Flashcards in Upper GI histopath Deck (35):
The oesophagus is made up of 2 types of epithelial cells, what are they? and how much of the oesophagus does each occupy?
Squamous upper 2/3
Simple columnar lower 1/3
(they are joined by the sqamou-columnar junction = Z line)
What are the complications of GORD? (5)
Haemorrhage - can present as malena or haematemesis
What is the commonest cause of oesophagitis?
Treatment for GORD (3)
Lifestyle changes - smoking cessation, weight loss
H2 receptor antagonists
What is Barrett's oesophagus?
Intestinal metaplasia of squamous mucosa > columnar epithelium following chronic GORD (because they have more goblet cells) > upwards migration of SCJ
What percentage of those with symptomatic GORD have Barrett's?
Where is oesophageal adenocarcinoma most commonly seen?
Distal 1/3 of oesophagus - because associated with Barrett's
Other risk factors for oesophageal adenocarcinoma (3)
prior radiation therapy
Oesophageal adenocarcinoma most common in which ethnicity? & gender?
M >> F
What are some risk factors for squamous cell carcinomas of oesophagus? (5)
Main is ETOH & smoking
In which ethnicity & gender is squamous cell carcinomas of oesophagus more common?
M > F
Presentation of squamous cell carcinomas of oesophagus? (4)
progressive dysphagia (solids then liquids)
severe weight loss
squamous cell carcinomas of oesophagus treatment?
Mainly palliative as it has rapid growth & early metastasis
What are oesophageal varices?
Dilated & engorged veins - most commonly due to portal HTN (back pressure)
Presentation of oesophageal varices? (1)
Management of Varices? (2)
Causes of acute gastritis (5)
Acute - neutrophils main wbc, causes:
NSAIDS, aspirin, acute H. Pylori, severe stress e.g. burn
Causes of Chronic gastritis (4)
Chronic - lymphocytes, plasma cells. Causes:
Chronic H. Pylori, pernicious anemia, alcohol, smoking
Special types of gastritis: infectious, chemical, IBD
Infectious - HSV, CMV
Chemical - foveolar hyperplasia
Complications of Gastritis (2)
Cancer (metaplasia > dysplasia > cancer)
What is a gastric ulcer?
A breach through muscularis mucosa, into the submucosa
Presentation of gastric ulcer (3)
Epigastric pain - relieved by antacids
worse with food
weight loss possible
Risk factors for gastric ulcer (4)
Smoking, H. Pylori, NSAIDs, delayed gastric emptying
(mostly occurs in elderly)
Investigations for gastric ulcer
Biopsy for H. Pylori status - PUNCHED OUT LESION with ROLLED margins
Complications of gastric ulcer (3)
Perforation (perform erect chest x-ray)
Gastric lymphoma cause
Due to chronic H-pylori - chronic ag stimulation > lymphoma
Treatment of Gastric lymphoma (1)
remove cause - H. Pylori triple therapy: PPI + clarithro + amox/ metro
Presentation of duodenal ulcer (3)
(4 times more common than GU)
relieved by food & milk
worse at night
(occurs in young adults)
Risk factors for duodenal ulcers (5)
drugs, H. pylori, NSAIDs, steroids, smoking
Complications of duodenal ulcer (2)
Coeliac disease HLA assocations (2)
HLA DQ2 & DQ8
(t-cell mediated disease)
gluten intolerance results in villous atrophy + malabsorption
Presentation of Coeliacs (7)
young children or Irish women
Symptoms of malabsorption - bloating, N&v, abdo pain, steatorrhea, weight loss
Rash - dermatitis herpetiformis
Serological tests in coeliacs (3) (abs)
Anti-endomysial (best sen & spec)
Anti gliadin (poor marker for disease control)
Gold standard investigation for Coeliacs
Upper GI endoscopy & duodenal biopsy - villous atrophy, crypt hyperplasia, lymphocyte infiltrate