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Kat's Pathology > Upper Gastrointestinal Disease > Flashcards

Upper Gastrointestinal Disease Flashcards

(44 cards)

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1
Q

Structure of normal GI

A

Epithelium
Submucosa
Muscularis propria

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2
Q

What is present in a normal oesophagus

A

Z line - squamo-columnar junction

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3
Q

Anatomy of the stomach

A 
Oesphagus 
Cardia
Fundus
Body 
Pyloric antrum 
Pylorus 
Dueodenum
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4
Q

Normal stomach (body) histology

A

Lined by gastric mucosa, columnar epithelium (foveolar, mucin secreting)

Specialised glands in the lamina propria

Muscularis mucosa

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5
Q

Normal stomach (antral) histology

A

Lined by gastric mucosa, columnar epithelium (fovelolar, mucin secreting)

Non-specialised glands in the lamina propria (gastric pits)

Muscularis mucosa

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6
Q

Normal duodenum histology

A

Glandular epithelium with goblet cells (intestinal type epithelium)

Villous architecture with a villous:crypt ratio of >2:1

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7
Q

Acute inflammation of the oesophagus

A

Oesophagitis

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8
Q

Chronic inflammation of the oesophagus

A

GORD

Barrett’s oesophagus

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9
Q

GORD

A

Gastro-oesophageal reflux disease
Commonest cause of oesophagitis
Reflux of acidic gastric contents

Causes:
Ulceration: necrotic slough, inflammatory exudate, granulation tissue
Fibrosis

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10
Q

Complications of GORD

A

Haemorrhage
Perforation
Strictures
Barrett’s oesophagus

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11
Q

Barrett’s oesophagus

A

Re-epithelialisation by metaplastic columnar epithelium usually with goblet cells (intestinal type epithelium)
AKA columnar lined oesophagus (CLO)

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12
Q

Metaplasia of the oesophagus

A

Glandular epithelium (intestinal type)

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13
Q

Dysplasia of the oesophagus

A

Changes showing some of the cytological and histological features of malignancy, but no invasion through the basement membrane

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14
Q

Adenocarcinoma of the oesophagus

A

Invasion through the basement membrane

Now the commonest type of oesophageal cancer

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15
Q

Change from GORD-Barrett’s-Cancer

A

Metaplasia - Dysplasia - Cancer

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16
Q

Squamous cell carcinoma of the oesophagus

A

Associated with alcohol and smoking
Mid/lower oesophagus
Invasion into the submucosa

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17
Q

Carconoma of the oesophagus

A

Poor prognosis

Diagnosis of a pre-invasive stage is very important

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18
Q

Cause of oesophageal varicies

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A

Cirrhosis of the liver (i.e. increased portal hypertension)

19
Q

Gastritis

Study These Flashcards
A

Inflammation of the gastric mucosa
Acute gastritis: acute insult
Chronic gastritis: chronic/persistent insult

20
Q

Causes of acute gastritis

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A

Chemical: aspirin, NSAIDs, alcohol, corrosives
Infection: e.g. helicobacter pylori

21
Q

Causes of chronic gastritis

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A

H pylori associated
Chemicals (NSAIDs, bile reflux into the antrum)
Autoimmune (body, auto-antibodies e.g. antiparietal)
Presence of lymphocytes +/- neutrophils
Mucosal associated lymphoid tissue induction (MALT)

22
Q

Helicobacter associated gastritis

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A

Caused by H.pylori infection
Pattern: chronic gastritis +/- activity
Outcome: CLO-IM-dysplasia, adenocarcinoma, lymphoma (MALToma)

23
Q

Helicobacter pylori and stomach cancer

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A

Helicobacter infection is associated with an 8x increased risk of (non-cardia) gastric cancer
cag-A-positive H.pylori have a needle like appendage that injects toxin into intercellular junctions allowing the bacteria to attach more easily.
This strain is associated with more chronic inflammation.
Treatment of the infection with antibiotics drastically reduces the risk of cancer.

24
Q

Other causes of gastritis

Study These Flashcards
A

Infection: CMV, strongyloides (immunosuppression)
IBD: Crohn’s disease

25
Why is gastritis concerning
Chronic gastritis --> ULCER = intestinal metaplasia --> dysplasia --> cancer
26
What should be done to all stomach ulcers
All ulcers should be biopsied to exclude malignancy
27
Complications of gastric ulcers
Bleeding: anaemia, shock (massive haemorrhage) Perforation: peritonitis
28
Intestinal metaplasia
As in the oesophagus Intestinal metaplasia in gastric mucosa in response to long term damage Increased cancer risk
29
Gastric epithelial dysplasia
Abnormal epithelial pattern of growth Some of the cytological and histological features of malignancy are present, but no invasive through the basement membrane
30
Causes of gastric cancer
Host factors and genes Bacterial virulence factors Environmental factors
31
Environmental factors for gastric cancer
Smoking | Poor diet
32
Gastric cancer
High incidence in Japan, Chile, Italy, China, Portugal, Russia More common in men >95% of all malignant tumors in stomach are adenocarcinomas
33
Classification of stomach adenocarcinomas
Intestinal - well differentiated | Diffuse - poorly differentiated (linitis plastica), includes signet ring cell carcinoma
34
Gastric cancer subtypes
95% are adenocarcinomas | Rest are: squamous cell carcinoma, lymphoms (MALToma), gastrointestinal stromal tumour (GIST), neuroendocrine tumours
35
Prognosis for gastric cancer
Overall survival is 15%
36
Gastric MALToma/ lymphoma
Chronic inflammation: Chronic immune stimulation B cell (marginal zone) lymphocytes Treatment: If limited to the stomach and H.pylori is present then H.pylori eradication
37
What is present in a normal duodenum
Villi
38
Duodenitis, Duodenal Ulcer and H. pylori infection
Increased acid production in the stomach which spills over into duodenum Chronic inflammation and gastric metaplasia with helicobacter infection. Especially in antral stomach infection = +++++ACID which spills into the duodenum.
39
Duodenal ulcers
Duodenitis and duodenal ulcer: good correlation between endoscopy and biopsy pathology
40
Endoscopy findings with duodenal ulcers
Endoscopy “itis”: 73.5% progress to ulcer, mainly erosive duodenitis (biopsy – neutrophils)
41
Pathogens causing duodenal ulcers (except H.pylori)
``` Immunosuppressed CMV Cryptosporidiosis Giardia lamblia infection Whipple's disease - trophryma whippelii ```
42
Duodenal malabsorption
Partial villous atrophy Histology: villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes (normal range <20 lymphocytes/100 enterocytes)
43
Coeliac disease
Diagnosis requires: endomysial antibodies and tissue transglutaminase antibodies Duodenal biopsies: On gluten rich diet showing villous atrophy Off gluten showing normal villi There are other causes of malabsorption with similar histology e.g. tropical sprue
44
Duodenal MALToma/lymphoma
Patients with coeliac disease have an increased risk of GIT cancers MALToma associated with Coeliac is in the duodenum T-cell origin: Enteropathy Associated T-cell Lymphoma

Kat's Pathology (105 decks)

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