GI Pathology Flashcards
What is oesophageal reflux?
Reflux of gastric acid into oesophagus
What happens when there is secrete oesophageal reflex?
Ulceration of oesophageal epithelium
What is the affect of oesophageal reflex on the epithelium?
Thickening
Name the complications of oesophageal reflex
Healing by fibrosis
Barretts oesophagus
What are the affects of healing by fibrosis for oesophageal reflux?
Stricture formation
Impaired oesophageal motility
oesophageal obstruction
What is Barrett’s oesophagus?
Transformation from squamous epithelium to glandular epithelium
Name the histological types of oesophageal cancer?
Squamous carcinoma
Adenocarcinoma
What are the risk factors for squamous oesophageal carcinoma?
Smoking
Alcohol
Diet
What are the risk factors for adenocarcinoma oesophageal cancer?
Barrett’s oesophagus
Obesity
Name the local affects of oesophageal cancer?
Obstruction
Ulceration
Perforation
How does oesophagus cancer spread?
Direct
Lymphatic spread
Blood spread
Where does oesophageal cancer spread to though the blood?
Liver
What is the prognosis of oesophageal cancer?
Very poor
5 year survival rate >15%
What is type A gastritis?
autoimmune
What is type B gastritis?
Bacterial
What is type C gastritis?
Chemical injury
What is autoimmune gastritis caused by?
Autoantibodies to parietal cells and intrinsic factor
What is gastritis?
inflammation of the gastric mucosa
What are the affects of loss of specialised cells in autoimmune gastritis?
Decreased acid secretion
Loss of intrinsic factor
How does autoimmune gastritis affects the epithelium?
Atrophy of specialised acid secreting gastric epithelium
What is the most common type of gastritis?
type B
What bacteria causes bacterial gastritis?
Helicobacter pylori
Where is Helicobacter pylori found?
In gastric mucus on surface of gastric epithelium
What type of bacterium is helicobacter pylori?
Gram negative
What does Helicobacter pylori do?
Increased acid production
What are the causes of chemical gastritis?
Drugs
Alcohol
Bile reflex
What drugs most commonly cause chemical gastritis?
NSAIDS
What is peptic ulceration?
Imbalance between acid secretion and mucosal barrier
What parts of the oesophagus does peptic ulceration affect?
Lower oesophagus
What parts of the stomach does peptic ulceration affect?
Body
Antrum
What parts of the duodenum does peptic ulceration affect?
First and second parts
What parts of the GI tract does peptic ulceration affect?
Oesophagus
Stomach
Duodenum
What bacteria is peptic ulceration associated with?
H. Pylori
Name the complications of peptic ulceration?
Bleeding
Perforation
Healing by fibrosis
What is stomach cancer associated with?
Previous H. Pylori infection
How does stomach cancer develop?
Develops though phases of intestinal meta plasma and dysplasia
What is the histology of stomach cancer?
Adenocarcinoma
Name the ways stomach cancer spreads?
Direct
Lymphatic
Blood
Transoelomic
Where does transcoelomic spread of stomach cancer occur?
Within peritoneal cavity
What is the prognosis of stomach cancer?
Very poor
5 year survival >20%
What is liver failure a complication of?
Acute liver injury
Chronic liver injury
What can cause acute liver injury?
Hepatitis
Bile duct obstruction
What can cause hepatitis?
Viruses
Alcohol
Drugs
How does viral hepatitis affect the liver?
Inflammation of liver
Liver cell damage and death of individual liver cells
What type of hepatitis progresses to chronic hepatitis and cirrhosis?
Hepatitis B, C
What type of hepatitis can cause liver failure due to severe damage?
Hepatitis A,B,E
In what type of hepatitis does the liver return to normal?
Hepatitis A,E
What is alcoholic liver disease?
Response of liver to excess alcohol
What can alcoholic liver disease progress to?
Cirrhosis
What are the affects of alcoholic hepatitis?
Acute inflammation
Liver cell death
Liver failure
What is jaundice caused by?
Altered metabolism of bilirubin
What is jaundice?
Increased circulating bilirubin
Name the pathways of bilirubin metabolism
Pre-hepatic
Hepatic
Post-hepatic
Describe pre-hepatic bilirubin metabolism
Breakdown of haemoglobin in spleen to form haem and glob in
Haem converted to bilirubin which is released
Describe hepatic bilirubin metabolism
Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into the biliary system
Describe post- hepatic bilirubin metabolism?
Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption
What is the cause of pre-hepatic jaundice?
Increased release of haemoglobin from red cells
What are the causes of hepatic jaundice?
Cholestasis
Intra-hepatic bile duct obstruction
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
What are the causes of cholestasis?
Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs
What is predicable drug induced cholestasis
Dose related
Give examples of intra-hepatic bile duct obstruction
Primary bile cholangitis
Primary sclerosing cholagnits
Tumours of the liver
Name the tumours of the liver
Hepatocellular carcinoma
Tumours of intra-hepatic bile duct
Metastatic tumours
What sex does primary biliary cholangitis affect?
Females
What is primary biliary cholangitis?
Organ specific auto-immune disease
What are the effects of primary biliary cholangitis?
Anti-mitochondrial auto-antibodies in serum
Raised serum alkaline phosphatase
What happens to the bile ducts in primary biliary cholangitis?
Gramulamous inflammtion
Loss of intra-hepatic bile ducts
What is primary sclerosing cholangitis?
Chronic inflammation and fibrous obliteration of bile ducts
What is primary sclerosing cholangitis associated with?
inflammatory bowel disease
What does primary sclerosing cholangitis give an increased risk of?
Development of cholangiocarcinoma
What is hepatic cirrhosis?
End stage chronic liver disease
What are the causes of cirrhosis?
Alcohol
Hepatitis
Immune mediated liver disease
Metabolic disorders
Obesity
What metabolic disorders cause cirrhosis
Primary haemochromatosis
Wilson’s disease
What is Wilson’s disease?
Excess copper
What is primary haemochromatosis?
Excess iron
What immune mediated liver diseases cause cirrhosis?
Auto-immune hepatitis
Primary biliary cholangitis
What are the affects of cirrhosis on liver structure?
Loss of normal structure
Replaced by nodules of hepatocytes and fibrous tissues
Name the complications of cirrhosis?
Liver failure
Portal hypertension
What does cirrhosis increase the risk for?
Hepatocellular carcinoma
What is hepatocellular carcinoma?
Malignant tumor of hepatocytes.
What is cholangiocarcinoma?
Malignant tumour of bile duct epithelium
What are the risk factors for gallstones?
Obesity
Diabetes
What is acute cholecystitis?
Acute inflammation of the gallbladder
How does acute cholecystitis affect the gallbladder?
Perforation of gall bladder
Biliary peritonitis
What is chronic cholecystitis?
Chronic inflammation and fibrosis of the gallbladder
What are the common causes of common bile duct obstruction
Gallstones
Bile duct tumours
Benign stricture
External compression
What are the affects of common bile duct obstruction?
Jaundice
No bile excreted into duodenum
Ascending cholangitis
What is ascending cholangitis?
Infection of bile prosimians to obstruction
What can happen if there is prolonged common bile duct obstruction?
Secondary biliary cirrhosis
How often are the cells in the small bowel renewed?
every 4-6 days
What type of crypts are found in the small bowel?
Stem
Goblet
Endocrine
Paneth
What cell types are found in the small bowel?
Goblet dells
Columnar absorptive cells
Endocrine cells
What type of crypts are found in the large bowel?
Tubular
What must the immune system balance in the GI tract?
Tolerance of harmless ingested substances against active defence reactions to potential microbial invaders
What is the bowel peristalsis mediated by?
Intrinsic myenteric plexus and extrinsic autonomic innervation neural control
What is the myenteric plexus made up of?
Meissener’s plexus
Auerbach plexus
Where is Meisseners plexus located?
Base of the submucosa
Where is Auerbach’s plexus located?
between the inner circular and outer longitudinal muscle layers of the muscularis propria
Define idiopathic inflammatory bowel disease
Chronic inflammatory conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal intraluminal flora
Name the main idiopathic inflammatory bowel diseases
Crohn’s disease
Ulcerative colitis
What gene mutation is associated with Crohn’s disease?
NOD2
what gene is associated with ulcerative colitis?
HLA
What is the cause of IBD?
Strong immune response against normal flora with defects in epithelial barrier
What is used to diagnose IBD
pANCA
which type of IBD is associated with p-ANCA
UC
What age does UC peak?
20-30 years
70-80 years
Where is UC found?
Localised to rectum
Where does UC commonly spread
Proximally
What is found in UC?
Psudopolyps
Ulceration
Inflammation
What is UC associated with?
Systemic manifestations
Are granumolas present in UC?
No
Where is the wall is UC limited to?
Mucosa and submucosa
How does UC affect the mucosa?
Mucosal atrophy
How does UC affect crypts?
Cyptisis
Crypt abscesses
Architectural disarray of crypts
Name complications of UC
Haemorrhage
Perforation
Toxic dilation
Describe dysplasia of UC progressing to cancer
Flat epithelial atypica
Adenomatous change
Invasive cancer
What is there an increased risk of if pancolitis is present in UC?
20-30 x higher risk of developing cancer
Where is Crohn’s disease located?
Anywhere from mouth to anus
What sex does Crohn’s disease affect more?
Females
What age does Crohn’s disease peak?
20-30 years
60-70 years
What race is Crohn’s disease most common?
Caucasians - Jewish population
Where is most Crohn’s disease located?
Small intestine
How does CD affect the mesentary?
Thickened
Oedematous
Fibrotic
Wrapping mesenteric fat
How does CD affect the lumen?
Narrowing of lumen due to thickened wall