Cell Pathology Case studies

Question 1

What are the effects of Helicobacter on the stomach

Answer 1

Inflammation: 
acute, chronic (including ulcers)
Cell  damage: 
atrophy, metaplasia, dysplasia 
Neoplasia: 
carcinoma, lymphoma

Question 2

What are the causes of gastritis

Answer 2

Oxygen deprivation
Chemical agents  = drugs- common
Infectious agents  = helicobacter- common
Immunological reactions = autoimmune- common
Genetic defects
Nutritional imbalances
Physical agents
Aging

Question 3

Describe the appearance of H.Pylori

Answer 3

Spirally, looks like a seagull

Question 4

Describe the range of pathologies of H.Pylori

Answer 4

can produce range of pathological processes (or none at all in 80% cases) e.g. Gastritis (inflammation) in 15-20%, and cancer in 1%. May be asymptomatic, cause ulceration. Its pathology has been studied and worked out.

Question 5

How will acute gastritis appear down an endoscope

Answer 5

Red- rubor
Swollen- tumor- oedema
It also may be painful for the patient- dolor

Question 6

Describe the histology of acute gastritis

Answer 6

The key inflammatory cell of acute inflammation is the

neutrophil polypmorph

Question 7

What is meant by an abscess

Answer 7

A large mass of dead and dying neutrophils.

Question 8

What may be another feature of acute gastritis

Answer 8

Acute peptic ulcer formation
If the inflammation is severe enough it will destroy the mucosae- forming an ulcer. Can breach peritoneal cavity- acid can leak into peritoneum- dangerous.

Question 9

Define an ulcer

Answer 9

“An open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane which fails to heal.
Ulcers range from small, painful sores in the mouth to bedsores and serious lesions of the stomach or intestine.”

Question 10

Describe how chronic gastritis appears down an endoscope

Answer 10

Loss of rugi due to atrophy- pathological.

Question 11

Describe the histology of chronic gastritis

Answer 11

The key inflammatory cell of chronic inflammation is the
lymphocyte
Formation of lymphoid follicles with germinal centres, the inflammation induces abnormal MALTs in the stomach (not normally present)- why there is an increased risk of lymphoma.

Question 12

What is granulomatous gastritis

Answer 12

A sub-set of chronic inflammation

Question 13

Describe the histology of granulomatous gastritis

Answer 13

Pale areas- indicating presence of activated macrophages

Question 14

Describe granulomatous inflammation

Answer 14

Granuloma= collection of activated macrophages (secreting cytokines not doing phagocytosis).
Particular form of chronic inflammation showing granuloma formation
Cluster of macrophages
Involves specific immune reaction T cells.
Type 4 hypersensitivity.

Question 15

What are the causes of granulomatous inflammation

Answer 15

Infection – TB, fungi, helicobacter
Foreign material- glass or metal
Reaction to tumours- good-shows that they have elicited an immune response
Immune diseases (sarcoid, Crohn’s)

Question 16

Describe the differences between acute and chronic ulcer formation

Answer 16

Pattern of inflammation
Acute- will heal normally
Chronic- fibrosis- scar tissue formation- replaces specialised cells- repair but not regeneration.

Question 17

Describe acute ulcer healing

Answer 17

Parenchymal cell regeneration and RESOLUTION

= acute gastric ulcer

Question 18

Describe chronic ulcer healing

Answer 18

REPAIR by connective tissue and SCAR TISSUE FORMATION

= chronic gastric ulcer

Question 19

What is the aim of plastic surgery

Answer 19

To reduce scarring

Question 20

Describe the atrophy associated with helicobacter gastritis

Answer 20

mucosa decreases in thickness; specialised cells are lost (hence reduced function)

Question 21

Describe the metaplasia associated with helicobacter gastritis

Answer 21

goblet cells (mucous secreting cells) are not normally present (found in intestines) - but gastric mucosa has changed to small intestinal mucosa due to metaplasia

Question 22

Describe the dysplasia associated with helicobacter gastritis

Answer 22

Adenocarcinoma- may contain glands producing mucous

Lymphoma- lymphocytes attack crypts.

Question 23

Despite their names, which tumours are malignant

Answer 23

Melanomas and lymphomas

Question 24

Distinguish between grading and staging

Answer 24

Grading:
based on the degree of histological differentiation
Staging
based on how far the tumour has spread

Staging- essential for prognosis

Question 25

Describe the staging of cancers

Answer 25

``` Combination of clinical, radiological and pathological findings Main staging system = “TNM” Size and spread of the primary Tumour Spread to regional Lymph Nodes Presence of Metastases ```

Question 26

What is atherosclerosis essentially a disease of

Answer 26

the intima

Question 27

What do we look at when analysing atheromas

Answer 27

How much of the artery is occluded: 60% open- Asymptomatic stable plaque. 20% open- Symptomatic stable plaque causing inducible ischaemia OR Unstable plaque with risk of rupture and acute ischaemic events.

Question 28

What are the common sites of clinically important atheromas

Answer 28

Coronary arteries Carotid arteries Aorta and / or iliac arteries

Question 29

What is a consequence of plaques becoming ulcerated

Answer 29

thrombosis on top off the plaque- can break off.

Question 30

Describe the different types of atherosclerotic plaques

Answer 30

Stable atherosclerotic plaques: stable angina, dementia, chronic lower limb ischaemia Thrombosis overlying an unstable atherosclerotic plaque: unstable angina, myocardial infarction, cerebral infarction, acute lower limb ischaemia Weakening of arterial wall leading to aneurysm formation

Question 31

Describe myocardial scarring

Answer 31

Appears white- scarring- atrophy and death of myocytes- replaced by collagen- lower metabolic requirement-

Question 32

What can myocardial scarring lead to

Answer 32

Chronic heart failure | results from loss of muscle cells as needed to pump

Question 33

Describe infarction

Answer 33

ischaemic death of tissue leads to acute cardiac failure, due to arrhythmias. Not replaced by scar tissue

Question 34

What are the consequences of MI

Answer 34

Acute cardiac failure | Sudden death

Question 35

What is meant by an aneurysm

Answer 35

An abnormal blood-filled bulge of a blood vessel and especially an artery resulting from weakening of the vessel wall.

Question 36

What are the consequences of a coronary artery aneurysm

Answer 36

Rupture | Thrombosis- damaged endothelium- turbulent flow- 2/3 requirements for thrombosis.

Question 37

Describe haemopericardium

Answer 37

Blood leaked into pericardium- due to rupture of coronary artery from MI

Question 38

In death certificates- what should be put in category 2

Answer 38

Things relating to the death, but not the proximate cause- usually a chronic condition e.g hypertension, diabetes.

Question 39

Why can plaques lead to aneurysms

Answer 39

Inner part of blood vessel thicker (due to plaque)- less diffusion of oxygen to smooth muscle, smooth muscle atrophy- becomes thinner- more prone to rupture- law of Laplace.