GI, Liver & Pancreas Flashcards
Barrett’s oesophagus – definition and morphology
Definition = DUE to REFLUX OESOPHAGITIS
Morphology:
- CHRONIC IRRITATION of the Oesophagal Mucosa BY GASTRIC JUICE leads to
- METAPLASIA of the SQUAMOUS EPITHELIUM into –> COLUMNAR Epithelium
Malignant tumours of oesophagus gross and histology
GROSS:
- DEVELOPS in the LOWER + MIDDLE Physiological Oesophageal Narrowing
1) ULCERATIVE = Looks like a NECROTIC ULCER
2) POLYPUS - PAPILLARY = STENOSIS of Oesophagus
3) SCHIRRHOUS = NARROWING of LUMEN, DUE to INFILTRATION
4) NODULAR = Seen in ADENOCARCINOMA
HISTOLOGY:
- SQUAMOUS Cell Carcinoma
- MOST COMMON
- WELL-Differentiated / Moderately-Differentiated
Complications of chronic stomach ulcers histology
1) HAEMORRHAGES = Due to EROSION of BVs in BASE of ULCER, FROM Fibrinoid NECROSIS
2) PERFORATION = DUE to Gastric / Duodenal Wall DESTRUCTION, where Ulcer REACHES the SEROSA
3) PENETRATION = Where Ulcer of Stomach POSTERIOR Wall PENETRATES into ADJACENT Organs (Pancreas, Liver, Transverse Colon, Gall Bladder)
4) PYLROIC STENOSIS:
- DUE to CHRONIC Inflammation + Development of FIBROTIC TISSUE around Ulcer
- The Pylorus is THICKENED, FIRM + DEFORMED with a NARROW Lumen
5) INFLAMMATORY Complications = Gastritis AND Duodenitis
6) MALIGNANT TRANSFORMATIONS
- CHRONIC CALLOUS Gastric Ulcer
- DYSPLASIA of Epithelium Lining
0 Grossly, Edges becomes SOFTER + SWOLLEN;
0 Micro, PROVE PRESENCE of ADENOCARCINOMA
Give a definition for early gastric carcinoma, Go to its macroscopic morphological forms /
gross histo changes. Can this tumours metastasize?
DEFINITION = ADENOCARCINOMA that’s LIMITED to the Mucosa + Submucosa OF the GASTRIC Epithelium
MACROSCOPIC FORMS:
1) PROTRUDED - Cauliflower Appearance
2) SUPERFICIAL (Intra-mucosal)
0 ELEVATED - the height is NO MORE than the THICKNESS of the Mucosa
0 FLAT - the lesion is on the SAME LEVEL as the ADJACENT Mucosa
0 DEPRESSED - UNDER the LEVEL of Adjacent Mucosa
METASTASIS IS POSSIBLE as the Adenocarcinoma can INFILTRATE into the SUBMUCOSA, but it happens RARELY!
Ulcerative colitis – histological features
- SMALL, ENDOSCOPIC Biopsies
- Divided into 2 MAJOR FORMS = With / Without ATROPHY of Villi
1) CHRONIC Enteritis W/O Villi = MARKED Inflammatory infiltrate of Lymph, Plasma Cells + Eosinophils
2) CHRONIC Enteritis WITH ATROPHY of Villi = Villi are SHORTENED, DILATED + DEFORMED, with SHALLOWER / WIDER Crypts
Large bowl carcinoma
DEFINITION = ADENOCARCINOMA of the COLON
0 GROSS:
- CAULFIFLOWER Appearance, UN
EVEN, Lobular Surface
- INFILTRATIVE = It INFILTRATES the Colon WALL, leading to CONSTRICTION + Bowel OBSTRUCTION
- ## ULCERATIVE = Ulcer PENETRATES the LOCAL Tissue + Colon0 MICROSCOPICALLY
- They’re ALL ADENOCARCINOMAS
a) MUCINOUS Carcinoma = MORE than 50% MUCINOUS Component
METASTASISE TO - Regional LN, Peritoneum + Pleura AND Liver / Lungs (Haematogenously)
Colorectal carcinoma – histological features, metastases
They’re ALL ADENOCARCINOMAS
a) MUCINOUS Carcinoma = MORE than 50% MUCINOUS Component
b) SIGNET-RING Cell Carcinoma = HIGHLY INVASIVE with Nucleus TO Periphery
METASTASISE TO - Regional LN, Peritoneum + Pleura AND Liver / Lungs (Haematogenously)
- Colorectal Cancer Cells BREAK AWAY from OG Tumour + TRAVEL VIA Blood / Lymph System TO OTHER Parts of Body (Liver, Lungs, Brain)
How many types of jaundice do you know? What are the morphological changes in
Jaundice?
1) PRE-HEPATIC
- EXCESSIVE RBC Breakdown, where Liver is UNABLE to CONJUGATE Bilirubin
- Unconjugated Bilirubin in Blood
2) HEPATOCELLULAR
- DYSFUNCTION of the Hepatic Cells
- Liver LOSES ABILITY to CONJUGATE Bilirubin
- BOTH Conjugated / Unconjugated IN BLOOD
3) POST-HEPATIC
- OBSTRUCTION of BILIARY DRAINAGE
- The Bilirubin that’s NOT EXCRETED becomes CONJUGATED by Liver
- CONJUGATED Hyperbilirubinemia
Give a definition and describe the morphological changes of liver cirrhosis
MORPHOLOGICAL CHANGES
1) Hepatocellular NECROSIS
- DESTRUCTION of Hepatocytes
- ## Causing COLLAPSE of LOBULAR Hepatic PARENCHYMA2) REPLACEMENT FIBROSIS / INFLAMMATION
- FIBROSIS is INCREASED VIA SYNTHESIS of Collagen + Collagen-Producing Cells
- Causing FAT STORAGE PROLIFERATION into Cells of SINUSOIDAL Epithelium
- ## TRANSFORMED into MYOFIBROBLASTS + FIBROCYTES3) REGENERATIVE NODULES
- SURVIVING Hepatocytes that UNDERGO REACTIVE HYPERPLASIA
Which organs are most affected by fat degeneration? How do we prove them
microscopically?
- STEATOSIS or FAT DEGENERATION often affects the LIVER
- Liver is PRIMARY ORGAN for LIPID Metabolism
- ## CAN ALSO occur in Kidneys, Heart, MuscleMICROSCOPICALLY:
- Lipid is DISSOLVED by SOLVENTS, and CLEAR VACUOLES can be seen
- Can be seen when FIXED + STAINED under Microscope
- SUDAN STAINING is used to PROVE for LIPID DROPPLETS
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GROSSLY: - Organ ENLARGEMENT
- Greasy
- YELLOW in Colour
List the main morphological types of cholecystitis and their complications
Cholecystitis is the ACUTE / CHRONIC Inflammation of the GALL BLADDER
MORHOLOGICAL TYPES
1) Acute = CALCULOUS / ACALCULOUS
a. EMPYEMA
0 DISTENDED & TENSE Gall Bladder w/ SEROSA covered in FIBRINOUS Exudate w/ Congestion + Haemorrhage
0 BRIGHT RED Mucosa
0 Lumen filled with Purulent Exudate AND Bile
0 Gall Bladder Wall w/ INFLAMMATORY Cells, Oedema, Congestion + Neutrophilic Exudate
b. GANGRENOUS
0 ABOVE + ABSCESSES in Wall
2) Chronic
0 HYPERTROPHIC
- Contracted, THICK, FIRM wall, that’s CALCIFIED with THICK MUCOSAL Folds;
- Lumen filled with GALLSTONES
- INTACT Epithelium, but BLUNT Villi
- Wall Contains - Lymph, Plasma Cells, Eosinophils + Adhesions
0 ATROPHIC
- Long standing OBSTRUCTION of Cystic Duct
- THIN Grey Wall, FLAT Mucosa, STONE-BLOCKING Cystic Duct
- TINY MUCOSAL Villi, ABSENT Muscularis, THIN Fibrous Wall containing inflammatory Cells
COMPLICATIONS
- Mucocele = IMPACTED Cystic Duct
- Empyema / Mirizzi Syndrome
- Jaundice
- Fistula
- Malignisation
- Ileus WITH Perforation
- ACUTE Pancreatitis
