Gastrointestinal Pathology Flashcards
what are the mucosal forms in the GIT
protective stratified squamous
secretory tubular
absorptive villi
absorptive and protective straight tubular glands
what are the congenital disorders of the mouth
cleft lip/palate
what are the inflammatory diseases of the mouth
ulcers
what are common infections of the mouth
herpes, candida albicans
what is a common tumour of the mouth
squamous cell carcinoma
what are the causes of squamous cell carcinoma of the mouth
alcohol, tobacco, HPV
What are the diseases of the pharynx
pharyngitis, tonsilitis, tumors; nasopharyngeal far east
diseases of the salivary glands
obstruction, inflammation, mumps, tumors
normal structure of the oesophagus
stratified squamous epithelium, sphincters prevent gastric reflux
what are the diseases of the oesophagus
congenital abnormalities, varices, esophagitis, tumors
what are the oesphagus structural disorders
achalasia (failure to relax), hiatus hernia (part stomach), diverticula (hollow pouch), laceration
what is achalasia
failure to relax
what are the causes of oesophagitis
reflux disease, physical, chemical, biological agents
what is GERD
reflux of gastric contents into the tubular oesophagus
what are the causes of GERD
defect in lower oesophageal sphincter, hiatus hernia, increased intra abdominal pressure, alcohol, medications
effects of reflux oesophagitis
cell injury, cell loss at lumen, increased basal proloferation, elongation of connective tissue papillae
what are the complications of reflux oesophagitis
bleeding, ulceration, fibrosis (stricture), barretts metaplasa
how is barretts metaplasia diagnosed
endoscopic evidence of columnar lining above GE junction
histologic evidence of intestinal metaplasia
what are benign oesphageal tumours
leoimyoma, squamous papilloma
what are the malignant tumours of the oesophagus
squamous cell carcinoma, adenocarcinoma
causes of adenocarcinoma
majority of barretts metaplasia
causes of squamous cell carcinoma
tobacco, alcohol, nitrosamines, repeated thermal injuries
disorders of the stomach
congenital (pyloric stenosis) , gastritis, ulceration, neoplasia
what is pyloric stenosis
hypertrophy of circular muscle at pylorus, obstructing outflow resulting in projectile vomiting
consequences of acute gastritis
decreased mucus -> decreased protective barrier
Acute gastric ulceration, vasodilation, neutrophils, haemorrhage
consequences of chronic gastritis
mucosal atrophy and intestinal metaplasia usually in the absence of erosions, may become dysplastic
causes of chronic gastritis
autoimmune chemicals, helicobacter pylori infection
what is autoimmune chronic gastritis
Antibodies to parietal cells and intrinsic factor (IF)
* Loss of parietal cells (glandular atrophy) -> loss HCl secretion ->
stimulate gastrin release -> hypergastrinaemia
* Lack IF -> Vit B12 deficiency, anaemia (macrocytic, pernicious)
diagnosis for Helicobacter pylori gastritis
urea breath test, serology for antibodies, stool antigen test, gastric biopsy,
what is Peptic Ulcer Disease (PUD)
chronic mucosal ulceration affecting the duodenum or stomach, Nearly all are associated with H. pylori infection; also NSAIDS, smoking
complications of PUD
– scarring -> strictures / obstruction, 2% patients
– breach of vessel = haemorrhage, 15-20% patients; 25% ulcer deaths
– perforation; 5% patients; 60% ulcer deaths
– malignant transformation occurs rarely
what are gastric polyps
any mass or nodule that projects above the
level of the surrounding mucosa
what are Hyperplastic / Inflammatory polyps
reactive lesions associated with chronic gastritis
what are the primary gastric tumours
gastric adenocarcinoma, primary gastric lymphoma, GI stromal tumours (GIST)
causes of Gastric Adenocarcinoma
Diet: high salt, smoked foods,
H. pylori , chronic gastritis, genetics (CDH1 gene)
what are the types of gastric adenocarcinoma
- intestinal type
- Gland formations
– Mucus secreting cells
– Moderately differentiated - diffuse type
– Poorly differentiated
– Little or no gland formation
– Signet ring cells
disorders of the small and large intestines
- Malabsorption
– Coeliac disease - Inflammatory disorders
– Crohn’s disease
– Ulcerative colitis - Vascular disorders
- Diverticular Disease
- Polyps and Tumours
congenital disorders of the intestine
Diverticula, meconium ileus, hirschsprung disease
what are diverticulum
abnormal hollow pouch communicating with the lumen of the structure from which it has arisen.– small sac-like structure in the wall of the intestines
– -> inflammation, ulceration, perforation, bacterial overgrowth
what are meckel diverticulum
tubular diverticulum in ileum
– Rule of 2s
what is meconium ileus
small intestine obstruction, viscous meconium, cystic fibrosis
what is hirschsprung disease
ganglionosis in muscle wall and submucosa-> lack of coordinated peristalsis: constipation, repeat obstruction
causes of malabsorption in the intestine
– Pancreatic disorders eg cystic fibrosis (CF)
– Biochemical disorders eg lactose intolerance
– Surgical resection
– Infection
– Tropical Sprue: tropics, bacterial?
– Coeliac disease
what is coeliac disease
- Immune mediated enteropathy
- Sensitivity to gliadin portion of gluten
– Wheat, rye, barley - Mechanisms of toxicity unknown
– Tissue injury as a result of immune response
– T-cell mediated chronic inflammatory reaction
morphology of coeliac disease
Villus atrophy and crypt hyperplasia on deudenal or jeujenal biopsy +/- intraepithelial lymphocytes
Crohn’s disease presentation
Intermittent attacks of mild diarrhoea, abdominal pain* 20% acute: right lower quadrant (RLQ) pain, bloody diarrhoea
crohns disease gross morphology
- Strictures
- Cobblestone appearance
- Fissures-> perforation
- Thickened wall
- Inflammation, fibrosis
- Luminal narrowing
microscopic features of crohns disease
crypt abscess
ulceration
noncaseating granuloma
transmural inflammation
thickening of wall
what is ulcerative colitis
chronic relapsing inflammatory disorder
attacks of bloody and stringy mucous diarrhoea and cramps
how long does ulcerative colitis last
days/weeks/months
genetic disposition of ulcerative colitis
HLA DR2
microscopic features of ulcerative colitis
diffuse superficial inflammation, crypt abscess, absence of granulomas
what are the differences between crohns disease and ulcerative colitis?
chrons: skip lesion, transmural inflammation, ganulomas, fissures and fistulae, slightly raised cancer risk
UC: rare skip lesion, mucosal inflammation, no granulomas, rare fissures, significantly raised cancer risk
complications of crohns disease
malabsorption, fistula, anal lesions, perforation, haemorrhage, increased risk of adenocarcinoma
complications of ulcerative colitis
blood loss, electrolyte disturbance, toxic dilation, colorectal cancer, liver, skin, eye, join involvement
what are some vascular disorders of the bowel
occlusive ischaemia and non occlusive ischaemia
causes of non occlusive ischaemia of the bowel
hypotension, vasoconstriction, shock, dehydration
what are diverticula
herniations of mucosa into the intestinal wall
complications of diverticular disease
perforation, haemorrhage, fistulae
what are the tumours of the colon and rectum
polyps, familial adenomatous polyposis, hereditary non polyposis colon cancer - lynch syndrome
what is a polyp
mass or nodule that projects above the surrounding mucosa
types of non neoplastic polyps
inflammatory (common in IBD)
hyperplastic (age)
types of neoplastic polyps
tubular, villous, tubulovillous
familial adenomatous polyposis is causes by mutations in what gene?
APC gene
untreated familial adenomatous polyposis results in…
colorectal adenocarcinoma 100%
