GI Pathology

Question 1

CCK produced by?

Answer 1

I cells in duodenum causing release of digestive enzymes

Question 2

How much secretion does pancreas produce per day?

Answer 2

2 litres

Question 3

Alpha cells produce?

Answer 3

Glucagon

Question 4

Insulin produced by?

Answer 4

Beta cells

Question 5

Delta cells produce

Answer 5

Somatostatin

Question 6

Pancreatic polypeptide has what role?

Answer 6

Self regulates secretions in pancreas

Question 7

Criteria for metabolic syndrome?

Answer 7

Fasting glucose >6
BP >140/90
Central obesity
Dyslipidaemia
Microalbuminaemia

Question 8

Diagnosis diabetes:

Fasting glucose?

Random glucose?

Answer 8

Fasting > 7.0

Random >11.1 mmol /L

Question 9

Impaired fasting glucose?

Answer 9

Fasting glucose 6.0-6.9

Question 10

Impaired glucose tolerance?

Answer 10

Glucose 7.8-11 after 2hr OGTT

Question 11

Most common causes of acute pancreatitis?

Answer 11

Gallstones

Alcohol

Question 12

Histology of acute pancreatitis?

Answer 12

Coagulative necrosis

Question 13

What is alcoholic pancreatitis associated with?

Answer 13

Formation of pseudocyst (collection of fluid)

Question 14

Top causes of chronic pancreatitis?

Answer 14

Alcohol

Question 15

Neoplastic epithelial cells with eosinophilia granular cytoplasm?

Answer 15

Acinar cell carcinoma

*positive immunoreactivity for lipase, trypsin and chymotrypsin

Question 16

Most common pancreatitis cancer?

Answer 16

Invasive Ductal adenocarcinoma

Question 17

Most common site of pancreatic Ca?

Answer 17

Head of pancreas

Question 18

Risk factors for pancreatic cancer?

Answer 18

Smoking, diet, genetic (FAP/HNPCC)

Question 19

Features of pancreatic Ca?

Answer 19

Courvoisier’s:

PainLESS jaundice and palpable gallbladder

+pruritis
+steatorrhoea
+diabetes

Question 20

Trousseau’s syndrome?

Answer 20

Recurrent superficial thrombophlebitis in pancreatic Ca due to hypercoagulabilty

Question 21

What cancers more commonly in tail of pancreas?

Answer 21

Neuroendocrine (islet cell)

Question 22

Tumour marker for pancreatic Ca?

Answer 22

CA19.9

Question 23

Zollinger Ellison syndrome?

Answer 23

Gastrinoma -> high acid output

Question 24

Necrolytic migrating erythema?

Answer 24

Glucagonoma

Question 25

Men 1?

Answer 25

PPP Parathyroid hyperplasia Phaeochromocytoma Pituitary adenoma

Question 26

Men 2a?

Answer 26

PPM Parathyroid hyerplasia Phaeochromocytoma Medullary thyroid cancer

Question 27

Men 2b?

Answer 27

PMM Phaeochromocytoma Medullary thyroid cancer Marfanoid

Question 28

Surgery for pancreatic Ca?

Answer 28

Whipples

Question 29

VIPomas cause?

Answer 29

Diarrhoea

Question 30

Hypoglycaemic attacks?

Answer 30

Insulinoma

Question 31

Ectopic pancreas sites?

Answer 31

Stomach, small intestine

Question 32

Failure of fusion of dorsal and ventral buds?

Answer 32

Pancreas divisum

Question 33

Annular pancreas risk?

Answer 33

Duodenal obstruction around age 1

Question 34

In liver lobule which zone is most metabolically active?

Answer 34

Zone 3 - near central hepatic vein

Question 35

Which zone receives most oxygen and nutrients?

Answer 35

Zone 1 (periportal)

Question 36

Most common benign lesion of liver?

Answer 36

Haemangioma

Question 37

Most common malignant liver tumour?

Answer 37

Metastasis

Question 38

Most common primary liver tumour?

Answer 38

HCC

Question 39

Major causes of cirrhosis?

Answer 39

Alcoholic liver disease NAFLD Hep B/Hep C

Question 40

Most common location of cholangiocarcinomas?

Answer 40

Perihilar

Question 41

Cholangio Ca assoc?

Answer 41

PSC and UC

Question 42

Causes of micronodular cirrhosis (<3mm)?

Answer 42

Alcoholic liver disease Haemochromatosis Biliary tract disease

Question 43

Mallory bodies

Answer 43

Alcoholic liver disease

Question 44

Causes of macronodular cirrhosis? (>3mm)

Answer 44

Viral hepatitis Wilsons a1AT deficiency

Question 45

Child Pugh score <7 indicates?

Answer 45

Child Pugh A 45% 5 yr survival

Question 46

Child's Pugh 7-9

Answer 46

Child's Pugh B 20% 5 yr survival

Question 47

Child's Pugh 10+

Answer 47

Child's Pugh C <20% 5 yr survival

Question 48

Most common cause of chronic liver disease in West?

Answer 48

NAFLD

Question 49

Anti Smooth Muscle antibodies for type 1 Anti LKM for type 2?

Answer 49

Autoimmune hepatitis

Question 50

Anti mitochondrial ab

Answer 50

Primary Biliary Cirrhosis *histology: bile duct loss with granulomas

Question 51

ERCP shows beading of bike ducts due to multi focal strictures?

Answer 51

Primary sclerosing cholangitis

Question 52

Inheritance for haemochromatosis?

Answer 52

Autosomal recessive

Question 53

Incidence rate haemochromatosis?

Answer 53

1 in 400 *1 in 10 caucasians is a carrier

Question 54

HFE gene on chromosome?

Answer 54

6

Question 55

Stain used for iron deposits in liver?

Answer 55

Prussian Blue

Question 56

Features of haemochromatosis?

Answer 56

Grey skin 'Bronze' diabetes Hepatomegaly (microbod cirrhosis) Joint pain

Question 57

Investigations for haemochromatosis? Iron? Ferritin? TIBC? Transferrin sat?

Answer 57

High Fe High ferritin Low TIBC High transferrin sat

Question 58

Treatment for haemochromatosis?

Answer 58

Venesection + desferrioxamine

Question 59

Wilson's disease inheritance?

Answer 59

Autosomal recessive

Question 60

Gene in wilsons?

Answer 60

ATP7B on ch 13

Question 61

Stain in wilsons?

Answer 61

Rhodanine stain for copper

Question 62

Features of wilsons?

Answer 62

Liver disease Neuro - Parkinsonism, psychosis Kayser Fleischer rings

Question 63

Alpha 1 antitrypsin deficiency leads to accumulation of a1AT in intracytoplasmic inclusions which stain with?

Answer 63

Periodic acid schiff

Question 64

Secretin produced by?

Answer 64

S cells of duodenum

Question 65

Mucinous hyperplasia in pancreatic ductal system suggests?

Answer 65

Metaplastic change

Question 66

Mutation associated wi h hereditary pancreatitis?

Answer 66

PRSS1

Question 67

Autoimmune pancreatitis demonstrates a raised......?

Answer 67

IgG4

Question 68

Why are pseudocysts not true cysts?

Answer 68

True cysts surrounded by epithelial cells whereas pseudocysts lined by fibrotic tissue