GIT/Renal Pathology

Question 1

What is Crohns Disease?

Answer 1

Inflammatory bowel disease characterized by transmural inflammation of the bowel wall, strictures and fistula formation

Question 2

Which parts of the GIT does Crohns disease affect?

Answer 2

Any part

Question 3

What develops on the surface of Crohns diseased tissue histologically?

Answer 3

Granuloma formation

Question 4

What other disease is linked with Crohns disease?

Answer 4

Colorectal cancer

Question 5

What is a bowel infarction? What are the causes of a bowel infarction?

Answer 5

Irreversible injury to the intestine due to insufficient blood flow. Causes include adhesions causing an bstruction, hernia strangulation, mesentric artery or vein thrombosis/embolism and volvulus.

Question 6

What are the symptoms associated with a bowel infarction? What occurs if the infarction is left untreated?

Answer 6

Severe abdominal pain, nausea and bloody stools. If the bowel is resected, patient can die from septic shock

Question 7

What characterises diverticulitis? Where does it occur?

Answer 7

Out-pouching of the layers of bowel wall, commonly occurring in the sigmoid colon.

Question 8

What are the causes of diverticulitis?

Answer 8

Low fiber diet, chronic constipation can contribute to diverticula formation. Inflammation of diverticula is could diverticulitis.

Question 9

What are the symptoms of diverticulitis and what complications can occur as a result of this disease?

Answer 9

Can result in left iliac fossa pain (in the case of sigmoid colon)

Complications include intestinal bleeding, fistula formation, bowel perforation and peritoneal infection or bowel obstruction due to strictures.

Question 10

What are the symptoms and risk factors of colon adenocarcinoma?

Answer 10

Vague symptoms: Blood stools, tiredness, weight loss

Risk factors: Cardiovascular disease, increasing age, family history, alcohol, obesity, western diet

Question 11

What is shown histologically in colon adenocarcinomas?

Answer 11

Pleomorphism

Question 12

What problems can result from an adenocarcinoma?

Answer 12

Luminal narrowing- bowel obstruction

Caecal cancers often cause anaemia

Question 13

What causes acute appendicitis?

Answer 13

Hardened faeces which calcify to form stones obstructing the lumen

Question 14

What can acute appendicitis lead to?

Answer 14

Obstructed appendix dilates to build up of inflammatory material, comprising its blood supply leading to gangrene and perforation. It can result in peritoneal infection and septic shock.

Question 15

What are the symptoms and causes of Pancreatitis?

Answer 15

Severe epigastric pain and nausea

Gallstones in bile duct, alcoholism, trauma, autoimmune conditions

Question 16

What can you observe on the surface of pancreases infected with pancreatitis?

Answer 16

Pale areas of enzymatic fat necrosis and dark patches of haemorrhage

Question 17

What occurs microscopically in Pancreatitis?

Answer 17

Calcification, widespread cell death, lobular oedema and inflammatory infiltrate around the ducts

Question 18

What are complications caused by Pancreatitis?

Answer 18

Retroperitoneal bleeding, diabetes, pseudocyst formation, multiple organ failure and shock

Question 19

What causes Cirrhosis?

Answer 19

Severe alcoholism, viral hepatitis infection, obesity causing steaosis and genetic conditions

Question 20

What are the complications of cirrhosis?

Answer 20

Bleeding oesophageal varices, splenomegaly, ascites, hepatic encephalopathy, kidney failure, hemorrhoids and development of primary liver cancer

Question 21

How does cirrhosis affect the size of liver?

Answer 21

Smaller than normal due to functional hepatocytes with non functional areas and regenerative nodules

Question 22

What is metastases to the liver, and how can it occur?

Answer 22

Secondary liver cancer

can occur through vascular or lymphatic spread

Question 23

How common is metastases of the liver compared with primary liver tumours? Why?

Answer 23

More common than primary tumours. GIT is drained by portal vein and is a potential route of spread for cancer cells

Question 24

How large are livers with metastatic disease compared with normal uninfected livers?

Answer 24

Larger than normal due to uninterrupted cell growth

Question 25

What occurs in adult polycystic kidney disease and how does someone get infected with it?

Answer 25

Involves replacemtn of functional kidney tissue with non functional fluid filled cysts, leading to early renal failure

It is inherited in an autosomal dominant fashion

Question 26

How large are polycystic kidneys compared with uninfected kidneys?

Answer 26

They are enlarged

Question 27

What risks are involved with adult polycystic disease?

Answer 27

Increased risk of developing berry aneurysms in the cerebral vasculature

Question 28

How do renal infarctions appear upon observation? How are they caused?

Answer 28

Pal peripheral based triangular areas caused by segmental renal artery thrombosis, arterial injury or systematic thromboembolism

Question 29

What occurs in these infarcted areas during the chronic phase

Answer 29

In chronic phase the areas shrink causing capsular contraction and renal cortical fibrosis

Question 30

What are the symptoms of renal infarction?

Answer 30

Flank pain and haematuria

Question 31

What happens in benign prostatic hyperplasia?

Answer 31

Enlarged gland compresss and narrows the prostatic segment of the urethra, resulting in chronic bladder outlet obstruction.
This causes bladder wall thickening, trabeculation, bladder diverticulum formation and possibly hydroureter

Question 32

What are the symptoms of prostatic hyperplasia?

Answer 32

Difficulty urinating

Question 33

What is uterine leiomyoma?

Answer 33

Benign tumours of smooth muscle extending from uterine layers.

Question 34

What is the appearance of the tumours in uterine leimyoma/fibroids?

Answer 34

Smooth, well circuscribed appearance and do not invade surrounding tissues. They can be submucosal, mural or subserosal

Some can be pedunculated on a stalk which predisposes to torsion and infarction

Question 35

What are the symptoms of uterine leiomyoma/fibroids?

Answer 35

They can be asymptomatic

Fibroids can cause patients to have chronic pelvic pain, heavy periods and excessive urination due to pressure on the bladder

They can also be a cause of infertility