Gastrointestinal Pathology Flashcards
1
Q
What are the primary tumours of the small bowel?
A
Lymphomas
Neuroendocrine tumours
Carcinomas
2
Q
What does coeliac disease do to the epithelia of the small intestine?
A
It results in a loss of villi due to attack from intraepithelial lymphocytes. This reduces the absorptive capacity of the small intestine and makes it non-functional
3
Q
What can be injected into an area of upper GI haemorrhage?
A
Adrenaline
4
Q
What are the causes of diarrhoea?
A
Infectious Agents - viruses, bacteria etc. Chronic disease Toxins Drugs Psychological factors
5
Q
What are the complications of diarrhoea?
A
Dehydration - Na+ and H2O loss
Metabolic Acidosis - HCO3- loss
Hypokalaemia - K+ loss
6
Q
What is the treatment of severe acute diarrhoea?
A
Rehydration therapy
Anti-infective agents, if appropriate
Non-antimicrobial antidiarrhoeal agents, symptomatic
7
Q
What is the pathophysiology of diarrhoea?
A
Impaired NaCl absorption
Presence of non or poorly absorbable solutes in the lumen
Hypermolility of the GI tract
Excessive secretion e.g. cholera
8
Q
What are oesophageal varicies?
A
Abnormal dilated veins in the oesophagus
9
Q
What is portal hypertension?
A
Increased blood pressure within the portal veins
10
Q
What is Crohn’s Disease?
A
A chronic inflammatory and ulcerating condition of the GI tract That can affect any part of the alimentary canal
11
Q
What are the causes of crohns disease?
A
Genetic susceptibility
Luminal microbial antigens and adjuvants
Immune response
Environmental triggers
12
Q
What is sepsis?
A
The systemic inflammatory response to infection
13
Q
What is perotinits?
A
Leakage of bowel contents into the perotineal cavity
14
Q
what is the progression of sepsis?
A
SIRS - Sepsis - Septic Shock
15
Q
What is gastroenteritis?
A
This is inflammation of the lining of the stomach, small and large intestines
16
Q
What amount of diarrhoea suggests infection of the small bowel?
A
Large amount
17
Q
What amount of bacteria suggests infection of the large bowel?
A
Small amount
18
Q
What is the most important virulent factor of shigella?
A
Shiga toxin
19
Q
What are the four types of shigella sp.?
A
S. dysenteriae
S. flexneri
S. boydii
S. sonnei
20
Q
What is the action of the shiga toxin?
A
Binds to receptors on renal cells, RBC and other
Inhibit protein synthesis
Cause cell death
21
Q
What is the most common pathogen causing diarrhoea?
A
Campylobacter
22
Q
What is diverticulosis?
A
It the development of out-pouches in the wall of the colon
23
Q
What is diverticulitis?
A
It is inflammation due to diverticular disease?
24
Q
What is a true diverticula?
A
This is where the diverticula involves all the layers of the intestinal wall
25
What is a false diverticula?
This is a herniation of the mucosal and submucosal layers through the intestine
26
What is an epithelial cell abnormality associated with ulcerative colitis?
Paneth cell metaplasia
27
What is the cause of achalasia?
A failure of the myenteric plexus to allow for the relaxation of the lower oesophageal sphincter.
28
What are mallory bodies?
These are bundles of damaged intermediate filaments seen in alcoholic hepatitis
29
What is gastroparesis?
This is a partial paralysis of the stomach that prevents it from opening and releasing food into the duodenum
30
What is refeeding syndrome?
This is an adverse clinical and biochemical response to feeding in severely malnourished patients.
31
What is the cause of refeeding syndrome?
Potentially fatal shifts in electrolytes and disturbances in organ function and metabolic regulation
32
What is haemocromatosis?
This is where the body absorbs excessive amounts of iron
33
Where in the body does iron accumulate?
```
Parenchymal organs
Liver
Pancreas
Heart
Pituitary Gland
Joints
Skin
```
34
How does conjugated bilirubin levels increase in the blood of patients with cholestasis?
The accumulation of bilirubin leads to an increase in pressure in the liver. This causes the bilirubin to diffuse across the tight junctions of the hepatocytes and into the blood. This hence causes jaundice.
35
What is puruitis?
Sever itchy and irritated skin
36
What causes pruitis in patients with cholangitis?
Increased bile salts and bile acids diffuses through the tight junctions of the liver hepatocytes. This causes the levels to increase in the blood
37
Why is unconjugated bilirubin not exreted from the body?
It is lipid soluble therefore cannot dissolve in water to be excreted
38
What is alpha-1-antitrysin deficiency?
This is an autosomal recessive condition where there is limited or no alpha-1-antitrypsin produced
39
What is alpha-1-antitrypsin?
This is an enzyme that is responsible for the inhibition of elastase. Elastase is a protease that breaks down protein.
40
What is Wilson's disease?
This is an autosomal recessive condition causing a disorder of copper metabolism. This leads to the accumulation of copper in the brain and liver
41
What protozoa is responsible for amoebiasis?
Entamoeba histolytica
42
What are leukoplakia?
Flat, raised white plaques in the mouth
43
What mediates the response in eosinophilic oesophagi's?
Th2 Cells
44
What cytokines are released in eosinophilic oesophagi's?
Il-5 and Il-13
45
What do the epithelial cells of the oesophagus release in eosinophilic oesophagitis?
Eotaxin
46
What is eotaxin?
This is a chemokine that can recruit eosinophils from the blood to the oesophageal mucosa
47
What are the two types of gallstones?
Cholesterol and pigment stones
48
How are cholesterol stones formed?
An imbalance in the ratio of cholesterol to bile salts
49
How are pigment stones formed?
Excess bilirubin
50
What are complications of c.diff infection?
Toxic megacolon
Bowel perforation
Renal failure
Sepsis
51
What does the hepatitis B surface antigen suggest?
The patient is infectious
52
What does the hepatitis B surface antibody suggest?
The patient has immunity either from previous infection or via vaccination
53
What does the hepatitis B core IgM antibody suggest?
They have acute infection.
54
What does the hepatitis B e antigen suggest?
They have acute infection
55
What does the hepatitis B core DNA suggest?
Indicator of viral replication
56
What does the anti-hep B core IgG antibody suggest?
Indicates previous or ongoing infection with hep B in an undefined time frame
57
What are the most common types of acute viral hepatitis?
A, B and E
58
What are the most common types of chronic viral hepatitis?
C and sometimes B
59
How is hepatitis A spread?
Faecal-oral transmission, associated with poor sanitation
60
How do we test for hepatitis A?
HAV IgM antibody
61
How is hepatitis B transmitted?
Blood-borne, sexually transmitted and vertical transmission
62
What is phase 1 of chronic HBV infection?
Immune Tolerant
Highly Infections
High levels of viral replication
Low levels of inflammation within the liver
63
What is phase 2 of chronic HBV infection?
Immune reactive
| Moderate severe inflammation within the liver
64
What is phase 3 of chronic HBV infection?
Inactive carrier
Low levels of inflammation within the liver
Low risk of cirrhosis
65
What is phase 4 of chronic HBV infection?
Virus abolishes HBeAg expression
Moderate severe inflammation within the liver
Low rate of spontaneous remission
66
What is phase 5 of chronic HBV infections?
Occult infection
| Low HBV DNA
67
How is hepatitis C spread?
Mainly blood borne spread, sexual transmission is rare
68
How do we test for HCV?
HCV IgG indicates virus at some point
| HCV RNA detected by PCR indicates active infection
69
What is a polyp?
A protrusion above the epithelial surface
70
What is the differential diagnosis of a colonic polyp?
Adenoma
Serrated polyp
Polypoid carcinoma
71
How does fibrosis occur in chronic liver disease?
The hepatic stellate cells are activated and attract inflammatory cells causing inflammation and fibrogenesis
72
What is the disease progression of NAFLD?
Normal
Steatosis
NASH
CIrrhosis
73
Which antimicrobial antibody is associated with primary biliary cholangitis?
M2
74
What is type 1 autoimmune hepatitis?
This is common in adults/ It is associated with antinuclear or anti smooth muscle antibodies. Soluble liver antigen is a marker of more severe disease
75
What is type 2 autoimmune hepatitis?
This is more common in children and young adults. It is characterised by the liver kidney microsomal antibody.
76
What is haemochromatosis?
Genetic iron overload syndrome
77
What is primary sclerosing cholangitis?
Autoimmune destructive disease of large and medium sized bile ducts
78
What does wilson's disease cause?
Loss of function of caeruloplasmin that is a copper binding protein.
79
What is Budd-Chiari Syndrome?
Thrombosis of hepatic veins
80
What are the four portocaval anastomosis sites of varices?
Oesophagus and gastric venous plexus
Umbilical vein
Retroperotineal collateral vessels
Haemorrhoidal venous plexus (anus)
81
What is compensated cirrhosis?
Clinically normal, incidental finding. There is compensation therefore the patient appears normal
82
What is decompensated cirrhosis?
There is no compensation. Liver failure
83
What are the drugs that can commonly cause liver disease?
Antibiotics - Co-amoxiclav, Flucloxacillin
NSAID
Statins
Anabolic Steroids - fat burners, protein powders
Paracetamol/paracetamol containing products
84
What is the most common liver tumour?
Haemangioma
85
What is pancreatitis?
Inflammation of the pancreas that may be acute or chronic
86
What activates the zymogens when they enter the duodenum?
Enteropeptidases
87
What is grey turners sign?
Bruising on the flanks of a patient
88
What is cullens sign?
Bruising around the umbilical region of the patient
89
What is the most common cause of physiological neonatal jaundice?
Hepatic immaturity
90
What are cholesterol gallstones?
These form due to an imbalance in the ratio of cholesterol to bile salts that disrupts micelle formation
91
What are features of liver failure?
Changes in Bilirubin and albumin
Ascites
Hepatic Encepalopathy
92
What are the cholestatic LFTs?
ALP
| GGT
93
What are the hepatocellular LFTs?
Alanine Amino Transferase
94
What are the exocrine tumours of the pancreas?
Adenocarcinoma
95
What are the endocrine tumours of the pancreas?
Gastrinoma
Insulinoma
Glucagonoma
96
What is the main tumour marker for pancreatic cancer?
CA 19-9
97
What causes acute cholecystitis?
A gallstone is lodged in the cystic duct or common bile duct
98
What is the treatment for GORD?
PPI
99
What type of cancer can Barrett's oesophagus develop into?
Adenocarcinoma.
100
What change does Barrett's oesophagus cause to the mucosa of the oesophagus?
Stratified squamous epithelium → columnar epithelial cells.
101
How do we treat acute crohn's disease?
Glucocorticoid - prednisolone, iv hydrocortisone
102
What is maintenance treatment for crohns deserve?
Immunosuppression - azathioprines, 6-mp
| Biologics - Anti-TNF (INfliximab)
103
What are the indications for surgery in patients with crohns disease?
```
Stenosis causing obstruction
Enterocutaneous fistulas
Intra-abdominal fistulas
Abscesses
Bleeding
Free perforation
```
104
What is a common cause of colovesical fistula?
Diverticular Disease
105
How do we remember the radiological features of crohns disease?
```
CROHNS
C - Cobblestone appearance
R - Rosethorn Ulcers
O - Obstruction of Bowel
H - Hyperplastic Mesenenteric Lymph Nodes
N - Narrowing of the intestinal lumer
S - Skip Leasions
```
106
What is Ulcerative colitis that only affects the rectum?
Proctitis
107
What is ulcerative colitis that affects the rectum and descending colon?
Left-sided colitis
108
What is ulcerative colitis that affects the rectum and entire large intestine?
Pancolitis
109
What is the stages of treatment of ulcerative colitis?
```
5 SIBS
5 - ASA
Steroids - Prednisolone, Budesomide
Immunosuppression - Azathioprine, 6-MU
Biologics - Anti TNF (Infliximab)
Surgery
```
110
What is a common radiological feature of ulcerative colitis?
Loss of haustration of the descending colon
111
Which antibody is associated with ulcerative colitis?
P-ANCA
112
What is the difference between gastritis and gastroenteritis?
Gastritis is inflammation of the stomach lining.
| Gastroenteritis is inflammation of the stomach and the bowels
113
What are the causes of peptic ulcers?
H. Pylori
NSAIDs
Caffiene
Spicy Foods
114
What are peptic ulcers?
A break in the superficial epithelial cells that extends down to the muscularis mucosa.
115
What can chronic gastritis lead to?
Epithelial metaplasia
Mucosal Atrophy
Gland Loss
116
What is secretory diarrhoea?
The intestinal mucosa secretes large amounts of salt as a result of stimulation of the CFTR causing increased chloride ions to be secreted into the bowel. This causes water to follow ions into the bowel lumen.
117
What causes the CFTR to excrete chloride ions?
cAMP
118
What is hyper-motility diarrhoea?
Disturbances in intestinal motility in which luminal contents progress too rapidly down the tract to allow sufficient contact time.
119
What is osmotic diarrhoea?
Water retention results when solutes fail to be broken down and thus cannot be absorbed. The osmotic gradient is reversed and water is attracted into the bowel.
120
Name a cause of osmotic diarrhoea?
Glucose/Galactose Malabsorption Syndrome
121
What is inflammatory diarrhoea?
The inflammatory process causes increase in capillary permeability, migration of the immune cells into the bowel wall and pain
122
What line separates the inner and outer anus?
Dentate Line
123
What are haemorrhoids?
Enlarged vascular cushions in the lower rectum and anal canal
124
What is a Nissen Fundoplication?
Treatment of GORD where the fundus is wrapped around the LOS to cause it to close
125
What is intusussception?
When there is invagination of one portion of bowel into the lumen of the adjacent bowel, most commonly in the ileo-caecal region
126
What type of immune cells mediate hepatitis?
CD8+ T cells
127
What type of hepatitis virus can only infect people who have already been infected with hepatitis B?
Hepatitis D
128
What do the MHC II molecules of people with coeliac disease encode?
HLA-DQ2 and HLA-DQ8
129
What is the action of H. Pylori?
They colonise the gastric mucosa and release adhesions that help them to adhere to gastric foveolar cells and proteases that damage mucosal cells.
130
What is a histological sign of H . Pylori infection?
Partial replacement of the gastric mucosal epithelium by intestinal metaplasia
131
What is the disease progression of NAFLD?
Steatosis
Non-Alcoholic Steatohepatitis
Fibrosis
Cirrhosis
132
What is primary biliary cholangitis?
T cells attack the lining of the bile ducts within the
133
What two drugs are used to treat primary biliary cholangitis?
Urso Deoxycholic Acid
| Obeticholic Acid
134
Which genes are responsible for haemochromatosis?
C282Y or H63D mutations on the HFE gene
135
What is the name for the process of depositing iron into the organs and tissues?
Haemosiderosis
136
Which genes are responsible for wilsons disease?
ATB7B gene
137
Which genes are responsible for alpha 1 antitrypsin deficiency?
SERPINA 1 mutations
138
At what points do the portal and systemic venous systems anastomose?
Inferior portion of the oesophagus
Superior portion of the anal canal
Round ligament of the liver (umbilical cord)
139
What pressure accounts for portal hypertension?
>12 mmHg
140
Which drug can be used to treat hepatic encephalopathy?
Rifaxamin
| Lactulose
141
What is the best way to measure liver failure?
Prothrombin time
142
Which clotting factor is characteristically increased in acute hepatic failure?
Factor VIII
143
What is the difference between a true and false diverticula?
True - involves all the layers of the bowel
| False - not all of the layers of the bowel are involved
144
What site is most commonly affected in ischaemic colitis?
Splenic flexure
145
What is the most common cause of gastroenteritis?
Viral Infection - Rotavirus, Norovirus, Adenovirus
146
What is enteric fever?
Typhoid fever
147
What are the causes of enteric fever?
Salmonella Typhi
| Salmonella Paratyphi
148
What is the causative pathogen of amoebiasis?
Entamoeba histolytica
149
What is the causative pathogen for giardiasis?
Giardia intestinalis (lamiblia)
150
What is a risk factor for femoral hernia?
Female gender
151
Where does anal fissure occur?
Distal to the pectinate line
152
Where is the most common site of an anal fissure?
Posterior midline
153
What blood test reveals the synthetic function of the liver?
Albumin
154
What blood test reveals the excretory function of the liver?
Bilirubin
155
What can be found at the base of a peptic ulcer?
Granulation tissue
156
What is intestinal thumb-prinitng a sign of on AXR?
Ulcerative Colitis
157
What is achalasia?
A failure of the lower oesophageal sphincter to relax
158
What is the blood supply to a meckels diverticulum?
Vitelline artery
159
What is zollinger-ellison syndrome?
A syndrome of excessive gastrin secretion from a gastrin secreting tumour
160
What is the difference between a pseudocyst and a cyst?
A cyst is surrounded by epithelial tissue
| A pseudocyst is surrounded by granulation tissue
161
What is the most common complication of ERCP?
Acute pancreatitis
162
Where is the most common site for intusussception?
Ileocolic
163
What does murphys sign suggest?
Acute cholecystitis
164
What is the treatment for primary biliary cholangitis?
Ursodeoxycholic acid
165
Which type of inguinal hernia reappears after reducing if the deep inguinal ring is occluded?
Direct inguinal hernia
166
What is the treatment for acute variceal bleeding?
Terlipressin and prophylactic antibiotics
167
When is a sengstaken-blakemore tube used?
When haemostasis isnt achieved by endoscopy
168
What can clostridium difficile cause on colonoscopy?
Pseudomembranous colitis - yellow plaques that can be easily dislodged
169
What is the most common causative pathogen of spontaneous bacterial peritonitis?
E.Coli
170
What does the pathogen giardia lamblia cause?
Fat malabsorption
171
What supplies the tail of the pancreas?
Splenic Artery
172
What supplies the head of the pancreas?
Pancreaticoduodenal artery
173
What is the most common location of the appendix?
Retrocaecal
174
What test is used to establish vitamin B12 deficiency?
Schilling Test
175
What is the most common cause of food poisoning?
Campylobacter
176
What pathogen is found on reheated rice?
Bacillus cereus -bacilli look like rice:)
177
What antibody is positive in primary biliary cirrhosis?
Anti-Mitochondrial Antibody
178
What antibody is positive in autoimmune hepatitis?
Anti-Smooth Muscle Antibody and Anti-Nuclear Antibody
179
What antibody is positive in Coeliac Disease?
Anti-Endomysial Antibody
