Upper Gastrointestinal Disease Flashcards Preview

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Flashcards in Upper Gastrointestinal Disease Deck (21)
1

Chronic gastritis

Ongoing inflammation of the stomach mucosa

Compared to acute gastritis, symptoms are less severe but more persistent

Can provide an environment in which dysplasia and carcinoma can arise

2

Chronic gastritis symptoms

upper abdominal pain
indigestion or bloating
nausea and vomiting
belching
loss of appetite or weight loss

However, it may be asymptomatic!

3

Chronic gastritis causes

Bacterial- Helicobacter pylori infection
Chemical
Alcohol
Tobacco
Caffeine
A- Autoimmune
Can lead to pernicious anaemia

Psychological stress

4

Helicobacter pylori

Gram-negative bacterium found in the stomach, particularly antrum
infects over half the world’s population and by age 5.
infection probably acquired via faecal-oral route
untreated, infection persists throughout life

5

H.Pylori - Discovery

It was identified in 1982 by Australian scientists Barry Marshall and Robin Warren
Found that it was present in patients with chronic gastritis and gastric ulcers, conditions not previously believed to have a microbial cause.
It is also linked to the development of duodenal ulcers and stomach cancer.

6

H.Pylori clinical presentation

80% asymptomatic
5-15% peptic ulcer disease
10% non-ulcer dyspepsia
1-3% gastric adenocarcinoma
0.5% gastric MALToma

7

H. Pylori - associations

Strongly associated with Chronic Gastritis
Strongly associated with duodenal ulcer
Fairly strongly associated with gastric ulcer
Associated with gastric carcinoma
Associated with gastric MALT lymphoma

8

Peptic ulcer Disease

Peptic ulcer disease (PUD) usually occurs in D1 or antrum (4:1).
Common causes are H. pylori (80 -100% DU, 65% gastric) and NSAIDs
Most ulcers are solitary
Symptoms include
Pain (gnawing, burning, aching)
Worse at night
Worse after meals

9

Peptic ulcer - complications

Complications include:
Bleeding leading to iron deficiency anaemia
Massive haematemesis
Perforation leading to peritonitis
Long term cancer at edge of ulcer

10

Barrett’s oesophagus

Normal lining of the oesophagus stratified squamous epithelium.
In Barrett’s oesophagus replaced by columnar epithelium with goblet cells (usually found lower in the gastrointestinal tract).
Thought to be an adaptation to chronic acid exposure from reflux oesophagitis
Process of dysplasia: low grade to high grade to invasive carcinoma
Strong association (about 0.5% per patient-year) with oesophageal adenocarcinoma
Need for surveillance

11

Types of Upper GI cancer

Oesophagus
Squamous carcinoma
Adenocarcinoma (Barrett’s)
Stomach
Adenocarcinoma
GI Stromal Tumours (GIST)
Small Bowel
Lymphoma
GI Stromal Tumours (GIST)
Neuroendocrine Tumours

12

Oesophageal carcinoma

Squamous cell carcinoma
Adults over 45
M:F 4:1
Risk factors include alcohol, tobacco, caustic injury, achalasia.
Insidious onset with late symptoms
Dysphagia, weight loss, haemorrahge, sepsis, respiratory fistula with aspiration
Overall 5 year survival of 9%

13

Oesophageal Adenocarcinoma

Adenocarcinoma – now more common
Largely from dysplastic change in Barrett’s oesophagus
M:F 7:1
Present with dysphagia, weight loss, haematemesis, chest pain, vomiting.
5 year survival

14

Oesophageal carcinoma spread

DIRECT
into surrounding tissues
LYMPHATIC
to paraoesophageal, paratracheal and cervical node groups
HAEMATOGENOUS
to liver or lung

15

Adenocarcinoma stomach

Adenocarcinoma – 90% of gastric malignancies
Precursor lesions
Pernicious anaemia (atrophic gastritis)
Intestinal metaplasia
Neoplastic polyps
Helicobacter associated gastritis

16

Adenocarcinoma stomach symptoms

Early symptoms resemble gastritis
Advanced symptoms
Weight loss, anorexia, anaemia, heamorrhage
Fungating exophytic growth
Prognosis depends on depth of invasion
5 year survival (early) after surgery 90%
Overall 5 year survival 30%

17

Adenocarcinoma stomach spread

Direct infiltration
Duodenum, pancreas, colon, liver, spleen
Lymphatic spread
Local and regional nodes
Virchow's node
Haematogenous
Liver, lungs
Transcoelomic
Omentum
Mesentery
Ovary (Krukenberg tumour) 

18

Small Bowel Neoplasia

Relatively rare compared to other GI malignancy
Different subtypes include:
adenocarcinoma (rare)
gastrointestinal stromal tumor
lymphoma
carcinoid (neuroendocrine) tumor

19

Risk factors for Small Bowel Neoplasia

Crohn's disease
Coeliac disease
Radiation exposure
Hereditary gastrointestinal cancer syndromes e.g. familial adenomatous polyposis

20

Coeliac disease

Extensive mucosal disease related to sensitivity to gluten
Prevalence in white Europeans of 0.5 – 1%
Immune mediated villous atrophy and malabsorption
Can be diagnosed via serological blood test (TTG) and biopsy -

21

Coeliac disease symptoms

pain and discomfort in the digestive tract,
chronic constipation and diarrhoea,
failure to thrive (in children),
anaemia
fatigue

Intestinal damage begins to heal within weeks of gluten being removed from the diet

Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel