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Pathology > GI > Flashcards

GI Flashcards

1
Q

What causes GORD?

A

red. lower oesophageal sphincter tone
hiatus hernia
delayed gastric emptying

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2
Q

Complications of GORD?

A

bleeding
ulceration
stricturing
Barrett’s oesophagus

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3
Q

What is the single most important risk factor for oesophageal adenocarcinoma?

A

Barrett’s oesophagus

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4
Q

What is Barrett’s oesophagus?

A

replacement of distal oesophageal squamous epithelium with glandular epithelium in response to chronic injury
Metaplasia

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5
Q

How is Barrett’s oesophagus diagnosed?

A 
Endoscopy
Biopsy (histological features)
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6
Q

What causes oesophageal varices?

A

Portal hypertension, usually due to liver cirrhosis

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7
Q

Causes of oesophageal haemorrhage?

A 
Reflux oesophagitis
Varices
Cancer
Mallory-Weiss tears
Foreign body injury
Boerhaave Syndrome
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8
Q

What is Boerhaave syndrome?

A

spontaneous perforation of the oesophagus that results from sudden increase in intraoesophageal pressure combined with negative intrathoracic pressure
e.g., severe straining or vomiting

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9
Q

Most common oesophageal carcinoma worldwide?

A

SCC (>90%)

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10
Q

Most common oesophageal carcinoma in developed countries?

A

Adenocarcinoma (50%)

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11
Q

Clinical features of oesophageal carcinoma?

A

Dysphagia, Odynophagia, Weight loss, Vomiting

Generally presents late

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12
Q

Prognosis of oesophageal carcinoma?

A

Poor- 5yr survival rate 20%

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13
Q

Oesophageal SCC risk factors?

A

Smoking and Alcohol!!!!!!

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14
Q

Characteristics of SCC?

A

Production of keratin

Destruction of intracellular bridges

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15
Q

Risk factors for Oesophageal Adenocarcinoma?

A

Barrett’s Oesophagus
Smoking
Obesity
*****NOT alcohol

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16
Q

What is pyloric stenosis?

A

congenital hypertrophy of gastric pylorus

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17
Q

When and how does pyloric stenosis present?

A

3-6 weeks old

projectile vomiting, palpable lump in RUQ, always hungry and malnourished

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18
Q

Treatment of pyloric stenosis?

A

Ramstedt pyloromyotomy

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19
Q

Causes of acute gastritis?

A 
NSAIDs
Alcohol
Smoking
Chemo
Uraemia
Inc. ICP
Severe burns
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20
Q

Chronic Gastritis Definition?

A

chronic mucosal inflammatory changes, leading to mucosal atrophy and intestinal metaplasia

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21
Q

Chronic Gastritis Causes?

A 
Helicobacter Pylori
Autoimmune Gastritis
Toxicity (alcohol, smoking)
Post-surgical
Obstruction
Radiation
Granulomatous Diseases
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22
Q

H. pylori diagnosis?

A

Urea Breath test

Gastric biopsy

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23
Q

H. pylori consequences?

A

peptic ulcers
gastric adenocarcinoma
gastric lymphoma (MALT)

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24
Q

What percentage of gastritis is caused by autoimmune gastritis?

A

Less than 10%

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25
Q

Complications of autoimmune gastritis?

A

Pernicious anaemia
Gastric Adenocarcinoma
Gastric neuroendocrine tumours

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26
Q

Causes of peptic ulcers?

A 
H. pylori
Stress
Smoking
Zollinger-Ellison syndrome
Hypercalcaemia
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27
Q

What is Zollinger-Ellison syndrome?

A

gastrin secreting tumour of pancreas- too much acid is secreted

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28
Q

Peptic Ulcer Complications?

A 
Bleeding, perforation, obstruction
Malignant transformation (not in duodenal ulcers, rarely in gastric ulcers)
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29
Q

Gastric carcinoma associations?

A 
H. pylori
Autoimmune Gastritis
Diet (salty, cured foods)
Gastric Adenoma
**********NOT smoking or alcohol
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30
Q

Spread of Gastric Carcinoma?

A

Direct- through stomach wall
Transcoloemic
Lymphatic- left supraclavicular node
Blood- brain, bone, lung, liver

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31
Q

What triggers malabsorption in Coeliac disease?

A

alpha-gliadin component of gluten

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32
Q

Genetic associations of coeliac disease?

A

HLA-B8, DR3, Dqw2

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33
Q

Symptoms of coeliac disease?

A

asymptomatic
anaemia, weight loss, failure to thrive
steatorrhea
osteomalacia in older ages (Vit D malabsorption)

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34
Q

Histology of Coeliac Disease?

A

Decreased villous height/ flat atrophic mucosa

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35
Q

Serology of Coeliac Disease?

A

Anti-tTG
Anti-gliadin antibodies (non-specific)
Anti-endomysial antibodies

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36
Q

Complications of coeliac disease?

A 
Refractory coeliac disease
Anaemia
Osteomalacia
GI malignancy (T cell lymphoma)
Dermatitis Hepetiformis
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37
Q

Types of gallstones?

A

Pigment (5-10%)
Cholesterol (10%)
Mixed (75-90%)

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38
Q

Gallstones Consequences?

A

80% asymptomatic
Biliary colic (pain in RUQ)
Calculous cholecystitis
Pancreatitis

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39
Q

Acute Cholecystitis Presentation?

A

unwell
RUQ pain, radiating to tip of right shoulder
nausea and vomiting
pyrexia
tenderness and guarding in right hypochondrium
Murphy’s sign

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40
Q

What is Murphy’s sign?

A

palpate right hypochondrium
get patient to take deep breath in
on inspiration, examiner’s hand comes into contact with inflamed gallbladder
intense pain

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41
Q

Chronic Cholecystitis symptoms and signs?

A

irregular attacks of RUQ pain, worse after eating fatty meals
tenderness in RUQ

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42
Q

What percentage of chronic cholecystitis is associated with cholelithiasis?

A

90%

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43
Q

What causes ‘strawberry gallbladder’?

A

Cholesterolosis

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44
Q

What is cholangitis?

A

inflammation of the bile ducts

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45
Q

What is Charcot’s triad?

A

fever + pain + jaundice

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46
Q

What is primary sclerosing cholangitis associated with?

A

destruction of extrahepatic biliary tree

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47
Q

What disease is associated with PSC?

A

IBD, especially ulcerative colitis

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48
Q

What is primary biliary cirrhosis associated with?

A

destruction of small intrahepatic bile ducts

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49
Q

What are raised in PBC?

A

anti-mitochondrial antibodies (95%)

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50
Q

What are raised anti-mitochondrial antibodies most associated with?

A

Primary Biliary Cirrhosis

51
Q

What genders suffer more commonly from PSC and PBC?

A

PSC- M:F = 2:1

PBC- primarily women

52
Q

What is the prognosis for carcinoma of the gallbladder?

A

dismal - 1% 5 yr survival rate

most have mets at diagnosis

53
Q

Risk factors for carcinoma of the gallbladder?

A

gallstones
PSC (ulcerative colitis)
liver fluke

54
Q

Main causes of pancreatitis?

A

alcohol, gallstones

55
Q

Presentation of acute pancreatitis?

A

severe epigastric pain, radiating to back
tenderness and guarding in upper abdomen
Cullens and Grey Turners sign
raised serum amylase

56
Q

What is Cullens sign?

A

discoloration around the umbilicus

57
Q

What is Grey Turners sign?

A

bruising of the flank region

58
Q

Presentation of carcinoma of the pancreas?

A

weight loss, jaundice

+/- epigastric pain

59
Q

Sites of pancreatic Ca?

A

Head- 60%
Body- 15-20%
Tail- 5%
Diffuse- 20%

60
Q

What is Whipple’s operation?

A

removes head of pancreas, duodenum, gallbladder and bile duct

61
Q

Prognosis of Pancreatic Ca?

A

dismal

5yr survival rate <5%

62
Q

What are 2 tumours of the pancreatic Islet cells?

A

Insulinoma (Beta Cells, 5% malignant)

Gastrinoma (Gastrin G-Cells, 60% malignant, Zollinger-Ellison syndrome)

63
Q

What is Meckel’s diverticulum?

A

incomplete obliteration of the vitelline duct leading to the formation of a ‘true diverticulum’
most common congenital abnormality of the GI tract

64
Q

What is Hirschsprung disease?

A

congenital aganglionic megacolon

leads to functional obstruction and dilatation of affected area

65
Q

Differential diagnosis for Hirschsprung disease?

A

Acquired forms of megacolon (Chagas’s disease, toxic megacolon)

66
Q

What genetic mutation is Hirschsprung disease associated with?

A

Trisomy 21

67
Q

What micro-organisms cause dysentery?

A

Shigella, Salmonella, Entamoeba histolytica

68
Q

What does C. Difficile cause?

A

Pseudomembranous Colitis

69
Q

What causes pseudomembranous colitis?

A

Clostridium Difficile

70
Q

Who does necrotising enterocolitis affect?

A

Premature babies after oral feeding is initiated

71
Q

Aetiology of IBD?

A

Genetic susceptibility, role of intestinal flora, abnormal T-cell response

72
Q

Which IBD skips lesions?

A

Crohn’s Disease

73
Q

Which IBD has continuous involvement?

A

Ulcerative Colitis

74
Q

What is the relationship between ulcerative colitis and smoking?

A

Ex-smokers > Never smokers > smokers

Smoking protects against UC

75
Q

Microscopic Crohn’s Disease?

A

Non-caseating granulomas (50%)
Transmural inflammation
Crypt abscesses and distortion

76
Q

Microscopic Ulcerative Colitis?

A

No granulomas
Diffuse, superficial inflammation (limited to mucosa)
Crypt abscesses and distortion

77
Q

Extra-intestinal manifestations of IBD?

A 
migratory polyarthritis
sacroiliitis
ankylosing spondylitis
erythema nodosum
clubbing
uveitis
pyoderma gangrenosum
PSC (ulcerative colitis)
78
Q

Examples of intestinal obstructions?

A

Hernia, Volvulus, Intussusception, Adhesions

79
Q

What is diverticular disease?

A

acquired outpouching of the mucosa, typically in the sigmoid colon

80
Q

Complications of diverticular disease?

A

Haemorrhage, inflammation (diverticulitis), Abscesses

81
Q

Causes of intestinal ischaemia?

A

arterial thrombosis, arterial embolism, venous thrombosis, nonocclusive ischaemia

82
Q

Where are hyperplastic polyps found?

A

Rectum (50%)- most common, serrated appearance, no dysplasia

Right-sided- less common, larger, KRAS mutation, may evolve to Ca

83
Q

Who are juvenile polyps most common in?

A

Children aged between 2 and 10 but can occur at any age

84
Q

What percentage of people over 40 have colorectal adenomas?

A

30%

85
Q

What percentage of colorectal adenomas progress to malignancy?

A

5%

86
Q

Risk factors for adenomas to progress to carcinoma?

A

Villous architecture
Size > 4cm
High grade dysplasia

87
Q

Types of colorectal carcinomas?

A

Adenocarcinomas vast majority

Neuroendocrine tumours

88
Q

Risk factors for colorectal carcinomas?

A

Diet- excess food, low fibre
Obesity
Physical inactivity
Aspirin may be protective

89
Q

Clinical features of colorectal carcinoma?

A

asymptomatic for many years
right-sided- iron deficiency anaemia, fatigue, malaise
left-sided- PR bleeding, abdo pain, changes in bowel habits

90
Q

Two most common molecular pathways for colorectal carcinomas?

A 
Chromosomal Instability (CIN)- FAP
Microsatellite Instability (MSI)- HNPCC- Lynch
91
Q

What genes are involved in the Chromosomal Instability Pathway?

A

APC, KRAS, DCC, p53

92
Q

What condition does mutation in the APC gene cause?

A

Familial Adenomatous Polyposis (FAP)

93
Q

What gene is mutated in Familial Adenomatous Polyposis?

A

APC Gene

94
Q

What causes HNPCC (Lynch Syndrome)?

A

mutations results in microsatellite instability, leading to rapid progression from adenomas to carcinomas

95
Q

Distinct pathological features of HNPCC (Lynch syndrome)?

A

right-sided, poorly differentiated, mucinous, lymphocytic host response

96
Q

Symptoms of acute appendicitis?

A 
Pain- umbilicus -> right iliac fossa
nausea and vomiting
abdominal tenderness
mild fever
elevated WCC
97
Q

Causative organisms of GI infections?

A

Viruses, Bacteria, Parasites (protozoa), Fungi (immunocompromised)

98
Q

What does Helicobacter pylori very actively produce and what does this do?

A

Produces urease

Splits urea

99
Q

What diseases are associated with H pylori?

A

Duodenal ulcer, gastric ulcer, gastritis, gastric lymphoma, gastric carcinoma, non-ulcer dyspepsia

100
Q

Diagnosis of H pylori?

A

Urea Breath test
Serology IgG
Endoscopy with biopsy
Faecal antigen testing

101
Q

Eradication of H pylori?

A

7 days of:
PPI
Antibiotics (Amoxicillin + Clarithromycin/Metronidazole)

102
Q

Causes of diarrhoea in Ireland?

A

Rotavirus, Norovirus
Campylobacter, C Diff, E Coli, Salmonella, Shigella
Cryptosporidia, Giardia lamblia

103
Q

Most common bacterial cause of diarrhoea in Ireland?

A

Campylobacter

104
Q

What is ‘rice-water stool’ associated with?

A

Cholera

105
Q

What is the source of Campylobacter?

A

Animals (poultry, cattle)

106
Q

Which infection is associated with recent antibiotic use?

A

Clostridium Difficile

107
Q

Spectrum of what C Diff can cause?

A

Diarrhoea
Pseudomembranous Colitis
Toxic megacolon

108
Q

Diagnosis of C Diff?

A

molecular methods (most sensitive)
Toxins A + B in stool
stool culture
endoscopy and biopsy (with care)

109
Q

C Diff treatment?

A

Stop antibiotics if possible
Oral metronidazole or vancomycin
Fidaxomicin (reduce recurrence)

110
Q

Control measures for E Coli O157?

A 
no pink hamburgers
keep fresh and cooked meats separate
pasteurize milk
hand hygiene at petting zoos
drinking water treatment
111
Q

Severe consequence of E Coli O157 infection?

A

Haemolytic uremic syndrome

112
Q

Where is shigellosis endemic?

A

Tropics

Subtropics

113
Q

What is the name of the human-adapted salmonella?

A 
Salmonella enterica (not carried by animals)
Typhoid
114
Q

Viral gastroenteritis can be severe in?

A

Elderly and children

115
Q

What does salmonella enterica cause?

A

Typhoid (enteric fever)

116
Q

What does shigella cause?

A

Dysentery

117
Q

What bacteria causes food poisoning following cooked meat being stored warm?

A

Clostridium Perfringens

Diarrhoea- resolves 24-48hrs

118
Q

What bacteria causes food poisoning following eating re-heated rice?

A

Bacillus cereus
Rapid-acting- vomiting
Slower-acting- diarrhoea

119
Q

When does staph aureus cause food poisoning?

A

Usually introduced during preparation

Lesions on hands NB

120
Q

What parasites cause GI infections?

A

Entamoeba histolytica- dysentery, not acquired in Ireland
Giardia lamblia- causes malabsorption
Cryptosporidium

121
Q

How common is Traveller’s Diarrhoea?

A

Very common

20-50% of travellers to developing country

122
Q

Most common cause of traveller’s diarrhoea?

A

E Coli serotype

local population immune

123
Q

What part of the colon is most affected in ischaemic colitis?

A

Splenic flexure

Pathology (13 decks)

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