CBL - Pathology

Question 1

On palpation in an abdominal exam, what is guarding?

What does it indicate?

Answer 1

Reflex contraction of the abdominal muscles

Guarding indicates peritonitis (which is always secondary to other inflammation)

Question 2

A 30yo woman presents to A&E with right iliac fossa pain, lasting 18 hours. What is the differential diagnosis?

Answer 2

Appendicitis
Ectopic pregnancy
UTIs
Kidney infection
Ovarian torsion/cyst rupture
Bowel obstruction
Abscess (tubulo-ovarian or psoas muscle)

Question 3

What are the 4 layers of the appendix wall?

Answer 3

Mucosa
Submucosa
Muscularis
Serosa/adventitia

Question 4

What features are present in the walls of the appendix?

Answer 4

Lymphoid follicles

Question 5

List some of the gross features of an inflamed specimen.

Explain what causes them.

Answer 5

Swollen - oedema and leakage from dilated blood vessels

Discoloured: dark red/purple - congestion in dilated blood vessels

Fibrino-purulent exudate on surface

Question 6

What is the proper name for describing something with loads of pus in it?

Answer 6

Suppurative

Question 7

What 2 features will cells with sub-lethal cell injury show?

Answer 7

Swollen

Degenerate

Question 8

Describe the characteristic clinical history of pain due to appendicitis.

Answer 8

Generalised abdominal pain at first, while only appendix is inflamed (because there aren’t any pain receptors inside the appendix so the pain spreads)

Acute localised right iliac fossa pain later on (because inflammation has spread to the peritoneum (i.e. peritonitis), which has more pain receptors, so the pain is more specific)

Question 9

What is a normal white cell count?

Answer 9

No more than 10 x10^9 per L of blood

Question 10

Define an ulcer.

Answer 10

Loss of integrity of an epithelial surface/mucosa

Question 11

Define a polyp.

Answer 11

Area of mucosa raised above adjacent surface.

Question 12

What are the normal numbers of the following cells in a white cell count:

a) Neutrophils?
b) Lymphocytes?
c) Eosinophils?
d) Monocytes?
e) Basophils?

Answer 12

Neutrophils: 2-7.5 x10^9/L

Lymphocytes: 1.3-3.5 x10^9/L

Eosinophils: 0.04-0.44 x10^9/L

Monocytes: 0.2-0.8 x10^9/L

Basophils: 0-0.01 x10^9/L

Question 13

List 5 features of the abnormal mucosa in Crohn’s disease.

Answer 13

Bifid crypts
Erosion of ulceration
Abnormal shapes of crypts
Lymphocyte infiltration
Granulomas

Question 14

How would you tell the difference between Crohn’s disease and ulcerative colitis?

Answer 14

Crohn’s disease:

• Has granulomas
• Affects whole mucosal thickness
• Affects whole GI tract
• Skips regions (i.e. can be patchy)