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Year 2: Clinical Pathology > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

Causes of Oesophagitis (5)

A 
gastro-esophageal reflux.
Bacterial
Viral - HSV1 and CMV
Fungal - candida
Chemical - ingestion of corrosive substance
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2
Q

Risk Factors for Gastro reflux (4)

A 
Hiatus hernia (overweight), 
defective lower esophageal sphincter, 
increased ab pressure (vomiting)
increase ab contents (outflow obstruction)
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3
Q

Histology of Oesophagitis (4)

A

Squamous cell affected basal cell hyperplasia, papillae elongation, inflammatory cells in basal laminae

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4
Q

Symptoms of Oesophagitis (1)

A

heart burn - mistake with cardiac symptoms?

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5
Q

Complications of Oesophagitis (6)

A

ulceration –> hemorrhage –> perforation –> fibrosis –> stricture/narrowing –> Barretts Oesophagus

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6
Q

Barrett’s Oesophagus

A

Chronic Reflux. Squamous cell metaplasia to collumnar, goblet cells (muscus secreting) in the laminae propria

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7
Q

Barrett’s Disease Progression (4)

A

Barrets –> dysplasia –> high grade –> adenocarcinoma

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8
Q

Oesophageal Carcinoma type + risk facors (5)

A 
Squamous cell
Tobacco (chew), 
alcohol 
thermal damage, 
HPV, ??
ethnicity
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9
Q

Presentation of Carcinoma and Adenocarcinoma (4)

A

Dysphasia - occlusion due to polypoidal lumps –> stricture and ulceration

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10
Q

Causes of Acute Gastritis (aggression (3) vs. Defense (3))

A

Increased aggression: chemical injury (NSAIDs, alcohol, smoking) corrosive radiation.
Impaired defense: delayed emptying (occlusion), prostoglandin imbalance = uncontrolled emptying, ischemic shock

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11
Q

Causes of Chronic Gastritis (ABC)

A 
A = autoiummune - antiparietal and anti intrinsic factor antibodies
B = Bacterial infections (H. Pylori)
C = Chemical injury (NSAIDs)
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12
Q

Gastritis

A

Inflammation the mucousa of the stomach

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13
Q

Peptic Ulcers (depth)

A

Localized defect at least as deep as submucosa (can perforate vessels and musculature).
AKA slightly more serious Gastritis

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14
Q

Causes of ulcers (5)

A 
Autoimmune
NSAIDs
H.Pylori
Hyperacidicity 
Duodenal- gastric relfux
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15
Q

Acute Vs Chronic ulcers (appearance)

A

Acute = full thickness, necrosis with slough/ debris (neutrophils and dead tissue), red if reach vessel

Chronic = clear cut edges, extensive granulation tissue and deep scaring into the musculature –> bleed to death

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16
Q

Stricturing, hemorrhage, perforation and penetration fistula

A

Complications of ulcers

Hemorrhage = aneamia and perforation = peritonitis

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17
Q

Gastric Cancers (4 examples)

A

adenocarcinomas, endocrine tumours, MALT lymphomas and stromal tumours

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18
Q

Macroscopic subtypes of gastric cancer (3)

A

1) Exophytic - protrude into lumen
2) Linitis plastica - spread all along mucosa (diffuse)
3) Excavated - concave lesion

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19
Q

Diffuse vs intestinal gastric cancers

A 
Diffuse = high grade, less differentiated, scattered growth
Intestinal = well differentiated, metaplasia, adenoma aspects
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20
Q

Coeliac disease: reaction to what, releases which cytokine and induces which immune cells to kill which body cells (name of pathogenesis)

A

Gliadin in Gluten –> IL-15 –> intraepithelial lymphocytes (IELs) –> enterocytes killed
Immune mediate enteropathy

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21
Q

Presentation of Ceoliac (4 types)

A 
Atypical = non specific symptoms
Silent = no symps but evident serology OR villous atrophy
Latent = no symps positive serology BUT no villous atrophy
Symptomatic = aneamia, diarrhoea, bloating, fatigue (+ positive results)
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22
Q

Serology test for Coeliac

A

BEFORE gluten free diet and biopsy. Non invasive. looks at: IgA antibodies to transglutaminases (TTG)
IgG antibodies deaminate gliadin

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23
Q

Histological signs of Coeliac (4)

A

villous atrophy, crypt elongation, increased IELs and laminae propria inflammation

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24
Q

Blind ended sacs of bowel and protrusions of mucosa and submucosa

A

Diverticular of the large bowel

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25
Q

Most common site for Diverticular

A

sigmoid colon inbetween the taemic coli

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26
Q

Risk factors for Diverticular?

A

Age (>60) and fiber content of diet

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27
Q

Causes of Diverticular (2)

A

1) Increased intralumen pressure - due to irregular/ unco-ordinated peristalsis
2) Points of weakness the bowel wall - changes in connective tissue with age

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28
Q

Symptoms of Diverticular and % Asymptomatic?

A

Cramps and alternating diarrhoea and constipation. 90%

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29
Q

Complications of Diverticular (acute and Chronic)

A 
Acute = Diverticulitis (bacterial) --> abscesses --> sepsis or perforations --> perionealitis
Chronic = Intestinal obstruction = vomiting, distension and pain. Fistulas and colitis (rectal bleeding)
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30
Q

Colitis Acute VS Chronic causes

A

Acute = Infective: Campylobactor, shigella, salmonella (stool cultures) OR antibiotic related

Chronic = idiopathic (unknown) OR Ischemic

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31
Q

IBD?

And prevalence

A

Idiopathic bowel disease. Age 20 - 40 peaks in urban areas and includes Ulcerative Colitis and Crohn’s disease

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32
Q

UC VS Crohns (site + appearance of ulcers)

A

UC = Rectum –> up, continuous.

Crohn’s = manly iliopathic, small bowel. Transmural (through wall), skip lesions (not continuous). ‘Cobble stone’ lateral and longitudinal ulcerations.

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33
Q

UC vs Crohns (Presentation)
Both?
differences

A

Both = diarrhoea, pain, anorexia and weight loss

UC = inc. urgency, diarrhoea and rectal bleeding, ab pain, Granular/ red tissue

Crohn’s = Relapsing diarrhoea with blood, colicky pain, palpable mass. Granulomas

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34
Q

UC vs Crohn’s (Complications)

A 
UC = toxic mega colon, perforation (emergency), bleeding (ulcers), carcinoma
Crohn's = Fistula, strictures, heamorrhage, large bowel cancer, short bowel syndrome (Malnutrition)
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35
Q

Ischemic Colitis - most common site?

A

Secondary to acute, chronic or intermittent reduction in blood flow.
Splenic flecture due to crossing over of blood supply (watershed)

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36
Q

3 types of Ischemic Colitis

A

Transient = sudden onset, urgency and rectal bleed. resolve in 2 days - 2 weeks
Chronic segmental ulceration
Acute gangrenous - 10-20% of cases = surgical emergency

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37
Q

Causes of Ischemic colitis (3)

A

1) arterial embolism following MI or AF = 50%
2) Arterial thrombosis of SMA OR heamorrhage infarction of thrombosis of the SMV 30%
3) Non-occlusive - due to low cardiac output + SMA vasoconstriction (post op)

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38
Q

Colorectal polyps - 3 morphologies

A

Mucosal protrusion - secondary to pathology or lesion in bowel
Pundulated - on a stem
Sessile - broad flat base
Flat

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39
Q

Neoplastic (benign vs malignant), haemartomatous, inflammatory or reactive - further divisions

A

Classification of polyps - epithelial of mesenchymal

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40
Q

Examples of Haemartomatous (2)

A

Peutz-jeghers: STK11 gene on chromosome 16 - autosomal dominant. Teens in 20s - ab pain, GI bleeds, aneamia. Multiple polyps in small bowel

Juvenile: sporadic, spherical pundulated in the colon and small bowel in children

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41
Q

Examples of benign neoplastic polyp

A

Adenomas = epithelial, polypoid and flat, recto-sigmoid and caecum. Precursor for CR cancer 80%
Adenoma –> adenocarcinoma over about 10 years
Either villous, tubular or both

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42
Q

Risk (7) and protection (4) for Colo-rectal cancer

A 
Risk = fat, red meat and calcium, obesity, oral contraceptive, alcohol and IBD
Protective = fiber, folate, NSAIDs and aspirin
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43
Q

Mutation in what gene = 100% lifetime risk of colon cancer

autosomal dominate

A

Mutation in APC Tumor suppressor gene –> multiple benign andenoma polyps

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44
Q

Which syndrome gives a 50% lifetime risk of colon cancer

autosomal dominate

A

Lynch syndrome - mutation in missmatch repair genes. Also ovarian, endometrial, gastric and urinary tract

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45
Q

Examples of Colo-rectal cancer (4)

A

adenocarcinoma (95%), squamous cell carcinoma, adenosquamous, neuroendocrine and undifferentiated

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46
Q

Grading of CR cancers

A

Duke’s A-D
A = bowel wall no nodes = highest 5 year survival
B = invasion of wall (peritoneal - transcoelomic)
C = Regional lymph mets (regardless of depth) highest frequency
D = distant mets (lung, liver)

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47
Q

Sterile Sites in the GI tract

A

Pancreas, peritoneal cavity, stomach, gall bladder and liver

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48
Q

Normal Flora of the oropharynx (7)

A

Viridans strept, strept pyogenes, candida, Staph, Neissuria and Haemophilus and anaerobes

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49
Q

Normal flora of the colon (4)

A

Candida, anaerobes (bacteriodes), Enterobacteriaceae (gram negative bacilli and coliforms), Gram positive enterococci

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50
Q

Most common Coliform in the colon

A

E.coli

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51
Q

Cause of Angular Celitus

A

Inflammation of the corners of the mouth by C.albicans

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52
Q

Oral candidiasis - presentation

A

Oral thrush - loss of taste and pain when eating

1) pseudomembrane plaques on buccal mucosal palate
2) Atropic = erythemia with no plaques

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53
Q

High Risk of Mucositis

A

Chemo induced - can last up to 2 weeks afterwards.

Bacteraemia (viridans strept)

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54
Q

Dental plaques (on the tooth) progression (3)

A

Carries - bacteria on surface of tooth
Pulpitis - erosion of bone by acid released from bacteria
periapical abcess - spread to base of the tooth (nerve)

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55
Q

Peridontal infections (in the gum) progression (3)

A

gingitvitis - inflammation
peridonitis - loss of soft tissue of tooth sockets
Vincents Angina - infection of soft tissue –> neck

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56
Q

Peritonsillar infection or Quinsy cause

A

S. Aureus = unilateral swelling of tonsil

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57
Q

Peritonsillar infection symptoms (4)

A

Sore throat, painful swallow, ear ache, deviation of uvula to affected side (airway compromised)

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58
Q

Complication of Parapharyngeal space infections

A

Carotid sheath infection –> supportive jugular thromboplebitis and Lemierre’s Syndrome

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59
Q

Cause of oesophageal rupture

A

increased interoesophageal pressure or negative interthoracic pressure
eg. straining and continuous vomiting

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60
Q

Complication of oesophageal rupture (5)

A

1) Gastric contents in medialstinum = chemical medialstinitis –> bacterial infection and medialstinal necrosis
2) Sternal pain, crepitations and crackles with every heart beat
3) Dysponea, sepsis, tachyponae, cyanosis, hypotension
4) Neck pain, difficulty swallowing and speaking
5) Epigastric pain that radiates to the shoulder, back pain

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61
Q

Treating a ruptured oesophagus

A

avoid oral intake, nutritional support, IV antiBs, PPI and drainage of fluid and necrotic tissue

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62
Q

H. Pylori mode of action

A

Uteruses hydrolyzes the acid in the stomach allowing other bacteria to penetrate the mucosal lining = ulceration

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63
Q

Testing for H. pylori (4)

A

Urease Breath test, faecal antigen, serology (IgG for chronic and IgM for acute), culturing and sensitivity testing

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64
Q

Cholangitis (bile duct): symptoms and test results

A

Fever, ab pain, jaundice.

Liver test = Inc phosphatases, GGT, and conjugated billirubin

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65
Q

Cause of Cholangitis

A

Enterobacterieae - secondary to stones, stenosis, stents and surgery

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66
Q

Cholecystitis (gall bladder) Test results

A

Elevated total serum billirubin and alkaline phosphatase.

Positive murphy’s sign and radiological image

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67
Q

Liver Abscess causes

A

Strephtocci or coliforms - Ascending biliary tract infection, post peritonitis or colonic perforation

Staph aureus - haematogenous from endocarditis

Entamoeba Histoltytica - parasite in amebic cyst in contaminated food or faecal matter –> Trophozoite stage (invasive disease)

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68
Q

Test results for Liver abscesses

A

Serum alkaline phosphatases and bilirubin elevated

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69
Q

Cause of bacterial overgrowth and consequences

A

Achorhydria (high acid states) eg. after surgery
Blind loops of bowel
impaired mobility and radiation damage

Results in malnutrition and chronic diarrhoea

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70
Q

Whipples Disease

Location, appearance cause and associated symptoms

A

Distal duodenum
White plagues
Tropheryma Whipplei found in sewage

Chronic malabsorption, ab pain, diarrhoea, weight loss

71
Q

Gastroenteritis pathogenesis

A

Toxins - staph or shigella

Direct invasion of bacteria into mucosal wall

72
Q

6 hours of Gastroenteritis symptoms

A

Straph Aureus or Bacillus cereus

73
Q

8-16 hours of gastroenteritis

A

Costridium infection

74
Q

16 + hours of GI symptoms

A

Viral or bacterial infection

75
Q

Bacterial causes of Gastroenteritis in Small bowel (6)

A 
Salmonella
E.coli
Clostridium
Staph aureus
Bacillus cereus
Vibro cholerae
76
Q

Bacterial Causes of gastroenteritis in colon (4)

A

Campylobacter
Shigella
C. Difficile
Enteroinvasive E. coli

77
Q

Viral causes of GI in the small bowel (3)

A

rotavirus
norovirus
astrovirus

78
Q

Viral cause of GI in the colon (3)

A

Cytomegalovirus
Adenovirus
Herpes simplex

79
Q

Parasytic GI in the small intestines (4)

A

Cryptosporidium
Microsporidium
Cyclospora
Giardia lamblia

80
Q

Bacterial Gastroenteritis worsened by AntiBs

A

Salmonella and Ecoli

81
Q

Mycobacterium tuberculosis

A

Aspiration of TB = non healing ulcers, obstructed gastric outflow, fistulas
Can be confused with malignancy

82
Q

Complications of intra-abdominal infections (4)
- treatment

+ For last one:

  • symptoms
  • causes
A

1) Diverticulitis - antiBs or abscess drainage surgery
2) Meckel’s Diverticulum = bleeding, obstruction, infections, perforation OR silent - surgically remove
3) Appendicitis - Surgical or AntiBs. CT difficult to diagnose
4) Intra-peritoneal abscess - Pus in localised areas = non specific sweating, anorexia, swinging fever, pain and swelling. Due to ulcers, diveriticula perforation, mesenteric ischemia, trauma, pancreatitis

83
Q

Structures in close proximity to the pancreas

A

spleen, duodenum, common bile duct, aorta, IVC, splenic arteries, adrenal glands

84
Q

Acute Pancreatitis Symptoms (3)

A

Ab pain –> back
N&V
Raised serum amylase and lipase

85
Q

Causes of Acute Pancreatitis

A

Gallstones
Alcohol
Rare = vascular insufficiency, mumps, coxackie B, hypercalcaemia
Idiopathic

86
Q

Pathogeneses of Acute pancreatitis

  • Mild
  • Severe
A

Leakage and activation of pancreatic enzymes

Mild = swollen and fat necrosis - chalky calcium deposits

Severe = Swollen, necrosis and haemorrhage in flanks, umbilicus signs and Pseudocytes/ abscess formation

87
Q

Complications of Acute Pancreatitis

A

shock, intravascular coagulation, haemorrhage, psuedocytes with pancreatic secretion

88
Q

Pathogenesis of Chronic Pancreatitis

A

Irregular involvement of gland
Atrophy - fibrosis occurs
Dilated and disordered ducts
Fatty replacement

89
Q

Symptoms of Chronic Pancreatitis

A

Back pain, weight loss

Fiborous tissue mimics cancer histologically and radiologically

90
Q

Causes of Chronic Pancreatitis - TIGARO

A 
Toxic - alcohol and smoking
Idiopathic
Genetic - PRSS1 and SPINK1 genes = cleavage of trypsin and self digestion
Obstruction to duct (cancer or scarring)
Recurrent Acute
Autoimmune
91
Q

Complications of Chronic Pancreatitis

A

Malabsorption of Fat and fat sol vitamins –> steatorrhoea
Diabetes
Pseudocytes
Stenosis of common bile duct

92
Q

Primary Pancreatic cancer

  • age
  • 5 year survival
  • Male Vs Female
  • Location
A 
Pancreatic adenocarcinoma
60 - 80 years
4% 5 year 
M>F
60% in Head and 30% in body
93
Q

Causes of pancreatic andeocarcinoma (4)

A

Smoking
Family history
Heavy alcohol and red meat
Chronic pancreatitis

94
Q

Genes/ genetic conditions involved in Pancreatic Andenocarcinoma

A

HNPCC (mismatch repair)
BRACA2 (famillia)
Lynch syndrome
ATM (ataxia telangiectasia)

95
Q

Presentation of
- Tumour
- Patient
in Pancreatic andenocarcinoma

A

Poorly defined, grey-white.
Associated with fibrosis (desmoplastic stroma)
Highly invasive and present in margins

Epigastric pain radiate to back
Weight loss, purities, nausea
Palpable gall bladder with no pain (Courvoisier's sign)
Trousseau's syndrome (Migraines)
Diabetes
Jaundice
96
Q

Pancreatic Neuroendocrine tumours

Most common type?

A

Endocrine tumour of the islets of Langerham

Insulinoma (benign) - increases hormone levels = hypoglycemia

97
Q

Risk factors of Neuroendocrine tumours

A

age 20 - 60
Male = female
MEN - multiply endocrine neoplasia (eg. thyroid or pituitary tumours)

98
Q

Functioning tumours

A

One that produces hormones
opo. Non- functioning

Results in the symptoms

99
Q

P67

A

marker of speed of tumour growth and proliferating
High = poorly differentiated + sinister advance
Low = well differentiated, more common

100
Q

Appearance of neuroendocrine tumours

A

Circumscribed or encapsulated
Solid
Multiple
Any where in the pancreas

101
Q

Symotoms of Glucagonoma

A

Stomatitis, rash, diabetes, wight loss

102
Q

Gastrinoma symptoms

A

Zollinger-Ellison syndrome:

Peptic ulcers and diarrhoea

103
Q

Somatostatimona symptoms

A

Diabetes, cholelithiasis, hypochorhydria

104
Q

VIPoma symptoms

A

Verner-Morrison syndrome:

Diarrhoea, hypoalkaemia and achlorydria

105
Q

Threshold/ measure for Jaundice

A

> 40umol/L billirubin in blood

106
Q

Pre hepatic Jaundice
Cause
Symptoms - type of billirubin
Signs

A

Too much billirubin produced
Haemolytic anaemia –> unconjugate billirubin in blood + not excreted
Yellow skin and eyes

107
Q

Hepatic Jaundice
Cause
Type of billirubin
Signs

A

Too few functioning liver cells

  • Acute diffuse live disease
  • Chronic liver disease
  • inborn errors

Conjugated billirubin = yellow eyes and dark urine

108
Q

Post Hepatic (obstructive) Jaundice
Causes
Type of billirubin
Signs

A

Bile duct obstruction (stones, stricture, tumour)
Conjugated - soluble and excrete but not through gut
Yellow eyes, pale stools and dark urine

109
Q

ALT

A

Alanine Transferase - released when liver cells die

110
Q

AST

A

Aspartite Transfrase - released when liver, muscle and RBC death

111
Q

ALP

When raised? (5)

A

Alkaline Phosphatases - produced in bile ducts

Raised in:

  • cholestasis
  • Infiltration disease
  • Space occupying lesion
  • cirrhosis (liver disease)
  • Jaundice
112
Q

Liver function test results for Jaundice

A

Raised AST and ALT and Alkaline phosphatases

Low Albumin and clotting factors

113
Q

Test for Jaundice

A

Ultrasound - bile ducts

Biopsy

114
Q

Cause of hepatic Jaundice

A

Heptatitis

115
Q

Acute Vs Chronic Hepatitis

A 
Acute = liver damage but the causes resides
Chronic = balance between damage and repair and cause doesn't reside
116
Q

Clinical spectrum of Hepatitis (6)

A

1) asympotatic
2) Malaise
3) Jaundice
4) Coagulopathy5
5) Encephalopathy
6) Death

117
Q

Cause of hepatitis (5) Identified on biopsy

A

Viral, toxic, metabolic (fatty liver disease), Inherited and autoimmune

118
Q

Parental Route of infection

A

Injected into blood stream

119
Q

Feacal -oral Hepatitis

A

A

120
Q

Paretnal Hepatitis

A

B (and D)

C

121
Q

Water bourne zoonosis hepatitis

A

E

122
Q

Highest risk to develope to chronic BUT least common Hep

A

Hep C

123
Q

Viral Hepatitis with vaccines

A

A and B

124
Q

Other virus that cause hepatitus as part of systemic disease

A

Epstein Barr (EBV), Cytomegalovirus (CMV), Herpes simplec (HSV)

125
Q

Fatty liver diseases (2)

A

Alcoholic or non alcoholic fatty liver disease (NAFLD)

126
Q

Pathogenesis of Alcoholic Fatty liver disease

A

High Alcoholic intake = overworked hepatocytes

Fatty change –> Alcoholic steatohepatocytes –> Cirrhosis

127
Q

Cause of NAFLD

A

Type 2 diabetes
High blood sugar = over work hepatocytes = stress response:
- inflammation
- oxidative stress (mitochondria death)

128
Q

Common Drugs that cause drug induced liver disease

A

Paracetamol and antiBs

129
Q

DILI

A

Drug induced liver injury

130
Q

Paracetamol induced hepatotoxicity - biopsy results

A

Uniform zonal necrosis

131
Q

DILI causes what type of hepatitis

A

Acute Hepatitis - damage prevent if drug stoped

132
Q

Inherited Cause of Hepatitis (3)

A

1) Haemochromatosis
2) Wilson’s Disease
3) Alpha 1 antitrypsin deficiency

133
Q 
Haemochromatosis or Bronzed diabetes
Cause
Symptoms
Signs/ test results
Treatment
A

Error of iron metabolism - abnormal HFE gene
Skin pigments, liver cirrhosis, carcinoma, diabetes, arthritis and cardiomyopathy
Perl’s stain on biospy = blue + high blood transferrin
Venesection (collect blood) - depletes iron stores

134
Q

Wilson’s disease
Cause
Symptoms
Signs

A

Error of copper metabolism
Liver cirrhosis and aucte liver failure, brain ataxia
Low serum copper but high urinary copper

135
Q

Alpha 1 antitrypsin deficiency
Causes
Signs
Symptoms

A

Abnormal enzyme = accumulates in globules of glycoprotein + insufficent levels in blood (cant neutralise proteolytic enzymes)
Positive PAD stain on liver biopsy
Liver cirrhosis and emphysema of lung

136
Q

Autoimmune cause of hepatitis (+ one defining factor)

A

Autoimmune hepatitis -
Chronic billiary disease
Primary Biliary cholangitis (PBC) - anti-mitochondrial antibodies
Primary Sclerosing Cholangitis (PSC) - associated with Ulcerative Colitis

137
Q

Diagnosis of Autoimmune hepatitis

Treatment?

A

Auto-antibodies, raised IgG and ALT.
Other autoimmune disease?
Plasma cells on biopsy
TREAT with immunosuppression

138
Q

Liver Cirrhosis definition

A

Diffuse hepatic process of fibrosis.
Normal liver architecture –> abnormal nodules
End of chronic liver disease

139
Q

Complications of fibrosis and liver disease

4

A

Portal hypertension = varices and splenomegaly, spider neavi, ascites
Liver cell failure = oedema, bruising, muscle wastage, hormone imbalance, ascites, poor fluid retention, jaundice and itching
Oestrogen XS = gynaecomastia, testicular atrophy
Vulnerable to infection

140
Q

Hepatic Failure - acute and chronic?

A 
Acute = rare but sever and rapid liver injury
Chronic = end stage liver disease
141
Q

Cause of Hepatic failure

A

Structure and function change due to cirrhosis

142
Q

Signs of Hepatic failure

A

Ascites (accumulation of fluid in abdomen)
Muscle wasting, bruising, gynaecomastia,
(Portal hypertension=) spider neavi, caput medusa

143
Q

Hepatic failure - biopsy?

A

NO - risk of haemorrhage

144
Q

Other signs of liver disease

A

Clubbing and osteoporosis

145
Q

LFT (liver function test) use?

A

Show diminishing Liver function

146
Q

Specific Liver function tests (what function they measure)

A

Blood Albumin - synthesis function
Blood Bilirubin - excretion function
Prothrombin time - Storage function

147
Q

Other non-specific LFT

A

glucose, urea, prothrombin, cholesterol, bile acids, steroid horomens, ferritin

imaging and biopsy

148
Q

Liver damage tests - what the measure

A 
Enzymes that are synthesised by cells in the bile canaliculi when they are damaged
Include 
- Alkaline photphatase
- GGT
- Bilirubin
- ALT
- AST
149
Q

GGT

A

Glutamyl transferase - elevated due to structural damage eg. alcohol, fatty liver, heart failure

150
Q

Alpha fetoprotein is?

A

tumour marker for primary hepatocellular carcinoma

151
Q

Elevation in Unconjugated bilirubin (3)

Pre hepatic and hepatic

A

Pre heptaic

  • Heamolysis
  • Inaffective erythropoiesis

Heptaic = inherited disorders of conjugation - Gilberts

152
Q

Elevation of conjugated bilirubin (7)

Post hepatic and hepatic

A

Post hepatic

  • Gallstones
  • Biliray strictures
  • Cancer of head of pancreas
  • Cholangitis

Hepatic

  • Intrahepatic obstruction
  • Hepatitis
  • Inherited disorders
153
Q

AST/ALT ratio elevated + normal ALP

A

Hepatitis - take cultures and serology

154
Q

AST/ALP normal and elevated ALP

A

Obstructive disease

155
Q

Antibodies screen

A

Autoimmune

156
Q

Urine tests to ID location of hepatic lesion

A

Prehepatic - no bilirubin in urine
Hepatic - variable
Post hepatic - Present in urine (dark) BUT no in stools (pale)

157
Q

Most common malignant primary Liver tumour

A

hepatocellular carcinoma

158
Q

Most common liver tumour

A

Secondary Mets from lung, breast, colon, pancreas and stomach

159
Q

Adenoma of hepatocytes (benign) caused by?

A

Exogenous steroiuds eg. Anabolic steroids or oral contraceptive pill

160
Q

Appearance of benign adenoma of the bile ducts

Macro and Micro

A

Macro - tiny white nodules (ductile cells) on surface of liver (mistaken for mets)
Micro - cuboidal, glandular - may contain bile

161
Q

Risk factors for Hepatocellular Carcinoma

A

Cirrhosis, fatty liver disease, Hep C and B. Male> female

162
Q

Diganosis of Hepatoceullar Carcinoma

A

Biopsy = poorly differentiated may produce bile (green)

Produce feto protein = raised levels in blood

163
Q

Prognosis and Treatment (6) of Hepatocellular Carcinoma

A 
<1 year 
Surveillance with ultrasound
Resection - no cirrhosis, small or peripheral
Transplant - <5cm or <3x <3cm
(for non -ressectable)
Ablation
Embolization
Chemo
164
Q

Two types of Cholangiocarcinoma (adenocarcinoma)

A

1) Central - around the hilus = obstructive jaundice due to inflamation
2) Peripheral - intrahepatic = late presentation

165
Q

Secondary liver tumours

A

Asymptomatice - many nodules before liver function impaired (large functional reserve)

166
Q

Secondary liver tumours treatment

A

Surgical resection - avoiding bleeds as much as possible

167
Q

Gall stones - causes

A

cholesterol, bile salts, bacterial growth = calcification = stone or calculus

168
Q

Gall stones - risk factors

A

Female, middle age, overweight, diabetes

169
Q

Types of gall stone (3)

A 
Cholesterol = yellow opalescent
Pigment = small and black + haemolytic anaemia
Mixed = most common 10% contain calcium - visible on X-ray
170
Q

Clinical features and complications (5) of Galls stones

A

Asymptomatic
Pain/ cramps - biliary colic

Jaundice
Colorectal bleeds
Localised pain as it moves
Cholecysitis 
Carcinoma risk
171
Q

Cholecystitis causes

A

Chemical or bacterial

Secondary to Stone

172
Q

Cholecystitis Acute vs Chronic

A

Acute = large, swollen gallbaldder, painful at site

Chronic = thickening/ fibrosis of gallbladder
Pain and Jaundice

173
Q

Courvoiser’s test

A

Palpable, non tender gallbladder + mild painless jaundice

= malignancy

174
Q

Crohn’s Vs UC - risk and protective factors

A

UC = smoking is protective

Corhn’s = genetic more common in women, smoking = risk

Year 2: Clinical Pathology (10 decks)

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