Pathology of the Upper GIT

Question 1

What is the pH of the stomach?

Answer 1

pH 2

Question 2

Why is the oesophageal sphincter so tight?

Answer 2

The oesophagus does not want to acid from the stomach so tight to prevent acid flowing up into it.

Question 3

What type of tissue must line acid producing compartments and why?

Answer 3

Glandular epithelium that produces mucous to help protect the walls

Question 4

What is oesophageal reflux?

Answer 4

Reflux of gastric acid into the oesophagus.

Question 5

What is a hiatus hernia?

Answer 5

When there is a prolapse of acidic stomach mucosa into the oesophagus.

Question 6

RECAP- Describe the lining of the oesophagus.

Answer 6

Stratified squamous non-keratinising but can make keratin

Question 7

What happens if you continually get gastric acid on the squamous epithelium of the oesophagus?

Answer 7

There will be thickening of the squamous epithelium- hyperplasia

Question 8

Define hyperplasia.

Answer 8

Increase in the number of cells

Question 9

Define hypertrophy.

Answer 9

Increase in the size of cells.

Question 10

What happens if there is severe oesophageal reflux?

Answer 10

Ulceration of the oesophageal epithelium.

Question 11

What are two complications for oesophageal reflux?

Answer 11

Healing by fibrosis
Barrett’s oesophagus

Question 12

Describe how healing by fibrosis can be a complication.

Answer 12

Mucous lined epithelium isn’t resistant to sharp foods like crisps which can scratch and cause pain/bleeding.
Therefore, fibroblasts produce collagen and materials to increase structural integrity but this can just cause oesophageal obstruction.

Question 13

What occurs in Barrett’s oesophagus?

Answer 13

Change of the usual squamous epithelium of the oesophagus into glandular epithelium.

Question 14

What is metaplasia?

Answer 14

Change in one type of epithelium in response to an environmental change

Question 15

Is metaplasia reversible?

Answer 15

Yes

Question 16

What happens if metaplasia is not treated?

Answer 16

It progresses onto dysplasia

Question 17

What happens after dysplasia?

Answer 17

Neoplasia (cancer)

Metaplasia -> Dysplasia -> Neoplasia

Question 18

What are some of the environmental factors that increase risks of oesophageal cancer by squamous carcinoma subtype.

Answer 18

Smoking
Alcohol
Dietary carcinogens

Question 19

What are the two histological subtypes of oesophageal cancer?

Answer 19

Squamous carcinoma
Adenocarcinoma

Question 20

Which histological subtype of oesophageal cancer develops from Barrett’s oesophagus?

Answer 20

Adenocarcinoma

Question 21

What are some of the environmental factors that increase risks of oesophageal cancer by adenocarcinoma subtype.

Answer 21

Barrett’s metaplasia
Obesity

Question 22

What are some of the local effects of oesophageal cancer?

Answer 22

Obstruction
Ulceration
Perforation

Question 23

Where can the direct spread of oesophageal cancer spread to?

Answer 23

Surrounding tissues

Question 24

How can oesophageal cancer spread quickly?

Answer 24

Good blood and lymphatic supply so cancer can travel into lymphatics.

Question 25

Which organ can get affected by the oesophageal cancer spreading through the blood?

Answer 25

Liver

Question 26

What is gastritis?

Answer 26

Stomach inflammation

Question 27

What are the three subtypes of gastritis?

Answer 27

Autoimmune Bacterial Chemical injury ABC

Question 28

If people have an autoimmune disorder, will they be more or less likely to get another?

Answer 28

More likely

Question 29

Which vitamin deficiency would be present in those with autoimmune gastritis?

Answer 29

Vitamin B12

Question 30

As a GP, if someone with a pre-existing autoimmune condition came in with a stomach ache, what would be important to consider?

Answer 30

Autoimmune gastritis

Question 31

Which bacteria causes bacterial gastritis?

Answer 31

Helicobacter pylori

Question 32

What does H.pylori produce?

Answer 32

Potassium

Question 33

Why does the production of potassium from H.pylori cause gastritis?

Answer 33

Binds to the sodium potassium pump and makes more acid in the stomach.

Question 34

Which foods should those with gastritis avoid?

Answer 34

Potassium rich foods -> a lot of people think you should avoid acidic foods but the stomach pH is 2 so the patient will not be eating foods with a pH less than that.

Question 35

What could cause chemical injury gastritis?

Answer 35

Bile reflux Drugs

Question 36

Define atrophy.

Answer 36

Cells are smaller

Question 37

Describe what happens to the epithelium in autoimmune gastritis.

Answer 37

Atrophy of specialised acid secreting gastric epithelium

Question 38

Which type of gastritis is the most common?

Answer 38

Bacterial gastritis

Question 39

Is Helicobacter bacteria gram positive or gram negative?

Answer 39

Gram negative

Question 40

Which drugs treat bacterial gastritis?

Answer 40

Proton pump inhibitors and antibiotics

Question 41

Which three things most often cause chemical gastritis?

Answer 41

Drugs (NSAIDs) Alcohol Bile reflux

Question 42

Why will their be hyperplasia of the cell epithelium in chemical gastritis?

Answer 42

To produce more mucus to counteract the chemicals causing damage

Question 43

When will peptic ulceration take place?

Answer 43

When there is an imbalance between the acid secretion and mucosal barrier.

Question 44

Which organs does peptic ulceration affect?

Answer 44

Stomach Duodenum Oesophagus

Question 45

Which part of the oesophagus can peptic ulceration occur in?

Answer 45

Lower oesophagus

Question 46

Which parts of the stomach does peptic ulceration usually occur in?

Answer 46

Body and antrum

Question 47

Which parts of the duodenum does peptic ulceration usually occur in?

Answer 47

First and second part

Question 48

What usually causes peptic ulcertaion?

Answer 48

H.pylori

Question 49

What are the complications of peptic ulceration?

Answer 49

Bleeding Perforation Healing by fibrosis

Question 50

What can acute bleeding in patients with peptic ulceration cause?

Answer 50

Haemorrhage

Question 51

If a patient has chronic bleeding from peptic ulceration, so a little bit of blood bleeding out continuously, what can this cause?

Answer 51

Anaemia

Question 52

What can perforation cause?

Answer 52

Peritonitis

Question 53

What can gastric cancer be associated with?

Answer 53

A previous H.pylori infection

Question 54

What is meant by transcoelomic spread of cancer?

Answer 54

Spread of cancer from the organ directly into the peritoneal cavity