Gastrointestinal Pathology Flashcards
What are the primary tumours of the small bowel?
Lymphomas
Neuroendocrine tumours
Carcinomas
What does coeliac disease do to the epithelia of the small intestine?
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
What can be injected into an area of upper GI haemorrhage?
Adrenaline
What are the causes of diarrhoea?
Infectious Agents - viruses, bacteria etc. Chronic disease Toxins Drugs Psychological factors
What are the complications of diarrhoea?
Dehydration - Na+ and H2O loss
Metabolic Acidosis - HCO3- loss
Hypokalaemia - K+ loss
What is the treatment of severe acute diarrhoea?
Rehydration therapy
Anti-infective agents, if appropriate
Non-antimicrobial antidiarrhoeal agents, symptomatic
What is the pathophysiology of diarrhoea?
Impaired NaCl absorption
Presence of non or poorly absorbable solutes in the lumen
Hypermolility of the GI tract
Excessive secretion e.g. cholera
What are oesophageal varicies?
Abnormal dilated veins in the oesophagus
What is portal hypertension?
Increased blood pressure within the portal veins
What is Crohn’s Disease?
A chronic inflammatory and ulcerating condition of the GI tract That can affect any part of the alimentary canal
What are the causes of crohns disease?
Genetic susceptibility
Luminal microbial antigens and adjuvants
Immune response
Environmental triggers
What is sepsis?
The systemic inflammatory response to infection
What is perotinits?
Leakage of bowel contents into the perotineal cavity
what is the progression of sepsis?
SIRS - Sepsis - Septic Shock
What is gastroenteritis?
This is inflammation of the lining of the stomach, small and large intestines
What amount of diarrhoea suggests infection of the small bowel?
Large amount
What amount of bacteria suggests infection of the large bowel?
Small amount
What is the most important virulent factor of shigella?
Shiga toxin
What are the four types of shigella sp.?
S. dysenteriae
S. flexneri
S. boydii
S. sonnei
What is the action of the shiga toxin?
Binds to receptors on renal cells, RBC and other
Inhibit protein synthesis
Cause cell death
What is the most common pathogen causing diarrhoea?
Campylobacter
What is diverticulosis?
It the development of out-pouches in the wall of the colon
What is diverticulitis?
It is inflammation due to diverticular disease?
What is a true diverticula?
This is where the diverticula involves all the layers of the intestinal wall
What is a false diverticula?
This is a herniation of the mucosal and submucosal layers through the intestine
What is an epithelial cell abnormality associated with ulcerative colitis?
Paneth cell metaplasia
What is the cause of achalasia?
A failure of the myenteric plexus to allow for the relaxation of the lower oesophageal sphincter.
What are mallory bodies?
These are bundles of damaged intermediate filaments seen in alcoholic hepatitis
What is gastroparesis?
This is a partial paralysis of the stomach that prevents it from opening and releasing food into the duodenum
What is refeeding syndrome?
This is an adverse clinical and biochemical response to feeding in severely malnourished patients.
What is the cause of refeeding syndrome?
Potentially fatal shifts in electrolytes and disturbances in organ function and metabolic regulation
What is haemocromatosis?
This is where the body absorbs excessive amounts of iron
Where in the body does iron accumulate?
Parenchymal organs Liver Pancreas Heart Pituitary Gland Joints Skin
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.
What is puruitis?
Sever itchy and irritated skin
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
Why is unconjugated bilirubin not exreted from the body?
It is lipid soluble therefore cannot dissolve in water to be excreted
What is alpha-1-antitrysin deficiency?
This is an autosomal recessive condition where there is limited or no alpha-1-antitrypsin produced
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.
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
What protozoa is responsible for amoebiasis?
Entamoeba histolytica
What are leukoplakia?
Flat, raised white plaques in the mouth
What mediates the response in eosinophilic oesophagi’s?
Th2 Cells
What cytokines are released in eosinophilic oesophagi’s?
Il-5 and Il-13
What do the epithelial cells of the oesophagus release in eosinophilic oesophagitis?
Eotaxin
What is eotaxin?
This is a chemokine that can recruit eosinophils from the blood to the oesophageal mucosa
What are the two types of gallstones?
Cholesterol and pigment stones
How are cholesterol stones formed?
An imbalance in the ratio of cholesterol to bile salts
How are pigment stones formed?
Excess bilirubin
What are complications of c.diff infection?
Toxic megacolon
Bowel perforation
Renal failure
Sepsis
What does the hepatitis B surface antigen suggest?
The patient is infectious
What does the hepatitis B surface antibody suggest?
The patient has immunity either from previous infection or via vaccination
What does the hepatitis B core IgM antibody suggest?
They have acute infection.
What does the hepatitis B e antigen suggest?
They have acute infection
What does the hepatitis B core DNA suggest?
Indicator of viral replication
What does the anti-hep B core IgG antibody suggest?
Indicates previous or ongoing infection with hep B in an undefined time frame
What are the most common types of acute viral hepatitis?
A, B and E
What are the most common types of chronic viral hepatitis?
C and sometimes B
How is hepatitis A spread?
Faecal-oral transmission, associated with poor sanitation
How do we test for hepatitis A?
HAV IgM antibody
How is hepatitis B transmitted?
Blood-borne, sexually transmitted and vertical transmission
What is phase 1 of chronic HBV infection?
Immune Tolerant
Highly Infections
High levels of viral replication
Low levels of inflammation within the liver
What is phase 2 of chronic HBV infection?
Immune reactive
Moderate severe inflammation within the liver
What is phase 3 of chronic HBV infection?
Inactive carrier
Low levels of inflammation within the liver
Low risk of cirrhosis
What is phase 4 of chronic HBV infection?
Virus abolishes HBeAg expression
Moderate severe inflammation within the liver
Low rate of spontaneous remission
What is phase 5 of chronic HBV infections?
Occult infection
Low HBV DNA
How is hepatitis C spread?
Mainly blood borne spread, sexual transmission is rare
How do we test for HCV?
HCV IgG indicates virus at some point
HCV RNA detected by PCR indicates active infection
What is a polyp?
A protrusion above the epithelial surface
What is the differential diagnosis of a colonic polyp?
Adenoma
Serrated polyp
Polypoid carcinoma
How does fibrosis occur in chronic liver disease?
The hepatic stellate cells are activated and attract inflammatory cells causing inflammation and fibrogenesis