GI tract pathology

Question 1

What is the main type of epithelium in the oesophagus?

Answer 1

squamous

Question 2

What is the name of the sphincter at the top of the oesophagus?

Answer 2

cricopharyngeal

Question 3

What epithelium lines the bottom 1.5-2cm of the oesophagus?

Answer 3

glandular columnar epithelium

Question 4

How far from the incisor teeth is the squamo-columnar junction?

Answer 4

40cm

Question 5

What is the common form of oesophagitis?

Answer 5

reflux oesophagitis

Question 6

What are the 4 main risk factors for reflux oesophagitis?

Answer 6

• defective lower oesophageal sphincter
• hiatus hernia
• increased intra-abdominal pressure
• increased gastric fluid volume due to gastric outflow stenosis

Question 7

What is a hiatus hernia?

Answer 7

abnormal bulging of a portion of the stomach through the diaphragm

Question 8

In which type of hiatus hernia will you get reflux symptoms?

Answer 8

sliding hiatus hernia

Question 9

How does the squamous epithelium of the oesophagus appear in reflux oesophagitis?

Answer 9

basal cell hyperplasia, elongation of papillae, increased desquamation

Question 10

How does the lamina propria appear in the oesophagus in reflux oesophagitis?

Answer 10

inflammatory cell infiltration

Question 11

What is the cause of Barrett’s oesophagus?

Answer 11

longstanding reflux

Question 12

What histological changes occur in someone with Barrett’s oesophagus?

Answer 12

squamous mucosa replaced by columnar mucosa> ‘glandular metaplasia’

Question 13

What are the 3 types of columnar mucosa that may be present in Barrett’s oesophagus?

Answer 13

• gastric cardia type
• gastric body type
• intestinal type

Question 14

What does Barrett’s increase risk of?

Answer 14

adenocarcinoma

Question 15

What are the 2 histological types of oesophageal carcinoma?

Answer 15

• squamous cell carcinoma

- adenocarcinoma

Question 16

What is the macroscopic appearance of adenocarcinoma?

Answer 16

plaque-like, nodular, fungating, ulceratedm depressed, infiltrating

Question 17

What are the main risk factors for squamous carcinoma?

Answer 17

• tobacco/smoking
• nutrition
• thermal injury
• HPV
• male
• ethnicity

Question 18

Where would you expect to find squamous carcinoma?

Answer 18

middle and lower third of the oesophagus

Question 19

What precedes squamous carcinoma?

Answer 19

squamous dysplasia

Question 20

What does pT mean?

Answer 20

depth of invasion of primary tumour

Question 21

What type of staging is used for squamous carcinoma?

Answer 21

TNM

Question 22

What do T, N and M stand for in TNM staging?

Answer 22

T-depth of invasion
N-nodular involvement
M-metastasis

Question 23

What are the 4 anatomical regions of the stomach?

Answer 23

cardia, fundus, body, antrum

Question 24

Describe the pathogen H. pylori?

Answer 24

gram negative spiral shaped bacterium

Question 25

Which anatomical region is H. pylori more common?

Answer 25

more common in antrum than in the body

Question 26

Define ulcer

Answer 26

localised defect extending at least into submucosa

Question 27

How would chronic gastric ulcer appear histiologically?

Answer 27

- Clear-cut edges overhanging the base - Extensive granulation and scar tissue at ulcer floor - Scarring often throughout the entire gastric wall with breaching of the muscularis propria - Bleeding

Question 28

What complications are associated with peptic ulcers?

Answer 28

- haemorrhage - perforation -> peritonitis - penetration into adjacent organ - stricturing

Question 29

What percentage of duodenal ulcers are caused by H.pylori?

Answer 29

95-100%

Question 30

Which is the most frequent gastric cancer?

Answer 30

adenocarcinoma

Question 31

Is carcinoma of GOJ associated with H.pylori?

Answer 31

NO

Question 32

Which microscopic subtype of gastric adenocarcinoma has a worse prognosis?

Answer 32

diffuse subtype

Question 33

What is coeliac disease?

Answer 33

immune mediated enteropathy

Question 34

What component in gluten causes the reaction in coeliac patients?>

Answer 34

gliadin

Question 35

In coeliacs disease, what does the IL15 production induce?

Answer 35

activation/proliferation of CD8+ IELS

Question 36

Which cancers may be associated with coeliac disease?

Answer 36

- enteropathy-associated T-cell lymphoma | - small intestinal adenomcarcinoma

Question 37

What are the two types of diverticulum?

Answer 37

congenital or acquired

Question 38

What is diverticulosis of the colon?

Answer 38

protrusions of mucosa and submucosa through the bowel wall

Question 39

What is the main cause of diverticulosis?

Answer 39

irregular/uncoordinated peristalsis

Question 40

Which are the points of relative weakness in the bowel wall where diverticuli are most likely to occur?

Answer 40

penetration of nutrient arteries between mesenteric and anti-mesenteric taenia coli

Question 41

What is the earliest stage od diverticulosis?

Answer 41

thickening of muscularis propria (prediverticular disease)

Question 42

What percentage of people with diverticulosis are asymptomatic?

Answer 42

90-99%

Question 43

What clinical features may someone with diverticulosis present with?

Answer 43

cramping abdominal pain and alternating constipation and diarrhoea

Question 44

Whata re some possible acute complications of diverticulosis?

Answer 44

- abcess - perforation - haemorrhage

Question 45

What are some possible chronic complications of diverticulosis?

Answer 45

- intestinal obstruction - fistula - diverticular colitis - polypoid prolapsing mucosal folds

Question 46

Define colitis

Answer 46

inflammation of colon

Question 47

How does ulcerative colitis present?

Answer 47

- diarrhoea - constipation - rectal bleeding - abdominal pain - anorexia - weight loss - anaemia

Question 48

what are the 3 main types of idiopathic inflammatory bowel disease?

Answer 48

ulcerative colitis, crohns disease, indeterminate colitis

Question 49

What complication may you get with ulcerative colitis?

Answer 49

- toxic megacolon and perforation - haemorrhage - stricture - carcinoma

Question 50

What is the most common pattern of Croh's disease?

Answer 50

ileocolic (30-55%)

Question 51

What complications may occur with Crohn's disease?

Answer 51

- toxic megacolon - perforation - fistula - stricture - haemorrhage - carcinoma - short bowel syndrome

Question 52

What hepatic extra-intestinal manifestations of IBD may occur?

Answer 52

- fatty change - granulomas - PCS - bile duct carcinoma

Question 53

What skeletal manifestations of IBD may occur?

Answer 53

- polyarthritis - sacro-ileitis - ankylosing spondylitis

Question 54

What are the possible renal manifestations of IBD?

Answer 54

kidney and bladder stones

Question 55

What are the possible haematological manifestations of IBD?

Answer 55

- anaemia - leucocytosis - thrombocytosis - thrombo-embolic disease

Question 56

What are the possible systemic manifestations of IBD?

Answer 56

amyloid, vasculitis

Question 57

What are the possible ocular manifestations of IBD?

Answer 57

- iritis - episcleritis - retinitis

Question 58

What are the possible muco-cutaneous manifestations of IBD?

Answer 58

- oral-apthoid ulcers - pyoderma gangernosum - erythema nodosum

Question 59

Define polyp

Answer 59

a mucosal protrusion

Question 60

How does peutz-jeghers syndrome present?

Answer 60

in teens or 20s with abdominal pain, GI bleeding and anaemia

Question 61

What is an adenoma?

Answer 61

benign epithelial tumour