A is a toxin
  • Switches off apoptosis in gastric cells and so damaged cells are not killed, so DNA damage in cells persists
24
Q

commonest opportunistic viral infection to cause gastritis

A

CMV

25
Q

Which IBD can cause gastritis

A

Crohn’s

26
Q

What is metaplasia and is it reversible?

A

Metaplasia is a change from one cell type to another and by definition is reversible - NOT precancerous

27
Q

What is dysplasia?

A

Some of the cytological and histological features of malignancy are present, but NO invasion through the basement membrane, so no chance of metastasis

Features of malignancy:

  • Big nuclei
  • Raised nucleocytoplasmic ratio
  • Increased mitoses
  • Abnormal mitoses
28
Q

Infection that is major RF of gastric cancer

A

H. pylori

29
Q

>95% of all malignant tumours in the stomach are what type?

A

ADENOCARCINOMAS

  • Can get well differentiated
  • or poorly differentiated: Linitis plastica, signet ring cell carcinoma
30
Q

Signet ring cells seen in which type of GI cancer?

A

poorly differentiated adenocarcinoma of gastric cancer

31
Q

Cause of ALMOST ALL duodenal ulcers

A
  • H. pylori
  • NB also cause of half gastric cancers
  • stimulates increased acid secretion which spills over the stomach and into the duodenum and induces acute duodenitis
32
Q

Pain in duodenal ulcer made worse/relieved by food?

A

Relieved

NB most of these ulcrs due to H pylori

33
Q

Very common parasite which exists in immunocompetent people and can affect duodenum

Another disease affecting duodenum

A

Giardia lablia infection

Whipple’s disease

34
Q

Histological changes in Malabsorption Partial Villous Atrophy (like in Coeliac)

A
  • Villous atrophy- become smaller
  • Crypt hyperplasia- become bigger
  • Increased intraepithelial lymphocytes
35
Q

Rule on food if wanting to do duodenal biopsy for Coeliac

A

Stay on gluten diet otherwise won’t see villous atrophy with increased intraepithelial lymphocytes

36
Q

Those with coeliac are more likely to develop which malignancy?

A

increased risk of GIT cancers: MALToma

AKA Enteropathy associated T-cell Lymphoma (EATL)

NB lymphomas in the stomach due to H. pylori are B cell lymphomas

37
Q

Does food help/worsen Sx of gastric ulcer?

A

WORSEN

38
Q

How invasive is gastric ulcer?

Link between gastric ulcer and cancer

A

defect goes THROUGH the muscularis mucosae (through the full thickness of the mucosa and into the submucosa)

  • Ulcers may become malignant, but cancers may also ulcerate
  • ALL ULCERS SHOULD BE BIOPSIED TO EXCLUDE MALIGNANCY

HistoPath (21 decks)

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