Upper GI Tract Pathology

Question 1

Hiatus hernia

Answer 1

Causes a reflux of gastric acid into the oesophagus

Question 2

Result of oesophageal reflux on squamous epithelium

Answer 2

Epithelium thickens

Question 3

Severe oesophageal reflux

Answer 3

Ulceration

Question 4

Complications of oesophageal reflux

Answer 4

Healing by fibrosis

Barrett’s oesophagus

Question 5

Oesophageal reflux healing by fibrosis

Answer 5

Stricture formation
Impaired oesophageal motility
Oesophageal obstruction

Question 6

Oesophageal stricture

Answer 6

A narrowing or tightening of the oesophagus that causes swallowing difficulties

Question 7

Barrett’s oesophagus

Answer 7

Type of metaplasia - from squamous to glandular epithelium

Pre malignant condition

Question 8

Histological types of oesophageal cancer

Answer 8

Squamous carcinoma

Adenocarcinoma (develops from Barrett’s oesophagus)

Question 9

Risk factors for oesophageal cancer (squamous carcinoma)

Answer 9

Smoking
Alcohol
Dietary carcinogens

Question 10

Risk factors for oesophageal cancer (adenocarcinoma)

Answer 10

Barrett’s metaplasia

Obesity

Question 11

Local effects of oesophageal cancer

Answer 11

Obstruction
Ulceration
Perforation

Question 12

Presentation of oesophageal cancer

Answer 12

Dysphagia - first food, then liquids

Question 13

Ulceration

Answer 13

Exposes blood vessels to lumenal contents

Question 14

Spread of ooesophageal cancer

Answer 14

Direct
Lymphatic
Blood

Question 15

Direct spread of oesophageal cancer

Answer 15

To surrounding structures

Question 16

Lymphatic spread of oesophageal cancer

Answer 16

To regional lymph nodes

Question 17

Blood spread of oesophageal cancer

Answer 17

To liver

Question 18

Metastases from oesophageal cancer

Answer 18

High proportion of presentations

Question 19

Type A gastritis

Answer 19

Autoimmune

Question 20

Type B gastritis

Answer 20

Bacterial

Question 21

Type C gastritis

Answer 21

Chemical injury

Question 22

Autoimmune gastritis

Answer 22

Organ-specific autoimmune disease
Autoantibodies to parietal cells and intrinsic factor
Associated with other autoimmune diseases

Question 23

Pathology of autoimmune gastritis

Answer 23

Atrophy of specialised acid secreting gastric epithelium

Loss of specialised gastric epithelial cells

Question 24

Loss of specialised acid secreting gastric epithelium

Answer 24

Decreased acid secretion

Loss of intrinsic factor leading to vitamin B12 deficiency (pernicious anaemia)

Question 25

Bacterial gastritis

Answer 25

Most common form | Helicobacter pylori related

Question 26

Helicobacter pylori

Answer 26

Gram negative bacterium Found in gastric mucus on surface of gastric epithelium Produces acute and chronic inflammatory response Increased acid production

Question 27

Chemical gastritis

Answer 27

Drugs (NSAIDs) Alcohol Bile reflux

Question 28

Peptic ulceration

Answer 28

Imbalance between acid secretion and mucosal barrier Affects oesophagus, stomach, duodenum Usually H. pylori associated

Question 29

Complications of peptic ulceration

Answer 29

Bleeding Perforation Healing by fibrosis

Question 30

Acute bleeding

Answer 30

Haemorrhage

Question 31

Chronic bleeding

Answer 31

Anaemia

Question 32

Perforation

Answer 32

Peritonitis

Question 33

Pathology of gastric cancer

Answer 33

Develops through phases of intestinal metaplasia and dysplasia Associated with previous H.pylori infection Adenocarcinoma

Question 34

Adenocarcinoma

Answer 34

Glandular cancer

Question 35

Spread of gastric cancer

Answer 35

Direct Lymphatic Blood spread Transcoelomic spread

Question 36

Transcoelomic spread

Answer 36

Spread within peritoneal cavity