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Semester 3 > GI Session 10 > Flashcards

GI Session 10 Flashcards

1
Q

What are the clinical features of oesophageal carcinoma?

A

Progressive worsening dysphasia from dry solids –> liquids and weightloss

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2
Q

What are the pathological features of oesophageal carcinoma?

A

Squamous cell can occur anywhere in the oesophagus

Adenocarcinoma occurs in the lower 1/3 where Barrett’s is seen

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3
Q

What is the pathogensis of SCC of the oesophagus?

A

HPV/tannin/vitamin A deficiency/riboflavin deficiency –> dysplasia –> neoplasia

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4
Q

What is the pathogensis of adenocarcinoma of the oesophagus?

A

Metaplaetic epithelium –> dysplasia –> neoplasia

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5
Q

What is the prognosis for oesophageal carcinoma?

A

Most pts present with advanced disease where there is direct spread through the oesophageal wall –> 5% 5-year survival rate

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6
Q

Describe the epidemiology of gastric cancer.

A

Accounts for 15% of cancer deaths worldwide
More common in men
High incidence in Japan, Columbia and Finland
Associated with gastritis and blood group A

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7
Q

What are the clinical features of gastric cancer?

A

Vague symptoms –> epigastric pain, vomiting and weight loss in advanced disease

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8
Q

What are the macroscopic pathological features of gastric cancer?

A

Early is confined to submucosa/mucosa

Late appears fungating, ulcerating, infiltrative

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9
Q

What are the microscopic features of gastric cancer?

A

Intestinal cancers are all adenocarcinomas with variable degrees of gland formation
Diffuse disease –> single cells, small cells, signet ring cells

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10
Q

What is the pathogenesis of gastric lymphoma?

A

H.pylori –> low grade lesion –> neoplasia of B lymphocytes

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11
Q

What is the pathogenesis of gastric cancer?

A

H.pylori –> early confined to mucosa/submucosa –> advanced spreads direct/lymph/liver/trans-coelomic to peritoneum +/- ovaries

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12
Q

What is the pathogensis of GI stromal tumours?

A

Intestinal cells of rajal (gastric pacemaker) become neoplastic –> C-kit serum marker release

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13
Q

What is used to assess the risk of unpredictable GI stromal tumours?

A

Site and size of lesion

Degree of pleomorphism, mitoses and necrosis

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14
Q

What is the commonest GI lymphoma?

A

Gastric

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15
Q

What is the prognosis of gastric cancer?

A

Early gastric = good
Advanced gastric = 10% 5-year survival rate
Lymphoma = good
Stromal = unpredictable

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16
Q

How are gastric cancers treated?

A

Surgery
Chemotherapy
Herceptin
Imatinib for stromal

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17
Q

Describe the epidemiology of oesophageal carcinoma.

A

Accounts for 2% of malignancies in the UK
Higher incidence in men
Highest incidence in China
SCC more common but incidence decreasing, opposite for adenocarcinoma

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18
Q

Describe the epidemiology of large intestine adenomas.

A

Increased incidence with age in western population and increased incidence with genetic syndromes

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19
Q

Describe the epidemiology of large intestine adenocarcinomas.

A

Peak at 60-70 y.o. In UK

Higher incidence in polyposis syndromes, UC and Crohn’s

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20
Q

Are carcinoid tumour, lymphoma and smooth muscle tumours of the large intestine common?

A

No, they are rare

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21
Q

What are the clinical features of large intestinal adenocarcinomas?

A

R side rectosigmoid –> anaemia

L side rectosigmoid –> obstructive symptoms

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22
Q

What are the pathological features of large intestinal adenomas?

A

Variable degree of dysplasia microscopically and sessile/pedunculated mascroscopically

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23
Q

What are the pathological features of large intestine adenocarcinomas?

A

60-70% rectosigmoid –> fungating on R, stenotic on L

See microscopically with moderately differentiated adenocarcinoma or occasionally mucinous or signet ring cell type

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24
Q

What provides evidence for the adenoma-carcinoma sequence?

A

Geographical and anatomical distributions very similar
Synchronous lesions
Metachronous lesions
Adenomas with invasion

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25
What is the aetiology of large intestine adenomas?
FAP | Gardeners syndrome
26
What is the pathogensis of large intestine adenocarcinoma?
+/- previous Adenoma | Low residue diet/slow transit time/high fat intake/genetics --> neoplasia
27
How does large intestine adenocarcinoma spread?
Directly Lymph Portal venous system
28
What is FAP?
Autosomal dominant in chromosome 5 --> 1000s of adenomas by 20 y.o.
29
What is Gardener's syndrome?
Similar to FAP --> nine and soft tissue tumours
30
Where are carcinoid tumours usually found in the large intestine?
Appendix but can be anywhere
31
Why do carcinoid large ins testing tumours have a normal mortality rate despite being hard to predict?
Rarely metastasise
32
How is the prognosis of large insets tonal adenocarcinoma assessed?
Duke's staging then TNM
33
What is commonly seen in advanced large intestine adenocarcinoma?
Liver metastases
34
What are the Tx options for adenocarcinoma of the large intestine?
Palliative chemotherapy Resection of liver deposits Local radiotherapy for rectal cancer
35
What are the primary malignant tumours of the liver?
Hepatocellular carcinoma Cholangiocarcinoma Helatiblastoma
36
What are the clinical features of carcinoma of the pancreas?
Early symptoms vague --> diagnosis delayed until weight loss, jaundice or Trossaeu's sign seen
37
What is Trosseau's sign?
Trypsin release --> fleeting thrombophlebitis
38
What can imagine allow in carcinoma of the pancreas?
Radiological diagnosis from small lesions
39
What are the pathological features of carcinoma of the pancreas?
2/3 in head --> firm pale mass which on cutting appears necrotic/haemorrhagic/cystic 80% ductal with well formed glands +/- mucin Some acinar tumours contain zymogen granules
40
What is the aetiology of carcinoma of the pancreas?
``` Islet cell tumours (rare) Gastrinoma --> Z-E syndrome Insulinoma --> hypoglycaemia Glucagonoma --> definitive skin rash (Vasoactive intestinal peptide) VIPoma -->Werner Morrison syndrome ```
41
What is the prognosis for any type of carcinoma of the pancreas?
Poor
42
What methods can be used to image the GI tract?
``` Plain X-rays Contrast studies: barium swallow/enema/meal/follow through or water-soluble contrasts US CT for emergency pts MRI Angiography ```
43
When should an AXR be requested?
Small/large bowel obstruction Acute IBD exacerbation ?toxic megacolon
44
When should an AXR not be requested?
Acute abdominal pain (most causes not visible) Renal colic Constipation
45
What projection are all AXR?
AP
46
What should be included in an AXR?
Public tubercle T5 Properitoneal fat stripes
47
When might properitoneal fat stripes not be visible?
Lost on pathology e.g. appendicitis
48
What contents should be seen in the bowel due to its transit time?
``` Stomach (medium t.t.) = fluid and lots of gas Small bowel (fast t.t.) = fluid Large bowel (slow t.t.) = faeces +/- gas ```
49
How can the small bowel and colon be distinguished on AXR?
Small bowel is central with valvulae conniventes | Colon is peripheral with haustra
50
How is the rule of 3s used to assess abnormal gas patterns?
>3 cm = small bowel obstruction >6 cm = large bowel obstruction with incompetent iliocaecal valve >9cm = large bowel with competent iliocaecal valve
51
What soft tissues should be identifiable on a normal AXR?
``` Liver Spleen L+R kidneys Bladder Psoas muscle ```
52
What can be used as an approximate measure of 3 cm on radiograph?
Vertebral body height
53
What causes small bowel obstructions?
Adhesions from surgery Hernias esp inguinal Tumours Inflammation
54
What are the progressive S/S of small bowel obstruction?
Vomiting --> mild distension --> absolute constipation --> colicky pain
55
What causes large bowel obstruction?
``` Colorectal carcinoma Diverticular stricture Hernia Volvulus Pseudo-obstruction ```
56
What are the S/S of large bowel obstruction?
Vomiting (faeculant when late) Significant distension Pain Early absolute constipation
57
What is the pathogenesis of volvulus?
Twisting around mesentery--> enclosed bowel loop --> dilation --> perforation and ischaemia
58
Why causes volvulus in the caecum?
Lack of mesentery
59
How does sigmoid volvulus appear on AXR?
Starts in LIF --> coffee bean sign to RUQ --> proximal bowel obstruction
60
What is the pathogenesis of toxic megacolon?
Acute deterioration of UC --> colonic dilatation --> oedema and pseudopolyps
61
What is the pathogenesis of lead pipe colon?
UC causes chronic inflammation --> loss of haustra so featureless colon
62
What is thumbprinting on AXR?
Active inflammation often in UC but also oedematous processes --> oedematous thickened haustra --> thickened wall
63
What extra-GI abnormalities are visible on AXR?
``` Renal calculi Chronic pancreatitis Vascular calcification AAA Foreign bodies ```
64
What is the pathogensis of pneumoperitoneum?
Peptic ulcer/diverticular/tumour/obstruction/trauma/iatrogenic --> air under diaphragm
65
What is used to identify pneumoperitoneum?
Erect CXR after sitting for 10-20 mins | CT
66
What is visible on CT taken at T12?
``` Loves of liver Curves of stomach Coeliac trunk AA IVC Hepatic veins ```
67
What is seen on CT taken at L1?
``` (Transpyloric plane of Addison) Lobes of liver Pancreatic head Renal hila Spleen Transverse colon ```
68
What are the advantages of using CT to image the abdomen?
Gives good spatial resolution Reformatting can be used to identify mechanisms of injury Can be used to build virtual colonoscopy instead of barium enema
69
What are the applications of MRI in imagine the abdomen?
Good spatial and contrast resolution Moving object cause blurring but this can be used with fluid to examine peristalsis in Crohn's (absent in active disease)
70
What is the clinical application of abdominal US?
Cheap and portable but highly user dependent Gallstones Dilated CBD Examine bowel wall layers e.g. In appendix Combine with endoscopy

Semester 3 (50 decks)

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