UGIT path

Question 1

how long is the oesophagus

Answer 1

25 cm

Question 2

what is the lining of the oesophagus

Answer 2

squamous epithelium

Question 3

what i the sphincter at the end vs start of the oesophagus called

Answer 3

cricopharygneal upper

gastro-oesophageal lower

Question 4

what is the distal oesophagus lined with

Answer 4

glandular collumnar mucosa

Question 5

where is the squamocolumnar junction

Answer 5

40cm from the incisor teeth

Question 6

what is the normal structure of the oesophagus

Answer 6

mucosa
submucosa
musculares propria
adventitia around each layer

Question 7

what is oesophgitis - and common causes

Answer 7

inflammation of the oesophagus
infectious - bacterial/viral/fungal eg HSV1 or candida
chemical is most common - ingestion or reflux of gastric contents

Question 8

what is the commonest form of oesophagitis

Answer 8

reflux of gastric acid or bile

Question 9

what are the two types of hiatus hernia

Answer 9

sliding - reflux symptoms

para-oesophageal hernia - strangulation and reflux = ischameia and infarction of the stomach

Question 10

what are some risk factors of reflux oesophagitis

Answer 10

defective lower sphincter
hiatus hernia
increased abdominal pressure
increased gastric fluid volume

Question 11

what is the histology of reflux oesophagitis

Answer 11

inflammatory cells causing loose distinction between basal and lamina propria - infiltration of WBC’s

Question 12

what are 5 complications of reflux oesophagitis

Answer 12

ulceration 
haemorrhage 
perforation
benign structure 
Barrett oesophagus

Question 13

what is barretts oesophagus

Answer 13

long standing gastro oesophageal reflux - proximal extension of the squamo-columnar junction = glandular metaplasia

Question 14

what is the disease progression of barretts oesophagus to carcinoma

Answer 14

barretts
low grade dysplasia
high grade dysplasia
adenocarcinoma

Question 15

describe oesophageal carcinoma and the two main types

Answer 15

squamous cell carcinoma - endemic tissue

adenocarcinoma - most common

Question 16

what is the most common cause of adenocarcinoma

Answer 16

mainly lower oesophagus
more males in whites
barretts oesohpasgus, tobacco, obesity

Question 17

what is preceded by squamous dysplasia

Answer 17

squamous carcinoma

Question 18

what are some risk factors of squamous carcinoma

Answer 18

hot beverages, HPV, male, black

Question 19

what is the staging system for oesophageal cancers

Answer 19

TNM
T - depth of invasion (grade of tumour)
N - regional lymph nodes
M - distant metastasis

Question 20

what is the normal anatomy of the stomach

Answer 20

cardia - area around in GO sphincter
fundus - located in upper part of stomach
body - main
antrum - near the pylorus

Question 21

what are the three stages of gastritis

Answer 21

normal - balance of aggressive and defensive forces
increased aggression - excessive alcohol, drugs ie aspirin, heavy smoking
impaired defences - ischameia, shock

Question 22

describe the causes of acute gastritis

Answer 22

usually due to chemical injury - drugs alcohol - to helibactor pylori infection

Question 23

describe the causes of chronic gastritis and risk

Answer 23

autoimmune - B12 deficiency
helibactor pylori
increased risk of gastric cancer and MALT lymphoma

Question 24

describe the structure and mode of infection of helibactor pylori

Answer 24

gram negative spiral shaped bacterium - live on surface epithelium and protected by the overlying mucus barrier

infection damages epithelium leading to chronic inflammation = decreased acid levels

Question 25

where is helibactor pylori infection most common

Answer 25

antrum of the stomach

Question 26

what is peptic ulcer disease and the major sites of effect

Answer 26

localised defect extending at least into submucosa - part of the lining is erosion - full lining is ulcer first part of duodenum junction of astral and body mucosa distal oesophagus

Question 27

what are the main causes of peptic ulcer disease

Answer 27

anything increasing stomach acid secretion, H pylori infection reflux, drugs, smoking, NSAIDS

Question 28

what is the specific histology of acute peptic ulcer

Answer 28

full thickness coagulative necrosis of mucosa or deeper layers

Question 29

what is the histology of chronic gastric ulcer

Answer 29

clear cut edges overhanging the base - extensive granulation and scar tissue

Question 30

what are the complications of peptic ulcer

Answer 30

haemorrhage peritonitis penetration into adjacent organs strictring - hour glass deformity - narrowing at centre of stomach

Question 31

what are the differences between gastric and duodenal ulcer

Answer 31

gastric - low incidence, increases with ages, normal/low acid levels in blood group A duodenal - higher incidence increases up to 35 y/o - elevated gastric acid, mainly from h pylori gastritis occurs in the bulbus in blood group O

Question 32

what is the most frequent gastric cancer

Answer 32

adenocarcinoma

Question 33

what are the differences in association between carcinoma of the GOJ and the gastric body/antrum

Answer 33

GOJ - associated with GO reflux not h Pylori/diet gastric body/antrum - non association with GO reflex

Question 34

what are the macroscopic subtypes of gastric cancer

Answer 34

plastica - ulceration involves all the stomach polypoidal - polyps ulcerated

Question 35

what are the microscopic subtypes of gastric cancer

Answer 35

intestinal - well differentiated | diffuse type - poor differentiation cadherin gene mutation = linitis plastica

Question 36

what does a loss in GDH1 gene lead to

Answer 36

cadherin (adhesion molecule) - diffuse type of microscopic gastric cancer

Question 37

what is HDGC and the mutation

Answer 37

hereditary diffuse type gastric cancer | germline - CDH1 mutations - adhesion molecule

Question 38

what type of pathology is coeliac disease

Answer 38

small bowel

Question 39

what is coeliac disease and the pathogenesis

Answer 39

immune mediated enteropathy due to gluten (gladin - causes epithelial cells to produce IL-15 = proliferation of CD8 intraepithelial lymphocytes - attacks tissue transglutaminase on bowel epithelium

Question 40

what non invasive procedures are there for coeliac and what i stew gold standard test

Answer 40

IgA antibodies to tissue transglutaminase IgA/G to deaminated gliadin tissue biopsy gold standard

Question 41

what are the clinical features and associations of coeliac disease

Answer 41

dermatitis herpeiformis | lymphocytic gastriis and lymphocytic colitis

Question 42

what cancers are associated with coeliac disease

Answer 42

enteropathy associated t cell lymphoma | small intestinal adenocarcinoma

Question 43

what is the treatment of coeliac and what risks does it reduce

Answer 43

gluten free diet - anaemia, female infertility, osteoporosis and cancer

Question 44

what is the morphology of coeliac disease

Answer 44

finger like projections of epithelial cells increased intraepithelial lymphocytes increased lamina proprietary inflammation