Pathology of the Upper GI Tract

Question 1

What are the 5 commonest upper Gi conditions?

Answer 1

Oesophageal reflux
Oesophageal cancer
Gastritis
Peptic ulceration
Gastric cancer

Question 2

What is oesophageal reflux? What is it caused by?

Answer 2

Reflux of gastric acid into oesophagus

Hiatus hernia

Question 3

What is a hiatus hernia?

Answer 3

A hiatus hernia is when part of your stomach moves up into your chest via the oesophageal hiatus

Question 4

What are the complitcations of oesophageal reflux?

Answer 4

Thickening of squamous epithelium
Ulceration of the oesophagus
Healing by fibrosis = Stricture formation
Barrett’s Oesophagus

Question 5

What is barrett’s oesophagus?

Answer 5

metaplasia - squamous epithelium gets transformed to glandular epithelium

Question 6

What is metaplasia

Answer 6

Abnormal change in the nature of a tissue

Question 7

What is a major risk that comes with having barrett’s?

Answer 7

It is a pre-malignant condition

Question 8

What is the 2 histological types of oesophageal cancer?

Answer 8

Squamous carcinoma

Adenocarcinoma - develops from barretts

Question 9

Is oesophageal cancer linked with environmental factors?

Answer 9

yes

Question 10

Risk factors for o. squamous carcinoma ?

Answer 10

Smoking
Alcohol
Dietary carcinogens

Question 11

Risk factors for O. adenocarcinoma?

Answer 11

Barretts

Obesity

Question 12

What is the local effects of o. cancer?

Answer 12

Obstruction
Ulceration
Perforation

Question 13

What are the ways o.cancer can spread?

Answer 13

Direct to surrounding tissues
Lymphatic spread to regional lymph nodes
Blood spread to distant sites - liver

Question 14

Prognosis for o. cancer?

Answer 14

Very poor - 5 yr survival rate less than 15%

Question 15

What is the 3rd most common GI cancer?

Answer 15

oesophageal

Question 16

What is gastritis?

Answer 16

Inflammation of the stomach mucosa

Question 17

Types of gastritis?

Answer 17

Types ABC

Autoimmune
Bacterial
Chemical Injury

Question 18

What happens in type A gastritis?

Answer 18

Autoantibodies attack parietal cells and intrinsic factor.

Causes atrophy of the specialised gastric epithelium and damages parietal cells
–> Decrease Acid Secretion & Loss of intrinsic factor

Question 19

Which type of gastritis is commonest?

Answer 19

Type B (bacterial)

Question 20

What bacteria is involved in type B gastritis?

Answer 20

Heliobactor Pylori (A gram -ve)

Question 21

Where is H. pylori found?

Answer 21

Gastric mucus on surface of gastric epithelium

Question 22

What does H.pylori do?

Answer 22

It releases ammonia
Stomach detects pH rise
Parietal cells release more acid
Increases acid = inflammation

Question 23

How is type B gastritis treated?

Answer 23

Antibiotics

Question 24

What causes Type C gastritis?

Answer 24

Drugs e.g. NSAIDS
Alcohol
Bile Reflux from Duodenum

Question 25

What is a peptic ulceration?

Answer 25

An imbalance of acid secretion and the mucosal barrier = an ulcer

Question 26

Where exactly do peptic ulcerations happen?

Answer 26

Lower oesophagus Body + antrum of stomach 1st & 2nd parts of duodenum

Question 27

What causes a peptic ulcer?

Answer 27

Too much acid Acid in a place it shouldn't It's usually associated with H.pylori infection

Question 28

Complications of a peptic ulcer?

Answer 28

Bleeding Perforation Fibrosis

Question 29

Describe the bleeding that comes with peptic ulcers.

Answer 29

Can be acute or chronic Chronic is more common due to capillary damage. it leads to anemia

Question 30

What happens due to perforations that come with peptic ulcers.

Answer 30

Gastric contents start to leak into the peritoneal cavity and cause peritonitis

Question 31

Why does fibrosis occur? Consequences of it?

Answer 31

Attempt to heal | Can lead to an obstruction of the GI tract

Question 32

How common is gastric cancer?

Answer 32

2nd commonest GI cancer

Question 33

How does gastric cancer develop?

Answer 33

Metaplasia and dysplasia of the stomach epithelium

Question 34

What is dysplasia?

Answer 34

the presence of cells of an abnormal type within a tissue

Question 35

What is gastric cancer associated with?

Answer 35

Previous H.pylori infections

Question 36

Histology of gastric cancer?

Answer 36

Adenocarcinomas

Question 37

What types of spread is there with stomach cancer?

Answer 37

Direct - surrounding tissues Regional - lymphatic Blood - Liver Transcoelomic - spread within the peritoneal cavity

Question 38

Stomach cancer prognosis?

Answer 38

Very poor - 5 yr rate is less than 20%