Upper GI tract pathology

Question 1

What does the upper GI tract consist of?

Answer 1

oesophagus, stomach and duodenum

Question 2

What type of pain do upper GI tract diseases cause?

Answer 2

Upper abdominal or retrosternal discomfort or pain or ‘indigestion’

Question 3

What are the diseases of the upper GI tract?

Answer 3

• Oesophageal reflux
• Oesophageal cancer
• Gastritis
• Peptic ulceration
• Gastric cancer

Question 4

What is one of the causes of oesophageal reflux?

Answer 4

Hiatus hernia - less sphincter action

Question 5

What are the outcomes of Oesophageal reflux?

Answer 5

• Thickening of squamous epithelium
• Ulceration of oesophagus when severe reflux
• Healing by fibrosis which results in stricture formation, reduced oesophageal motility and obstruction (scar tissue contracts - problem with passing food)
• Barrett’s oesophagus - Metaplasia – transformation of one normal tissue to another tissue – transformation from squamous epithelium to glandular epithelium, precursor of oesophageal adenocarcinoma

Question 6

What are the two types of oesophageal cancer?

Answer 6

–Squamous carcinoma

–Adenocarcinoma

•Develops from Barrett’s oesophagus

Question 7

What are the Risk Factors for
Oesophageal Cancer?

Answer 7

•Squamous carcinoma

–Smoking

–Alcohol

–Dietary carcinogens

•Adenocarcinoma

–Barrett’s metaplasia

–Obesity

Question 8

What are the local effects of oesophageal cancer?

Answer 8

• Obstruction
• Ulceration
• Perforation

Question 9

What is meant by ulcer?

Answer 9

An erosion of the skin or mucus membrane

Question 10

Describe the spread of oesophageal cancer

Answer 10

•Direct

–To surrounding structures

•Lymphatic spread

–To regional lymph nodes

•Blood spread

–Liver

Question 11

What is the prognosis of oesophageal cancer?

Answer 11

•Very poor

–5 year survival rate less than 15%

Question 12

What are the different ways of getting gastritis?

Answer 12

ABC

A - Autoimmune

B - Bacterial

C - Chemical injury

Question 13

What do autoantibodies attack in autoimmune gastritis?

Answer 13

Parietal cells and intrinsic factor

Question 14

What is the result of autoimmune gastritis on the epithelium of the stomach?

Answer 14

Acid secreting epithelium and specialised gastric epithelial cells are lost

Results in a decrease in acid secretion and a loss in intrinsic factor (Vitamin B12 deficiency (pernicious anaemia))

Question 15

What is the most common type of gastritis?

Answer 15

Bacterial

Question 16

What bacteria is responsible for bacterial gastritis and how does it function?

Answer 16

Helicobacter pylori - gram negative, found in the gastric mucus

H. pylori also neutralizes the acid in its environment by producing large amounts of urease, which breaks down the urea present in the stomach to carbon dioxide and ammonia. These react with the strong acids in the environment to produce a neutralized area around H. pylori. This increases acid produciton by the stomach.

Causes an acute and a chronic inflammatory response

Question 17

What are the common causes of chemical gastritis?

Answer 17

•Drugs

–Non-steroidal anti-inflammatory drugs (NSAIDs)

• Alcohol
• Bile reflux (from duodenum into the stomach)

Question 18

What causes peptic ulceration?

Answer 18

•Imbalance between acid secretion and mucosal barrier

Question 19

What does peptic ulceration affect?

Answer 19

All parts of the upper GI

–Lower oesophagus

–Body and antrum of stomach

–First and second parts of duodenum

Question 20

What is peptic ulceration often secondary to?

Answer 20

H. Pylori associated

Question 21

What are the complications of peptic ulceration?

Answer 21

•Bleeding

–Acute = haemorrhage

–Chronic = anaemia

•Perforation

–Peritonitis

•Healing by fibrosis

–Obstruction (Obstruction in distal stomach, lower oesphagus or even duodenum)

Question 22

What is gastric cancer often secondary to?

Answer 22

H.Pylori

Question 23

What type of cancer is gastric cancer?

Answer 23

Adenocarcinoma

Question 24

Where is obstruction likely to occur as a result of gastric cancer?

Answer 24

In the antrum of the stomach as opposed to the stomach

Question 25

What is the spread of stomach cancer?

Answer 25

•Direct

–Spread to surrounding structures

•Lymphatic

–Spread to regional lymph nodes

•Blood spread

–Liver

•Transcoelomic spread

–Spread within peritoneal cavity

Question 26

What is the prognosis of stomach cancer?

Answer 26

•Very poor

–5 year survival rate less than 20%