UPPER GI Tract

Question 1

What consists of the UPPER GI tract?

Answer 1

• Esophagus
• Stomach
• Intestines

Question 2

What’s chronic gastritis?

Answer 2

• It’s ongoing inflammation of the stomach mucosa
• Compared to acute Gastritis, symptoms less severe but more persistent
• Provides environment where dysplasia and carcinoma can arise.
• Causing many symptoms: upper abdo pain, indigestion/ bloating, belching, nausia, loss of apetite.

Question 3

What’s DYSPLASIA?

Answer 3

It’s the enlargement of an organ or tissue by rapid increase of abnormal cells .
Can be a development disorder or early stage cancer.

Question 4

What disorder are these factors describing:

• Ongoing inflammation of stomach mucosa
• Compared to the acute variety, symptoms are less severe but more persistent
• Provides an environment in which dysplasia and carcinoma can arise.

Answer 4

This is describing CHRONIC GASTRITIS

Question 5

What are the symptoms of chronic gastritis

Answer 5

• Upper abdo pain
• Indigestion/ bloating
• Nausea + vomiting
• Belching
• Loss of appetite or weight loss
• CAN BE ASYMPTOMATIC

Question 6

What disorder do these symptoms represent?

• can be asymptomatic
• belching
• indigestion/ bloating
• upper abdo pain
• nausea / vomiting
• loss of appetite/ weight loss

Answer 6

These symptoms are describing CHRONIC GASTRITIS

Question 7

What can cause chronic gastritis?

Answer 7

A - autoimmune
B - bacterial (H.Pylori)
C - chemical (alcohol, tobacco, caffeine)

and psychological stress

Question 8

What disease do these things cause:
A- Autoimmune
B- Bacteria (H.Pylori)
C- Chemical (tobacco, alcohol, caffeine)

Psychological stress

Answer 8

These things all may cause CHRONIC GASTRITIS

Question 9

What does H.Pylori stand for

Answer 9

It stands for the bacteria:
Helicobacter pylori

(Gram -ve found in stomach particularly the antrum. Infects half the world pop by age 5. Faecal-oral route)

Question 10

What is the bacterial H.Pylori linked to?

Answer 10

It’s been linked to:

• Chronic gastritis
• Development of duodenal ulcers
• Development of stomach cancer.
• Associated with gastric ulcer

Question 11

Some clinical presentations of H.Pylori?

Answer 11

• 80% asymptomatics!
• 5-10% peptic ulcer disease
• 10% non-ulcer dyspepsia
• 1-3% gastric adenocarcinoma
• 0.5% gastric MALToma

Question 12

What are common causes of peptic ulcer disease?

Answer 12

• H.Pylori infection

- NSAIDS

Question 13

True or false:

Most ulcers come in groups?

Answer 13

FALSE

Most ulcers are solitary

Question 14

Name some symptoms of peptic ulcer disease?

Answer 14

• Pain (gnawing, burning, aching)
• Worse at night
• Worse after meals

Question 15

What condition can these complications arise from?

• Bleeding leading to iron deficiency anaemia
• haematemesis (vomiting blood)
• perforation leading to peritonitis

Answer 15

These complications are from peptic ulcer disease.

Can also cause long term cancer at the edge of the ulcer.

Question 16

Name some complications of peptic ulcer disease…

Answer 16

• Bleeding leading to iron deficiency (anemia)
• Haematemesis (vomiting blood)
• perforation leading to peritoneum inflammation (peritonitis)
• Long term cancer at the edge of ulcer

Question 17

What’s Barrett’s Oesphagus?

Answer 17

It’s a condition where the normal (stratified squamous) epithelium of the oesophagus is replaced by columnar epithelium with goblet cells (usually in lower GI tract). Thought to be an adaptation to chronic acid reflux.

Question 18

What is the name of the condition where the cells of the oesophagus are changed from stratified squamous -> colunmar epithelium with goblet cells.

Answer 18

Barrett’s Oesophagus

Thought to be linked with chronic acid reflux.

Question 19

What condition has a strong association with oesophageal adenocarcinoma (0.5% per patient per year)

Answer 19

Barrett’s oesophagus

Large need for surveillance if people have this condition to prevent cancer.

Question 20

What are the types of UPPER GI tract cancers?

Answer 20

• Oesophagus (squamous carcinoma, adenocarcinoma (barrett’s)
• Stomach (Adenocarcinoma, GI stromal tumours)
• Small bowel (Lymphoma, GI stromal tumours, Neuroendocrine tumours)

Question 21

What’s another name for the cancer largely caused by Barrett’s oesophagus

Answer 21

Adenocarcinoma of the oesophagus

Question 22

What are some risk factors for developing Oesophageal squamous cell carcinoma?

Answer 22

• Adults over 45
• Male (4:1 female)
• Alcohol
• Tobacco
• Caustic injury to oesophagus
• Achalasia (condition where muscles at end of oesophagus don’t relax causing food to stay there)

Question 23

Name some symptoms of oesophageal squamous cell carcinoma.

Answer 23

• Dysphagia (difficulty swallowing)
• Weight loss
• Haemorrhage
• Sepsis
• Respiratory Fistula (with aspiration)
• Over five year survival 9%

Question 24

What are the types of Oesophageal cancers?

Answer 24

• Oesophageal squamous cell carcinoma

- Oesophageal Adenocarcinoma (Barrett’s)

Question 25

How might an oesophageal carcinoma spread?

Answer 25

- Directly (into surrounding tissue) - Lymphatic (to paraoesophageal, paratracheal and cervical node groups) - Haematogenous (to liver or lung)

Question 26

What precursor lesions may put someone at risk of getting stomach adenocarcinoma?

Answer 26

- Pernicious anaemia (atrophic gastritis) - Intestinal Metaplasia - Neoplastic polyps - Helicobacter associated gastritis

Question 27

True or false: Stomach adenocarcinoma is quite a rare carcinoma?

Answer 27

FALSE: | It's 2nd most common carcinoma worldwide

Question 28

Symptoms of Stomach Adenocarcinoma?

Answer 28

- Early symptoms resemble gastritis | - Advanced (Weight loss, anorexia, anaemia, heamorrhage)

Question 29

How might adenocarcinoma of the stomach spread?

Answer 29

- Direct (duodenum, pancreas, colon, liver, spleen) - Lymphatic (local + regional, verchow's node) - Haematogenous (liver lungs) - Transcoelomic - Omentum - Mesentery - Ovary (Krukenberg tumour)

Question 30

True or false: Small bowel neoplasia is quite a common GI malignancy

Answer 30

FALSE It's quite a rare GI malignancy

Question 31

What are some of the risk factors for small intestinal cancer?

Answer 31

- Crohn's disease - Ceoliac disease - Radiation exposure - Hereditary GI cancer syndromes (familial adenomatous polyposis)

Question 32

What type of cancer does these problems predispose you to? - Crohn's disease - Ceoliac disease - Radiation exposure - Hereditary GI cancer syndromes (familial adenomatous polyposis)

Answer 32

These conditions are all risk factors for developing small intestinal cancer.

Question 33

What causes extensive mucosal disease related to gluten sensitivity?

Answer 33

Coeliac's disease

Question 34

What is coeliac's disease?

Answer 34

Extensive mucosal disease related to sensitivity to gluten. It's immune mediated.

Question 35

What do these symptoms characterise? - pain and discomfort in the digestive tract, - chronic constipation and diarrhoea, - failure to thrive (in children), - anaemia - fatigue

Answer 35

Coeliac's disease

Question 36

Name some possible SE of Coeliac's disease

Answer 36

- pain and discomfort in the digestive tract, - chronic constipation and diarrhoea, - failure to thrive (in children), - anaemia - fatigue All symptoms including intestinal damage begins to heal within weeks of gluten being removed.

Question 37

If you have coeliac's disease, what are you more at risk of getting?

Answer 37

Having Coeliac disease can lead to increased risk of: - Adenocarcinoma - Lymphoma of the small bowel!