Upper GI Pathology Year 2
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Questions and Answers

What is the primary epithelium type found in the mucosa of the oesophagus?

  • Cuboidal epithelium
  • Ciliated epithelium
  • Squamous epithelium (correct)
  • Columnar epithelium

    • Which type of oesophageal diverticulum involves all four layers of the wall?

  • Pulsion diverticulum
  • False diverticulum
  • Functional diverticulum
  • True diverticulum (correct)

    • Which condition is characterized by 'failure to relax' of the oesophageal sphincter?

  • Scleroderma
  • Achalasia (correct)
  • Reflux esophagitis
  • Diverticulitis

    • What anatomical abnormality is associated with trachea-oesophageal fistula?

    <p>Atresia</p> Signup and view all the answers

    What consequence results from an increased resting tone of the lower oesophageal sphincter?

    <p>Functional obstruction of the oesophagus</p> Signup and view all the answers

    Which type of hiatus hernia is the most common, representing 95% of cases?

    <p>Axial hernia</p> Signup and view all the answers

    Which of the following is NOT considered a major category causing dysphagia?

    <p>Lesions in the mucosa</p> Signup and view all the answers

    Which condition is NOT a primary cause of achalasia?

    <p>Amyloidosis</p> Signup and view all the answers

    What causes pulsion diverticula?

    <p>Pressure within the lumen</p> Signup and view all the answers

    What is the most common cause of oesophageal perforation?

    <p>Severe vomiting</p> Signup and view all the answers

    Which factor contributes to the development of oesophageal varices?

    <p>Portal hypertension</p> Signup and view all the answers

    What is the key histological feature of Barrett's oesophagus?

    <p>Columnar epithelium replacement</p> Signup and view all the answers

    What is the composition of a 'false' diverticulum?

    <p>Only mucosa and submucosa</p> Signup and view all the answers

    What histological changes are characteristic of reflux oesophagitis?

    <p>Basal cell hyperplasia with eosinophils</p> Signup and view all the answers

    What are potential causes of oesophagitis?

    <p>Infections, chemical irritants, and reflux</p> Signup and view all the answers

    What type of metaplasia is referred to as Barrett's oesophagus?

    <p>Squamous to glandular mucosa transition</p> Signup and view all the answers

    Which infectious agent is commonly associated with secondary achalasia?

    <p>Trypanosoma</p> Signup and view all the answers

    What characteristic finding might suggest the presence of a Mallory-Weiss tear?

    <p>Longitudinal tear in mucosa</p> Signup and view all the answers

    What is a common complication of oesophageal perforation?

    <p>Mediastinitis</p> Signup and view all the answers

    Which of the following factors could lead to reflux oesophagitis?

    <p>Hiatus hernia</p> Signup and view all the answers

    What is the term used to describe the change from squamous mucosa to glandular mucosa in the oesophagus due to chronic acid exposure?

    <p>Metaplasia</p> Signup and view all the answers

    What characterizes long-segment Barrett's oesophagus?

    <p>More than 3 cm of columnar epithelium</p> Signup and view all the answers

    Which condition results from chronic acid exposure leading to a change in oesophageal mucosa?

    <p>Barrett's oesophagus</p> Signup and view all the answers

    Which of the following is NOT a benign or malignant tumor of the oropharynx, oesophagus, or stomach?

    <p>Myopathy</p> Signup and view all the answers

    What is a common cause of salivary gland enlargement?

    <p>Viral infection</p> Signup and view all the answers

    What is the annual risk percentage of developing adenocarcinoma from Barrett's oesophagus?

    <p>0.5%</p> Signup and view all the answers

    Which histological type accounts for 70% of oesophageal cancers?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which location is most commonly affected by squamous cell carcinoma of the oesophagus?

    <p>Mid third</p> Signup and view all the answers

    What is a common lifestyle risk factor for the development of squamous cell carcinoma of the oesophagus?

    <p>Tobacco use</p> Signup and view all the answers

    What percentage of oesophageal malignancies does adenocarcinoma represent?

    <p>Around 85-90%</p> Signup and view all the answers

    What type of treatment is frequently employed for oesophageal cancer?

    <p>Surgical resection</p> Signup and view all the answers

    Which of the following is NOT a benign tumor of the oesophagus?

    <p>Adenocarcinoma</p> Signup and view all the answers

    What is a common symptom associated with both squamous cell carcinoma and adenocarcinoma of the oesophagus?

    <p>Dysphagia</p> Signup and view all the answers

    Which of the following is NOT a known cause of acute gastritis?

    <p>Acid exposure</p> Signup and view all the answers

    What histological feature is commonly observed in acute gastritis?

    <p>Infiltration by neutrophils</p> Signup and view all the answers

    Which of the following is a characteristic feature of erythroplakia?

    <p>Red, velvety area</p> Signup and view all the answers

    Which type of gastritis is characterized by the presence of mucosal atrophy and epithelial metaplasia?

    <p>Autoimmune chronic gastritis</p> Signup and view all the answers

    The presence of which bacteria is primarily associated with Helicobacter-associated gastritis?

    <p>Helicobacter pylori</p> Signup and view all the answers

    What type of salivary gland tumor is most common in the parotid gland?

    <p>Pleomorphic adenoma</p> Signup and view all the answers

    Which of the following statements about chronic gastritis is correct?

    <p>It can involve acute and chronic inflammatory responses.</p> Signup and view all the answers

    Which of the following factors is associated with Warthin’s tumor?

    <p>Older males</p> Signup and view all the answers

    What is the primary characteristic indicating malignant salivary gland tumors?

    <p>Rapid growth</p> Signup and view all the answers

    What is one potential complication of untreated chronic gastritis?

    <p>Development of dysplasia</p> Signup and view all the answers

    Which condition is NOT associated with Helicobacter pylori infection?

    <p>Esophageal reflux disease</p> Signup and view all the answers

    Which condition is characterized by inflammation of the salivary glands?

    <p>Sialadenitis</p> Signup and view all the answers

    What histological change is characterized by the infiltration of lymphocytes and plasma cells?

    <p>Chronic gastritis</p> Signup and view all the answers

    Which of the following substances is known to be corrosive and can contribute to acute gastritis?

    <p>Paraquat</p> Signup and view all the answers

    Which of the following is a common symptom of both acute and chronic gastritis?

    <p>Melaena</p> Signup and view all the answers

    What factor is associated with a higher risk of developing gastric carcinoma?

    <p>Family history</p> Signup and view all the answers

    Which histological type of gastric cancer is known for being more infiltrative and having a worse prognosis?

    <p>Diffuse type</p> Signup and view all the answers

    What is the 5-year survival rate for localized gastric cancer?

    <p>70%</p> Signup and view all the answers

    Which method is primarily used to treat Gastrointestinal Stromal Tumours (GIST)?

    <p>Tyrosine kinase inhibitor (Gleevec™)</p> Signup and view all the answers

    Which condition is characterized by a white plaque in the mouth that cannot be removed by scraping?

    <p>Leucoplakia</p> Signup and view all the answers

    What is the cure rate for submucosal involvement in early gastric cancer?

    <p>80-89%</p> Signup and view all the answers

    What is a common clinical feature of GISTs in adults?

    <p>Melaena</p> Signup and view all the answers

    What is a common diagnostic method for Helicobacter-Associated Gastritis?

    <p>Urea breath test</p> Signup and view all the answers

    Which of the following is NOT typically associated with benign tumors of the mouth?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which prognostic factor is important in determining the outcome for gastric cancer?

    <p>Depth of invasion</p> Signup and view all the answers

    Which condition is characterized by autoantibodies against parietal cells?

    <p>Autoimmune chronic gastritis</p> Signup and view all the answers

    What is the main cause of malignant tumors in the mouth linked to squamous cell carcinoma?

    <p>Irritative factors to the mucosa</p> Signup and view all the answers

    What histological change is observed in intestinal metaplasia?

    <p>Metaplasia from gastric to small intestinal epithelium</p> Signup and view all the answers

    Which type of gastritis is most commonly associated with prior gastric surgery?

    <p>Chemical / reflux gastritis</p> Signup and view all the answers

    What is the risk associated with autoimmune chronic gastritis?

    <p>Increased risk of gastric cancer</p> Signup and view all the answers

    Which of the following is NOT a typical site for peptic ulcers?

    <p>Gallbladder</p> Signup and view all the answers

    What is a consequence of decreased intrinsic factor production in autoimmune chronic gastritis?

    <p>Megaloblastic anemia due to decreased vitamin B12</p> Signup and view all the answers

    Which feature is typically seen microscopically in chemical / reflux gastritis?

    <p>Vascular ectasia</p> Signup and view all the answers

    What is a defining feature of peptic ulcers?

    <p>Breach in the mucosa extending through the muscularis mucosae into the submucosa</p> Signup and view all the answers

    What is the term for the condition where gastric epithelium undergoes metaplasia to resemble small intestine?

    <p>Intestinal metaplasia</p> Signup and view all the answers

    What is the primary factor that influences the prognosis of gastric carcinoma?

    <p>Depth of invasion</p> Signup and view all the answers

    Which type of gastric carcinoma is characterized by diffuse growth and a worse prognosis?

    <p>Diffuse type</p> Signup and view all the answers

    Which factor is associated with a significantly improved cure rate in early gastric cancer?

    <p>Confined to the mucosa</p> Signup and view all the answers

    What is a common mutation associated with Gastrointestinal Stromal Tumours (GIST)?

    <p>CD117 (c-kit)</p> Signup and view all the answers

    Which symptom is least likely associated with gastrointestinal stromal tumors (GIST) in adults?

    <p>Xerostomia</p> Signup and view all the answers

    Which of the following is a primary cause of acute gastritis?

    <p>Chronic alcohol consumption</p> Signup and view all the answers

    What histological feature is characteristic of chronic gastritis?

    <p>Infiltration by lymphocytes and plasma cells</p> Signup and view all the answers

    Which type of gastritis is commonly associated with autoimmune processes?

    <p>Autoimmune chronic gastritis</p> Signup and view all the answers

    Which clinical presentation is most consistent with acute gastritis?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is a common histological finding associated with Helicobacter-associated gastritis?

    <p>Lymphoid aggregates</p> Signup and view all the answers

    Which of the following factors is least likely to cause acute gastritis?

    <p>Long-term antibiotic therapy</p> Signup and view all the answers

    Which feature differentiates chronic gastritis from acute gastritis?

    <p>Mucosal atrophy</p> Signup and view all the answers

    What complication is associated with untreated chronic gastritis?

    <p>Gastric malignancy</p> Signup and view all the answers

    Which statement about Helicobacter pylori is accurate?

    <p>It is a urease-producing gram-negative bacterium.</p> Signup and view all the answers

    Which factor is correlated with the development of gastric carcinoma?

    <p>Chronic inflammation and atrophy</p> Signup and view all the answers

    What is the estimated annual risk percentage for the development of adenocarcinoma in patients with Barrett's oesophagus?

    <p>0.5%</p> Signup and view all the answers

    Which histological subtype is most prevalent among oesophageal cancers?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which condition is primarily associated with the development of adenocarcinoma of the oesophagus?

    <p>Barrett's oesophagus</p> Signup and view all the answers

    What is a common clinical feature associated with both types of oesophageal cancer?

    <p>Dysphagia</p> Signup and view all the answers

    What factor significantly increases the risk of developing squamous cell carcinoma of the oesophagus?

    <p>Alcohol consumption</p> Signup and view all the answers

    Which of the following statements about oesophageal cancer prognosis is accurate?

    <p>5-year survival decreases with lymph node involvement.</p> Signup and view all the answers

    What is a major feature for the presence of Barrett's oesophagus identified during an endoscopy?

    <p>Presence of goblet cells</p> Signup and view all the answers

    What type of oesophageal cancer is primarily characterized by ulcerating gross appearance?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    What is a common clinical presentation of gastric ulcers?

    <p>Epigastric pain worsened at night</p> Signup and view all the answers

    Which of the following statements accurately describes autoimmune chronic gastritis?

    <p>It may lead to pernicious anemia due to vitamin B12 deficiency.</p> Signup and view all the answers

    What microscopical feature is most indicative of reflux gastritis?

    <p>Foveolar hyperplasia</p> Signup and view all the answers

    In the microscopic appearance of peptic ulcers, which zone is NOT typically identified?

    <p>Granulomatous tissue</p> Signup and view all the answers

    In terms of gastric cancer risk, which condition is closely linked to intestinal metaplasia?

    <p>Chronic gastritis</p> Signup and view all the answers

    Which complication of peptic ulcers can result in life-threatening scenarios?

    <p>Perforation of the ulcer</p> Signup and view all the answers

    Which diagnosis can be definitively established through a biopsy?

    <p>Helicobacter-associated gastritis</p> Signup and view all the answers

    What is a characteristic feature of stress ulcers?

    <p>They are often associated with severe physical stress or trauma.</p> Signup and view all the answers

    What underlying condition must be considered when treating a patient with autoimmune chronic gastritis?

    <p>Parietal cell destruction</p> Signup and view all the answers

    Which symptom is often associated with duodenal ulcers?

    <p>Pain alleviated by eating or taking alkalis</p> Signup and view all the answers

    Which site is least commonly involved in peptic ulcer disease?

    <p>Jejunum</p> Signup and view all the answers

    What is NOT a characteristic of the gross appearance of peptic ulcers?

    <p>Rough and irregular margins</p> Signup and view all the answers

    What is the primary etiological factor in peptic ulcer disease?

    <p>Helicobacter pylori infection</p> Signup and view all the answers

    What is a potential outcome of prolonged peptic ulcer disease?

    <p>Development of dysplasia in surrounding tissues</p> Signup and view all the answers

    Which condition is characterized by metaplasia of gastric epithelium to small intestinal epithelium?

    <p>Chronic gastritis</p> Signup and view all the answers

    Which of the following is true regarding the vascular changes in the scarred area of peptic ulcers?

    <p>They may exhibit thickening and thrombosis.</p> Signup and view all the answers

    Which of the following statements about the urea breath test is correct?

    <p>It detects the presence of Helicobacter pylori.</p> Signup and view all the answers

    Which treatment option is generally not indicated for peptic ulcer disease?

    <p>Surgery for uncomplicated cases</p> Signup and view all the answers

    What is a distinguishing characteristic of complications arising from peptic ulcers?

    <p>Haemorrhage and perforation are the most frequent complications.</p> Signup and view all the answers

    Which condition may show a histological feature of vascular ectasia?

    <p>Chemical gastritis</p> Signup and view all the answers

    Which type of benign tumor is the most common in the parotid gland?

    <p>Pleomorphic adenoma</p> Signup and view all the answers

    Which characteristic is indicative of malignant transformation in pleomorphic adenoma?

    <p>Rapid growth of the tumor</p> Signup and view all the answers

    What is the percentage of Warthin's tumors that can be classified as multifocal?

    <p>10%</p> Signup and view all the answers

    What histological feature is observed in adenoid cystic carcinoma?

    <p>Cribriform, solid and tubular glands</p> Signup and view all the answers

    Which of the following statements about pleomorphic adenoma is correct?

    <p>Malignant transformation occurs in about 5% of cases.</p> Signup and view all the answers

    Which of the following is a typical characteristic of malignant salivary gland tumors?

    <p>Usually arise from minor glands</p> Signup and view all the answers

    A hiatus hernia can be classified into two types: [blank] and sliding (95%):

    <p>paraesophageal</p> Signup and view all the answers

    Commonly due to instrumentation or severe vomiting , the esophagus is a condition characterized by a tear in the mucosa of the esophagus. This condition is known as a [blank].

    <p>Mallory-Weiss syndrome</p> Signup and view all the answers

    Dilated veins due to portal hypertension, prevalent in cirrhotic patients, are known as [blank].

    <p>esophageal varices</p> Signup and view all the answers

    Causes of Achalasia

    Primary: Neural imbalance, degenerative conditions, diabetes.

    Secondary:

    Infectious ________.

    Infiltrative (tumors, amyloidosis, sarcoidosis)

    <p>agents Trypanosoma and Polio</p> Signup and view all the answers

    One of the common fungal infections of the upper GI tract is [blank].

    <p>Candida albicans</p> Signup and view all the answers

    In inflammatory disorders, examples of viral infections include [blank] and [blank].

    <p>herpes, CMV</p> Signup and view all the answers

    Inflammatory disorders can be caused by organisms such as fungal (Candida albicans), viral (Herpes, CMV), and by [blank] exposure or caustic substances.

    <p>radiation</p> Signup and view all the answers

    Which of the following are contributing factors to reflux? (Select all that apply)

    <p>Abdominal pressure</p> Signup and view all the answers

    Which of the following histological features are characteristic of Reflux Esophagitis? (Select all that apply)

    <p>Basal cell hyperplasia</p> Signup and view all the answers

    Which statements about the Esophagogastric Junction are correct? (Select all that apply)

    <p>It is located between the esophagus and stomach.</p> Signup and view all the answers

    Which of the following statements is true regarding Barrett's esophagus?

    <p>It involves squamous to glandular mucosa transformation due to chronic acid irritation.</p> Signup and view all the answers

    Which condition may develop dysplasia, leading to a risk of adenocarcinoma at approximately 0.5% per year?

    <p>Gastroesophageal reflux disease (GERD)</p> Signup and view all the answers

    Which of the following are benign tumours found in the oesophagus? (Select all that apply)

    <p>Leiomyomas</p> Signup and view all the answers

    Oesophageal tumours include benign types such as leiomyomas, lipomas, and fibromas.

    <p>True</p> Signup and view all the answers

    Malignant primary tumors predominantly are epithelial, with which of the following distributions?

    <p>Squamous (70%) and glandular (25%) types.</p> Signup and view all the answers

    Which of the following gross appearances is associated with oesophageal tumours? (Select all that apply)

    <p>All of the above</p> Signup and view all the answers

    What are common risk factors for squamous cell carcinoma (SCC) of the esophagus? (Select all that apply)

    <p>Dietary deficiencies</p> Signup and view all the answers

    Which of the following statements about squamous cell carcinoma (SCC) of the esophagus is true? (Select all that apply)

    <p>Most common in the mid third of the esophagus.</p> Signup and view all the answers

    Which of the following are risk factors for squamous cell carcinoma (SCC) of the esophagus? (Select all that apply)

    <p>Long-standing oesophagitis</p> Signup and view all the answers

    Which changes are associated with chronic gastritis? (Select all that apply)

    <p>Mucosal atrophy</p> Signup and view all the answers

    Chronic gastritis histology reveals lymphocyte and plasma cell infiltration. Which type of chronic gastritis is associated with this histological finding?

    <p>Type A (Autoimmune)</p> Signup and view all the answers

    What is a characteristic feature of acute gastritis?

    <p>Influx of neutrophils and edema</p> Signup and view all the answers

    Which of the following statements about H. pylori is correct?

    <p>It generates ammonia through urease activity.</p> Signup and view all the answers

    Which of the following statements about H. pylori is true?

    <p>gram-negative rod</p> Signup and view all the answers

    Which of the following statements about urease is true?

    <p>Urease generates ammonia and breaks down proteins.</p> Signup and view all the answers

    What characterizes Diffuse Antral Gastritis (DAG) in the stomach's antral region?

    <p>Loss of mucosal integrity stomach's antral region,</p> Signup and view all the answers

    Diffuse Antral Gastritis (DAG) is primarily caused by which of the following?

    <p>Helicobacter pylori infection</p> Signup and view all the answers

    What is true about Multifocal Atrophic Gastritis (MAG)?

    <p>A more widespread form of gastritis that causes atrophy of the gastric mucosa.</p> Signup and view all the answers

    H. pylori bacteria are found in the superficial mucous layers of the stomach lining. Which diagnostic technique can be used to detect the bacteria?

    <p>PAS staining</p> Signup and view all the answers

    Which of the following complications is associated with Autoimmune Chronic Gastritis?

    <p>Increased risk of gastric carcinoma</p> Signup and view all the answers

    What condition is typically associated with Autoimmune Chronic Gastritis and is characterized by the presence of autoantibodies against parietal cells?

    <p>Pernicious anemia</p> Signup and view all the answers

    There is a decrease in gastric acid production due to the loss of parietal cells, which condition does this describe?

    <p>A condition known as hypochlorhydria.</p> Signup and view all the answers

    Autoimmune chronic gastritis is often seen in conjunction with other autoimmune diseases, including which of the following? (Select all that apply)

    <p>Hashimoto’s thyroiditis</p> Signup and view all the answers

    In patients with chemical reflux gastritis, microscopy reveals which of the following features?

    <p>Foveolar hyperplasia and fibromuscular changes</p> Signup and view all the answers

    Intestinal metaplasia associated with chronic gastritis refers to which of the following transformations?

    <p>Transformation of gastric epithelium into intestinal-type epithelium.</p> Signup and view all the answers

    Which condition is characterized by gastrin-secreting tumors (gastrinomas) that cause excessive gastric acid production, leading to multiple peptic ulcers?

    <p>Zollinger-Ellison Syndrome</p> Signup and view all the answers

    Which of the following descriptions accurately describes peptic ulcers?

    <p>Round-oval shape with sharply punched-out edges and a smooth base, surrounded by oedematous and reddened mucosa.</p> Signup and view all the answers

    What are the characteristic features of an ulcer under miacroscob described in the provided details?

    <p>Fibrosis in the base and walls with three distinct zones</p> Signup and view all the answers

    Three distinct zones of ulcer under microscopy are [blank].

    <p>superficial slough, granulation zone, and scar zone.</p> Signup and view all the answers

    Under microscopy, ulcers can be categorized into three distinct zones which help in understanding the healing process and pathology. Vessels within the scarred area are ..........

    <p>thickened by the inflammation and are occasionally thrombosed</p> Signup and view all the answers

    Acute Gastric Ulcers ("Stress Ulcers"): Microscopy: ............... The ulcers typically occur under conditions of severe stress.

    <p>usually &lt;1mm in size, single or multiple, without scarring or thickening of blood vessels</p> Signup and view all the answers

    Acute gastric ulcers are also known as 'Stress Ulcers' and can lead to [blank] and may heal without scarring within days to several weeks.

    <p>severe bleeding</p> Signup and view all the answers

    GIST tumors are often associated with .......; treated with tyrosine kinase inhibitors like Gleevec™.

    <p>CD117 (c-kit) mutations</p> Signup and view all the answers

    Clinical features of GIST include: [blank]

    <p>abdominal pain, melaena, and rarely obstruction</p> Signup and view all the answers

    Gastrointestinal stromal tumors (GISTs) commonly present with abdominal pain and may cause melaena, while obstruction is a rare occurrence. Which of the following statements is true regarding GISTs?

    <p>GISTs are primarily found in the small intestine.</p> Signup and view all the answers

    A patient presents with abdominal pain without obstruction and is an adult. What is the likely diagnosis?

    <p>Gastrointestinal stromal tumors (GISTs)</p> Signup and view all the answers

    What is the most common site for gastric carcinoma and its prevalence? 50-60%

    <p>Antrum:</p> Signup and view all the answers

    What is the least common site for gastric carcinoma and its prevalence?

    <p>Fundus, 5%</p> Signup and view all the answers

    Benign tumors include squamous papillomas linked to which of the following HPV types?

    <p>HPV types 6 &amp; 11</p> Signup and view all the answers

    Malignant tumors of the upper gastrointestinal tract are primarily classified as squamous cell carcinoma (>95%). Which of the following factors are linked to these types of malignancies?

    <p>HPV 18,16</p> Signup and view all the answers

    Glossitis: Deficiencies in B12 and iron are associated with which condition?

    <p>Plummer-Vinson syndrome</p> Signup and view all the answers

    Which of the following infections is associated with hairy leukoplakia in HIV patients?

    <p>EBV infection</p> Signup and view all the answers

    Leukoplakia: A white plaque or patch on mucous membranes, often considered.....

    <p>premalignant due to its potential to develop into oral cancer</p> Signup and view all the answers

    Red, velvety patch with a high risk of malignancy; common in smokers and males. What is this condition called?

    <p>Erythroplakia</p> Signup and view all the answers

    Salivary Glands secrete proteins and fluid, categorized as mucinous or mixed. Ducts are lined by what type of epithelium?

    <p>Cuboidal epithelium</p> Signup and view all the answers

    Study Notes

    Learning Outcomes

    • Understand normal anatomy of the mouth, esophagus, and stomach.
    • Recognize benign and malignant tumors of the oropharynx, esophagus, and stomach.
    • Identify common conditions affecting the mouth and causes of salivary gland enlargement.
    • Diagnose causes of esophagitis and gastritis.
    • Define Barrett's esophagus.

    Esophagus Anatomy

    • Mucosa: Comprises squamous epithelium and lamina propria (loose connective tissue).
    • Submucosa: Contains connective tissue, blood vessels, and nerves.
    • Muscle Layer: Enables peristalsis.
    • Adventitia: Connective tissue covering the esophagus.

    Symptoms of Esophageal Disorders

    • Dysphagia (difficulty swallowing) caused by:
      • Lesions in the lumen (e.g., foreign body, tumors)
      • Lesions in the wall (e.g., tumors, strictures)
      • Lesions outside the wall (e.g., tumors, aortic aneurysms)
      • Functional lesions (e.g., achalasia)

    Anatomic Disorders of Esophagus

    • Developmental Abnormalities:
      • Atresia/Fistula: Often linked to pulmonary issues.
    • Acquired Abnormalities:
      • Diverticula:
        • True (involves all layers) vs. False (involves only mucosa/submucosa).
        • Pulsion: Pressure-induced; Traction: Local pathology-related.
      • Webs/Rings:
        • Webs: Thin mucosal folds (2-3mm).
        • Rings: Bands involving mucosa and submucosa.

    Hiatus Hernia

    • Affects 1-20% of adults.
    • Separation of diaphragmatic crura into:
      • Sliding (95%): Movement of stomach through diaphragm.
      • Paraesophageal: Non-axial positioning.
      • Common Complications
        • Reflux: Particularly with sliding hernias, GERD is common due to the weakening of the LES.
        • Ulceration: Both types of hernias can result in ulcers within the herniated portion of the stomach due to the continuous acid exposure or mechanical irritation.

    Esophageal Motor Disorders

    • Achalasia:
      • Characterized by failure to relax with three key abnormalities:
        • Aperistalsis (lack of peristalsis)
        • Incomplete relaxation of lower esophageal sphincter during swallowing
        • Increased resting tone of lower esophageal sphincter

    Causes of Achalasia

    • Primary: Neural imbalance, degenerative conditions, diabetes.
    • Secondary:
      • Infectious (Trypanosoma, Polio)
      • Infiltrative (tumors, amyloidosis, sarcoidosis)

    Other Esophageal Abnormalities

    • Esophageal Perforation:
      • Commonly due to instrumentation or severe vomiting (Mallory-Weiss tear).
    • Esophageal Varices:
      • Dilated veins due to portal hypertension, prevalent in cirrhotic patients.

    Inflammatory Disorders

    • Infective:
      • Fungal (Candida albicans), viral (Herpes, CMV).
    • Physical agents:
      • Radiation exposure, caustic substances.
    • Reflux:
      • Contributing factors include abdominal pressure, hiatus hernia, smoking, and alcohol.

    Reflux Esophagitis

    • Histological features include:
      • Basal cell hyperplasia, eosinophils increase, elongated lamina propria papillae.

    Esophagogastric Junction

    • Location between esophagus and stomach.
    • Contains:
      • Squamous Mucosa: Protective against physical trauma.
      • Glandular Mucosa: Produces mucus for acid protection.

    Metaplasia in the Esophagus

    • Chronic acid irritation leads to squamous to glandular mucosa transformation known as Barrett's esophagus.
    • Long-segment Barrett's: Defined as more than 3 cm of columnar epithelium.

    Barrett’s Oesophagus

    • Characterized by a junction between squamous and glandular mucosa observed during Upper GI Endoscopy.
    • Associated with persistent reflux in 3-12% of symptomatic patients.
    • May develop dysplasia, leading to a risk of adenocarcinoma at approximately 0.5% per year.
    • Requires regular surveillance endoscopy for early detection.

    Oesophageal Tumours

    • Benign tumours include leiomyomas, lipomas, and fibromas.
    • Malignant primary tumours predominantly are epithelial, with squamous (70%) and glandular (25%) types.
    • Other types include gastrointestinal stromal tumours (GIST) and secondary tumours.
    • Clinical presentation often includes dysphagia, especially for solids, along with diagnostic methods like endoscopy and biopsy.

    Squamous Cell Carcinoma (SCC)

    • Most common in the mid third of the oesophagus.
    • Histology shows keratinizing or non-keratinizing squamous lesions.
    • Symptoms include dysphagia, odynophagia, and weight loss.
    • Risk factors consist of dietary deficiencies, alcohol, tobacco use, chronic oesophagitis, achalasia, Plummer-Vinson syndrome, and genetic predispositions.

    Adenocarcinoma

    • Accounts for 85-90% of cases arising from Barrett's oesophagus, primarily located in the lower third of the oesophagus.
    • Represents approximately half of all oesophageal malignancies, with a typical onset in the mid-60s.

    Prognosis of Oesophageal Cancer

    • Spread occurs locally, to lymph nodes, and through the bloodstream.
    • Prognosis varies by stage:
      • 5-year survival for local disease ~45%, nodal disease ~25%, and distant spread ~5%.
    • Treatment options include neoadjuvant chemotherapy and radiotherapy, oesophageal resection (40% success), stenting, and adjuvant chemotherapy/radiotherapy.

    Inflammatory Disorders of the Stomach: Acute Gastritis

    • Causes include alcohol, NSAIDs, steroids, smoking, corrosives, stress, uraemia, and gastric irradiation.
    • Presentation may be asymptomatic or include epigastric pain, nausea, vomiting, anaemia, and gastrointestinal bleeding.
    • Histologically shows neutrophilic influx and oedema.

    Chronic Gastritis

    • Associated chronic mucosal changes lead to mucosal atrophy and epithelial metaplasia.
    • Most prevalent types:
      • Helicobacter-associated gastritis
      • Autoimmune chronic gastritis
      • Chemical/reflux gastritis
    • Histology reveals lymphocyte and plasma cell infiltration.

    Helicobacter-associated Gastritis

    • Affects individuals at any age and primarily involves the antrum and corpus of the stomach.
    • Caused by H. pylori, leading to epithelial damage, inflammation, and lymphoid aggregates.
    • Increased risk for peptic ulcers and gastric cancer.

    Autoimmune Chronic Gastritis

    • Typically affects the elderly with autoantibodies against parietal cells.

    • Associated with pernicious anaemia and increased gastric carcinoma risk (2-4%).Pernicious Anemia: It is a specific type of megaloblastic anemia caused by a vitamin B12 deficiency.

    • There is a decrease in gastric acid production due to the loss of parietal cells, a condition known as hypochlorhydria.

      • Autoimmune chronic gastritis is often seen in conjunction with other autoimmune diseases, including:

        -Hashimoto’s thyroiditis (an autoimmune thyroid disorder).

        -Addison's disease (an autoimmune condition affecting the adrenal glands).

    • Histological features include gland destruction and mucosal atrophy.

    Chemical / Reflux Gastritis

    • Results from the reflux of duodenal fluid and bile.
    • Frequently occurs post-gastric surgery.
    • Microscopy shows foveolar hyperplasia and fibromuscular changes.

    intestinal metaplasia

    • Associated with Chronic Gastritis
    • refers to the transformation of gastric epithelium (the normal lining of the stomach) into intestinal-type epithelium. This means that the cells lining the stomach take on characteristics of those normally found in the small intestine.
    • can progress to dysplasia
    • Endoscopic Surveillance: Patients with intestinal metaplasia, especially those with chronic gastritis or a history of H. pylori infection, may require regular endoscopic surveillance.

    Peptic Ulcer Disease

    • Caused by gastric acid affecting various sites, including the duodenum and stomach.

    • Represents a breach extending into the submucosa or deeper.

    • Risk factors include H. pylori infection, blood group A, family history, and Zollinger-Ellison syndrome.

    • Peptic ulcers: round-oval, sharply punched-out, straight walls, level margins, smooth base.

    • Surrounding mucosa appears oedematous and reddened.

    • Peptic ulcers – microscopic appearance

      • Ulcer on microscob shows fibrosis in the base and walls; has three zones: superficial slough, chronically inflamed granulation tissue, deep fibrous scar.
      • Vessel walls in scarred area may be thickened and occasionally thrombosed.

      clinical presentation for gastric and duodenal ulcers:

      Gastric Ulcers:

      • Pain: Epigastric pain that tends to be worse at night or 1-3 hours after eating.
      • Symptoms: Loss of appetite, weight loss, nausea, vomiting, bloating, belching.
      • Pain Characteristics: Often constant, can be aggravated by food.

      Duodenal Ulcers:

      • Pain: Typically relieved by eating or antacids. Pain may refer to the back, chest, or left upper quadrant (LUQ).
      • Symptoms: Iron-deficiency anemia, hematemesis (vomiting blood), melena (black tarry stools).
      • Complications: Penetrating ulcers can cause severe pain and potential perforation.

      Acute Gastric Ulcers (“Stress Ulcers”):

      • Development: Arise from acute erosive gastritis due to severe stress or shock (e.g., Cushing’s, Curling’s ulcers from burns or trauma) and can be drug-induced.
      • Microscopy: Ranges from erosion to ulceration, usually <1mm in size, single or multiple, without scarring or thickening of blood vessels.
      • Outcomes:
        • Severe bleeding.
        • Typically heal without scarring within days to several weeks.
        • May progress to chronic peptic ulcers.
      • Key Determinant: The ability to correct the underlying condition significantly affects the outcome.

    Benign Tumours of the Stomach:

    • Polyp: A nodule or mass projecting above the mucosa, uncommon in the stomach.
      • Hyperplastic Polyps (90%): Arise in chronic gastritis.
      • Adenomas (5-10%): Dysplastic epithelium with malignant potential, can be sessile or pedunculated.
      • Hamartomas: Includes Peutz-Jeghers and juvenile polyps.
      • Fundic Gland Polyps.
      • Lipomas.
      • Schwannomas.

    Malignant Tumours of the Stomach:

    • Carcinoma: Most common (90-95%).
    • Lymphoma: 4%.
    • Carcinoid Tumours: 3%.
    • Mesenchymal Tumours: 2%, including:
      • GIST (Gastrointestinal Stromal Tumours): Range from benign to malignant.
      • Leiomyosarcoma.

    Gastric Carcinoma:

    • Histologically classified into intestinal and diffuse types.

    • Epidemiology: Common cause of cancer-related deaths (after lung and colon), with a male-to-female ratio of 2:1. More prevalent in East Asia (Japan, China).

    • Risk Factors:

      • Dietary: Smoked & salted foods, low fruit and vegetables, nitrites (from food, water, meat preservation).
      • Medical Conditions: Adenomatous polyps, pernicious anemia, prior partial gastrectomy, peptic ulcer disease.
      • Infection: H. pylori.
      • Metaplasia: Intestinal metaplasia.
      • Genetic: Blood group A, family history.

    Spread occurs locally, via lymphatics (with involvement of Virchow’s node), or haematogenously.

    gastric Carcinoma Locations and Prevalence:

    • Antrum: 50-60% (most common site).
    • Body: 30-40%.
    • Fundus: 5-10% (least common).
    • Cardia: 10-20% (associated with Barrett’s esophagus and GERD).

    Gastric Cancer Spread and Prognosis:

    • Spread:

      • Local: Adjacent organs like duodenum, pancreas, retroperitoneum.
      • Trans-coelomic: Krukenberg tumour in ovaries.
      • Lymphatic: Virchow’s node (supraclavicular) and Troisier’s sign.
      • Haematogenous: Bloodborne spread.

    • Prognosis:

      • Localized: 70% 5-year survival.
      • Regional: 30% 5-year survival.
      • Distal (distant metastases): 5% 5-year survival.
      • Overall 5-year survival rate: 32%.

    Early Gastric Cancer

    • Confined to mucosa or submucosa, regardless of lymph node status.
    • Cure rates are high for intramucosal (93%) and submucosal cancers (80-89%).

    Gastrointestinal Stromal Tumours (mesenchymal tumor)

    • Non-epithelial neoplasms arising from interstitial cells of Cajal. (“pacemakers” of the intestine)

    • Often associated with CD117 (c-kit) mutations; treated with tyrosine kinase inhibitors like Gleevec™.

    • Clinical features include:

       Adults

       Abdominal pain

       Melaena

       Rarely obstruction

    Tumours of the Mouth

    • Benign tumours include squamous papillomas linked to HPV types 6 & 11.
    • Malignant cases are primarily squamous cell carcinomas, often found in the floor of mouth, tongue, and hard palate, with significant risk factors including tobacco and HPV 16/18.

    Other Oral Conditions

    • Aphthous ulcers may be associated with Crohn’s disease.
    • Xerostomia (dry mouth) can be caused by autoimmune conditions or medications.
    • Glossitis linked to nutritional deficiencies notably in vitamin B12 and iron or plummer-vinsion syndrom
    • Leucoplakia (white plaque) poses a premalignant risk; hairy leukoplakia is HIV-associated with EBV infaection
    • Erythroplakia has a high correlation with oral cancers, especially among smokers.

    Salivary Glands Pathology

    • Sialadenitis presents with sialorrhoea (excess saliva) and xerostomia.
    • Benign tumours include pleomorphic adenomas (most common in parotid gland) and Warthin’s tumour.
    • Malignant tumours are more frequently found in minor glands, often presenting with rapid growth and pain. Types include mucoepidermoid and adenoid cystic carcinoma.

    Tumours of the Mouth

    • Benign lesions include squamous papillomas associated with HPV types 6 and 11.
    • Malignant tumours are primarily squamous cell carcinoma (>95%), linked to tobacco, alcohol, HPV types 16 and 18, and environmental factors.

    Other Oral Conditions

    • Aphthous Ulcers: May be related to Crohn’s disease.
    • Xerostomia: Dry mouth resulting from autoimmune conditions, medications, or radiation.
    • Glossitis: Deficiencies in B12 and iron; associated with Plummer-Vinson syndrome.
    • Leucoplakia: White plaque not removable by scraping; cause unclear.
    • Erythroplakia: Red, velvety patch with a high risk of malignancy; common in smokers and males.

    Salivary Glands:

    • Secrete proteins and fluid, categorized as mucinous or mixed.
    • Ducts lined by cuboidal epithelium.

    Pathology of Salivary Glands:

    • Inflammation (Sialadenitis):

      • Can lead to Sialorrhoea (excessive saliva) or Xerostomia (dry mouth).
      • Parotid gland involvement:
        • Viral (e.g., mumps).
        • Suppurative (e.g., Staphylococcus aureus).
        • Autoimmune (e.g., Sjogren’s syndrome).

    • Tumours:

      • Can be either benign or malignant.

    Benign Tumours

    • Typically present as painless swelling.

    • Pleomorphic Adenoma: Most common parotid tumour.

      • More frequent in females than males.
      • Encapsulated structure with epithelial elements embedded in mucoid and chondroid stroma.
      • Treated through wide excision; however, local recurrence is common.
      • Difficult to completely excise, with a 25% chance of nucleation.
      • Risk of malignant transformation occurs in approximately 2%.

    • Warthin’s Tumour: Accounts for 10% of parotid tumours.

      • Predominantly found in older males, especially smokers.
      • Features include a double layer of epithelial cells in a dense lymphoid stroma, with oncocytes and secretory cells, possibly exhibiting squamous metaplasia.
      • Known as "adenolymphoma."
      • Multifocality and bilateral occurrence found in 10% of cases.

    Malignant Tumours

    • More frequently observed in minor salivary glands.
    • Indications of malignancy include rapid growth and pain.
    • Types of Malignant Tumours:
      • Mucoepidermoid Carcinoma: Composed of glandular and squamous cells.
      • Adenoid Cystic Carcinoma: Characterized by cribriform, solid, and tubular gland formations, often with perineural invasion.
      • Acinic Cell Carcinoma: Resembles normal acinar cells.
      • Carcinoma ex Pleomorphic Adenoma: Originates from benign pleomorphic adenomas, transforming into malignant forms.

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    Description

    This quiz covers key concepts in Upper GI Pathology for Year 2 students at RCSI. It focuses on normal anatomy and conditions affecting the mouth, esophagus, and stomach, including benign and malignant tumors. Understand the causes of salivary gland enlargement and other related topics to prepare for your pathology exams.

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