Upper GI histopath Flashcards Preview

Pathology > Upper GI histopath > Flashcards

Flashcards in Upper GI histopath Deck (35):
1

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)

2

What are the complications of GORD? (5)

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

3

What is the commonest cause of oesophagitis?

GORD

4

Treatment for GORD (3)

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

5

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

6

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

10%

7

Where is oesophageal adenocarcinoma most commonly seen?

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

8

Other risk factors for oesophageal adenocarcinoma (3)

smoking
obesity
prior radiation therapy

9

Oesophageal adenocarcinoma most common in which ethnicity? & gender?

Caucasians
M >> F

10

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

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

11

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

Afro-carribeans
M > F

12

Presentation of squamous cell carcinomas of oesophagus? (4)

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

13

squamous cell carcinomas of oesophagus treatment?

Mainly palliative as it has rapid growth & early metastasis

14

What are oesophageal varices?

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

15

Presentation of oesophageal varices? (1)

Severe haematemesis

16

Management of Varices? (2)

Emergency endoscopy
Sclerotherapy/ banding

17

Causes of acute gastritis (5)

Acute - neutrophils main wbc, causes:
NSAIDS, aspirin, acute H. Pylori, severe stress e.g. burn

18

Causes of Chronic gastritis (4)

Chronic - lymphocytes, plasma cells. Causes:
Chronic H. Pylori, pernicious anemia, alcohol, smoking

19

Special types of gastritis: infectious, chemical, IBD

Infectious - HSV, CMV
Chemical - foveolar hyperplasia
IBD

20

Complications of Gastritis (2)

Ulcer
Cancer (metaplasia > dysplasia > cancer)

21

What is a gastric ulcer?

A breach through muscularis mucosa, into the submucosa

22

Presentation of gastric ulcer (3)

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

23

Risk factors for gastric ulcer (4)

Smoking, H. Pylori, NSAIDs, delayed gastric emptying
(mostly occurs in elderly)

24

Investigations for gastric ulcer

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

25

Complications of gastric ulcer (3)

Malignancy
IDA
Perforation (perform erect chest x-ray)

26

Gastric lymphoma cause

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

27

Treatment of Gastric lymphoma (1)

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

28

Presentation of duodenal ulcer (3)

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

29

Risk factors for duodenal ulcers (5)

drugs, H. pylori, NSAIDs, steroids, smoking

30

Complications of duodenal ulcer (2)

IDA, Perforation

31

Coeliac disease HLA assocations (2)

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

32

Presentation of Coeliacs (7)

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

33

Serological tests in coeliacs (3) (abs)

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

34

Gold standard investigation for Coeliacs

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

35

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

10% if not treated properly