In this lecture we were told about 5 of the commonest upper GI conditions:
- Oesophageal Reflux
- Oesophageal Cancer
- Peptic Ulceration
- Gastric Cancer
What is oesophageal reflux?
Reflux of gastric acid into the oesophagus
What causes oesophageal reflux?
Often caused by a hiatus hernia
What are the consequences of oesophageal reflux?
- Thickening of squamous epithelium
- Ulceration of the oesophagus
- Fibrosis -> Stricture formation
- Barrett’s Oesophagus
Define Barrett’s Oesophagus?
A Type of metaplasia where the squamous epithelium transforms into glandular epithelium
It predisposes one to oesophageal cancer (i.e. pre-malignant)
How common is oesophageal cancer?
The 3rd commonest form of alimentary tract cancer
What are the types of oesophageal cancer?
Two histological types:
- Squamous Carcinoma
Which type of oesophageal cancer does Barrett’s oesophagus predispose you to>
What are the risk factors for oesophageal cancer?
- Dietary Carcinogens
- Barrett’s Metaplasia
What are the local effects of oesophageal cancer?
Perforation -> food in thoracic cavity -> infection -> abscess
How does oesophageal cancer spread/
Direct to surrounding structures
Through lymphatics to regional lymph nodes
Through blood, most often to the liver
Whats the prognosis on oesophageal cancer?
Pretty fucking dire mate
5yr survival is <15%
What is gastritis?
Inflammation of the stomach mucosa
What types of gastritis are there?
Type A - Autoimmune
Type B - Bacterial
Type C - Chemical Injury
What happens in type A gastritis?
Autoantibodies attack parietal cells and intrinsic factor.
Causes atrophy of the specialised gastric epithelium that secrete gastric acid (parietal cells)
–> Decrease Acid Secretion & Loss of intrinsic factor
Which type of gastritis is commonest?
Type B (bacterial)
What bacteria is involved in type B gastritis?
Heliobactor Pylori (A gram -ve bacterium)
How does type B gastritis work?
Heliobacter pylori releases ammonia –> stomach detects pH rise –> Parietal cells release more acid –> Inflames itself
How is type B gastritis treated?
What causes Type C gastritis?
Drugs e.g. NSAIDS
Bile Reflux from Duodenum
What is peptic ulceration?
An imbalance of acid secretion and the mucosal barrier
Can be related to too much acid or acid where it shouldn’t be
(Usually associated with H pylori causing an increase in HCl secretion)
Where does peptic ulceration take place?
Body + antrum of stomach
1st & 2nd sections of duodenum
What are hte complications of peptic ulceration?
- Acute haemorrhage
- Chronic (more common, due to capillaries breaking) can lead to anaemia
- Digestive contents enter peritoneal cavity
- Causes Peritonitis
- Can heal to form obstruction of the GI tract
How common is gastric cancer?
The 2nd commonest alimentary tract cancer
How does gastric cancer develop?
Through phases of metaplasia and dysplasia of the stomach epithelium
What conditions are heliobactor pylori associated with?
Type B gastritis
Past infection is highly associated with gastric cancer
What type of cancer is gastric cancer?
Adenocarcinoma, as it effects the stomach lining which is glandular epithelium
How does gastric cancer spread?
Direct - to surrounding structures
Blood - Mostly often to liver
Transcoelomic - Through peritoneal cavity
Whats the prognosis for gastric cancer?
Almost as bad as oesophageal
Bet you didnt see that coming did ya
5 yr survival <20%