Upper GI Tract Pathology

Question 1

What is oesophageal reflux?

Answer 1

Reflux of gastric acid into oesophagus

Question 2

What commonly causes oesophageal reflux?

Answer 2

Hiatus hernia

Question 3

What is a hiatus hernia?

Answer 3

Part of stomach protrudes into thorax

Question 4

What is thickening of oesophageal squamous epithelium a pathological response to?

Answer 4

Presence of acid in oesophagus (usually short lived)

Question 5

What occurs in the oesophagus when reflux is severe?

Answer 5

Ulceration

Question 6

What is present in anatomy of the oesophagus which should prevent reflux?

Answer 6

Lower oesophageal sphincter

Question 7

What are 2 possible complications from oesophageal reflux?

Answer 7

• Healing by fibrosis

- Barretts

Question 8

Describe oesophageal healing by fibrosis

Answer 8

Stricture formation; impaired oesophageal motility; oesophageal obstruction

Question 9

What is Barrett’s oesophagus?

Answer 9

Type of metaplasia; pre-malignant condition for adenocarcinoma oesophageal cancer

Question 10

What is metaplasia and what occurs in Barretts metaplasia?

Answer 10

Metaplasia is transformation from one normal tissue type to another normal tissue type - in Barretts it is squamous to glandular epithelium

Question 11

What are the 2 histological types of oesophageal cancer?

Answer 11

SQUAMOUS CARCINOMA

ADENOCARCINOMA

Question 12

Give 3 risk factors for squamous carcinoma

Answer 12

• smoking
• alcohol
• dietary carcinogens e.g. processed meats

Question 13

Give 2 risk factors for adenocarcinoma

Answer 13

• Barrett’s

- obesity (increased reflux due to increased intra-abdominal pressure)

Question 14

Give 3 local effects of oesophageal cancer

Answer 14

Obstruction
Perforation
Ulceration

Question 15

Where does oesophageal cancer directly spread?

Answer 15

To surrounding structures i.e. lungs, lymphatic spread to regional lymph nodes

Question 16

Where can oesophageal cancer spread via blood?

Answer 16

Liver

Question 17

What is the prognosis for oesophageal cancer?

Answer 17

VERY POOR (5 year survival rate less than 15%; high percentage have metastatic disease)

Question 18

What are the 3 types of gastritis?

Answer 18

Autoimmune (TYPE A)
Bacterial (TYPE B)
Chemical injury (TYPE C)

Question 19

What is type A gastritis?

Answer 19

Organ-specific autoimmune disease; autoantibodies to parietal cells and therefore intrinsic factor; associated with other autoimmune diseases

Question 20

Describe the pathology of type A gastritis

Answer 20

Atrophy of specialised acid secreting gastric epithelium; loss of specialised gastric epithelial cells

Question 21

What does the pathology of type A gastritis result in?

Answer 21

• Decrease acid secretion

- Loss of intrinsic factor (B12 deficiency - pernicious anaemia)

Question 22

What is the role of parietal cells in the stomach?

Answer 22

Make stomach acid and intrinsic factor

Question 23

How can a person with type A gastritis present?

Answer 23

Tired, pale complexion, heart problems (exercise intolerance, palpitations), pernicious anaemia, person usually has other autoimmune disease

Question 24

What is the most common type of gastritis?

Answer 24

Bacterial

Question 25

What bacteria is typically associated with bacterial (type B) gastritis?

Answer 25

H. pylori (gram neg)

Question 26

What does H. pylori produce?

Answer 26

Enzyme that convert urease to ammonia and carbonate (therefore rising pH associated with infection)

Question 27

How does someone with type B gastritis present?

Answer 27

Nausea, bloating, vomiting, indigestion, burning/gnawing feeling in stomach between meals, haematemesis, black tarry stool (acute and chronic inflammatory response)

Question 28

What does the produce produce to try to combat type B gastritis?

Answer 28

Inflammatory acid - to try to raise pH - leads to acid reflux (so treatment often includes e.g. PPI or H2-blocker as well as abx)

Question 29

Where is H pylori found?

Answer 29

Gastric mucous on surface of gastric epithelium

Question 30

What can cause type C gastritis?

Answer 30

- Drugs (NSAIDs) - Alcohol - Bile reflux

Question 31

What causes peptic ulceration?

Answer 31

Imbalance between acid secretion and mucosal barrier

Question 32

Where can peptic ulcers appear?

Answer 32

Lower oesophagus, body + antrum of stomach, 1st + 2nd parts of stomach, 1st + 2nd parts of duodenum

Question 33

What bacteria is peptic ulceration associated with?

Answer 33

H. pylori (because causes increased acid secretion)

Question 34

What are 3 potential complications of peptic ulceration?

Answer 34

- Bleeding - Perforation - Healing by fibrosis

Question 35

What are some further complications from bleeding of peptic ulcer?

Answer 35

``` Acute = haemhorrage (large blood vessel at base of ulcer) Chronic = anaemia ```

Question 36

What is a further complication of perforation?

Answer 36

Release of gastric contents into peritoneum - resulting in peritonitis

Question 37

What is peritonitis?

Answer 37

Inflammation of the peritoneum; serious condition - IV abx immediately to treat

Question 38

What can healing by fibrosis result in?

Answer 38

Obstruction in lumen

Question 39

What is the 2nd commonest cancer of the alimentary tract?

Answer 39

Stomach cancer

Question 40

How does stomach cancer develop?

Answer 40

Phases of intestinal metaplasia and dysplasia

Question 41

What infection is stomach cancer associated with?

Answer 41

H. pylori

Question 42

Histologically, what type of cancer is stomach cancer?

Answer 42

Adenocarcinoma - arises in glandular epithelium

Question 43

Where can stomach cancer directly spread?

Answer 43

Surrounding structures; lymphatic spread to regional lymph nodes

Question 44

Where can stomach cancer spread via blood?

Answer 44

Liver

Question 45

What other type of spread is found in stomach cancer?

Answer 45

Trans-coelemic spread - within peritoneal cavity

Question 46

What is the prognosis for stomach cancer?

Answer 46

Very poor - 5 yr survival rate under 20%