Alimentary pathology

Question 1

What is dyspepsia?

Answer 1

A group of symptoms describing pain or discomfort in the upper abdomen

Question 2

What are the symptoms of dyspepsia?

Answer 2

Upper abdominal pain or discomfort 
Retrosternal pain 
Anorexia
Nausea
Vomiting 
Early satiety
Bloating 
Heartburn

Question 3

What is anorexia?

Answer 3

Loss of appetite or loss of interest in food

Question 4

What are the two main types of dyspepsia?

Answer 4

Organic dyspepsia

Functional dyspepsia

Question 5

What is organic dyspepsia?

Answer 5

Dyspepsia caused by a clearly defined underlying pathological process adversely affecting the structure and function of cells in the alimentary canal

Question 6

What is functional dyspepsia?

Answer 6

Dyspepsia occurring despite no abnormalities being present in the cells of the alimentary canal

Question 7

Causes of organic dyspepsia in the upper GI tract?

Answer 7

GORD
Peptic ulcer disease
Gastric cancer
Gastritis

Question 8

Causes of organic dyspepsia in the colon?

Answer 8

IBD

Colonic cancer

Question 9

Causes of organic dyspepsia in small intestine?

Answer 9

Duodenal ulcer

Coeliac disease

Question 10

What are red flag symptoms of dyspepsia?

Answer 10

Anorexia 
Weight loss
Iron deficiency anaemia 
Recent onset in a patient over 55y/o
Persistence despite treatment 
GI bleeding 
Mass
Dysphagia

Question 11

Appropriate response to red flag symptom in patient with dyspepsia?

Answer 11

Referral for endoscopy

Question 12

What are the functions of an upper GI endoscopy?

Answer 12

Diagnosis

Therapeutic function

Question 13

What is the risk of perforation in an upper GI endoscopy?

Answer 13

1 in 2000

Question 14

Appropriate response to a patient presenting with dyspepsia who has no red flag symptoms and is younger than 55 y/o?

Answer 14

Test for Helicobacter pylori

Question 15

What type of bacteria is Helicobacter pylori?

Answer 15

Spiral (comma) shaped
Flagellated
Gram negative

Question 16

Where in the alimentary canal does Helicobacter pylori colonise?

Answer 16

Gastric type mucosa

Question 17

How does Helicobacter pylori survive the harsh conditions of the stomach?

Answer 17

Uses flagellum to hide in gastric mucus

Uses urease to create protective alkaline halo

Question 18

Helicobacter pylori infection raises the risk of what serious GI pathology?

Answer 18

Gastric cancer

Question 19

What are the potential outcomes of infection with Helicobacter Pylori?

Answer 19

Asymptomatic 
Chronic gastritis 
Intestinal metaplasia 
Gastric cancer 
MALT lymphoma
Chronic atrophic gastritis 
Peptic ulcer

Question 20

What is the potential outcome of chronic Helicobacter pylori infection in the antrum of the stomach?

Answer 20

Duodenal ulcer

Question 21

What is the potential outcome of chronic Helicobacter pylori infection in the body of the stomach?

Answer 21

Gastric cancer

Question 22

What is liver failure a complication of?

Answer 22

Acute liver injury

Chronic liver injury

Question 23

What are the potential causes of acute liver injury?

Answer 23

Drugs
Alcohol
Viruses
Bile duct obstruction

Question 24

Which two causes of viral hepatitis are closely related?

Answer 24

Hepatitis B and D

Question 25

Which causes of viral hepatitis lead to chronic hepatitis and cirrhosis?

Answer 25

Hepatitis B and C

Question 26

What cells are damaged by hepatitis?

Answer 26

Hepatocytes

Question 27

What are the potential outcomes of viral hepatitis?

Answer 27

Resolution and return to normal function Chronic hepatitis leading to cirrhosis Liver failure

Question 28

Reason for excess alcohol consumption causing a fatty liver?

Answer 28

Alcohol affects fat metabolism

Question 29

What is jaundice?

Answer 29

Excess circulating bilirubin

Question 30

Three components of bilirubin metabolism pathway?

Answer 30

Pre-hepatic Hepatic Post-hepatic

Question 31

What processes occur in the pre-hepatic stage of bilirubin metabolism pathway?

Answer 31

Haemoglobin from erythrocytes is broken down within the spleen to create haem and globin Haem is converted into bilirubin and released back into the bloodstream

Question 32

What is bilirubin synthesised from?

Answer 32

Haem

Question 33

What processes occur in the hepatic segment of the bilirubin metabolism pathway?

Answer 33

Bilirubin is conjugated in the hepatocytes to increase its solubility. Bilirubin is secreted into the bile ducts

Question 34

What processes occur in the post-hepatic segment of the bilirubin metabolism pathway?

Answer 34

Bilirubin conjugate circulates in the small intestine and is broken down. Bilirubin is reabsorbed into the blood via the enterohepatic circulation

Question 35

What are the classifications of the causes of jaundice?

Answer 35

Pre-hepatic Hepatic Post-hepatic

Question 36

What causes pre-hepatic jaundice?

Answer 36

Excess degradation of erythrocytes in the spleen

Question 37

What are the causes of hepatic jaundice?

Answer 37

Cholestasis | Intra hepatic bile duct obstruction

Question 38

What is cholestasis?

Answer 38

Accumulation of bile in the bile canaliculi and hepatocytes

Question 39

What are the causes of cholestasis

Answer 39

``` Drugs Hepatitis (viral or alcoholic) Intra-hepatic bile duct obstruction Hormonal influences Cirrhosis Liver failure ```

Question 40

What is predictable drug induced cholestasis?

Answer 40

Cholestasis caused by drugs which is related to dose.

Question 41

What is unpredictable drug induced cholestasis?

Answer 41

Cholestasis caused by drugs which is unrelated to dose

Question 42

Which type of drug induced cholestasis is more common?

Answer 42

Unpredictable cholestasis

Question 43

What are the two main types of drug induced cholestasis?

Answer 43

Predictable and unpredictable

Question 44

What are the causes of intra-hepatic bile duct obstruction?

Answer 44

Tumours of the liver Primary biliary cholangitis Primary sclerosis cholangitis

Question 45

What is the cause of primary biliary cholangitis?

Answer 45

Autoimmune dysfunction

Question 46

What protein is found to have a raised level in the blood of those with primary biliary cholangitis?

Answer 46

Alkaline phosphatase

Question 47

What is the difference in the inflammatory processes of primary biliary cholangitis and primary sclerosing cholangitis?

Answer 47

Primary biliary cholangitis presents as granulomatous inflammation while primary sclerosis cholangitis does not

Question 48

What condition massively raises the risk of developing cholangiocarcinoma?

Answer 48

Primary sclerosis cholangitis

Question 49

What is cirrhosis of the liver?

Answer 49

The response of the liver to chronic injury

Question 50

What are the causes of cirrhosis?

Answer 50

``` Alcoholic liver disease Infection with hepatitis B or C Primary biliary cholangitis Auto-immune hepatitis Metabolic disorders Excess iron or copper Obesity Idiopathic cirrhosis ```

Question 51

What metals can cause liver cirrhosis when present in excess quantities?

Answer 51

Iron and copper

Question 52

What is the commonest cause of liver cirrhosis?

Answer 52

Idiopathic liver cirrhosis

Question 53

What is normal liver structure replaced with in liver cirrhosis?

Answer 53

Nodules of hepatocytes | Fibrotic scar tissue

Question 54

What is the most common source of liver tumours?

Answer 54

Metastasis from other sites in the body

Question 55

Main types of liver tumour?

Answer 55

Metastasis from other sites in the body Hepatocellular carcinoma Cholangiocarcinoma

Question 56

What type of liver tumour is caused mainly by liver cirrhosis?

Answer 56

Hepatocellular carcinoma

Question 57

What are the causes of extra-hepatic jaundice?

Answer 57

Gallstones Obstruction of the extra-hepatic bile ducts Gallbladder disease

Question 58

What are the main risk factors for gallstones?

Answer 58

Obesity | Diabetes mellitus

Question 59

What are the causes of a common bile duct obstruction?

Answer 59

Tumour of the cells of the bile duct External compression of the bile duct Gallstones Benign stricture as a result of scarring

Question 60

What are the potential complications of a common bile duct obstruction?

Answer 60

Ascending cholangitis Secondary jaundice Secondary biliary cirrhosis