Upper GI histopath

Question 1

The oesophagus is made up of 2 types of epithelial cells, what are they? and how much of the oesophagus does each occupy?

Answer 1

Squamous upper 2/3
Simple columnar lower 1/3
(they are joined by the sqamou-columnar junction = Z line)

Question 2

What are the complications of GORD? (5)

Answer 2

Ulceration
Haemorrhage - can present as malena or haematemesis
Barrett's oesophagus
Stricture
Perforation

Question 3

What is the commonest cause of oesophagitis?

Answer 3

GORD

Question 4

Treatment for GORD (3)

Answer 4

Lifestyle changes - smoking cessation, weight loss
PPI
H2 receptor antagonists

Question 5

What is Barrett’s oesophagus?

Answer 5

Intestinal metaplasia of squamous mucosa > columnar epithelium following chronic GORD (because they have more goblet cells) > upwards migration of SCJ

Question 6

What percentage of those with symptomatic GORD have Barrett’s?

Answer 6

10%

Question 7

Where is oesophageal adenocarcinoma most commonly seen?

Answer 7

Distal 1/3 of oesophagus - because associated with Barrett’s

Question 8

Other risk factors for oesophageal adenocarcinoma (3)

Answer 8

smoking
obesity
prior radiation therapy

Question 9

Oesophageal adenocarcinoma most common in which ethnicity? & gender?

Answer 9

Caucasians

M&raquo_space; F

Question 10

What are some risk factors for squamous cell carcinomas of oesophagus? (5)

Answer 10

Main is ETOH & smoking
achalasia
Plummer-vinson syndrome
nutritional deficiencies
nitrosamines

Question 11

In which ethnicity & gender is squamous cell carcinomas of oesophagus more common?

Answer 11

Afro-carribeans

M > F

Question 12

Presentation of squamous cell carcinomas of oesophagus? (4)

Answer 12

progressive dysphagia (solids then liquids)
odynophagia
severe weight loss
anorexia

Question 13

squamous cell carcinomas of oesophagus treatment?

Answer 13

Mainly palliative as it has rapid growth & early metastasis

Question 14

What are oesophageal varices?

Answer 14

Dilated & engorged veins - most commonly due to portal HTN (back pressure)

Question 15

Presentation of oesophageal varices? (1)

Answer 15

Severe haematemesis

Question 16

Management of Varices? (2)

Answer 16

Emergency endoscopy

Sclerotherapy/ banding

Question 17

Causes of acute gastritis (5)

Answer 17

Acute - neutrophils main wbc, causes:

NSAIDS, aspirin, acute H. Pylori, severe stress e.g. burn

Question 18

Causes of Chronic gastritis (4)

Answer 18

Chronic - lymphocytes, plasma cells. Causes:

Chronic H. Pylori, pernicious anemia, alcohol, smoking

Question 19

Special types of gastritis: infectious, chemical, IBD

Answer 19

Infectious - HSV, CMV
Chemical - foveolar hyperplasia
IBD

Question 20

Complications of Gastritis (2)

Answer 20

Ulcer

Cancer (metaplasia > dysplasia > cancer)

Question 21

What is a gastric ulcer?

Answer 21

A breach through muscularis mucosa, into the submucosa

Question 22

Presentation of gastric ulcer (3)

Answer 22

Epigastric pain - relieved by antacids
worse with food
weight loss possible

Question 23

Risk factors for gastric ulcer (4)

Answer 23

Smoking, H. Pylori, NSAIDs, delayed gastric emptying

mostly occurs in elderly

Question 24

Investigations for gastric ulcer

Answer 24

Biopsy for H. Pylori status - PUNCHED OUT LESION with ROLLED margins

Question 25

Complications of gastric ulcer (3)

Answer 25

Malignancy IDA Perforation (perform erect chest x-ray)

Question 26

Gastric lymphoma cause

Answer 26

Due to chronic H-pylori - chronic ag stimulation > lymphoma

Question 27

Treatment of Gastric lymphoma (1)

Answer 27

remove cause - H. Pylori triple therapy: PPI + clarithro + amox/ metro

Question 28

Presentation of duodenal ulcer (3)

Answer 28

``` (4 times more common than GU) Epigastric pain relieved by food & milk worse at night (occurs in young adults) ```

Question 29

Risk factors for duodenal ulcers (5)

Answer 29

drugs, H. pylori, NSAIDs, steroids, smoking

Question 30

Complications of duodenal ulcer (2)

Answer 30

IDA, Perforation

Question 31

Coeliac disease HLA assocations (2)

Answer 31

HLA DQ2 & DQ8 (t-cell mediated disease) gluten intolerance results in villous atrophy + malabsorption

Question 32

Presentation of Coeliacs (7)

Answer 32

young children or Irish women Symptoms of malabsorption - bloating, N&v, abdo pain, steatorrhea, weight loss IDA Rash - dermatitis herpetiformis

Question 33

Serological tests in coeliacs (3) (abs)

Answer 33

``` Anti-endomysial (best sen & spec) Anti TTG Anti gliadin (poor marker for disease control) ```

Question 34

Gold standard investigation for Coeliacs

Answer 34

Upper GI endoscopy & duodenal biopsy - villous atrophy, crypt hyperplasia, lymphocyte infiltrate

Question 35

Risk of Duodenal T-cell lymphoma in coeliacs not treated properly ?

Answer 35

10% if not treated properly