Upper GI pathology

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  • Created by: hadar
  • Created on: 28-02-18 11:33
What is the transition of epithelium as you move down the oesophagus to stomach?
from stratified squamous epithelial cells to columnar epithelium
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What is oesophagitis?
inflammation of the oesophagus- can be acute or chronic
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What causes oesophagitis?
1)infectious- bacterial/ viral (HSV1,CMV)/ fungal (candida) 2)chemical- ingestion of corrosive substances/ reflex of gastric contents
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What are the risk factors for reflux oesophagitis?
1)defective lower oesophageal sphincter 2)hiatus hernia 3)increased intra-abdominal pressure 4)increased gastric fluid volume due to gastric outflow stenosis
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What is a hiatus hernia?
An abnormal bulging of a portion of the stomach through the diaphragm-- sliding hiatus hernia=reflux symptoms -- para-oesophageal hernia=strangulation
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What histological features do you see in reflux oesophagitis with regards to the squamous epithelium?
1)basal cell hyperplasia 2)elongation of papillae 3)increased cell desquamation 4)inflammation
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What histological features do you see in reflux oesophagitis with regards to the lamina propria?
Inflammatory cell infiltration- neutrophils, eosinophils, lymphocytes
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What possible complications could you get with reflux oesophagitis?
1)ulceration 2)haemorrhage 3)perforation 4)benign stricture- segmental narrowing 5)barrett's oesophagus
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What causes barrett's oesophagus?
longstanding gastro-oesophageal reflux
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What are the risk factors for barrette oesophagus?
same as reflux- male, overweight, caucasian
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What histological features are present in barrett's oesophagus?
squamous mucosa replaced by columnar mucosa--> glandular metaplasia
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What macroscopic features are present in Barrett's oesophagus?
proximal extension of the squamo-columnar junction
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What are the types of columnar mucosa? (3)
1)gastric cardia type 2)gastric body type 3)intestinal type- specialised Barrett's mucosa
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What is the disease progression of Barrett's oesophagus?
barrett's--> low grade dysplasia --> high grade dysplasia--> adenocarcinoma
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What are the 2 main histological types of oesophageal carcinomas?
1)squamous cell carcinoma 2)adenocarcinoma
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What are the causes of adenocarcinoma of the oesophagus?
1)barretts 2)smoking 3)obesity
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Which location is adenocarcinoma of the oesophagus mainly present?
mainly lower oesophagus
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What are the risk factors for squamous carcinoma of the oesophagus?
1)smoking 2)alcohol 3)nutrition-sources of nitrosamines 4)thermal injury- hot drinks 5)human papilloma virus 6)male 7)ethnicity-black
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Which location is squamous carcinoma of oesophagus mainly found?
middle and lower third-->
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What is the macroscopic appearance of oesophageal cancer?
1)polypoidal 2)structuring 3)ulceration
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How is oesophageal cancer staged?
TNM system
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What is pT (in staging)and what are the stages?
pT = depth of invasion of the primary tumour pT1: tumour invades lamina propria, muscularis mucosae or submucosa pT2: tumour invades muscularis propria pT3: tumour invades adventitia pT4: tumour invades adjacent structures
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What is pN (in staging) and the stages?
pN = regional lymph nodes pN0: no regional lymph node metastasis pN1: regional lymph node metastasis in 1 or 2 nodes pN2: regional lymph node metastasis in 3 to 6 nodes pN3: regional lymph node metastasis in 7 or more nodes
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Describe the normal stomach anatomical and histological regions
4 anatomical region= cardia, funds, body, antrum 3 histological regions with different functions= cardia, body, antrum
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What causes acute gastritis and what are the consequences?
caused usually due to chemical injury= drugs (NSAID), alcohol, H.pylori -- the effects depends on the severity of the injury - can get erosion and haemorrhage
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What are the 3 causes of chronic gastritis?
1)autoimmune- anti-parietal+ anti-intrinsic factor antibodies 2)H.pylori infection 3)chemical injury- NSAIDS, blue reflux, alcohol- direct injury
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What is H.pylori, what does it cause?
Gram negative spiral shaped bacterium Lives on the epithelial surface protected by overlying mucus barrier Damages the epithelium causing chronic inflammation of mucosa More common in antrum than body
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What are the consequences of H.pylori?
Results in glandular atrophy, replacement fibrosis and intestinal metaplasia
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What are the main sites for peptic ulcer disease?
1)first part of duodenum 2)junction of antral and body mucosa 3)distal oesophagus
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What are the main risk factors for peptic ulcer disease?
1)hyperacidity 2)H.pylori infection 3)duodena-gastric reflux 4)drugs-NSAID 5)smoking
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What is peptic ulcer disease ?
Localised defect extending at least into the submucosa
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What is seen histologically in acute gastric ulcer?
1)full thickness coagulative necrosis of mucosa (or deeper layers) 2)covered with ulcer slough (necrotic debris+ fibrin+ neutrophils) 3)granulation tissue at ulcer floor
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What is seen histologically in chronic gastric ulcer?
1) clear-cut edges overhanging the base 2)extensive granulation and scar tissue at ulcer floor 3)scarring often throughout the entire gastric wall with breaching of the muscular propria 4)bleeding
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What possible complications if peptic ulcers?
1)haemorrhage (acure/chronic-anaemia) 2)perforation-peritonitis 3)penetration into an adjacent organ- liver/pancreas 4)structuring-hour-glass deformity
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What types of gastric cancer are there?
most frequent= adenocarcinoma less frequent= endocrine tumours, MALT lymphomas, stroll tumours (GIST)
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What are the risk factor for gastric adenocarcinoma?
1)Diet (smoked/cured meat or fish, pickled vegetables) 2)Helicobacter pylori infection 3)Bile reflux (e.g. post Billroth II operation) 4)Hypochlorhydria (allows bacterial growth) 5)~1% hereditary
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What is associated with carcinoma of GOJ?
White males - Association with GO reflux - No association with H. pylori / diet - Increased incidence in recent years
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What is associated with carcinoma of gastric body/antrum?
Association with H. pylori - Association with diet (salt, low fruit & vegetables) - No association with GO reflux - Decreased incidence in recent years
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what are the microscopic subtypes of gastric cancer?
1) intestinal type- Well or moderately differentiated/May undergo intestinal metaplasia and adenoma steps 2)diffuse type- poorly differentiated/ scattered growth/ catherine loss-mutation
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What is the mutation of hereditary diffuse type gastric cancer (HDGC)?
Germline CDH1/E-cadherin mutation
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What is the pathogenesis of coeliac disease?
Reaction to gliadin- Increase CD8+ intraepithelial lymphocytes- IL15 produced by the epithelium-activation/proliferation of CD8+(cytotoxic)-kill enterocytes-CD8+ dont recognise gliadin directly Gliadin-induced IL15 secretion by epithelium
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What are the different clinical presentations of coeliac?
1)atypical presentation/ non specific symptoms 2)silent disease- positive serology/villous atrophy but no signs 3)latent disease- positive serology but no villous atrophy 4)symptomatic patients- anaemia, chronic diarrhoea, bloating, chronic fatigue
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What associations with coeliac disease?
1)Dermatitis herpetiformis - 10% of patients 2)Lymphocytic gastritis and lymphocytic colitis 3)cancer- Enteropathy-associated T-cell lymphoma/Small intestinal adenocarcinoma
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How would you diagnose coeliac disease?
1)Non-invasive serologic tests- IgA antibodies to tissue transglutaminase (TTG) IgA/IgG antibodies to deamidated gliadin Anti-endomysial antibodies-highly specific but less sensitive 2) Tissue biopsy
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How would you treat coeliac disease?
1)Gluten-free diet-symptomatic improvement for most patients Reduces risk of long-term complications including anaemia, female infertility, osteoporosis, and cancer
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What are the histological features of coeliac disease?
1)villous atrophy 2)crypt elongation 3)increased IEL's 4)increased lamina propria inflammation
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Card 2

Front

What is oesophagitis?

Back

inflammation of the oesophagus- can be acute or chronic

Card 3

Front

What causes oesophagitis?

Back

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Card 4

Front

What are the risk factors for reflux oesophagitis?

Back

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Card 5

Front

What is a hiatus hernia?

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