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GI > Pathology: Lecture 1 = Mouth & oesophagus and Lecture 2 = Stomach > Flashcards

Pathology: Lecture 1 = Mouth & oesophagus and Lecture 2 = Stomach Flashcards

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1
Q

look at photo of normal oesophagus - slide 7.

What is an important line in the oesophagus?

A

look at photo of normal oesophagus - slide 7

= Z line

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2
Q

look at histological slide of oesophagus - slide 9.

A

look at histological slide of oesophagus - slide 0

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3
Q

what are some inflammatory disorders of the oesophagus?

A

1) acute oesophagitis (rare)

2) chronic oesophagus (common)

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4
Q

what is acute oesophagitis?

A

= corrosive following chemical ingestion

- infective in immunocompromised patiens. e.g. cadidiasis, herpes, CMV

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5
Q

what is chronic oesophagittis also known as?

A

= reflux diseases “reflex oesophagitis”

- rare causes include Crohn’s disease

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6
Q

what is reflux oesophagitis?

A

= inflammation of oesophagus due to reflex low pH gastric contents

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7
Q

what might reflux oesophagitis be due to?

A

= defective sphincter mechanism +/- hiatus hernia

= abnormal oesophageal motility

= increased intra-abdominal pressure (pregnancy and obese people)

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8
Q

how would reflux oesophagus show microscopically?

A

1) basal zone epithelial expansion
& lengthening of papillae

2) intra-epithelial neutrophils, lymphocytes and eosinophils

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9
Q

what are complications of reflux?

A

1) ulceration (bleeding)
2) stricture
3) Barrett’s Oesophagus

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10
Q

what is Barrett’s oesophagus in pathological terms?

A

= replacement of stratified squamous epithelium by columnar epithelium

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11
Q

when does Barrett’s oesopjaus occur?

A

= due to persistent reflux of acid or bile

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12
Q

what may cause Barrett’s oesophagus?

A

= due to expansion of columnar epithelium from gastric glands or from sub-mucosal glands
- may be due to differentiation rom oesophageal stem cells

  • protective response, faster regeneration
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13
Q

what macroscopically would you see in Barrett’s oesophagus?

A

= red velvety mucosa in lower oesophagus

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14
Q

what would you see under a microscope, hidtrologically, in Barrett’s oesophagus?

A

1) columnar lined mucosa with intestinal metaplasia

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15
Q

describe eh mucosa in barrette’s oesophagus and what does this cause an increased risk of developing?

A

= unstable mucosa (contains damage)

+ increased risk of developing dysplasia & carcinoma and adenocarcinoma of oesophagus
+ requires surveillance although value of this is disputed

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16
Q

what is allergic oeosphagitis?

A

= eosinophilic oesophagitis

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17
Q

what do people with allergic oeosphagitis present with?

A
  • personal/family history of allergy
  • asthma
  • young
  • males > females
  • pH probe negative for reflux
  • increased eosinophils in blood
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18
Q

what would the oesophagus look like in allergic oeosphagitis?

A
  • corrugated (feline) or spotty’ oesophagus
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19
Q

describe the histological appearance in allergic oeosphagtiis?

A

= large numbers of intra-epithelial eosinophils

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20
Q

what could you treat allergic oeosphagitis with?

A

= steroids
= chromoglycate
= montelukast

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21
Q

what is a common type of benign oesophageal tumour?

A

= squamous cell papilloma

  • rare
  • papillary
  • asymptomatic
  • HPV related
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22
Q

what are 4 other benign oesophageal tumours?

A
  • Leiomyomas
  • Lipomas
  • Fibrovascular polyps
  • Granular cell tumours
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23
Q

what are 2 examples of malignant oesophageal tumours?

A

1) squamous cell carcinoma

2) adenocarcinoma

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24
Q

describe the epidemiology and causes of squamous cell carcinoma?

A

= commoner in males

Causes;

  • vit A/zinc deficiency
  • tannic acid/strong tea
  • smoking, alcohol
  • HPV
  • oesophagitis
  • genetic
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25
describe the histological appearance of squamous cell carcinoma?
= Severe dysplasia a in squamous layer
26
what does squamous cell carcinoma cause?
= obstruction and dysphagia
27
what would you see macroscopically in squamous cell carcinoma?
- keratin formation | - invasive type squamous cells
28
where is adenocarcinoma of oesophagus most common?
- in lower 1/3 of oesophagus | - commoner in males/obese individuals
29
describe the pathogenesis of adenocarcinoma of oesophagus?
1) genetic factors, reflux diseases, others 2) chronic reflux oeosphagitis 3) Barret's oesophagus (intestinal metaplasia) 4) low grade dysplasia 5) high grade dysplasia 6) adenocarcinoma
30
similarly to squamous cell carcinoma, what does adenocarcinoma cause?
= obstruction and dysphagia
31
what are the 3 mechanisms for metastases of carcinoma of oesophagus?
1) direct invasion 2) lymphatic permutation 3) vascular invasion
32
what may you present with if there is a carcinoma of oesophagus?
Dysphagia; - due to tumour obstruction General symptoms; - anaemia - weigh loss - loss energy = due to effects of metastases
33
what are 2 other oesophageal pathology?
1) mallory Weiss tear | 2) oesophageal varices
34
what is the cancer most common to oral cavity ?
oral squamous cell carcinoma
35
what do oral squamous cell carcinomas present with and what are high risk and low risk sites?
- white, red, speckled, ulcers or lumps High risk sites; - floor of mouth - lateral border of venture tongue - soft palate - retromolar pad - tonsils pillars RARE; - on hard palate - dorsum of tongue
36
what are the causes of oral squamous cell carcinomas?
1) Tobacco 2) Alcohol 3) Betel quid 4) Viral - HPV (p16) 5) Chronic infections 6) Nutritional deficiencies 7) Genetics 8) Post Transplant 9) Pt with history of primary oral SCC, increased risk of developing new second primary
37
what do ALL malignant squamous epithelium show?
= invasion and destruction of local tissues
38
what are variants of malignant squamous epithelium?
- verrucous and acantholytic
39
describe the differentiation of malignancy?
- Well-differentiated tumour cells very obviously squamous with ‘prickles’ and keratinization - Moderately differentiated - Poorly differentiated, may be difficult to identify tumour cells as epithelial
40
what are the features relating to prognosis of squamous cell carcinoma?
1) Tumour diameter 2) Depth of invasion 3) Pattern of invasion- cohesive versus non-cohesive front 4) Lymphovascular invasion 5) Neural invasion by tumour 6) Involvement of surgical margins 7) Metastatic disease 8) Extracapsular spread of lymph node metastases
41
what are the tumour stages of cancers?
= TNM system ``` T= greatest diameter of tumour, structures invaded N= lymph node status M= metastasis ``` Eg pT2N1MX
42
how do you treat it?
1) surgery | 2) adjuvant therapy
43
LECTURE 2 - pathology of stomach
LECTURE 2 - pathology of stomach
44
what are 2 inflammatory disorders of the stomach?
1) acute gastritis | 2) chronic gastritis
45
what is acute gastritis and what are 4 possible causes?
= irritant chemical injury caused by; - severe burns - shock - severe trauma - head injury
46
what is chronic gastritis and what are 3 possible causes?
- auto-immune - bacterial - chemical
47
what are 3 rare inflammatory disorders of the stomach?
- lymphocytic - eosinophilic - granulomatous
48
what bacteria is associated with chronic gastritis?
= H. pylori
49
how would you identify chronic gastritis?
red, inflamed stomach
50
what happens in auto-immune chronic gastritis and what does it result in? (rare)
= anti-parietal and anti-intrinsic factor antibodies attack causing atrophy and intestinal metaplasia in body of stomach Resulting in; = pernicious anaemia, microcytic, due to B12 deficiency + increased risk of malignancy - SACDC
51
what happens in H. pylori associated chronic gastritis? (most common)
= bacteria inhabits a niche between epithelial cell surface and mucous barrier - excites early acute inflammatory response - if not cleared, then a chronic active inflammation ensures
52
what is critical in H. pylori associated chronic gastritis?
IL8
53
what type of bacteria is H. pylori involved in chronic gastritis?
= gram negative curvilinear rod like.
54
what produces anti- H. pylori antibodies and what does it increase the risk of?
= lamina propria plasma cells Increasing risk of; - of duodenal ulcers - of gastric ulcers - of gastric carcinoma - of gastric lymphoma
55
what is chemical gastritis due to?
- NSAIIDS - alcohol - bile regluc
56
what happens in chemical gastritis?
= direct injury to mucus layer by fat solvents
57
what is chemical gastritis marked by?
= epithelial regeneration, hyperplasia, congestion and little inflammation - may produce erosion and ulcers
58
what is peptic ulceration?
a breach in gastro-intestinal mucosa as a result of acid and pepsin attack
59
what are chronic peptic ulcers and what are 4 common sites for them?
= ulceration which is longstanding and deep Common sites; - duodenum (1st part) - stomach (junction of body and antrum) - oesophagi-gastric junction - stomal ulcers
60
describe the pathogenesis of chronic duodenal ulcers?
= increased attack and failure of defence - increased acid in duodenum produces gastric metaplasia, and leads to H. pylori infection, inflammation, epithelial damage and ulceration ALSO - failure of mucosal defence
61
describe the morphology of peptic ulcers?
2-10cm across | - edges clear cut, punched out
62
describe the microscopic appearance of peptic ulcers?
- layered appearance - Floor of necrotic fibrinopurulent debris - Base of inflamed Granulation tissue - Deepest layer is fibrotic scar tissue
63
what are 5 complications of peptic ulcers?
1) perforation 2) penetration 3) haemorrhage 4) stenosis 5) intractable pain
64
what are 2 examples of benign (polyps) gastric tumours?
1) hyperplastic polyps | 2) cystic fundic gland polyps
65
what are 3 examples of malignant (tumour) gastric tumours?
1) carcinomas - adenocarcinomas 2) lymphomas 3) gastrointestinal stromal tumours (GISTs)
66
what is the major cause of gastric adenocarcinomas?
= H. pylori patients with H. pylori infections/anti-bodies have higher risk of cancer
67
describe the pathogenesis of gastric adenocarcinomas?
1) H. pylori infection 2) chronic gastris 3) intestinal metaplasia/atrophy 4) dysplasia 5) carcinoma
68
what are 4 other pre-malignant conditions associated with gastric adenocarcinoma?
1) pernicious anaemia 2) partial gastrectomy 3) HNPC/Lynch syndrome 4) menetrier's disease
69
what are 2 sub-types of gastric adenocarcinomas?
1) intestinal type - exophytic/polypoid mass 2) diffuse type - expands/infiltrates stomach wall
70
describe the appearance of gastric adenocarcinomas?
= raised rolled edges
71
what does benign peptic ulcers mimic?
= cancer but is more punched out and lacks raised rolled edges
72
describe the histological appearance of adenocarcinomas intestinal type?
= gland formation
73
describe histological appearance of gastric adenocarcinomas - diffuse type?
= red and bloody
74
what are 3 possible histological appearance of gastric adenocarinnomas - in diffuse form?
1) linitis plastica 2) signed ring type 3) sclerosis
75
what is the difference between intestinal and diffuse gastric adenocarcinoma?
Intestinal = slightly better prognosis
76
where does gastric adenocarcinoma spread to locally?
= into other organs and peritoneal cavity and ovaries ... Kruckenberg = lymph nodes = haematogenous (liver)
77
describe gastric lymphoma?
= maltoma - associated with H. pylori infection - continuous inflammation inducing an evolution into a clonal B cell proliferation... low grade lymphoma - if unchecked into evolves into a high grade B cell lymphoma

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