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Sam Clin Path > Gastro > Flashcards

Gastro Flashcards

1
Q

Approx length of oesophagus?

A

25cm

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2
Q

Upper sphincter of Oesophagus =?

A

cricopharyngeal

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3
Q

Where are the distal 1-2cm of oesophagus located?

A

below diaphragm

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4
Q

Lining of most distal oesophagus = ?

A

Glandular (columnar) mucosa

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5
Q

Where is squamo columnar junction usually located?

A

40cm from incisors

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6
Q

Most common form of oesophagitis?

A

Reflux oesophagitis

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7
Q

Risks for reflux?

A

Defective sphincter
Hiatus hernia
Increased abdo pressure
increase gastric fluid (outflow stenosis)

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8
Q

Strangulation is associated with which hiatus hernia?

A

Paraoesophageal

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9
Q

Type of hiatus hernia causing heartburn?

A

Sliding hiatus

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10
Q

Histological features of reflux?

A

basal cell hyperplasia, increased desquamation. infiltration of inflammatory cells

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11
Q

Cause of barretts oesophagus?

A

Longstanding reflux

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12
Q

Risk factors for barrets?

A

As normal reflux (male, overweight and caucasian)

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13
Q

Histology of barrets?

A

Glandular metaplasia (squamous replaced by columnar)

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14
Q

Is barretts pre-malignant?

A

Yes! surveillance useful

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15
Q

Barrets eventually may lead to what?

A

Adenocarcinoma

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16
Q

Two types of oesophageal cancer…?

A

Adeno and squamous

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17
Q

Uk has lower incidnce of what type of oesopho cancer than the other/other countries?

A

Squamous 30%

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18
Q

Male or femal more likely to get adenocarcinoma of oesophagus?

A

Male 7:1

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19
Q

Risk for squamous carcinoma of oesophagus?

A

Black, male, hpv, hot drinks!

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20
Q

Squamous higher or lower than adenocarcinoma in oesophagus?

A

Usually higher up

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21
Q

TNM staging uses what?

A

pT depth of primary invasion

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22
Q

pT stages?

A 
1= lamina, submucos
2= muscularis
3= adventitia
4= adjacent structures
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23
Q

Node staging in oesophageal cancer?

A 
1= 1 or 2
2= 3-6
3= 7+
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24
Q

Metastasis grading in oesophagus?

A

M0 is none M1 = some!

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25
Q

Causes of chronic gastritis?

A

H.pylori
chemical
Nsaid
Bile reflux and alcohol

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26
Q

Pylori, talk to me gram etc?

A

Gram neg, flagellae, lives on epithelium

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27
Q

Where is h.pylori more common in stomach?

A

Antrum

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28
Q

Major sites for peptic ulcers?

A

Duodenum first part, antral body, distal oesophagus

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29
Q

Histology of gastric ulcer?

A

full thickness coagulative, ulcer and granulation

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30
Q

H.pylori more associated with gastric or duodenal?

A

Duodenal

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31
Q

Duodenal or gastric ulcers are more likely?

A

Duodenal 3:1

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32
Q

Duodenal or gastric ulcer in younger?

A

Duodenal

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33
Q

Most frequent gastric cancer type?

A

Adeno

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34
Q

Aetiology of gastric cancer?

A

Diet(smoked food pickled)
H.pylori
bile reflux
Low pH

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35
Q

Carcinoma of GOJ increase or decrease recent and associated with?

A

Increase and in white males. no diet assoc or h.pylori, is assoc with reflux

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36
Q

Body and antrum of stomach cancer associations?

A

Diet assocaited, h.pylori but no reflux assoc

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37
Q

Mutation in what = HDGC hereditary gastric cancer ?

A

Cadherin

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38
Q

What causes the issue in gluten intolerant people?

A

Gliadin, cells express IL15

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39
Q

IL15 induces activation of what?

A

CD8= cells kill enterocytes

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40
Q

Mechanism of coeliac disease?

A

Not CD8 but IL15 expression from gliadin

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41
Q

Coleiac assocaited with what? (10%)

A

Dematitis herpeformis

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42
Q

Test for coeliac?

A

TTG Transglutaminase

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43
Q

What is diagnostic for coeliac?

A

Only a biopsy

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44
Q

Where are diverticulum most common?

A

Sigmoid colon

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45
Q

Diverticular in colon or mostly acquired or congenital?

A

Acquired

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46
Q

Where are the diverticular in the sigmoid?

A

Between mesenteric and antimesenteric taeni coli

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47
Q

Diet protection in divertucla disease?

A

High fibre

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48
Q

Diverticular sex distribution?

49
Q

Why do diverticula form?

A

Increased pressure pushes out loops

50
Q

Histological diverticular problems?

A

Thickening of muscularis, elastosis of taenei coli

51
Q

Chronic complications of diverticulosis?

A

Stricture, fistula, or colitis

52
Q

Most common colitis bacteria?

A

Camplylobacter and salmonella

53
Q

Idiopathic imflammatory bowel disease=?

A

UC and chrons or indeterminate

54
Q

Peak age of IBD onset?

55
Q

Crohns mor common in who?

A

Females slightly

56
Q

Risk factors for IBD?

A

Smoking, oral contraceptive although smoking protective against UC

57
Q

Appendicectomy in childhood protective against?

58
Q

Strong genetic element in which?

59
Q

Narrowing is rare in which IBD?

60
Q

UC inflammation restricted to which layers?

A

Superficial

61
Q

Crohns affects where?

A

All of the tract

62
Q

which ibd is full thickness?(transmural)

63
Q

Most common place for crohns?

64
Q

Crohns is patchy or continuous?

65
Q

Fistulae seen in which IBD?

66
Q

Rectum always involved?

67
Q

Granulomas present in which ibd?

68
Q

Cancer incidence in IUC?

A

After a long time >10yrs

69
Q

What is a polyp?

A

Submucosal protrusion

70
Q

hamartomatous polyps?

A

Peutz jeghers and juvenile

71
Q

Muco-cutaneous pigmentation in which syndrome?

A

peutz jeghers

72
Q

80% of adenomas n small bowel do what?

A

Progress to carcinoma in 10-15years

73
Q

% penetrance for cancer in FAP?

A

100% lifetime

74
Q

FAP due to mutation where?

A

APC supressor gene

75
Q

HNPCC cause?

A

DNA mismatch problem

76
Q

HNPCC other cancers?

A

Ovarian endomtrial urinary

77
Q

Bowel cancer often

spreads where haematogenously?

A

Liver and lungs

78
Q

Most bowel cancers are of what type?

A

Adenocarcinoma

79
Q

Most colorectal cancers fall into which grading category?

A

Moderately differentiated (60-80%)

80
Q

Which staging often used for bowels?

81
Q

Nodal staging for bowel ?

A

N0 = none
N1= 1-3
N2=4+

82
Q

Stage A dukes?

A

Confined to bowel wall no lymph nodes

83
Q

Dukes Stage B?

A

Invading through wall but no lymph involvement

84
Q

Dukes stage C?

A

Regional metastasis of lymph nodes

85
Q

Dukes D?

A

Distant metastasis

86
Q

Most tumours are dukes …?

A

C survival of approx 40-50% 5 yr

87
Q

Dukes A survival?

A

> 90% 5 yrs

88
Q

Majority of bacteria in the gut are what?

A

Obligate anaerobes

89
Q

Coliforms are outnumbered in the gut by anaerobes how much?

A

by 100 times

90
Q

Leading cause of malnutrition in under 5’s?

A

Diarrhoeal disease

91
Q

E-coli bad strain?

92
Q

Why is cryptosporidium hard to get rid of?

A

Resistant oocytes (chlorine resistant)

93
Q

Two mechanism by which bacteria cause disease in the gut?

A

toxins or adherence

94
Q

Bacteria causing enteritis through adherence?

A

Shigella, e-coli (adherent) campylobcter, salmonellae

95
Q

E-coli produces a toxin what type?

A

Shiga like toxin

96
Q

E-coli 0157 can cause what complication?

A

Haemolytic uraemic syndrome (10-15%)

97
Q

Major source of e-coli 0157

98
Q

Typhoidal salmonella?

A

Disseminated salmonella

99
Q

Toxin producing gastro organisms abx?

A

No may cause more toxin release

100
Q

Which bacterium may require abx in gastro?

A

Campylobacter if long duration + severe or blood culture +ve

101
Q

% of post antibiotic diarrhoea = c diff?

102
Q

> 99% of pseudomembranous colitis caused by what?

103
Q

Which abx can drive 027 strain of c diff?

A

fluoroquinolones

104
Q

C diff therapy?

A

metro and vanc

105
Q

New abx for c diff

A

fidaxomicin

106
Q

Principle of abx therapy?

A

Start smart then focus!

107
Q

Organisms particularly associated with bowel cancer?

A

Clostridium septicum and Strep gallolyticus

108
Q

Cholangitis is what?

A

Infection of common bile duct or biliary tree

109
Q

Pyogenic liver abscess, spread from?

A

Other intra abdo infect or haematagenous- mesenteric infection or systemic (hep artery)

110
Q

High swinging fever sign of what abdo?

A

Abscess , fever of 39 then normal then back up etc

111
Q

Subphrenic abscess often has pain where?

A

Shoulder of side and hiccups

112
Q

Pelvic abscess presentation?

A

urinary frequent + tenesmus

113
Q

Infected ascites causes?

A

spontaneous bacterial peritonitis

114
Q

Tb in bowel where?/

A

Ileo-caecal

115
Q

Liver abscess possible organism?

A

Strep milleri, poly microbe

116
Q

Treatment for intestinal source under 65 yrs?

A

Cefuroxime + metro

117
Q

Intestinal source treatment >65years?

118
Q

When to switch IV abx?

A

After 48hrs apyrexial and normal WCC

Sam Clin Path (9 decks)

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