Upper GI Tract Pathology

Question 1

define oesophageal reflux

Answer 1

reflux of acid into oesophagus

Question 2

how can oesophageal reflux arise?

Answer 2

if the lower oesophageal sphincter doesn’t work properly a hiatus hernia occurs where the stomach refluxes into the oesophagus.

Question 3

what is the response of the oesophageal epithelium to gastric acid?

Answer 3

thickening of the squamous epithelium

Question 4

what can occur in severe reflux?

Answer 4

ulceration of the epithelium creates inflammation

Question 5

what complications can occur with an oesophageal reflux?

Answer 5

> fibrosis

> barrett’s oesophagus

Question 6

describe the process of fibrotic healing of an oesophageal reflux

Answer 6

> stricture formation, scar tissue causes narrowing of tube
impaired oesophageal motility
= oesophageal obstruction

Question 7

what is metaplasia?

Answer 7

one normal tissue transforms into another normal tissue

Question 8

what metaplasia takes place in barretts oesophagus?

Answer 8

squamous epithelium transforms to glandular epithelium

Question 9

what can barretts oesophagus predispose?

Answer 9

malignant conditions, cancer

Question 10

what is the third commonest cancer of the alimentary tract?

Answer 10

oesophageal cancer

Question 11

what are the two histological types of oesophageal cancer?

Answer 11

squamous carcinoma

adenocarcinoma

Question 12

what type of oesophageal cancer arises from barretts oesophagus?

Answer 12

adenocarcinoma

Question 13

what are the risk factors associated with squamous carcinoma oesophageal cancer?

Answer 13

smoking
alcohol
dietary carcinogens

Question 14

how can obesity lead to (adenocarcinoma) oesophageal cancer?

Answer 14

the large abdomen puts pressure on the stomach, pushing it through the lower oesophageal sphincter creating a hernia

Question 15

what are the local effects of oesophageal cancer?

Answer 15

> obstruction
ulceration
perforation

Question 16

how may ulceration from an oesophageal tumour cause anaemia?

Answer 16

ulceration causes cell death so when the vessels on top of the ulcer erode there is blood loss = anaemia

Question 17

describe perforation of an oesophageal tumour

Answer 17

if cell death is sustained a hole through the tumour may occur. food may then enter the thorax and cause infection.

Question 18

how may oesophageal cancer spread?

Answer 18

> directly to surrounding structures
through the lymphatics to regional lymph nodes
through the blood to the liver

Question 19

what is the prognosis for oesophageal cancer?

Answer 19

very poor as the 5 year survival rate is less than 15%

Question 20

what are the three types of gastritis?

Answer 20

> autoimmune
bacterial
chemical injury

Question 21

what is the most common type of gastritis?

Answer 21

bacterial

Question 22

what do antibodies in autoimmune gastritis target?

Answer 22

parietal cells and intrinsic factor

Question 23

what is autoimmune gastritis associated with?

Answer 23

other autoimmune diseases

Question 24

what is the pathology of autoimmune gastritis?

Answer 24

> atrophy of specialised acid secreting gastric epithelium
loss of specialised gastric epithelial cells: decreased secretion factor and loss of intrinsic factor (pernicious anaemia)

Question 25

describe the bacteria that causes bacterial gastritis

Answer 25

> helicobacter pylori related > gram negative > found in gastric mucous of surface epithelium

Question 26

what is the effect of bacterial in bacterial gastritis?

Answer 26

> increase in acid production | > acute and chronic inflammatory response

Question 27

is bacterial gastritis treatable?

Answer 27

yes and reversible

Question 28

what can cause chemical gastritis?

Answer 28

> Drugs (NSAIDs) > alcohol > bile reflux

Question 29

an imbalance in what causes peptic ulceration?

Answer 29

between the acid secretion and mucosal barrier

Question 30

what parts of the alimentary system are effected by peptic ulceration?

Answer 30

> lower oesophagus > body and antrum of the stomach > first and second parts of the duodenum

Question 31

what is peptic ulceration often associated with?

Answer 31

H. pylori (increased gastric acid)

Question 32

what are the complications associated with peptic ulceration?

Answer 32

> bleeding (acute/chronic) > perforation (peritonitis) > Fibrosis (obstruction)

Question 33

what is the second commonest cancer of the alimentary tract?

Answer 33

gastric cancer

Question 34

what phase does gastric cancer develop?

Answer 34

through phases of intestinal metaplasia and dysplasia

Question 35

what infection gastric cancer often associated with?

Answer 35

previous h. pylori infection

Question 36

what is the histology of gastric cancer?

Answer 36

adenocarcinoma

Question 37

how does stomach cancer spread?

Answer 37

> directly > through lymphatics > through the blood > transcoelomic

Question 38

describe transcoelomic spread of stomach cancer

Answer 38

the tumour penetrates all layers of the stomach wall and tumour cells are released in the peritoneal cavity

Question 39

what is the prognosis of stomach cancer?

Answer 39

very poor, 5 year survival rate is less than 20%